The Curse of Curves: Sex Differences in the Associations Between Body Shape and Pain Expression

Visually induced analgesia during face or limb stimulation in healthy and migraine subjects

Background

Visually induced analgesia (VIA) defines a phenomenon in which viewing one’s own body part during its painful stimulation decreases the perception of pain. VIA occurs during direct vision of the stimulated body part and also when seeing it reflected in a mirror. To the best of our knowledge, VIA has not been studied in the trigeminal area, where it could be relevant for the control of headache.

Subjects and methods

We used heat stimuli (53°C) to induce pain in the right forehead or wrist in 11 healthy subjects (HSs) and 14 female migraine without aura (MO) patients between attacks. The subjects rated pain on a visual analog scale (VAS) and underwent contact heat-evoked potential (CHEP) recordings (five sequential blocks of four responses) with or without observation of their face/wrist in a mirror.

Results

During wrist stimulation, amplitude of the first block of P1–P2 components of CHEPs decreased compared to that in the control recording when HSs were seeing their wrist reflected in the mirror (p = 0.036; Z = 2.08); however, this was not found in MO patients. In the latter, the VAS pain score increased viewing the reflected wrist (p = 0.049; Z = 1.96). Seeing their forehead reflected in the mirror induced a significant increase in N2 latency of CHEPs in HSs, as well as an amplitude reduction in the first block of P1–P2 components of CHEPs both in HSs (p = 0.007; Z = 2.69) and MO patients (p = 0.035; Z = 2.10). Visualizing the body part did not modify habituation of CHEP amplitudes over the five blocks of averaged responses, neither during wrist nor during forehead stimulation.

Conclusion

This study adds to the available knowledge on VIA and demonstrates this phenomenon for painful stimuli in the trigeminal area, as long as CHEPs are used as indices of central pain processing. In migraine patients during interictal periods, VIA assessed with CHEPs is within normal limits in the face but absent at the wrist, possibly reflecting dysfunctioning of extracephalic pain control.

How nurse gender influences patient priority assignments in US emergency departments

The goals of this study were to compare whether emergency department (ED) patients' pain intensity (PI) is measured differently by male and female nurses and to determine whether PI, heart rate (HR), and respiratory rate (RR) were used to prioritize patient urgency differently by male and female nurses. The associations between patients' PI|HR|RR and the Emergency Severity Index (ESI) scores they were assigned by attending nurses were analyzed using a national database of electronic medical records of US Veterans Affairs ED patients from 2008 to 2012. A total of 129,991 patients presenting for emergency care (Mage = 59.5, 92% males) and their triage nurses (n = 774, Mage = 47.5, 18% males) were analyzed, resulting in a total of 359,642 patient-provider interactions. Patients' PI did not differ by the nurse's gender; however a cross-classified mixed-effects model showed that nurse gender influenced how PI and RR measurements informed the ESI levels that male patients received. Higher PI levels were associated with more urgent (higher priority) ESI levels by female nurses, yet less urgent ESI levels by male nurses. In contrast, male patients with high RR received more urgent ESI levels by male nurses, whereas the nurse gender did not influence ESI assignments for female patients. These findings show that ED patients receive disparate treatment based on inherent characteristics of their triage nurses, and more standardized (eg, automated) protocols that can account for implicit social factors on health care practice for reliably assessing and prioritizing ED patients may be currently warranted.

Quality of Life Experiences among Women with Atrial Fibrillation: Findings from an Online Survey

BACKGROUND

Although atrial fibrillation (AF) is the most common abnormal heart rhythm in men and women, there are gender differences. Mortality for women with AF can be 2.5 times greater than for men. AF risk among women is also greater than in men when patients have additional conditions. Women are more likely to experience longer symptomatic episodes, more recurrences, and higher ventricular rates during AF. We sought to explore presentation, comorbidities, treatment, and quality-of-life issues among women with AF.

METHODS

A convenience sample of 332 women with AF completed a 58-item online survey fielded for 2 weeks in April 2015.

RESULTS

Of the respondents, 94% were Caucasian; 76% consumed four or fewer servings of fruits or vegetables per day; 43% engaged in moderate physical activity for 10 minutes 3 or fewer days per week; 41% had a body mass index (BMI) of greater than 30 kg/m(2); and 85% had never attended an AF support group. Women with AF often juggle many health conditions. Almost none had participated in an AF clinical trial. The ability to complete activities of daily living was associated significantly and positively with fruit/vegetable consumption and physical activity and significantly and negatively associated with BMI. Self-efficacy was associated significantly with physical activity and support group attendance. Open-ended comments showed many women patients have outstanding questions about their AF.

CONCLUSIONS

AF education resources should underscore the positive physical and mental health effects of increasing fruit/vegetable consumption and physical activity. Caregivers, clinicians, and women with AF need to be made aware of the benefits of support groups, whether in-person or online, and clinical trials. Future research should engage in effective recruitment of non-White women with AF.