Pain
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Pain expression in neonates instigated by heel-lance for blood sampling purposes was systematically described using measures of facial expression and cry and compared across sleep/waking states and sex. From gate-control theory it was hypothesized that pain behavior would vary with the ongoing functional state of the infant, rather than solely reflecting tissue insult. Awake-alert but inactive infants responded with the most facial activity, consistent with current views that infants in this state are most receptive to environmental stimulation. ⋯ Sex differences were apparent in speed of response, with boys showing shorter time to cry and to display facial action following heel-lance. The findings of facial action variation across sleep/waking state were interpreted as indicating that the biological and behavioral context of pain events affects behavioral expression, even at the earliest time developmentally, before the opportunity for learned response patterns occurs. Issues raised by the study include the importance of using measurement techniques which are independent of preconceived categories of affective response.
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Different types of pain patients used visual analogue scales (VAS) to rate their level of pain sensation intensity (VAS sensory) and degree of unpleasantness (VAS affective) associated with pain experienced at its maximum, usual, and minimum intensity. Women used the same VAS to rate their labor pain during early, active, and transition phases of stage I and in pushing (stage II). ⋯ Affective VAS but not sensory VAS ratings of pain were considerably reduced when women in labor focused on the birth of the child as compared to when they focused on their pain. The results underscore the importance of utilizing separate measures of the sensory intensity versus the affective dimension of clinical pain and provide evidence that the affective dimension of different types of clinical pain is powerfully and differentially influenced by psychological contextual factors.
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Dorsal column stimulation was undertaken in 10 patients referred to the Pain Relief Clinic for management of otherwise intractable angina pectoris. All patients were on maximal medical therapy and were determined to be unsuitable for coronary artery revascularization by the referring cardiologists. Dorsal column stimulation was beneficial in all patients by decreasing the frequency and severity of anginal attacks. The mechanism of action of dorsal column stimulation in this condition is uncertain.
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Comparative Study
Ankle joint urate arthritis (AJUA) in rats: an alternative animal model of arthritis to that produced by Freund's adjuvant.
Injection of sodium urate crystals into one ankle joint in the rat produces arthritis which is fully developed within 24 h. The time-course and dose-response of associated inflammation and sensory abnormalities are described. Following intra-articular sodium urate rats reduce the weight placed on the paw of the treated hind limb and develop a limp in their gait. ⋯ Joint pathology is reflected by tissue oedema and the infiltration of polymorphonuclear leucocytes. However, there is no destruction or decrease in density of bone. It is proposed that this model of arthritis may have ethical and scientific advantages over adjuvant arthritis in the study of some aspects of the neural mechanisms of arthritis.
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This study used behavioral assessment techniques to analyze pain in osteoarthritis (OA) patients. Eighty-seven OA patients having chronic knee pain served as subjects. Pain behavior was evaluated using a standard observation method and functional impairment was assessed using the Arthritis Impact Measurement Scales. ⋯ Patients receiving disability support payments were much more functionally limited than those not receiving this financial support. Patients scoring high on the Pain Control and Rational Thinking factor of the CSQ were much less functionally impaired, walked a 5 m course more rapidly and moved from a standing to a sitting or reclining position more quickly than patients scoring low on this factor. The implications of these results for behavioral treatment of OA knee pain are discussed.