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da Silva Tagliaferro EP, Riley JL, Gilbert GH, da Silva SRC, Rosell FL, Junior AV, Gordan VV. EVIDENCE-PRACTICE GAP IN TREATMENT DECISIONS ABOUT DEFECTIVE COMPOSITE AND AMALGAM RESTORATIONS AMONG BRAZILIAN DENTISTS. Braz J Oral Sci 2023; 22:e231640. [PMID: 38077621 PMCID: PMC10702847 DOI: 10.20396/bjos.v22i00.8671640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). Aim: this study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap.
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Affiliation(s)
- Elaine Pereira da Silva Tagliaferro
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Joseph L Riley
- University of Florida College of Dentistry, Director, Pain Clinical Research Unit, UF CTSI, South Atlantic Region, Dental Practice-based Research Network, Clinical and Translational Research Building (CTRB), Room 2227, 2004 Mowry Road, Box 100404, Gainesville, FL 32610-0404, The United States of America
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, Room SDB 109, School of Dentistry, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0007, The United States of America
| | - Silvio Rocha Correa da Silva
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Fernanda Lopez Rosell
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Aylton Valsecki Junior
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Valeria Veiga Gordan
- University of Florida, College of Dentistry, Room D9-6 P.O. Box 100415, Gainesville, FL 32610-0415, The United States of America
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Fullwood D, Means S, Paxton R, Wells B, Riley JL, Stickley Z, Tucker C, You L, Elie M, Thomas C, Anton S, Pahor M, Wilkie DJ. Avoidance-Endurance Model in Older Black Men with Low Back Pain: Exploring Relationships. J Racial Ethn Health Disparities 2023; 10:1310-1318. [PMID: 35501598 PMCID: PMC10597575 DOI: 10.1007/s40615-022-01316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was to investigate functional performance and pain intensity outcomes for associations with negative cognitive orientations, avoidance behaviors, and fear of pain in older Black men with low back pain (LBP). METHODS Sixty Black men aged 60 and older (70 years[Formula: see text]) with LBP completed the Short Physical Performance Battery (SPPB), the 400-m walk test, and subjective measures of avoidance behaviors, back performance, pain intensity, and pain catastrophizing (i.e., rumination, magnification, and helplessness). Multiple regression models were used to examine associations. RESULTS Higher helplessness scores were associated with worse back performance (ß = 0.55, p = 0.02), slower walking speed (ß = 0.30, p = 0.02), and higher average pain intensity (ß = 0.22, [Formula: see text] p = 0.03). Higher rumination scores were associated with better back performance (ß = - 0.36, p = 0.04). Avoidance behaviors, fear of pain, and magnification were not significantly associated with any of the variables included in the tested models. CONCLUSION Negative cognitive internalization is associated with limitations in functional performance in older Black men with LBP. Additional research is needed to further examine the cognitive orientations for understanding experienced pain and function in this population. Such research may inform the development of interventions for improving functional performance outcomes of older Black men with LBP.
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Affiliation(s)
- Dottington Fullwood
- Institute On Aging, University of Florida, 2004 Mowry Road, CTRB 3118, Gainesville, FL, 32611, USA.
| | - Sydney Means
- Institute On Aging, University of Florida, 2004 Mowry Road, CTRB 3118, Gainesville, FL, 32611, USA
| | - Raheem Paxton
- Department of Community Medicine and Population Health, University of Alabama, Tuscaloosa, AL, USA
| | - Brandi Wells
- Jacksonville Aging Studies Center, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Joseph L Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Zachary Stickley
- Department of Educational Psychology, Leadership, & Counseling, Texas Tech University, Lubbock, TX, USA
| | - Carolyn Tucker
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Lu You
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - Marie Elie
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Carol Thomas
- Y Healthy Living Center, Johnson Family YMCA, Jacksonville, FL, USA
| | - Stephen Anton
- Institute On Aging, University of Florida, 2004 Mowry Road, CTRB 3118, Gainesville, FL, 32611, USA
| | - Marco Pahor
- Institute On Aging, University of Florida, 2004 Mowry Road, CTRB 3118, Gainesville, FL, 32611, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, USA
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Staud R, Godfrey MM, Riley JL, Fillingim RB. Efficiency of pain inhibition and facilitation of fibromyalgia patients is not different from healthy controls: Relevance of sensitivity-adjusted test stimuli. Br J Pain 2023; 17:182-194. [PMID: 37057258 PMCID: PMC10088420 DOI: 10.1177/20494637221138318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Pain is a dynamic phenomenon dependent on the balance of endogenous excitatory and inhibitory systems, which can be characterized by quantitative sensory testing. Many previous studies of pain modulatory capacity of patients with fibromyalgia syndrome (FM) have reported decreased pain inhibition or increased pain facilitation. This is the first study to assess pain modulation, including conditioned pain modulation (CPM) and temporal pain summation, in the same healthy control (HC) and FM participants. Methods Only sensitivity-adjusted stimuli were utilized for testing of conditioned pain modulation (CPM) and temporal pain summation in 23 FM patients and 28 HC. All subjects received sensitivity-adjusted ramp-hold (sRH) during testing of pain facilitation (temporal summation) and pain inhibition (CPM). CPM efficacy was evaluated with test stimuli applied either concurrently or after application of the conditioning stimulus. Finally, the effects of CPM on pressure pain thresholds were tested. Results FM subjects required significantly less intense test and conditioning stimuli than HC participants to achieve standardized pain ratings of 50 ± 10 numerical rating scale (NRS) (p = 0.03). Using such stimuli, FM subjects' temporal pain summation and CPM efficacy was not significantly different from HC (all p > 0.05), suggesting similar pain facilitation and inhibition. Furthermore, the CPM efficacy of FM and HC participants was similar regardless of whether the test stimuli were applied during or after the conditioning stimulus (p > 0.05). Conclusion Similar to previous studies, FM participants demonstrated hyperalgesia to heat, cold, and mechanical stimuli. However, using only sensitivity-adjusted stimuli during CPM and temporal summation testing, FM patients demonstrated similarly effective pain inhibition and facilitation than HC, suggesting that their pain modulation is not abnormal.
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Affiliation(s)
- Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Joseph L Riley
- College of Dentistry, University of Florida, Gainesville, FL, USA
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Wilson AT, Bishop MD, Beneciuk JM, Tilley HE, Riley JL, Cruz-Almeida Y, Bialosky JE. Expectations affect pain sensitivity changes during massage. J Man Manip Ther 2023; 31:84-92. [PMID: 36069038 PMCID: PMC10013429 DOI: 10.1080/10669817.2022.2118449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Pain-inducing massage produces comparable changes in pain sensitivity as a cold pressor task, suggesting shared neurophysiological mechanisms of conditioned pain modulation. Manual therapy and conditioned pain modulation are influenced by positive and negative expectations. Therefore, the purpose of this study was to examine the effects of positive and negative expectations on pain-free and pain-inducing massage. METHODS 56 healthy participants were randomly assigned to receive a positive or negative expectation instructional set followed by a pain-inducing or a pain-free massage. Pressure pain threshold (PPT) was measured followed by each interval of massage. A repeated measures ANCOVA controlling for post-randomization differences in sex tested for massage x expectation set x PPT interaction effects, as well as two-way interaction effects. RESULTS A significant three-way interaction effect (p = 0.04) and time x expectation interaction effect was observed for individuals receiving pain inducing massage (p = 0.02). Individuals who received the positive expectation instructional set demonstrated significantly higher PPT at minutes 3 and 4 of massage compared to individuals who received the negative expectation instructional set. CONCLUSIONS Expectations impact pain sensitivity changes produced during massage. Clinicians planning to provide pain-inducing massage should consider the role of expectations in modulating pain sensitivity changes.
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Affiliation(s)
- Abigail T Wilson
- School of Kinesiology and Physical Therapy, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
- Musculoskeletal Research Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Mark D. Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Jason M. Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL
| | - Hannah E. Tilley
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Joseph L. Riley
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Joel E. Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL
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Wilson AT, Riley JL, Bishop MD, Beneciuk JM, Cruz-Almeida Y, Markut K, Redd C, LeBlond N, Pham PH, Shirey D, Bialosky JE. Pain phenotyping and investigation of outcomes in physical therapy: An exploratory study in patients with low back pain. PLoS One 2023; 18:e0281517. [PMID: 36787322 PMCID: PMC9928110 DOI: 10.1371/journal.pone.0281517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/25/2023] [Indexed: 02/15/2023] Open
Abstract
Phenotypes have been proposed as a method of characterizing subgroups based on biopsychosocial factors to identify responders to analgesic treatments. This study aimed to, first, confirm phenotypes in patients with low back pain receiving physical therapy based on an a priori set of factors used to derive subgroups in other pain populations. Second, an exploratory analysis examined if phenotypes differentiated pain and disability outcomes at four weeks of physical therapy. Fifty-five participants completed psychological questionnaires and pressure pain threshold (PPT). Somatization, anxiety, and depression domains of the Symptom-Checklist-90-Revised, and PPT, were entered into a hierarchical agglomerative cluster analysis with Ward's method to identify phenotypes. Repeated measures ANOVAs assessed pain ratings and disability by phenotype at four weeks. Three clusters emerged: 1) high emotional distress and pain sensitivity (n = 10), 2) low emotional distress (n = 34), 3) low pain sensitivity (n = 11). As an exploratory study, clusters did not differentiate pain ratings or disability after four weeks of physical therapy (p's>0.05). However, trends were observed as magnitude of change for pain varied by phenotype. This supports the characterization of homogenous subgroups based on a protocol conducted in the clinical setting with varying effect sizes noted by phenotype for short-term changes in pain. As an exploratory study, future studies should aim to repeat this trial in a larger sample of patients.
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Affiliation(s)
- Abigail T. Wilson
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
- * E-mail:
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, United States of America
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida, United States of America
| | - Mark D. Bishop
- University of Florida Department of Physical Therapy, Gainesville, Florida, United States of America
| | - Jason M. Beneciuk
- University of Florida Department of Physical Therapy, Gainesville, Florida, United States of America
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida, United States of America
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, United States of America
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida, United States of America
| | - Keri Markut
- University of Florida Health Rehab Center-Orthopedic and Sports Medicine Institute, Gainesville, Florida, United States of America
| | - Charlotte Redd
- University of Florida Health Rehab Center-Orthopedic and Sports Medicine Institute, Gainesville, Florida, United States of America
| | - Nicholas LeBlond
- Duke University Health System Durham, North Carolina, United States of America
| | - Patrick H. Pham
- Brooks Rehabilitation, Jacksonville, Florida, United States of America
| | - David Shirey
- Brooks Rehabilitation, Jacksonville, Florida, United States of America
| | - Joel E. Bialosky
- University of Florida Department of Physical Therapy, Gainesville, Florida, United States of America
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida, United States of America
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Wilson AT, Riley JL, Bishop MD, Beneciuk JM, Cruz-Almeida Y, Bialosky JE. Characteristics and Outcomes of Patients Receiving Physical Therapy for Low Back Pain with a Nociplastic Pain Presentation: A Secondary Analysis. Pain Res Manag 2023; 2023:5326261. [PMID: 36935875 PMCID: PMC10023235 DOI: 10.1155/2023/5326261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 03/21/2023]
Abstract
Introduction Individuals with low back pain (LBP) may be classified based on mechanistic descriptors, such as a nociplastic pain presentation (NPP). The purpose of this secondary analysis was to examine the frequency and characteristics of patients with a NPP referred to physical therapy with LBP. Additionally, we characterized patients with LBP meeting the criteria for NPP by demographic, clinical, psychological, and pain sensitivity variables. Finally, we examined short- and long-term clinical outcomes in patients with a NPP compared to those without a NPP. Materials and Methods Patients referred to physical therapy for LBP completed the Patient Self-report Survey for the Assessment of Fibromyalgia. Participants were categorized as "LBP with NPP" or "LBP without NPP" based on the threshold established in this measure. A rank sum test examined for differences in pain-related psychological factors and pressure-pain threshold between groups. Next, a Friedman test examined if LBP intensity and disability trajectories differed by groups at one and six months after initiation of physical therapy. Results 22.2% of patients referred to physical therapy for LBP met the criteria for a NPP. Patients with a NPP reported significantly greater disability, pain catastrophizing, depression, anxiety, and somatization compared to individuals without a NPP (p < 0.05). Pressure-pain threshold did not differ between groups (p > 0.05). Individuals with LBP with a NPP demonstrated nonsignificant, small to medium reductions in pain and disability at one and six months. Individuals experiencing LBP without a NPP demonstrated significant reductions in pain and disability in the short- and long term. Conclusion Patients with LBP with a NPP displayed greater negative pain-related psychological factors but similar pain sensitivity compared to LBP without NPP.
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Affiliation(s)
- Abigail T. Wilson
- 1University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
- 2Musculoskeletal Research Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Joseph L. Riley
- 3University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL, USA
| | - Mark D. Bishop
- 4Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- 5University of Florida Department of Physical Therapy, Gainesville, FL, USA
| | - Jason M. Beneciuk
- 5University of Florida Department of Physical Therapy, Gainesville, FL, USA
- 6Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Yenisel Cruz-Almeida
- 3University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL, USA
- 4Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Joel E. Bialosky
- 5University of Florida Department of Physical Therapy, Gainesville, FL, USA
- 6Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
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Velly AM, Anderson GC, Look JO, Riley JL, Rindal DB, Johnson K, Wang Q, Fricton J, Huff K, Ohrbach R, Gilbert GH, Schiffman E. Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study. J Am Dent Assoc 2022; 153:144-157. [PMID: 34973705 PMCID: PMC8799528 DOI: 10.1016/j.adaj.2021.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients often seek consultation with dentists for temporomandibular disorders (TMDs). The objectives of this article were to describe the methods of a large prospective cohort study of painful TMD management, practitioners' and patients' characteristics, and practitioners' initial treatment recommendations conducted by The National Dental Practice-Based Research Network (the "network"). METHODS Participating dentists recruited into this study treated patients seeking treatment for painful TMDs. The authors developed self-report instruments based on well-accepted instruments. The authors collected demographics, biopsychosocial characteristics, TMD symptoms, diagnoses, treatments, treatment adherence, and painful TMDs and jaw function outcomes through 6 months. RESULTS Participating dentists were predominately White (76.8%) and male (62.2%), had a mean age of 52 years, and were general practitioners (73.5%) with 23.8% having completed an orofacial pain residency. Of the 1,901 patients with painful TMDs recruited, the predominant demographics were White (84.3%) and female (83.3%). Patients' mean age was 44 years, 88.8% self-reported good to excellent health, and 85.9% had education beyond high school. Eighty-two percent had pain or stiffness of the jaw on awakening, and 40.3% had low-intensity pain. The most frequent diagnoses were myalgia (72.4%) and headache attributed to TMDs (51.0%). Self-care instruction (89.4%), intraoral appliances (75.4%), and medications (57.6%) were recommended frequently. CONCLUSIONS The characteristics of this TMD cohort include those typical of US patients with painful TMDs. Network practitioners typically managed TMDs using conservative treatments. PRACTICAL IMPLICATIONS This study provides credible data regarding painful TMDs and TMD management provided by network practitioners across the United States. Knowledge acquired of treatment recommendations and patient reports may support future research and improve dental school curricula.
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Affiliation(s)
- Ana Miriam Velly
- McGill University, Faculty of Dental Medicine and Oral Health Sciences, Research Department of Dentistry SMBD - Jewish General Hospital; Network for Canadian Oral Health Research (NCOHR); Orofacial Pain Working Group, NCOHR
| | - Gary C. Anderson
- Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - John O. Look
- Division of TMD and Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - Joseph L. Riley
- College of Dentistry, University of Florida; Pain Clinical Research Unit, University of Florida Clinical and Translational Science Institute, Gainesville, FL
| | | | | | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - James Fricton
- School of Dentistry, University of Minnesota, Minneapolis, MN; HealthPartners Institute, Bloomington, MN; Minnesota Head and Neck Pain Clinic, Minneapolis, MN
| | | | - Richard Ohrbach
- Department of Oral and Diagnostic Sciences, School of Dental Medicine, State University of New York, University at Buffalo, Buffalo, NY
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Eric Schiffman
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
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Valdes-Hernandez PA, Montesino-Goicolea S, Hoyos L, Porges EC, Huo Z, Ebner NC, Woods AJ, Cohen R, Riley JL, Fillingim RB, Cruz-Almeida Y. Resting-state functional connectivity patterns are associated with worst pain duration in community-dwelling older adults. Pain Rep 2021; 6:e978. [PMID: 34901680 PMCID: PMC8660002 DOI: 10.1097/pr9.0000000000000978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION An individual's chronic pain history is associated with brain morphometric alterations; but little is known about the association between pain history and brain function. OBJECTIVES This cross-sectional study aimed at determining how worst musculoskeletal pain intensity (WPINT) moderated the association between worst musculoskeletal pain duration (WPDUR) and brain resting-state magnetic resonance imaging functional connectivity (RSFC) in community-dwelling older adults (60-94 years, 75% females, 97% right-handed). METHODS Resting-state magnetic resonance imaging functional connectivity between region of interests was linearly regressed on WPDUR and WPINT. Predictions were compared with a control group's average RSFC (61-85 years, 47% females, 95% right-handed). RESULTS Three significant patterns emerged: (1) the positive association between WPDUR and RSFC between the medial prefrontal cortex, in the anterior salience network (SN), and bilateral lateral Brodmann area 6, in the visuospatial network (VSN), in participants with more severe chronic pain, resulting in abnormally lower RSFC for shorter WPDUR; (2) the negative association between WPDUR and RSFC between right VSN occipitotemporal cortex (lateral BA37 and visual V5) and bilateral VSN lateral Brodmann area 6, independently of WPINT, resulting in abnormally higher and lower RSFC for shorter and longer WPDUR, respectively; and (3) the positive association between WPDUR and the left hemisphere's salience network-default mode network connectivity (between the hippocampus and both dorsal insula and ventral or opercular BA44), independently of WPINT, resulting in abnormally higher RSFC for longer WPDUR. CONCLUSION Musculoskeletal effects on brain functional networks of general healthy individuals could accumulate until being observable at older ages. Results invite to examinations of these effects' impact on function and memory.
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Affiliation(s)
- Pedro A. Valdes-Hernandez
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Soamy Montesino-Goicolea
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Lorraine Hoyos
- University of Central Florida, Department of Clinical Sciences, Orlando, Florida, USA
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Natalie C. Ebner
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, USA
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
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Cardoso J, Apagueno B, Lysne P, Hoyos L, Porges E, Riley JL, Fillingim RB, Woods AJ, Cohen R, Cruz-Almeida Y. Pain and the Montreal Cognitive Assessment (MoCA) in Aging. Pain Med 2021; 22:1776-1783. [PMID: 33718961 DOI: 10.1093/pm/pnab003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The present study aimed to determine whether specific cognitive domains part of the Montreal Cognitive Assessment (MoCA) are significantly lower in community-dwelling older adults with chronic pain compared with older adults without pain and whether these domains would be associated with self-reported pain, disability, and somatosensory function. DESIGN Secondary data analysis, cross-sectional. SETTING University of Florida. SUBJECTS Individuals over 60 years old enrolled in the Neuromodulatory Examination of Pain and mobility Across the Lifespan (NEPAL) study were included if they completed the MoCA and other study measures (n = 62). Most participants reported pain on most days during the past three months (63%). METHODS Subjects underwent a health assessment (HAS) and a quantitative sensory testing (QST) session. Health/medical history, cognitive function and self-reported pain measures were administered during the HAS. Mechanical and thermal detection, and thermal pain thresholds were assessed during the QST session. RESULTS Older adults with chronic pain had lower MoCA scores compared with controls on domains of executive function, attention, memory, and language (P < 0.05). The attention and language domains survived adjustments for age, sex, education, depression, and pain duration (P < 0.05). Attention was significantly associated with all pain characteristics including pain intensity and disability, while executive function was associated with mechanical detection (P < 0.05). CONCLUSION Our results support previous findings that individuals with chronic pain tend to show poorer cognitive functioning compared with pain-free controls in domains of attention and executive function. Our findings also extend these findings to community-dwelling older adults, who are already most vulnerable to age-related cognitive declines.
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Affiliation(s)
- Josue Cardoso
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida
| | - Brandon Apagueno
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Paige Lysne
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida
| | - Lorraine Hoyos
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Eric Porges
- Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, Florida.,Department of Clinical & Health Psychology, College of Health Professions, University of Florida, Gainesville, Florida.,Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Joseph L Riley
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida.,Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, Florida
| | - Adam J Woods
- Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, Florida.,Department of Clinical & Health Psychology, College of Health Professions, University of Florida, Gainesville, Florida.,Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Ronald Cohen
- Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, Florida.,Department of Clinical & Health Psychology, College of Health Professions, University of Florida, Gainesville, Florida.,Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida.,Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, Florida.,Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
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10
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Cruz-Almeida Y, Forbes M, Cohen RC, Woods AJ, Fillingim RB, Riley JL, Porges ES. Brain gamma-aminobutyric acid, but not glutamine and glutamate levels are lower in older adults with chronic musculoskeletal pain: considerations by sex and brain location. Pain Rep 2021; 6:e952. [PMID: 34514275 PMCID: PMC8423393 DOI: 10.1097/pr9.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES GABAergic and glutamatergic neurotransmitter systems are central to the pathophysiology of chronic pain and are equally affected by aging processes. We measured levels of frontal gamma-aminobutyric acid (GABA) and the combined resonance of glutamate and glutamine (Glx) in vivo using proton magnetic resonance spectroscopy (1H-MRS) to elucidate age-specific and pain-specific associations with clinical and experimental pain in older adults. METHODS Younger (18-24, n = 24) and older (60-94, n = 41) individuals part of a larger study (Neuromodulatory Examination of Pain and Mobility Across the Lifespan [NEPAL]) underwent questionnaires, quantitative sensory testing, and 1H-MRS Mescher-Garwood point-resolved spectroscopy to measure GABA and Glx levels in prefrontal and sensorimotor brain regions. RESULTS Older participants had significantly lower sensorimotor, but not prefrontal, GABA and Glx levels, compared with younger controls (P's < 0.05). Younger controls had significantly higher prefrontal and sensorimotor GABA, but not Glx, levels compared with older controls and older adults with chronic pain (P's < 0.05). Older males with chronic pain had significantly lower prefrontal GABA compared with older and younger male controls (P's < 0.05). Prefrontal GABA, but not Glx, was significantly associated with self-reported and experimental pain measures (P's < 0.05). Our results are the first to focus exclusively on age and pain differences in GABA and Glx including younger and older controls to elucidate aging and pain contributions to brain GABAergic and glutamatergic processes. CONCLUSION Evaluation of both the neuroinhibitory and neuroexcitatory mechanisms provide promising potential for improving both our understanding of the mechanisms of chronic pain in aging and opportunities for effective, individualized treatments.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Megan Forbes
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ronald C. Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B. Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Joseph L. Riley
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Eric S. Porges
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
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11
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Simon CB, Lentz TA, Orr L, Bishop MD, Fillingim RB, Riley JL, George SZ. Static and Dynamic Pain Sensitivity in Adults With Persistent Low Back Pain: Comparison to Healthy Controls and Associations With Movement-evoked Pain Versus Traditional Clinical Pain Measures. Clin J Pain 2021; 37:494-503. [PMID: 33999558 PMCID: PMC8194013 DOI: 10.1097/ajp.0000000000000945] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/31/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Despite its impact, individual factors associated with persistent low back pain (LBP) remain poorly understood. This study investigated static and dynamic pain sensitivity in adults with persistent LBP versus pain-free controls; and investigated associations between pain sensitivity and 3 clinical pain measures: recalled, resting, and movement-evoked pain (MEP). MATERIALS AND METHODS A lifespan sample of 60 adults with persistent LBP and 30 age-matched/sex-matched controls completed 4 laboratory sessions. Static pain sensitivity (pressure pain threshold [PPT], heat pain threshold) and dynamic pain sensitivity (heat pain aftersensations [AS], temporal summation [TS] of second heat pain) were measured. Demographic and clinical factors collected were education, global cognition, and perceived health. Resting and recalled pain were measured via questionnaire, and MEP via the Back Performance Scale. RESULTS LBP participants demonstrated lower PPT remotely (hand; F1,84=5.34, P=0.024) and locally (low back; F1,84=9.55, P=0.003) and also had higher AS (F1,84=6.01, P=0.016). Neither static nor dynamic pain sensitivity were associated with recalled pain (P>0.05). However, static pain sensitivity (local PPT) explained an additional 9% variance in resting pain, while dynamic pain sensitivity (AS, TS) explained an additional 10% to 12% variance in MEP. DISCUSSION This study characterized pain sensitivity measures among individuals with persistent LBP and suggests static pain sensitivity plays a larger role in resting pain while dynamic pain sensitivity plays a larger role in MEP. Future studies will confirm these relationships and elucidate the extent to which changes in static or dynamic pain sensitivity predict or mediate clinical pain among adults with persistent LBP.
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Affiliation(s)
- Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Trevor A. Lentz
- Department of Orthopaedic Surgery, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
| | | | - Mark D. Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
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12
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Wilson AT, Riley JL, Bishop MD, Beneciuk JM, Godza M, Cruz-Almeida Y, Bialosky JE. A psychophysical study comparing massage to conditioned pain modulation: A single blind randomized controlled trial in healthy participants. J Bodyw Mov Ther 2021; 27:426-435. [PMID: 34391267 DOI: 10.1016/j.jbmt.2021.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/10/2021] [Accepted: 02/28/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Pain-inducing massage results in greater pain inhibition than pain free massage, suggesting a mechanism dependent on conditioned pain modulation (CPM). The purpose of this study was to test the hypothesis that pain inducing massage produces similar magnitude of reduction in pain sensitivity as a cold pressor task and that baseline conditioned pain modulation efficiency predicts pain inducing massage related hypoalgesia. METHODS Sixty healthy participants were randomly assigned to receive either pain inducing massage to the neck, cold pressor task to the hand, or pain free massage to the neck. Participants also underwent pre and immediate post-intervention quantitative sensory testing. A repeated measures ANCOVA determined between group differences in pain sensitivity changes. RESULTS Pain inducing massage used as a conditioning stimulus resulted in comparable experimental pain sensitivity changes as a cold pressor task (p > 0.05). Pain intensity during the intervention demonstrated a weak correlation (r = 0.20, p = 0.12) with changes in pain sensitivity at a remote site. Individuals with an efficient CPM at baseline who received the pain inducing massage displayed greater increases in pressure pain threshold compared to individuals with a less efficient CPM indicating the potential benefit of treatment stratification by mechanism. CONCLUSION Although pain inducing massage resulted in less self-reported pain than a cold pressor task, both resulted in similar magnitude of the CPM response, suggesting shared underlying mechanisms. Understanding mechanisms of interventions can move us closer to mechanistic based treatments for pain which is consistent with a personalized medicine approach to care.
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Affiliation(s)
- Abigail T Wilson
- University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA.
| | - Joseph L Riley
- University of Florida College of Dentistry, Interim Associate Dean of Faculty Affairs, Director, Pain Clinical Research Unit, Pain Research & Intervention Center of Excellence, UF CTSI, University of Florida, Health Center Office, D2-148, Gainesville, FL, 32610-0404, USA.
| | - Mark D Bishop
- University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA.
| | - Jason M Beneciuk
- University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA; College of Public Health and Health Professions (University of Florida) Research Collaboration, USA.
| | - Mutsa Godza
- University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA.
| | - Yenisel Cruz-Almeida
- University of Florida Term Professor, Colleges of Dentistry and Medicine, Associate Director, UF Pain Research & Intervention Center of Excellence, UF CTSI. PO Box 103628, 1329 SW 16th Street, Ste 5180, Gainesville, FL, USA.
| | - Joel E Bialosky
- University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA; College of Public Health and Health Professions (University of Florida) Research Collaboration, USA.
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13
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Tagliaferro EPDS, Valsecki Júnior A, Rosell FL, Silva SRCD, Riley JL, Gilbert GH, Gordan VV. Methods for Caries Prevention in Children Reported by Dentists from a Brazilian Community. Pesqui Bras Odontopediatria Clín Integr 2021. [DOI: 10.1590/pboci.2021.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Montesino-Goicolea S, Valdes-Hernandez PA, Hoyos L, Woods AJ, Cohen R, Huo Z, Riley JL, Porges EC, Fillingim RB, Cruz-Almeida Y. Cortical Thickness Mediates the Association Between Self-Reported Pain and Sleep Quality in Community-Dwelling Older Adults. J Pain Res 2020; 13:2389-2400. [PMID: 33061554 PMCID: PMC7522519 DOI: 10.2147/jpr.s260611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Musculoskeletal pain is prevalent in older adults representing the leading cause of disability in this population. Similarly, nearly half of older adults complain of difficulty sleeping. We aimed to explore the relationship between sleep quality with self-reported musculoskeletal pain, somatosensory and pain thresholds in community-dwelling older adults and further explore brain regions that may contribute to this association. METHODS Older adults (>60 years old, n=69) from the NEPAL study completed demographic, pain and sleep assessments followed by a quantitative sensory testing battery. A subset (n=49) also underwent a 3T high-resolution, T1-weighted anatomical scan. RESULTS Poorer sleep quality using the Pittsburgh Sleep Quality Index was positively associated with self-reported pain measures (all p's >0.05), but not somatosensory and pain thresholds (all p's >0.05). Using a non-parametric threshold-free cluster enhancement (TFCE) approach, worse sleep quality was significantly associated with lower cortical thickness in the precentral, postcentral, precuneus, superior parietal, and lateral occipital regions (TFCE-FWE-corrected at p < 0.05). Further, only postcentral cortical thickness significantly mediated the association between sleep quality and self-reported pain intensity using bootstrapped mediation methods. CONCLUSION Our findings in older adults are similar to previous studies in younger individuals where sleep is significantly associated with self-reported pain. Specifically, our study implicates brain structure as a significant mediator of this association in aging. Future larger studies are needed to replicate our findings and to further understand if the brain can be a therapeutic target for both improved sleep and pain relief in older individuals.
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Affiliation(s)
- Soamy Montesino-Goicolea
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
| | - Pedro A Valdes-Hernandez
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
| | - Lorraine Hoyos
- University of Central, Florida College of Medicine, Orlando, FL, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Clinical and Health Psychology, College of Health Professions, University of Florida, Gainesville, FL, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Clinical and Health Psychology, College of Health Professions, University of Florida, Gainesville, FL, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph L Riley
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Eric C Porges
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Clinical and Health Psychology, College of Health Professions, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
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da Silva Tagliaferro EP, da Silva SRC, Rosell FL, Valsecki A, Riley JL, Gilbert GH, Gordan VV. METHODS FOR CARIES PREVENTION IN ADULTS AMONG DENTISTS FROM A BRAZILIAN COMMUNITY: Adult' caries prevention among Brazilian dentists. Braz J Oral Sci 2020; 19. [PMID: 32461752 DOI: 10.20396/bjos.v19i0.8656224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Little is known about dental practice patterns of caries prevention in adults among Brazilian dentists. OBJECTIVE To quantify procedures used for caries prevention for adult patients among dentists from a Brazilian community. METHODS Dentists (n=197) who reported that at least 10% of their patients are more than 18 years old participated in the first Brazilian study that used a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" from the U.S. National Dental Practice-Based Research Network. A questionnaire about characteristics of their practice and patient population were also completed by the dentists. Generalized linear regression models and a hierarchal clustering procedure were used (p<0.05). RESULTS In-office fluoride application was the preventive method most often reported. The main predictors for recommending some preventive agent were: female dentist (dental sealant; in-office fluoride; non-prescription fluoride) and percentage of patients interested in caries prevention (dental sealant; in-office fluoride; non-prescription fluoride). Other predictors included private practice (dental sealant), percentage of patients 65 years or older (in-office fluoride), graduation from a private dental school (non-prescription fluoride), years since dental school graduation (chlorhexidine rinse) and using a preventive method (recommending sealant/fluoride/chlorhexidine rinse/sugarless, xylitol gum). Cluster analysis showed that dentists in the largest subgroup seldom used any of the preventive agents. CONCLUSION Dentists most often reported in-office fluoride as a method for caries prevention in adults. Some practitioner, practice and patients' characteristics were positively associated with more-frequent use of a preventive agent.
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Affiliation(s)
- Elaine Pereira da Silva Tagliaferro
- Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Silvio Rocha Correa da Silva
- Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Fernanda Lopez Rosell
- Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Aylton Valsecki
- Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Joseph L Riley
- University of Florida College of Dentistry, Director, Pain Clinical Research Unit, UF CTSI, Deputy Director, South Atlantic Region, Dental Practice-based Research Network, Clinical and Translational Research Building (CTRB), Room 2227, 2004 Mowry Road, Box 100404, Gainesville, FL 32610-0404, The United States of America
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, Room SDB 109, School of Dentistry, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0007, The United States of America
| | - Valeria Veiga Gordan
- Dental Practice-Based Research, University of Florida, College of Dentistry, Room D9-6 P.O. Box 100415, Gainesville, FL 32610-0415, The United States of America
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Booker S, Cardoso J, Cruz-Almeida Y, Sibille KT, Terry EL, Powell-Roach KL, Riley JL, Goodin BR, Bartley EJ, Addison AS, Staud R, Redden D, Bradley L, Fillingim RB. Movement-evoked pain, physical function, and perceived stress: An observational study of ethnic/racial differences in aging non-Hispanic Blacks and non-Hispanic Whites with knee osteoarthritis. Exp Gerontol 2019; 124:110622. [PMID: 31154005 PMCID: PMC6660381 DOI: 10.1016/j.exger.2019.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a pervasive musculoskeletal condition, often exacerbated by movement-evoked pain (MEP). Despite established research demonstrating significant racial differences in OA pain, few studies have investigated ethnic/racial group differences in MEP and lower extremity function and their association with psychosocial factors, such as perceived stress. Therefore, the primary aims were: (1) to identify ethnic/racial group differences in persons with or at risk for knee OA pain based on MEP, physical performance, and perceived stress measures, and (2) to determine if perceived stress explains the relationship between MEP and function in non-Hispanic Blacks (NHBs) and non-Hispanic Whites (NHWs). METHODS A total of 162 NHB and NHW community-dwelling older adults (50-78 years of age) were included in this analysis from the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD) cross-sectional cohort study. Demographic, anthropometric, pain and functional parameters were assessed using a battery of validated instruments. Descriptive statistics, parametric, and multivariate analyses were conducted to determine ethnic/racial differences in perceived stress, MEP, and function. RESULTS Our results support the hypothesis that among persons with knee OA pain, NHBs have significantly greater MEP and lower functional level, despite similar levels of perceived stress. However, perceived stress was more strongly related to MEP in NHB compared to NHWs. Differences in function were limited to walking speed, where NHWs demonstrated faster gait speed. CONCLUSIONS Our cross-sectional study demonstrated important ethnic/racial differences in MEP and function. Also, perceived stress had a stronger effect on MEP in NHBs, suggesting that perceived stress may more strongly influence pain with physical movement among NHB adults. MEP may be a clinically important pain outcome to measure in persons with OA, and these data warrant future research on the impact of stress on pain and functional outcomes in older adults, particularly in NHBs.
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Affiliation(s)
- Staja Booker
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA.
| | - Josue Cardoso
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Yenisel Cruz-Almeida
- The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA; The University of Florida, Department of Aging & Geriatric Research, College of Medicine, Gainesville, FL 32611, USA
| | - Kimberly T Sibille
- The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA; The University of Florida, Department of Aging & Geriatric Research, College of Medicine, Gainesville, FL 32611, USA
| | - Ellen L Terry
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Keesha L Powell-Roach
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Joseph L Riley
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Burel R Goodin
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL 35294, USA
| | - Emily J Bartley
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | | | - Roland Staud
- The University of Florida, Department of Medicine, Gainesville, FL 32608, USA
| | - David Redden
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, AL 35294, USA; University of Alabama at Birmingham, Department Medicine and Rheumatology, Birmingham, AL 35294, USA
| | - Laurence Bradley
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Roger B Fillingim
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
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Lysne P, Cohen R, Hoyos L, Fillingim RB, Riley JL, Cruz-Almeida Y. Age and pain differences in non-verbal fluency performance: Associations with cortical thickness and subcortical volumes. Exp Gerontol 2019; 126:110708. [PMID: 31445107 DOI: 10.1016/j.exger.2019.110708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 11/20/2022]
Abstract
Musculoskeletal pain is a cause of disability in older individuals and is commonly associated with executive function deficits. In particular, verbal fluency deficits have been previously reported in older individuals with and without musculoskeletal pain, however, no studies have examined non-verbal fluency. The present study investigated non-verbal fluency performance in younger and older individuals and associations with clinical and experimental pain. The NEPAL study included older (n = 63) and younger (n = 28) individuals who completed demographic, and clinical pain assessments followed by a multi-modal QST battery. A subset of participants (older n = 39/63, younger n = 11/28) underwent a structural 3T MRI to extract cortical thickness and subcortical gray matter volumes. The Ruff Figural Fluency Test was administered to assess fluid/divergent thinking, ability to shift cognitive set, and planning strategies. Total Unique Designs drawn and Error Ratio assessed participants' ability to minimize repetition while maximizing unique productions. Adjusting for race and education, older participants with chronic pain had significantly lower Total Unique Designs (67.1 ± 20.3) compared to older adults without chronic pain (78.8 ± 15.9) and younger controls (93.8 ± 20.3, p < 0.001). Within the older sample, those with chronic pain had a significantly greater Error Ratio (0.22 ± 0.3) compared to those without chronic pain (0.09 ± 0.06) and younger controls (0.05 ± 0.05, p = 0.002). In older participants, greater Total Unique Design scores were significantly associated only with lower pressure pain sensitivity (r = 0.300, p = 0.031) while greater Error Ratio scores were significantly associated with greater thermal pain sensitivity (r = 0.304, p = 0.027). However, after accounting for sleep quality, clinical and experimental pain associations were eliminated. Across all participants, non-verbal fluency performance was associated with cortical thickness in frontal, parietal and temporal regions as well as several subcortical gray matter structures even after adjusting for multiple comparisons (p's < 0.001). Our findings suggest a pain-related deficit in non-verbal fluency beyond the established age-related decrements that may be dependent on sleep quality and was associated with specific patterns of gray matter structure.
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Affiliation(s)
- Paige Lysne
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States of America; Institute on Aging, University of Florida, Gainesville, FL, United States of America
| | - Ronald Cohen
- Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, United States of America; Department of Clinical & Health Psychology, College of Health Professions, University of Florida, Gainesville, FL, United States of America
| | - Lorraine Hoyos
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States of America; Institute on Aging, University of Florida, Gainesville, FL, United States of America
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States of America; Institute on Aging, University of Florida, Gainesville, FL, United States of America; Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States of America
| | - Joseph L Riley
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States of America; Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States of America
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States of America; Institute on Aging, University of Florida, Gainesville, FL, United States of America; Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, United States of America; Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States of America; Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States of America.
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18
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Staud R, Godfrey MM, Mejia M, Ramanlal R, Riley JL, Robinson ME. Usefulness of Ramp & Hold Procedures for Testing of Pain Facilitation in Human Participants: Comparisons With Temporal Summation of Second Pain. J Pain 2019; 21:390-398. [PMID: 31425887 DOI: 10.1016/j.jpain.2019.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022]
Abstract
Quantitative sensory testing (QST) is used to systematically interrogate normal responding and alterations of nervous system function, including pain-related central sensitization (CS). However, up to now, QST of CS in human subjects has been mostly focused on temporal summation of second pain (TSSP), has been difficult to perform, and has been associated with low reliability. In contrast, slow ramp & hold (RH) procedures are simpler tests of temporal summation and easier to perform. We examined the usefulness of RH procedures as reliable generators of CS using 2 validated QST procedures: decay of pain aftersensations and wind-down. Twenty-seven pain-free subjects (74% female) were enrolled into the study. Trains of sensitivity-adjusted TSSP or RH heat stimuli were applied to the hands of participants to achieve moderate temporal pain summation (50 Numerical Rating Scale [NRS] [0-100]). Fifteen-second aftersensations and 30-second wind-down related to TSSP or RH were used for CS comparisons. Reliability of all test procedures was tested over 24 hours. Use of sensitivity-adjusted TSSP and RH heat stimuli resulted in average pain ratings of 48.2 and 49.6 NRS, respectively. Aftersensations or wind-down decay were not significantly different after either TSSP or RH, (all P > .05), indicating that each procedure achieved similar levels of short-term CS. Sensitivity-adjusted RH stimuli were well tolerated and resulted in reliable pain increases of ∼50 NRS. The magnitude of short-term CS, determined by aftersensations and wind-down was similar after sensitivity-adjusted TSSP and RH stimuli (P > .05), suggesting that pain facilitation of healthy participants and likely chronic pain patients can not only be tested with TSSP but also with RH procedures. PERSPECTIVE: This article examines the ability of RH procedures to generate similar central sensitivity augmentation than TSSP. The results suggest that RH is similarly well suited as TSSP to explore central pain mechanisms in healthy subjects and most likely also in chronic pain patients.
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Affiliation(s)
- Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida.
| | | | - Marlin Mejia
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Riddhi Ramanlal
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Joseph L Riley
- Department of Dentistry, University of Florida, Gainesville, Florida
| | - Michael E Robinson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
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Cruz-Almeida Y, Fillingim RB, Riley JL, Woods AJ, Porges E, Cohen R, Cole J. Chronic pain is associated with a brain aging biomarker in community-dwelling older adults. Pain 2019; 160:1119-1130. [PMID: 31009418 PMCID: PMC6752890 DOI: 10.1097/j.pain.0000000000001491] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Chronic pain is associated with brain atrophy with limited evidence on its impact in the older adult's brain. We aimed to determine the associations between chronic pain and a brain aging biomarker in persons aged 60 to 83 years old. Participants of the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study (N = 47) completed demographic, psychological, and pain assessments followed by a quantitative sensory testing battery and a T1-weighted magnetic resonance imaging. We estimated a brain-predicted age difference (brain-PAD) that has been previously reported to predict overall mortality risk (brain-PAD, calculated as brain-predicted age minus chronological age), using an established machine-learning model. Analyses of covariances and Pearson/Spearman correlations were used to determine associations of brain-PAD with pain, somatosensory function, and psychological function. Individuals with chronic pain (n = 33) had "older" brains for their age compared with those without (n = 14; F[1,41] = 4.9; P = 0.033). Greater average worst pain intensity was associated with an "older" brain (r = 0.464; P = 0.011). Among participants with chronic pain, those who reported having pain treatments during the past 3 months had "younger" brains compared with those who did not (F[1,27] = 12.3; P = 0.002). An "older" brain was significantly associated with decreased vibratory (r = 0.323; P = 0.033) and thermal (r = 0.345; P = 0.023) detection, deficient endogenous pain inhibition (F[1,25] = 4.6; P = 0.044), lower positive affect (r = -0.474; P = 0.005), a less agreeable (r = -0.439; P = 0.020), and less emotionally stable personality (r = -0.387; P = 0.042). Our findings suggest that chronic pain is associated with added "age-like" brain atrophy in relatively healthy, community-dwelling older individuals, and future studies are needed to determine the directionality of our findings. A brain aging biomarker may help identify people with chronic pain at a greater risk of functional decline and poorer health outcomes.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Institute on Aging, University of Florida, Gainesville, FL, United States
- Cognitive Aging and Memory Clinical Translational Program, McKnight Brain Foundation, University of Florida, Gainesville, FL, United States
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Institute on Aging, University of Florida, Gainesville, FL, United States
| | - Joseph L Riley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Institute on Aging, University of Florida, Gainesville, FL, United States
| | - Adam J Woods
- Cognitive Aging and Memory Clinical Translational Program, McKnight Brain Foundation, University of Florida, Gainesville, FL, United States
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States
- Department of Clinical and Health Psychology, College of Health Professions, University of Florida, Gainesville, FL, United States
| | - Eric Porges
- Cognitive Aging and Memory Clinical Translational Program, McKnight Brain Foundation, University of Florida, Gainesville, FL, United States
- Department of Clinical and Health Psychology, College of Health Professions, University of Florida, Gainesville, FL, United States
| | - Ronald Cohen
- Cognitive Aging and Memory Clinical Translational Program, McKnight Brain Foundation, University of Florida, Gainesville, FL, United States
- Department of Clinical and Health Psychology, College of Health Professions, University of Florida, Gainesville, FL, United States
| | - James Cole
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Affiliation(s)
- Duane B. Corbett
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - Todd M. Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
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21
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Kakudate N, Yokoyama Y, Sumida F, Matsumoto Y, Riley JL, Gordan VV, Gilbert GH. Practice-based research agenda priorities selected by patients: findings from a dental practice-based research network. Int Dent J 2018; 69:183-191. [PMID: 30350855 DOI: 10.1111/idj.12447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to identify (i) which practice-based research agendas had the highest priority among patients and (ii) whether priorities varied significantly with patient age and gender. METHODS We conducted a cross-sectional questionnaire survey of 482 patients from 11 outpatient dental practices. The patients were shown 31 items concerning practice-based research questions and asked to select the three items in which they were most interested. We generated a rank order of the 31 items. Subsequently, the 31 items were categorised into 10 groups, and we performed subgroup analyses according to age and gender using chi-square tests. RESULTS "Age-specific care to maintain oral health (n = 86)" was rated as the most interesting research question. When data were analysed according to age, patients less than 40 years old rated "Orthodontic treatment", "Esthetic dental care" and "Topical fluoride application" as interesting questions significantly more frequently than did patients 40 years old or older (P < 0.01)?, while patients 40 years old or older rated "Regular dental check-ups", "Dental implant", "Diet and food" and "Social health insurance" as more interesting than did patients less than 40 years old (P < 0.05). When data were analysed according to gender, female patients rated the questions on aesthetic dental care as more interesting than did male patients (P < 0.01), whereas male patients rated questions on toothbrushing as more interesting than did female patients (P < 0.05). CONCLUSIONS Patients assessed "Age-specific care to maintain oral health" as the highest priority among a broad range of research topics. This study also quantified patient priorities for research agendas according to age and gender group. Designing future research with these priorities in mind will promote patient-centred evidence.
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Affiliation(s)
- Naoki Kakudate
- Division of Clinical Epidemiology, Kyushu Dental University, Kitakyushu, Japan.,University of Florida College of Dentistry, Gainesville, FL, USA
| | - Yoko Yokoyama
- Graduate School of Media and Governance, Keio University, Fujisawa-city, Japan
| | | | | | - Joseph L Riley
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Tagliaferro E, Junior AV, Rosell FL, Silva S, Riley JL, Gilbert GH, Gordan VV. Caries Diagnosis in Dental Practices: Results From Dentists in a Brazilian Community. Oper Dent 2018; 44:E23-E31. [PMID: 30212272 DOI: 10.2341/18-034-c] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to assess practices related to diagnosis of dental caries among dentists (n=217) from Araraquara, São Paulo State, Brazil. Data on sociodemographic information and practitioner characteristics were collected using a pretested questionnaire, and data on practices related to caries diagnosis were gathered by using a translated and culturally adapted questionnaire from the US National Dental Practice-Based Research Network. Descriptive statistics and regression analyses were used for data analysis. Respondents reported using in most of their patients radiographs (Rx) to diagnose proximal caries (59%), explorer (Ex) for the diagnosis of occlusal caries (64%) and on the margins of existing restorations (79%), as well as air jet (AJ) with drying (92%). Magnification (M) (25%), fiber optic transillumination (FOTI; 14%), and laser fluorescence (LF) (3%) were used in the minority of patients. Regression analysis revealed that the following dentists' characteristics were significantly associated (p<0.05) with the use of diagnostic methods on a greater percentage of their patients: advanced degree (Rx, FOTI), higher percentage of patients with individualized caries prevention (Rx, FOTI, M), more years since dental school graduation (Ex, M), and work in an exclusively private practice model (LF). In conclusion, most Brazilian dentists from Araraquara reported they most commonly use visual, tactile, and radiographic imaging for the diagnosis of dental caries. Some dentists' characteristics, such as time from dental school graduation and having a postgraduation course, were associated with the use of certain diagnostic methods.
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23
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Cruz-Almeida Y, Aguirre M, Sorenson H, Tighe P, Wallet SM, Riley JL. Age differences in salivary markers of inflammation in response to experimental pain: does venipuncture matter? J Pain Res 2017; 10:2365-2372. [PMID: 29042812 PMCID: PMC5633270 DOI: 10.2147/jpr.s138460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
An important consideration in mechanistic research using biomarkers should include the use of saliva as an alternative to blood. The use of saliva would allow the study of susceptible populations such as older adults where venipuncture may not be feasible. Although saliva has been most commonly used to measure cortisol and tumor necrosis factor-α (TNFα), there is limited evidence that other cytokines found in saliva significantly change in response to laboratory-induced pain. Therefore, the aim of the current preliminary study was to characterize the time course, duration and magnitude of changes of commonly measured pro- (interleukin [IL]-6, IL-8) and anti-inflammatory (IL-10, IL-4) cytokines in saliva samples and to test for age-related differences in separate experimental painful and non-painful control sessions. In addition, we also tested whether venipuncture results in significant cytokine alterations similar to a painful stimulus in a non-painful, non-venipuncture control session. All cytokines were significantly induced by the cold pressor task compared to a warm control session (p < 0.001). Specifically, healthy older adults experienced greater salivary changes in all cytokines during the cold pressor session compared to younger adults in the non-painful sessions (p < 0.001). There were no significant differences between the venipuncture and non-venipuncture sessions across all cytokines (p > 0.05). Our findings support the use of saliva as a substitute for blood in both young and older healthy individuals to measure changes after experimental pain stimulation. In addition, venipuncture alone is not sufficient to induce IL-6, IL-8, IL-10 and IL-4. Future studies in the community are urgently needed to validate and further move translational mechanistic pain research to those populations most underrepresented in clinical research.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence.,Institute on Aging.,Department of Aging and Geriatric Research
| | - Maria Aguirre
- Pain Research and Intervention Center of Excellence.,Department of Community Dentistry & Behavioral Science
| | - Heather Sorenson
- Department of Community Dentistry & Behavioral Science.,Department of Oral Biology
| | - Patrick Tighe
- Pain Research and Intervention Center of Excellence.,Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Shannon M Wallet
- Department of Community Dentistry & Behavioral Science.,Department of Oral Biology
| | - Joseph L Riley
- Pain Research and Intervention Center of Excellence.,Department of Community Dentistry & Behavioral Science
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24
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Naugle KM, Cruz-Almeida Y, Fillingim RB, Riley JL. Loss of Temporal Inhibition of Nociceptive Information Is Associated With Aging and Bodily Pain. J Pain 2017; 18:1496-1504. [PMID: 28847735 DOI: 10.1016/j.jpain.2017.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 08/02/2017] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
Abstract
An age-related decline in endogenous pain inhibitory processes likely places older adults at an increased risk for chronic pain. Limited research indicates that older adults may be characterized by deficient offset analgesia, an inhibitory temporal sharpening mechanism that increases the detectability of minor decreases in noxious stimulus intensity. The primary purpose of the study was to examine age differences in offset analgesia in community-dwelling younger, middle-aged, and older adults. An additional aim of the study was to determine whether the magnitude of offset analgesia predicted self-reported bodily pain. Eighty-seven younger adults, 42 middle-aged adults, and 60 older adults completed 4 offset analgesia trials and 3 constant temperature trials in which a noxious heat stimulus was applied to the volar forearm for 40 seconds. The offset trials consisted of 3 continuous phases: an initial 10-second painful stimulus, either a 1.0°C or .4°C increase in temperature from the initial 10-second painful stimulus for 10 seconds, and either a 1.0°C or .4°C decrease back to the initial testing temperature for 20 seconds. During each trial, subjects rated pain intensity continuously using an electronic visual analog scale (0-100). All subjects also completed the Short-Form Health Survey-36 including the Bodily Pain subscale. The results indicated that older and middle-aged adults showed reduced offset analgesia compared with younger adults in the 1.0°C and .4°C offset trials. Furthermore, the magnitude of offset analgesia predicted self-reported bodily pain, with those exhibiting reduced offset analgesia reporting greater bodily pain. Dysfunction of this endogenous inhibitory system could increase the risk of developing chronic pain for middle-aged and older adults. PERSPECTIVE Older and middle-aged adults showed reduced offset analgesia compared with younger adults. The significant association between reduced offset analgesia and pain in daily life supports the notion that pain modulatory deficits are associated with not just a chronic pain condition but with the experience of pain in general.
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Affiliation(s)
- Kelly M Naugle
- Department of Kinesiology, School of Physical Education and Tourism Management, Indiana University Purdue University, Indianapolis, Indiana
| | - Yenisel Cruz-Almeida
- Department of Aging & Geriatric Research and Neuroscience, College of Medicine, Institute on Aging, University of Florida, Gainesville, Florida; College of Dentistry and Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- College of Dentistry and Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Joseph L Riley
- College of Dentistry and Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida.
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25
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Cruz-Almeida Y, Cardoso J, Riley JL, Goodin B, King CD, Petrov M, Bartley EJ, Sibille KT, Glover TL, Herbert MS, Bulls HW, Addison A, Staud R, Redden D, Bradley LA, Fillingim RB. Physical performance and movement-evoked pain profiles in community-dwelling individuals at risk for knee osteoarthritis. Exp Gerontol 2017; 98:186-191. [PMID: 28842222 DOI: 10.1016/j.exger.2017.08.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/07/2017] [Accepted: 08/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Knee pain associated with osteoarthritis is a significant contributor to decreased physical function. Recent evidence supports the inter-individual heterogeneity associated with knee pain presentation, but whether there is similar heterogeneity in physical performance among these individuals has not been previously examined. The aim of the present study was to characterize the variability in physical performance profiles and the pain evoked by their performance (i.e., movement-evoked pain). METHODS In a secondary analysis of the community-based study Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD), individuals (n=270) completed functional, pain, psychological, and somatosensory assessments. Hierarchical cluster analysis was used to derive physical function profiles that were subsequently compared across several clinical, psychological and experimental pain measures. RESULTS Our results support the hypothesis that among persons with knee OA pain, three different physical performance profiles exist with varying degrees of movement-evoked pain. Even as all three groups experienced moderate to severe levels of spontaneous knee pain, those individuals with the most severe movement-evoked pain and lowest physical functional performance also had the least favorable psychological characteristics along with increased mechanical pain sensitivity and temporal summation. CONCLUSIONS Our findings support the need for the assessment and consideration of movement-evoked pain during physical performance tasks as these have the potential to increase the value of functional and pain assessments clinically. The identification of the mechanisms driving pain burden within homogeneous groups of individuals will ultimately allow for targeted implementation of treatments consistent with a biopsychosocial model of pain.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Institute on Aging, University of Florida, USA; Cognitive Aging & Memory Clinical Translational Research Program, University of Florida, USA; Department of Aging & Geriatric Research, College of Medicine, University of Florida, USA; Department of Neuroscience, College of Medicine, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA.
| | - Josue Cardoso
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | - Joseph L Riley
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | - Burel Goodin
- Department of Psychology, University of Alabama at Birmingham, USA
| | - Christopher D King
- Pain Research Center, Cincinnati Children's Hospital Medical Center, USA
| | - Megan Petrov
- College of Nursing & Health Innovation, Arizona State University, USA
| | - Emily J Bartley
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | - Kimberly T Sibille
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Institute on Aging, University of Florida, USA; Department of Aging & Geriatric Research, College of Medicine, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | - Toni L Glover
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | | | - Hailey W Bulls
- Department of Psychology, University of Alabama at Birmingham, USA
| | - Adriana Addison
- Department of Psychology, University of Alabama at Birmingham, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - David Redden
- Departments of Biostatistics and Medicine and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laurence A Bradley
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Institute on Aging, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
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26
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Riley JL, Gilbert GH, Ford GW, Fellows JL, Rindal B, Gordan VV. Judgment of the Quality of Restorative Care as Predictors of Restoration Retreatment: Findings from the National Dental PBRN. JDR Clin Trans Res 2017; 2:151-157. [PMID: 28529977 DOI: 10.1177/2380084416675838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The primary aim of this study was to test the hypothesis that a patient's subjective assessments of the dentist's technical competence, quality of care, and anticipated restoration longevity during a restorative visit are predictive of restoration outcome. This prospective cohort study involved 3,326 patients who received treatment for a defective restoration in a permanent tooth, participated in a baseline patient satisfaction survey, and returned for follow-up. Of the 4,400 restorations that were examined by 150 dentists, 266 (6%) received additional treatment after baseline. Reporting satisfaction with the technical skill of the dentist or quality of the dental work at baseline was not associated with retreatment after baseline. However, patients' views at baseline that the fee was reasonable (odds ratio [OR], 1.6) was associated with retreatment after baseline, whereas satisfaction at baseline with how long the filling would last (OR, 0.6) was associated with less retreatment. These findings suggest that retreatment occurs more often for patients who at baseline are satisfied with the cost or who at baseline have less confidence in the restoration. The authors found no associations between restoration retreatment and the patients' baseline evaluations of the technical skills of their dentists or perceptions of quality care. KNOWLEDGE TRANSFER STATEMENT Dental patients' ratings of their dentist's skills were not related to a restoration needing retreatment. Patients focus on other aspects of the dental visit when making this judgment.
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Affiliation(s)
- J L Riley
- Department of Community Dentistry and Behavioral Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - G H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - G W Ford
- Private dental practice, Atlanta, GA
| | - J L Fellows
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - B Rindal
- HealthPartners, Minneapolis, MN, USA
| | - V V Gordan
- Department of Restorative Dental Sciences, Operative Dentistry Division, University of Florida College of Dentistry, Gainesville, FL, USA
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Riley JL, Cruz-Almeida Y, Dasilva Ribeiro MC, Simon CB, Eckert NR, Aguirre M, Sorenson HL, Tighe PJ, Edwards RR, Wallet SM. Age Differences in the Time Course and Magnitude of Changes in Circulating Neuropeptides After Pain Evocation in Humans. J Pain 2017; 18:1078-1086. [PMID: 28461253 DOI: 10.1016/j.jpain.2017.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 04/11/2017] [Accepted: 04/18/2017] [Indexed: 12/28/2022]
Abstract
This study tested the hypothesis that older adults would have a stronger response for substance P (facilitatory) but weaker response to β-endorphin (inhibitory), in magnitude as well as time course. Eight younger and 9 older adults underwent 3 experimental sessions using well validated laboratory pain models: cold pressor task, contact heat pain, and a nonpainful control. Blood was collected through an indwelling catheter at baseline and 3, 15, 30, 45, and 60 minutes after stimuli administration. Older adults had higher baseline levels of both neuropeptides suggesting increased peripheral activity compared with younger adults. After the cold pressor task, older adults demonstrated a quick and strong release of substance P with dramatic recovery, whereas young adults maintained a constant low-grade response. Unlike substance P, β-endorphin increased between 3 and 15 minutes for both groups with the upsurge substantially higher for older adults. After heat pain, younger adults had an immediate surge in circulating substance P and β-endorphin that was more pronounced than among older adults. However, levels of substance P for younger adults slowly tapered whereas they continued to climb for the older adults through 30 minutes. β-endorphin peaked at 30 minutes for both groups and returned to baseline. No changes were observed during the nonpainful control session. PERSPECTIVE Older adults had higher baseline levels of substance P and β-endorphin suggesting increased peripheral activity compared with younger adults. After pain evocation, older adults demonstrated a more intense early response for both neuropeptides suggesting peripheral mechanisms involved in the response to pain may change with age.
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Affiliation(s)
- Joseph L Riley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida.
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Institute of Aging, College of Medicine, University of Florida, Gainesville, Florida
| | - Margarete C Dasilva Ribeiro
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Department of Restorative Dentistry, College of Dentistry, University of Florida, Gainesville, Florida
| | - Corey B Simon
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Nathan R Eckert
- Department of Kinesiology, University of Indianapolis, Indianapolis, Indiana
| | - Maria Aguirre
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Heather L Sorenson
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida
| | - Patrick J Tighe
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida
| | - Robert R Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham and Women's Hospital, Chestnut Hill, Massachusetts
| | - Shannon M Wallet
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida
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Abstract
Protocols of temporal summation (TS) of pain typically involve the delivery of brief repetitive noxious pulses of a constant intensity while measuring the perceived intensity of pain after each pulse. The size percept of noxious repetitive stimulation has been poorly characterized. Furthermore, no studies have investigated age differences in TS of cold pain. The current study examined TS of pain intensity and the perceived size of the painful area during repetitive noxious heat and cold pulses in healthy younger (n = 104) and older adults (n = 40). Trials of 10 brief repetitive noxious heat or cold pulses were delivered to the upper extremities. Participants rated the perceived size of the painful area or intensity of pain after each pulse. The magnitude of change for the size percept and intensity for pain were calculated for each trial. The results indicated that older adults experienced greater TS of the size percept of cold stimuli compared with younger adults. Additionally, older women experienced greater TS of the size percept of heat stimuli compared with older men and all younger participants. No overall age or sex differences were found in the TS of pain intensity for cold or heat trials. These results suggest dysfunctional modulation of the spatial percept of the painful stimuli by older adults, and in particular older women, during repetitive noxious thermal pulses.
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Affiliation(s)
- Kelly M Naugle
- Department of Kinesiology, School of Physical Education and Tourism Management, Indiana University Purdue University Indianapolis, IN, USA
| | - Yenisel Cruz-Almeida
- College of Medicine and Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- College of Dentistry and Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- College of Medicine and Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Joseph L Riley
- College of Dentistry and Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
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Mitchell ST, Funkhouser E, Gordan VV, Riley JL, Makhija SK, Litaker MS, Gilbert GH. Satisfaction with dental care among patients who receive invasive or non-invasive treatment for non-cavitated early dental caries: findings from one region of the National Dental PBRN. BMC Oral Health 2017; 17:70. [PMID: 28347303 PMCID: PMC5368933 DOI: 10.1186/s12903-017-0363-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objectives were to: (1) quantify patient satisfaction with treatment for early dental caries overall, and according to whether or not (2a) the patient received invasive treatment; (2b) was high-risk for dental caries, and had dental insurance; and (3) encourage practitioners to begin using non-invasive approaches to early caries management. METHODS Ten practitioners recorded patient, lesion, and treatment information about non-cavitated early caries lesions. Information on 276 consecutive patients with complete data was included, who received either non-invasive (no dental restoration) or invasive (dental restoration) treatment. Patients completed a patient satisfaction questionnaire and were classified as dissatisfied if they did not "agree" or "strongly agree" with any of 14 satisfaction items. RESULTS Patients had a mean (± SD) age of 41.8 (±15.8) years, 64% were female and 88% were white. Twenty-five percent (n = 68) were dissatisfied in at least one of the 14 satisfaction items. Satisfaction levels did not significantly vary by patient's gender, race, caries risk category, or affected tooth surface location. Overall, 11% (28 of 276) received invasive treatment; satisfaction did not differ between patients who had invasive or non-invasive treatment. Seven patients received invasive treatment at their request even though that was not what their practitioner recommended; 5 out of 6 were satisfied with their treatment nonetheless. CONCLUSIONS About one-fourth of patients treated for non-cavitated early caries were dissatisfied with at least some aspect of their dental care experience. Satisfaction of patients who received invasive treatment did not differ from those who received non-invasive treatment.
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Affiliation(s)
- Sonya T Mitchell
- University of Alabama at Birmingham, SDB Room 609; Box 48, 1720 Second Avenue South, Birmingham, AL, 35294-0007, USA.
| | - Ellen Funkhouser
- Department of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Joseph L Riley
- Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Sonia K Makhija
- University of Alabama at Birmingham, SDB Room 609; Box 48, 1720 Second Avenue South, Birmingham, AL, 35294-0007, USA
| | - Mark S Litaker
- University of Alabama at Birmingham, SDB Room 609; Box 48, 1720 Second Avenue South, Birmingham, AL, 35294-0007, USA
| | - Gregg H Gilbert
- University of Alabama at Birmingham, SDB Room 609; Box 48, 1720 Second Avenue South, Birmingham, AL, 35294-0007, USA
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Gordan VV, Riley JL, Rindal DB, Qvist V, Fellows JL, Dilbone DA, Brotman SG, Gilbert GH. Repair or Replacement of Restorations: A Prospective cohort study by dentists in The National Dental Practice-Based Research Network. Tex Dent J 2017; 134:20-32. [PMID: 30549672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND A prospective cohort study that included dentists in The National Dental Practice-Based Research Network was conducted to quantify 12-month failures of restorations that were repaired or replaced at baseline. The study tested the hypothesis that no significant differences exist in failure percentages between repaired and replaced restorations after 12 months. It also tested the hypothesis that certain dentist, patient, and restoration characteristics are significantly associated with the incidence of restoration failure. METHODS Dentists recorded data for 50 or more consecutive defective restorations. The restorations that were either - repaired or replaced were recalled after 12 months and characterized for developing defects. RESULTS Dentists (N = 195) recorded data on 5,889 restorations; 378 restorations required additional treatment (74 repaired, 171 replaced, 84 teeth received endodontic treatment, and 49 were extracted). Multivariable logistic regression analysis indicated that additional treatment was more likely to occur if the original restoration had been repaired (7%) compared with replaced (5%) (odds ratio [OR], 1.6; P < .001; 95% confidence interval [CI], 1.2-2.1), if a molar was restored (7%) compared with premolars or anterior teeth (5% and 6%, respectively) (OR, 1.4; P = .010; 95% CI, 1.1-1.7), and if the primary reason was a fracture (8%) compared with other reasons (6%) (OR, 1.3; P = .033; 95% CI, 1.1-1.6). CONCLUSIONS An additional treatment was more likely to occur within the first year if the original restoration had been repaired (7%) compared with being replaced (5%). However, repaired restorations were less likely to need an aggressive treatment (replacement, endodontic treatment, or extraction) than replaced restorations. PRACTICAL IMPLICATIONS One year after repair or replacement of a defective restoration, the failure rate was low. However, repaired restorations were less likely to need an aggressive treatment than replaced restorations.
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Eckert NR, Vierck CJ, Simon CB, Cruz-Almeida Y, Fillingim RB, Riley JL. Testing Assumptions in Human Pain Models: Psychophysical Differences Between First and Second Pain. J Pain 2016; 18:266-273. [PMID: 27888117 DOI: 10.1016/j.jpain.2016.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/12/2016] [Accepted: 10/31/2016] [Indexed: 11/26/2022]
Abstract
Acute pain arises from activation of myelinated (A delta) and unmyelinated (C) nociceptive afferents, leading to first (A-fiber) or second (C-fiber) pain sensations. The current study sought to investigate first and second pain within glabrous and hairy skin sites in human upper limbs. Fifty healthy adults (25 male/25 female, 18-30 years old, mean = 20.5 ± 1.4 years) participated in a psychophysical study investigating electronically rated, thermal first and second pain sensations within the glabrous skin at the palm and hairy skin of the forearm. Repeated measures analysis of variance indicated that the threshold for first pain was lower (more sensitive) than for second pain (P = .004), for glabrous as well as hairy skin, and thresholds at glabrous skin were higher than for hairy skin (P = .001). Hairy skin presented a steeper slope for testing, whereas there were no differences in slope between first and second pain. The study findings support assumptions associated with mechanistic differences between first and second pain sensations, while offering a novel method for producing first and second pain with the same thermal stimulus. Efforts to understand abnormalities among people with clinical pain and development of new therapeutic agents will benefit from specific psychophysical methods. PERSPECTIVE This article presents a novel method for directly comparing first and second pain within the same thermal stimulus. The ability to directly compare first and second pain sensations can aid in understanding pain abnormalities in clinical pain and development of therapeutic aids.
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Affiliation(s)
- Nathanial R Eckert
- University of Florida, College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida.
| | - Charles J Vierck
- University of Florida, College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida
| | - Corey B Simon
- University of Florida, College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida
| | - Yenisel Cruz-Almeida
- University of Florida, College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida
| | - Roger B Fillingim
- University of Florida, College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida
| | - Joseph L Riley
- University of Florida, College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida
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Cardoso JS, Riley JL, Glover T, Sibille KT, Bartley EJ, Goodin BR, Bulls HW, Herbert M, Addison AS, Staud R, Redden DT, Bradley LA, Fillingim RB, Cruz-Almeida Y. Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis. Pain 2016; 157:2104-2114. [PMID: 27340911 PMCID: PMC4988907 DOI: 10.1097/j.pain.0000000000000625] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pain among individuals with knee osteoarthritis (OA) is associated with significant disability in older adults, and recent evidence demonstrates enhanced experimental pain sensitivity. Although previous research showed considerable heterogeneity in the OA clinical pain presentation, less is known regarding the variability in responses to experimental pain. The present study included individuals with knee OA (n = 292) who participated in the Understanding Pain and Limitations in Osteoarthritic Disease study and completed demographic and psychological questionnaires followed by a multimodal quantitative sensory testing (QST) session. Quantitative sensory testing measures were subjected to variable reduction procedures to derive pain sensitivity index scores, which in turn were entered into a cluster analysis. Five clusters were significantly different across all pain sensitivity index variables (P < 0.001) and were characterized by: (1) low pain sensitivity to pressure pain (N = 39); (2) average pain sensitivity across most modalities (N = 88); (3) high temporal summation of punctate pain (N = 38); (4) high cold pain sensitivity (N = 80); and (5) high sensitivity to heat pain and temporal summation of heat pain (N = 41). Clusters differed significantly by race, gender, somatic reactivity, and catastrophizing (P < 0.05). Our findings support the notion that there are distinct subgroups or phenotypes based on experimental pain sensitivity in community-dwelling older adults with knee OA, expanding previous findings of similar cluster characterizations in healthy adults. Future research is needed to further understand the pathophysiological mechanisms underlying pain within these subgroups, which may be of added value in tailoring effective treatments for people with OA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Yenisel Cruz-Almeida
- Corresponding Author: Yenisel Cruz-Almeida, MSPH, PhD, 2004 Mowry Road, Suite 2144, Gainesville, FL 32607, , Phone: 352-294-5845
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Glover TL, Goodin BR, King CD, Sibille KT, Herbert MS, Sotolongo AS, Cruz-Almeida Y, Bartley EJ, Bulls HW, Horgas AL, Redden DT, Riley JL, Staud R, Fessler BJ, Bradley LA, Fillingim RB. A Cross-sectional Examination of Vitamin D, Obesity, and Measures of Pain and Function in Middle-aged and Older Adults With Knee Osteoarthritis. Clin J Pain 2016; 31:1060-7. [PMID: 25569220 DOI: 10.1097/ajp.0000000000000210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The prevalence of knee osteoarthritis (OA) is increasing with the aging population and is exacerbated by the growing numbers of obese older adults. Low levels of vitamin D, measured by serum 25-hydroxyvitamin D (25(OH)D), in older adults and obese individuals are correlated with several negative health conditions, including chronic pain. This cross-sectional study sought to examine the interactive influence of 25(OH)D levels and obesity on knee OA pain and functional performance measures. METHODS The sample consisted of 256 (63% female) racially diverse (55% black/African Americans) middle-aged and older adults (mean age 56.8 y). Blood was collected for analysis of 25(OH)D by high-performance liquid chromatography. Participants provided self-report regarding knee OA pain and underwent a lower extremity functional performance test. RESULTS Results demonstrated that obesity was associated with lower levels of 25(OH)D. Participants with adequate 25(OH)D levels reported significantly less knee OA pain compared with participants with deficient or insufficient levels, regardless of obesity status. Furthermore, there was a significant interaction between obesity and 25(OH)D levels for lower extremity functional performance, such that obese individuals with adequate 25(OH)D levels demonstrated better performance than those obese participants with deficient or insufficient 25(OH)D levels. DISCUSSION The mechanisms by which adequate 25(OH)D levels are associated with pain severity and improved function have not been completely elucidated. It may be that the pleiotropic role of biologically active 25(OH)D influences pain and pain processing through peripheral and central mechanisms. Alternatively, higher levels of pain may lead to reduced outdoor activity, which may contribute to both obesity and decreased vitamin D. Thus, investigating vitamin D status in obese and nonobese individuals with knee OA warrants further study.
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Affiliation(s)
- Toni L Glover
- *College of Nursing, Adult and Elderly Nursing Departments of ‡Community Dentistry and Behavioral Science, College of Dentistry §Aging and Geriatric Research, Institute on Aging **Medicine, University of Florida, Gainesville, FL Departments of †Psychology and Anesthesiology ∥Psychology ¶Medicine, Division of Clinical Immunology and Rheumatology #Biostatistics, University of Alabama at Birmingham ††Department of Clinical Immunology and Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL
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Bartley EJ, King CD, Sibille KT, Cruz-Almeida Y, Riley JL, Glover TL, Goodin BR, Sotolongo AS, Herbert MS, Bulls HW, Staud R, Fessler BJ, Redden DT, Bradley LA, Fillingim RB. Enhanced Pain Sensitivity Among Individuals With Symptomatic Knee Osteoarthritis: Potential Sex Differences in Central Sensitization. Arthritis Care Res (Hoboken) 2016; 68:472-80. [PMID: 26434740 DOI: 10.1002/acr.22712] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/15/2015] [Accepted: 08/18/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Symptomatic knee osteoarthritis (OA) is a condition commonly associated with increased pain, disability, and functional limitations. Given the poor correspondence between radiographic evidence and clinical pain, central sensitization has been implicated as a potential mechanism underlying pain facilitation in knee OA. Sex may be a moderator of centrally mediated changes in knee OA pain; however, few studies have systematically assessed this. Therefore, the aim of this study was to examine differences in peripheral and central sensitization in men and women with symptomatic knee OA, as well as to determine whether these differences vary across age (middle age versus older age). METHODS Participants (n = 288) between the ages of 45 and 85 years completed a battery of quantitative sensory pain procedures assessing sensitivity to contact heat, cold pressor, mechanical pressure, and punctate stimuli. Differences in temporal summation (TS) were examined, as well as measures of clinical pain and functional performance. RESULTS When compared to men, women exhibited greater sensitivity to multiple pain modalities (i.e., lower heat, cold, pressure thresholds/tolerances, greater TS of pain); however, there were no sex differences in clinical pain, with the exception of greater widespread pain observed in women. Although there were select age-related differences in pain sensitivity, sex differences in pain varied minimally across the age cohort. CONCLUSION Overall, these findings provide evidence for greater overall sensitivity to experimental pain in women with symptomatic knee OA compared to men, suggesting that enhanced central sensitivity may be an important contributor to pain in this group.
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Abstract
Temporal summation (TS) of pain protocols typically involve the delivery of brief repetitive noxious stimuli held at a constant intensity and measuring the consequent increase in the perceived intensity of pain sensations. To date, no studies have examined the effect of a TS protocol on the perceived spatial dimensions of the pain experience and its interaction with age. This study used a new TS protocol that examined changes in the perceived size of the painful area in 22 younger adults and 20 older adults. Four trials of ten brief heat pulses delivered at a constant intensity were administered on the volar forearm. Interpulse intervals (IPIs) were 2.5 seconds or 3.5 seconds. Subjects rated the peak pain intensity (trials 1 and 3) or the size of the painful area (trials 2 and 4) after each pulse on a 0-100 scale. The magnitude of summation was calculated for each trial. Three seconds and 6 seconds after delivering the last heat pulse, the subjects rated the intensity or the size of any remaining pain (aftersensations). The results indicated that older adults compared to younger adults exhibited significantly greater summation of size ratings for the 2.5-second and 3.5-second IPI trials and size of pain aftersensations at 3 seconds following the 2.5-second IPI TS trial. These results suggest that aging is associated with enhanced endogenous facilitation of the perceived size of pain. The potential clinical and mechanistic implications of enhanced TS of size of pain remain unknown and warrant further investigation.
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Affiliation(s)
- Kelly M Naugle
- Department of Kinesiology, School of Physical Education and Tourism Management, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, USA; Department of Aging and Geriatric Research, College of Medicine, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, USA
| | - Roland Staud
- Pain Research and Intervention Center of Excellence, University of Florida, USA; Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph L Riley
- Pain Research and Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, USA
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Naugle KM, Naugle KE, Riley JL. Reduced Modulation of Pain in Older Adults After Isometric and Aerobic Exercise. J Pain 2016; 17:719-28. [PMID: 26993959 DOI: 10.1016/j.jpain.2016.02.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/18/2015] [Accepted: 02/23/2016] [Indexed: 01/08/2023]
Abstract
UNLABELLED Laboratory-based studies show that acute aerobic and isometric exercise reduces sensitivity to painful stimuli in young healthy individuals, indicative of a hypoalgesic response. However, little is known regarding the effect of aging on exercise-induced hypoalgesia (EIH). The purpose of this study was to examine age differences in EIH after submaximal isometric exercise and moderate and vigorous aerobic exercise. Healthy older and younger adults completed 1 training session and 4 testing sessions consisting of a submaximal isometric handgrip exercise, vigorous or moderate intensity stationary cycling, or quiet rest (control). The following measures were taken before and after exercise/quiet rest: 1) pressure pain thresholds, 2) suprathreshold pressure pain ratings, 3) pain ratings during 30 seconds of prolonged noxious heat stimulation, and 4) temporal summation of heat pain. The results revealed age differences in EIH after isometric and aerobic exercise, with younger adults experiencing greater EIH compared with older adults. The age differences in EIH varied across pain induction techniques and exercise type. These results provide evidence for abnormal pain modulation after acute exercise in older adults. PERSPECTIVE This article enhances our understanding of the influence of a single bout of exercise on pain sensitivity and perception in healthy older compared with younger adults. This knowledge could help clinicians optimize exercise as a method of pain management.
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Affiliation(s)
- Kelly M Naugle
- Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, Gainesville, Florida.
| | - Keith E Naugle
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Joseph L Riley
- Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, Gainesville, Florida
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Gilbert GH, Riley JL, Eleazer PD, Benjamin PL, Funkhouser E. Discordance between presumed standard of care and actual clinical practice: the example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network. BMJ Open 2015; 5:e009779. [PMID: 26656026 PMCID: PMC4679916 DOI: 10.1136/bmjopen-2015-009779] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Use of a rubber dam during root canal treatment is considered the standard of care because it enhances patient safety and optimises the odds of successful treatment. Nonetheless, not all dentists use a rubber dam, creating disconnect between presumed standard of care and what is actually done in clinical practice. Little is known about dentists' attitudes towards use of the rubber dam in their practices. The objectives were to: (1) quantify these attitudes and (2) test the hypothesis that specific attitudes are significantly associated with rubber dam use. SETTING National Dental Practice-Based Research Network (NationalDentalPBRN.org). PARTICIPANTS 1490 network dentists. OUTCOME MEASURES Dentists completed a questionnaire about their attitudes towards rubber dam use during root canal treatment. Three attitude scales comprised 33 items that used a 5-point ordinal scale to measure beliefs about effectiveness, inconvenience, ease of placement, comparison to other isolation techniques and patient factors. Factor analysis, cluster analysis and multivariable logistic regression analysed the relationship between attitudes and rubber dam use. RESULTS All items had responses at each point on the 5-point scale, with an overall pattern of substantial variation across dentists. Five attitudinal factors (rubber dam effectiveness; inconvenient/time-consuming; ease of placement; effectiveness compared to Isolite; patient factors) and 4 clusters of practitioners were identified. Each factor and cluster was independently and strongly associated with rubber dam use. CONCLUSIONS General dentists have substantial variation in attitudes about rubber dam use. Beliefs that rubber dam use is not effective, inconvenient, time-consuming, not easy to place or affected by patient factors, were independently and significantly associated with lower rubber dam use. These attitudes explain why there is substantial discordance between presumed standard of care and actual practice.
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Affiliation(s)
- Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph L Riley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Paul D Eleazer
- Department of Endodontics, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Ellen Funkhouser
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Cruz-Almeida Y, Aguirre M, Sorenson HL, Tighe P, Wallet SM, Riley JL. Age differences in cytokine expression under conditions of health using experimental pain models. Exp Gerontol 2015; 72:150-6. [PMID: 26456458 DOI: 10.1016/j.exger.2015.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 11/20/2022]
Abstract
Older adults are at an increased risk to develop frequent and prolonged pain. Emerging evidence proposes a link between immune changes and pain, which is consistent with the inflammation theory of aging and the increased incidence of age-related diseases. This study tested the hypothesis that older adults show greater immune responses to experimental pain compared to younger individuals. Study subjects (8 younger and 9 older healthy adults) underwent 3 experimental sessions using well-validated human experimental pain models: the cold pressor task (CPT), focal heat pain (FHP), and a non-painful thermal control. Blood was collected through an indwelling catheter at baseline and 3, 15, 30, 45, 60, and 90 min post-stimuli administration. Pro-inflammatory cytokines (TNF-α IL-6 and IL-8) peaked at the same time points for both groups, with greater elevations among older subjects for TNF-α and IL-8 in both pain models and elevations in IL-6 only for CPT. Anti-inflammatory cytokines (IL-4, IL-5, and IL-10) generally peaked later for the older subjects, with increased elevations for FHP but not the CPT. These data are consistent with the assertion that age-related immune system dysregulation may account for the increased prevalence of pain in older adults.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence (PRICE), United States; Institute of Aging, College of Medicine, United States; Department of Community Dentistry and Behavioral Science, College of Dentistry, United States
| | - Maria Aguirre
- Pain Research & Intervention Center of Excellence (PRICE), United States; Department of Community Dentistry and Behavioral Science, College of Dentistry, United States
| | | | - Patrick Tighe
- Pain Research & Intervention Center of Excellence (PRICE), United States; Department of Anesthesiology, College of Medicine, United States
| | | | - Joseph L Riley
- Pain Research & Intervention Center of Excellence (PRICE), United States; Department of Community Dentistry and Behavioral Science, College of Dentistry, United States
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Simon CB, Riley JL, Coronado RA, Valencia C, Wright TW, Moser MW, Farmer KW, George SZ. Older Age as a Prognostic Factor of Attenuated Pain Recovery After Shoulder Arthroscopy. PM R 2015; 8:297-304. [PMID: 26376336 DOI: 10.1016/j.pmrj.2015.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Shoulder pain and surgery are common among older adults. However, the extent to which older age affects recovery after shoulder surgery is not well understood. OBJECTIVE To assess influence of older age on postoperative recovery factors 3 and 6 months after shoulder arthroscopy. DESIGN Prospective cohort study. SETTING University-affiliated outpatient orthopedic surgical center. PATIENTS A convenience sample of 139 persons between 20 and 79 years of age who experienced shoulder pain, had musculoskeletal dysfunction based on imaging and physician assessment, and were scheduled for an arthroscopic shoulder procedure. MAIN OUTCOME MEASURES Postoperative outcomes were compared among younger, middle-aged, and older adults before surgery and at 3 and 6 months after surgery using analysis of variance modeling. Movement-evoked pain and an experimental laboratory correlate of pain processing were assessed at each time point. The influence of older age on 3- and 6-month pain outcomes were determined via multivariate regression analyses after accounting for preoperative, intraoperative, and postoperative prognostic factors. RESULTS Older adults had higher movement-evoked pain intensity (F2,108 = 5.18, P = .007) and experimental pain response (F2,111 = 7.24, P = .001) at 3 months compared with young and middle-aged adults. After controlling for key prognostic factors, older age remained a positive predictor of 3-month movement-evoked pain (R(2) = 0.05; standardized [St.] β = 0.263, P = .031) and experimental pain response (R(2) = 0.07; St. β = 0.295, P = .014). Further, older age remained a positive predictor of movement-evoked pain at 6 months (R(2) = 0.04; St. β = 0.231, P = .004), despite no age group differences in outcome. Older age was found to be the strongest predictor of 3- and 6-month movement-evoked pain. CONCLUSION Older adults may experience more pain related to movement, as well as endogenous pain excitation, in the first few months after shoulder arthroscopy. Future age-related research should consider use of movement-evoked pain intensity and experimental pain response as pain outcomes, as well as the utility of such measures in clinical care.
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Affiliation(s)
- Corey B Simon
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, 2004 Mowry Rd, PO Box 100242, Gainesville, FL 32610; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL(∗).
| | - Joseph L Riley
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL(†)
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, Nashville, TN(‡)
| | - Carolina Valencia
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN(¶)
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL(§)
| | - Michael W Moser
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL(∗∗)
| | - Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL(††)
| | - Steven Z George
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, 2004 Mowry Rd, PO Box 100242, Gainesville, FL 32610; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL(‡‡)
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Simon CB, Riley JL, Fillingim RB, Bishop MD, George SZ. Age Group Comparisons of TENS Response Among Individuals With Chronic Axial Low Back Pain. J Pain 2015; 16:1268-1279. [PMID: 26342650 DOI: 10.1016/j.jpain.2015.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 08/05/2015] [Accepted: 08/19/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED Chronic low back pain (CLBP) is a highly prevalent and disabling musculoskeletal pain condition among older adults. Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat CLBP, however response to TENS in older adults compared with younger adults is untested. In a dose-response study stratified by age, 60 participants with axial CLBP (20 young, 20 middle-aged, 20 older) received four 20-minute sessions of high-frequency high-intensity TENS over a 2- to 3-week period in a laboratory-controlled setting. Experimental measures of pain sensitivity (mechanical pressure pain detection threshold) and central pain excitability (phasic heat temporal summation and heat aftersensations) were assessed before and after TENS. Episodic or immediate axial CLBP relief was assessed after TENS via measures of resting pain, movement-evoked-pain, and self-reported disability. Cumulative or prolonged axial CLBP relief was assessed by comparing daily pain reports across sessions. Independent of age, individuals experienced episodic increase in the pressure pain detection threshold and reduction in aftersensation after TENS application. Similarly, all groups, on average, experienced episodic axial CLBP relief via improved resting pain, movement-evoked pain, and disability report. Under this design, no cumulative effect was observed as daily pain did not improve for any age group across the 4 sessions. However, older adults received higher TENS amplitude across all sessions to achieve TENS responses similar to those in younger adults. These findings suggest that older adults experience similar episodic axial CLBP relief to that of younger individuals after high-frequency, high-intensity TENS when higher dose parameters are used. PERSPECTIVE This study examined age group differences in experimental and axial CLBP response to TENS, delivered under the current recommended parameters of strong, but tolerable amplitude. Older adults had comparable TENS response although at higher TENS amplitude than younger adults, which may have important mechanistic and clinical implications.
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Affiliation(s)
- Corey B Simon
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.
| | - Joseph L Riley
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Mark D Bishop
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Steven Z George
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
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Logan HL, Guo Y, Emanuel AS, Shepperd JA, Dodd VJ, Marks JG, Muller KE, Riley JL. Determinants of First-Time Cancer Examinations in a Rural Community: A Mechanism for Behavior Change. Am J Public Health 2015; 105:1424-31. [PMID: 25973820 DOI: 10.2105/ajph.2014.302516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES After conducting a media campaign focusing on the importance of oral and pharyngeal cancer (OPC) examinations, we assessed mechanisms of behavior change among individuals receiving an OPC examination for the first time. METHODS We used data from 2 waves of telephone surveys of individuals residing in 36 rural census tracts in northern Florida (n = 806). The second survey occurred after our media intervention. We developed media messages and modes of message delivery with community members via focus groups and intercept interviews. We performed a mediation analysis to examine behavior change mechanisms. RESULTS Greater exposure to media messages corresponded with heightened concern about OPC. Heightened concern, in turn, predicted receipt of a first-time OPC examination, but only among men. CONCLUSIONS We extended earlier studies by measuring an outcome behavior (receipt of an OPC examination) and demonstrating that the putative mechanism of action (concern about the disease) explained the link between a media intervention and engaging in the target behavior. Improving the quality of media campaigns by engaging community stakeholders in selecting messages and delivery methods is an effective strategy in building public health interventions aimed at changing behaviors.
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Affiliation(s)
- Henrietta L Logan
- At the time of the study, Henrietta L. Logan, Amber S. Emanuel, Virginia J. Dodd, John G. Marks, and Joseph L. Riley III were with the Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville. Yi Guo and Keith E. Muller were with the Department of Health Outcomes and Policy, College of Medicine, University of Florida. James A. Shepperd was with the Department of Psychology, College of Liberal Arts and Science, University of Florida
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Naugle KM, Cruz-Almeida Y, Vierck CJ, Mauderli AP, Riley JL. Age-related differences in conditioned pain modulation of sensitizing and desensitizing trends during response dependent stimulation. Behav Brain Res 2015; 289:61-8. [PMID: 25907744 DOI: 10.1016/j.bbr.2015.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/06/2015] [Accepted: 04/10/2015] [Indexed: 01/01/2023]
Abstract
The current study evaluated age differences in conditioned pain modulation using a test stimulus that provided the opportunity to evaluate changes in heat pain sensitivity, sensitization, and desensitization within the same paradigm. During this psychophysical test, pain intensity clamping uses REsponse Dependent STIMulation (REDSTIM) methodology to automatically adjust stimulus intensity to maintain a desired pain rating set-point. Specifically, stimulus intensity increases until a pre-defined pain rating (the setpoint) is exceeded, and then decreases until pain ratings fall below the setpoint, with continued increases and decreases dictated by ratings. The subjects are blinded in terms of the setpoint and stimulus intensities. Younger and older subjects completed two test sessions of two REDSTIM trials, with presentation of conditioning cold stimulation between the trials of one session but not the other. The results indicated that conditioning cold stimulation similarly decreased the overall sensitivity of younger and older subjects, as measured by the average temperature that maintained a setpoint rating of 20 (on a scale of 0-100). The conditioning stimulus also significantly enhanced sensitization following ascending stimulus progressions and desensitization following descending stimulus progressions in older subjects relative to younger subjects. Thus, older subjects experienced greater swings in sensitivity in response to varying levels of painful stimulation. These results are discussed in terms of control over pain intensity by descending central modulatory systems. These findings potentially shed new light on the central control over descending inhibition and facilitation of pain.
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Affiliation(s)
- Kelly M Naugle
- Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, P.O. Box 103628, Gainesville, FL 32611, USA.
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32611, USA
| | - Charles J Vierck
- Department of Neuroscience, McKnight Brain Institute, University of Florida, P.O. Box 103628, Gainesville, FL 32611, USA
| | - Andre P Mauderli
- Neuroanalytics Corporation, 3700 NW 91st St. C200, Gainesville, FL 32606, USA
| | - Joseph L Riley
- Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, P.O. Box 103628, Gainesville, FL 32611, USA
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Cruz-Almeida Y, Naugle KM, Vierck CJ, Fillingim RB, Riley JL. Reliability of pain intensity clamping using response-dependent thermal stimulation in healthy volunteers. BMC Neurosci 2015; 16:21. [PMID: 25909597 PMCID: PMC4409722 DOI: 10.1186/s12868-015-0164-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 04/10/2015] [Indexed: 12/02/2022] Open
Abstract
Background Pain intensity clamping uses the REsponse-Dependent Stimulation (REDSTIM) methodology to automatically adjust stimulus intensity to maintain a desired pain rating set-point which is continuously monitored from a subject’s real-time pain ratings. REDSTIM blinds subjects regarding the pain intensity set-point, supporting its use for assessing intervention efficacy. By maintaining the pain intensity at a constant level, a potential decrease in pain sensitivity can be detected by an increase in thermode temperature (unknown to the subject) and not by pain ratings alone. Further, previously described sensitizing and desensitizing trends within REDSTIM provide a novel insight into human pain mechanisms overcoming limitations of conventional testing methods. The purpose of the present study was to assess the test-retest reliability of pain intensity clamping using REDSTIM during three separate sessions. Methods We used a method for testing changes in pain sensitivity of human subjects (REDSTIM) where the stimulus temperature is modulated to clamp pain intensity near a desired set-point. Temperature serves as the response variable and is used to infer pain sensitivity. Several measures were analyzed for reliability including average temperature and area under the curve (AUC). Intraclass correlation coefficients were calculated for each measure at pain rating set-points of 20/100 and 35/100. Results Sixteen healthy individuals (mean age = 21.6 ± 3.9) participated in three experiments two days apart at both pain rating set-points. Most reliability coefficients were in the moderate to substantial range (r’s = 0.79 to 0.94) except for the negative AUC (r = 0.52), but only at the 20/100 pain rating set-point. Conclusions The present study supports the test-retest reliability of pain intensity clamping using the REDSTIM methodology while providing a novel tool to examine human pain modulatory mechanisms and overcoming common shortcomings of conventional quantitative sensory testing methods.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Institute on Aging, University of Florida, Gainesville, FL, USA. .,Cognitive Aging & Memory, University of Florida, Gainesville, FL, USA. .,Pain Research and Intervention Center of Excellence, Gainesville, USA. .,Department of Aging & Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, USA. .,Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA. .,Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA.
| | - Kelly M Naugle
- Department of Kinesiology, IUPUI, Indianapolis, IN, USA.
| | - Charles J Vierck
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Roger B Fillingim
- Institute on Aging, University of Florida, Gainesville, FL, USA. .,Pain Research and Intervention Center of Excellence, Gainesville, USA. .,Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA.
| | - Joseph L Riley
- Pain Research and Intervention Center of Excellence, Gainesville, USA. .,Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA.
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Abstract
INTRODUCTION Despite many studies investigating exercise-induced hypoalgesia, there is limited understanding of the optimal intensity of aerobic exercise in producing hypoalgesic effects across different types of pain stimuli. Given that not all individuals are willing or capable of engaging in high-intensity aerobic exercise, whether moderate-intensity aerobic exercise (MAE) is associated with a hypoalgesic response and whether this response generalizes to multiple pain induction techniques needs to be substantiated. PURPOSE This study's purpose is to test for differences in the magnitude of pressure and heat pain modulation induced by MAE and vigorous-intensity aerobic exercise (VAE). METHODS Twelve healthy young males and 15 females completed one training session and three testing sessions consisting of 25 min of 1) stationary cycling at 70% HR reserve, 2) stationary cycling at 50% HR reserve, or 3) quiet rest (control). Pain testing was conducted on both forearms before and immediately after each condition and included the following tests: pressure pain thresholds, suprathreshold pressure pain test, static continuous heat test, and repetitive pulse heat pain test. Repeated-measures ANOVA was conducted on each pain measure. RESULTS VAE and MAE reduced pain ratings during static continuous heat stimuli and repetitive heat pulse stimuli, with VAE producing larger effects. VAE also increased pressure pain thresholds, whereas neither exercise influenced suprathreshold pressure pain ratings. CONCLUSION These results suggest that MAE is capable of producing a hypoalgesic effect using continuous and repetitive pulse heat stimuli. However, a dose-response effect was evident as VAE produced larger effects than MAE.
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Affiliation(s)
- Kelly Marie Naugle
- 1Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL; and 2Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
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Riley JL, Gordan VV, Ajmo CT, Bockman H, Jackson MB, Gilbert GH. Dentists' use of caries risk assessment and individualized caries prevention for their adult patients: Findings from The Dental Practice-Based Research Network. Tex Dent J 2015; 132:18-29. [PMID: 26234018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Few studies have examined dentists' subjective ratings of importance of caries risk factors or tested whether dentists use this information in treatment planning. This study tested several hypotheses related to caries risk assessment (CRA) and individualized caries prevention (ICP). METHODS Data were collected as part of a questionnaire entitled 'Assessment of Caries Diagnosis and Caries Treatment' completed by 547 practitioners who belong to The Dental Practice-Based Research Network (DPBRN), a consortium of participating practices and dental organizations. RESULTS Sixty-nine percent of DPBRN dentists perform CRA on their patients. Recently graduated dentists, dentists with busier practices, and those who believe a dentist can predict future caries were the most likely to use CRA. The association between CRA and individualized prevention was weaker than expected (r = 0.21). Dentists who perform CRA provide ICP to 57% of their patients, compared with 42% for dentists who do not perform CRA. Based on their responses to radiographic and clinical scenarios in the questionnaire, dentists who use CRA appear to use this information in restorative decisions. CONCLUSION A substantial percentage of DPBRN dentists do not perform CRA, and there is not a strong linkage between its use and use of individualized preventive regimens for adult patients. More progress in the implementation of current scientific evidence in this area is warranted.
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Abstract
UNLABELLED Considerable evidence suggests regular physical activity can reduce chronic pain symptoms. The dysfunction of endogenous facilitatory and inhibitory systems has been implicated in multiple chronic pain conditions. However, few studies have investigated the relationship between levels of physical activity and descending pain modulatory function. PURPOSE The purpose of this study was to determine whether self-reported levels of physical activity in healthy adults predicted 1) pain sensitivity to heat and cold stimuli, 2) pain facilitatory function as tested by temporal summation (TS) of pain, and 3) pain inhibitory function as tested by conditioned pain modulation (CPM) and offset analgesia. METHODS Forty-eight healthy adults (age range = 18-76 yr) completed the International Physical Activity Questionnaire (IPAQ) and the following pain tests: heat pain thresholds, heat pain suprathresholds, cold pressor pain, TS of heat pain, CPM, and offset analgesia. The IPAQ measured levels of walking, moderate, vigorous, and total physical activity over the past 7 d. Hierarchical linear regressions were conducted to determine the relationship between each pain test and self-reported levels of physical activity while controlling for age, sex, and psychological variables. RESULTS Self-reported total and vigorous physical activity predicted TS and CPM (P < 0.05). Individuals who self-reported more vigorous and total physical activity exhibited reduced TS of pain and greater CPM. The IPAQ measures did not predict any of the other pain measures. CONCLUSIONS These results suggest that healthy older and younger adults who self-report greater levels of vigorous and total physical activity exhibit enhanced descending pain modulatory function. Improved descending pain modulation may be a mechanism through which exercise reduces or prevents chronic pain symptoms.
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Affiliation(s)
- Kelly M Naugle
- Pain Research and Intervention Center of Excellence, University of Florida, Gainsville, FL
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Cruz-Almeida Y, Sibille KT, Goodin BR, Petrov ME, Bartley EJ, Riley JL, King CD, Glover TL, Sotolongo A, Herbert MS, Schmidt JK, Fessler BJ, Staud R, Redden D, Bradley LA, Fillingim RB. Racial and ethnic differences in older adults with knee osteoarthritis. Arthritis Rheumatol 2014; 66:1800-10. [PMID: 24729357 DOI: 10.1002/art.38620] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/04/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) contributes significantly to disability in older individuals, and racial/ethnic minorities are disproportionately affected. The present study aimed to characterize differences in clinical and experimental pain, including pain inhibition, among older African American (AA) and non-Hispanic white (NHW) subjects with knee OA. METHODS AA and NHW subjects with knee OA (n = 267) completed clinical and functional pain assessments, including quantitative sensory testing (QST). We hypothesized that, when compared to NHW subjects, AA subjects would display 1) lower pain tolerance and higher ratings of heat-, mechanical-, and cold-induced pain, 2) greater temporal summation of pain, 3) reduced pain inhibition, and 4) greater clinical pain and poorer function. In addition, we hypothesized that the findings from QST would significantly predict the severity of clinical pain within each race/ethnicity. RESULTS AA subjects with knee OA displayed increased pain sensitivity, greater temporal summation, and reduced pain inhibition when compared to NHW subjects with knee OA. Moreover, AA subjects reported greater clinical pain and poorer function. Racial/ethnic differences in clinical pain became nonsignificant when the analyses were controlled for education and annual income, whereas differences in QST findings remained highly significant. Although the extent of pain inhibition predicted the severity of clinical pain in both groups, different QST measures were additionally predictive of clinical pain within each group. CONCLUSION The results of this study establish that there are racial/ethnic differences in experimental and clinical pain and function in older individuals with knee OA. Our findings indicating that different QST measures were associated with clinical pain within the 2 racial/ethnic groups, whereas reduced pain inhibition was important in all participants, warrant further study in order to elucidate the common and group-specific pathophysiologic mechanisms contributing to clinical pain in OA.
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Kakudate N, Sumida F, Matsumoto Y, Yokoyama Y, Riley JL, Gilbert GH, Gordan VV. Dentists' decisions to conduct caries risk assessment in a Dental Practice-Based Research Network. Community Dent Oral Epidemiol 2014; 43:128-34. [PMID: 25175077 DOI: 10.1111/cdoe.12127] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/09/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES (i) To quantify the importance that dentists place on caries risk factors when developing a caries treatment plan and (ii) to test the hypothesis that the ratings of importance for specific factors are significantly associated with whether or not the dentist performs caries risk assessment (CRA). METHODS This study used a cross-sectional study design consisting of a questionnaire survey. The study queried dentists who worked in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which seeks to engage dentists in investigating research questions and sharing experiences and expertise (n = 282). Participants (n = 189) were asked to rate the importance of caries risk factors when developing a caries treatment plan in both adult and pediatric patients. RESULTS Oral hygiene status was rated as the most important risk factor when developing a treatment plan in both adult and pediatric patients, whereas the use of fluorides was rated as the least important. Results of multiple logistic regression analysis showed that the odds ratios for the decision to perform CRA in the adult patient for past caries experience and use of fluorides were 2.61 (95% confidence interval [CI]: 1.29-5.29) and 1.85 (95% CI: 1.12-3.04), respectively, whereas that for oral hygiene was 3.84 (95% CI: 1.15-12.79) and use of fluorides 1.79 (95% CI: 1.06-3.03) in the pediatric patient. CONCLUSIONS These results suggest that enhancing dentists' concept of the importance of current use of fluorides when developing a treatment plan may increase the percentage of dentists who conduct CRA in both adult and pediatric patients (clinicaltrials.gov registration number: NCT01680848).
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Affiliation(s)
- Naoki Kakudate
- Educational Cooperation Center, Kyushu Dental University, Kitakyushu, Japan
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Tighe PJ, Riley JL, Fillingim RB. Sex differences in the incidence of severe pain events following surgery: a review of 333,000 pain scores. Pain Med 2014; 15:1390-404. [PMID: 25039440 DOI: 10.1111/pme.12498] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE/BACKGROUND Prior work has not addressed sex differences in the incidence of severe postoperative pain episodes. The goal of this study was to examine sex differences in clinical postoperative pain scores across an array of surgical procedures using direct comparisons of numeric rating scale pain scores as well as using the incidence of severe pain events (SPEs). DESIGN/SETTING Retrospective cohort study of over 300,000 clinical pain score observations recorded from adult patients undergoing nonambulatory surgery at a tertiary care academic medical center over a 1-year period. METHODS/PATIENTS To test the hypothesis that the number of SPE on postoperative day (POD) 1 differed by sex after controlling for procedure, we calculated Cochran-Mantel-Haenszel statistics of sex by count of SPE, controlling for type of surgery. ASSESSMENT TOOLS/OUTCOMES Pain scores were collected from clinical nursing records where they were documented using the numeric rating scale. RESULTS In female patients, 10,989 (25.09%) of 43,806 POD 1 pain scores were considered SPE compared with 10,786 (22.45%) of 48,055 POD 1 pain scores in male patients. This produced an overall odds ratio of 1.16 (99% confidence interval 1.11-1.20) for females vs males to report an SPE for a pain score on POD 1. Estimates of the odds that a given pain observation represents an SPE for female vs male patients after controlling for type of surgery yielded an odds ratio of 1.14 (99% confidence interval, 1.10-1.19). CONCLUSION Female patients experience greater mean pain scores, as well as a higher incidence of SPE, on POD 1 for a variety of surgical procedures.
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Affiliation(s)
- Patrick J Tighe
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida, USA
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Cruz-Almeida Y, King CD, Goodin BR, Sibille KT, Glover TL, Riley JL, Sotolongo A, Herbert MS, Schmidt J, Fessler BJ, Redden DT, Staud R, Bradley LA, Fillingim RB. Psychological profiles and pain characteristics of older adults with knee osteoarthritis. Arthritis Care Res (Hoboken) 2014; 65:1786-94. [PMID: 23861288 DOI: 10.1002/acr.22070] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/17/2013] [Accepted: 06/21/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify psychological profiles in persons with knee osteoarthritis (OA) and to determine the relationship between these profiles and specific pain and sensory characteristics, including temporal summation and conditioned pain modulation. METHODS Individuals with knee OA (n = 194) completed psychological, health, and sensory assessments. Hierarchical cluster analysis was used to derive psychological profiles that were compared across several clinical pain/disability and experimental pain responses. RESULTS Cluster 1 had high optimism with low negative affect, pain vigilance, anger, and depression, along with the lowest self-reported pain/disability and the lowest sensitivity to mechanical, pressure, and thermal pain (P < 0.01 for all). Cluster 2 had low positive affect with high somatic reactivity, while cluster 3 showed high pain vigilance with low optimism. Clusters 2 and 3 had intermediate levels of self-reported pain/disability and cluster 3 experienced central sensitization to mechanical stimuli. Participants in cluster 3 also displayed significant pain facilitation (P < 0.05). Cluster 4 exhibited the highest pain vigilance, reactivity, negative affect, anger, and depression. These individuals experienced the highest self-reported pain/disability, including widespread pain (P < 0.001 for all). Cluster 4 was most sensitive to mechanical, pressure, and thermal stimuli, and showed significant central sensitization to mechanical and thermal stimuli (P < 0.001 for all). CONCLUSION Our findings demonstrate the existence of homogeneous psychological profiles displaying unique sets of clinical and somatosensory characteristics. Multidisciplinary treatment approaches consistent with the biopsychosocial model of pain should provide significant advantages if targeted to profiles such as those in our OA sample.
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