Pain
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This paper reports the development and validation of the Pain Beliefs Questionnaire (PBQ). This is a 20-item questionnaire covering beliefs about the cause and treatment of pain. It was administered to 294 subjects, comprising 100 chronic pain patients and 194 controls. ⋯ Secondly, as predicted significant associations were observed between scores on the Organic Beliefs scale and scores on the Chance and Powerful Others scales of the Multidimensional Health Locus of Control (MHLC), and also between the Psychological Beliefs and Internal scales of the MHLC. No relationship, however, emerged between these scales and measures of pain intensity. The implications of these findings for the assessment and management of chronic pain patients, and in the understanding of the development of chronic pain, are discussed.
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Electrical stimulation of the subdiaphragmatic branch of the vagus nerve (SDVAS) inhibits the nociceptive tail flick (TF) reflex. The present experiments examined (1) the central substrates mediating SDVAS-produced inhibition of the TF reflex and (2) the effects of SDVAS on either background or noxious heat-evoked responses of spinal dorsal horn neurons. Microinjections of ibotenic acid in the ipsilateral nucleus tractus solitarius (NTS), nucleus raphe magnus (NRM), or bilateral locus coeruleus/subcoeruleus (LC/SC) significantly increased the intensity of SDVAS required to inhibit the TF reflex in lightly anesthetized rats. ⋯ SDVAS produced a significant rightward, parallel shift in the stimulus response function (SRF) of class-2 neurons to noxious, graded heat stimuli ranging from 40 to 52 degrees C, while SDVAS produced a significant increase in the threshold and a significant reduction in the slope of the SRF of class-3 neurons. These data indicate that SDVAS generally inhibits noxious heat-evoked responses of lumbosacral spinal dorsal horn neurons in the rat, but does not significantly affect background activity of the same neurons. Furthermore, the inhibition of the TF reflex produced by SDVAS depends on central relays in the ipsilateral NTS, NRM, and bilateral LC/SC.
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This study investigated how specific expressive behaviors (verbal report of pain level and the frequency of emitting specific non-verbal facial expressions of pain) may change over the course of a chronic pain condition. Based on the concept of chronic pain behaviors, we hypothesized that both verbal and non-verbal behavior would increase with duration of pain. Thirty-six women with chronic temporomandibular disorder (TMD) pain (duration over 6 months) were compared with 35 recent onset cases (first episode, duration < or = 2 months). ⋯ Coping strategies were also similar, although chronic cases showed a greater tendency to catastrophize. Self-report measures of ambient facial pain, as well as the pain of clinical examination and cold pressor stimulation, revealed no significant differences between the 2 groups. In contrast, rates of pain facial expression were significantly higher for chronic cases under all conditions of the experiment, including baseline.(ABSTRACT TRUNCATED AT 250 WORDS)
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A number of facial actions have been found to be associated with pain. However, the consistency with which these actions occur during pain of different types has not been examined. This paper focuses on the consistency of facial expressions during pain induced by several modalities of nociceptive stimulation. ⋯ The findings suggest that the 4 actions identified carry the bulk of facial information about pain. They also provide evidence for the existence of a universal facial expression of pain. Implications of the findings for the measurement of pain expression are discussed.
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Randomized Controlled Trial Clinical Trial
The postmastectomy pain syndrome and topical capsaicin: a randomized trial.
This paper describes a randomized parallel trial of topical 0.075% capsaicin versus vehicle (placebo) in the postmastectomy pain syndrome (PMPS). The study was double-blind in design; however, this was compromised by the burning sensation induced by capsaicin. ⋯ Five of 13 patients on capsaicin were categorized as good-to-excellent responses with 8 (62%) having 50% or greater improvement. Only 1 of 10 cases had a good response to vehicle with 3 rated as 50% or better.