Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized trial of electronic versus paper pain diaries in children: impact on compliance, accuracy, and acceptability.
Electronic diary assessment of pain and disability has become increasingly popular in adult chronic pain research but use of this methodology with children has received limited attention. The aim of this study was to compare two formats of a prospective daily diary (handheld computer=e-diary; paper diary=p-diary) on children's compliance, accuracy, and acceptability ratings. Sixty children, ages 8-16 (M=12.3) with headaches or juvenile idiopathic arthritis, were randomized to receive either e-diaries administered via home visits (n=30) or p-diaries (n=30) handed out during clinic visits for return by mail. ⋯ Children rated both diary formats as highly acceptable and easy to use. A significant gender x diary format interaction (P<0.01) was found for compliance where boys demonstrated greater compliance with the e-diary format. Findings demonstrated that the e-diary was feasible to use with children and showed significantly greater compliance and accuracy in diary recording compared to traditional paper diaries in a population of children with recurrent pain.
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Comparative Study
Comprehensive description of newborn distress behavior in response to acute pain (newborn male circumcision).
One of the most difficult challenges still facing researchers and clinicians is assessing pain in the newborn. Behaviors provide one of the most promising avenues for deepening our fundamental understanding of complex phenomenon like newborn pain, and are key to developing descriptive-level knowledge to further newborn pain assessment efforts. In this ethologically based research, we report on the duration and frequency of neonatal distress behavior to seven distinct noxious and non-noxious but distress-provoking events including baseline (diaper change, post-diaper change, application of arm and leg restraints, post-application of arm and leg restraints, circumcision, post-circumcision) associated with newborn surgical pain. ⋯ This led to the identification of (1) 40 distress behaviors as they occurred along the continuum of distress, (2) eight distress behaviors specific to surgery, (3) 11 classes of behaviors occurring within the five sub-phases of circumcision, and (4) a description of 25 distinct post-distress behaviors. Findings support the ability to distinguish distress behaviors specific to pain and the ability to detect prolonged distress as well as individual differences in distress-related pain expression. Findings also justify ongoing use of ethological approaches to further newborn pain assessment and to investigate poorly understood topics such as infant self-regulation within the context of pain (pain recovery).
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Comparative Study
Effects of stimulus duration on heat induced pain: the relationship between real-time and post-stimulus pain ratings.
Pain is a temporally dynamic experience. Yet, in most instances, pain ratings are acquired in a static fashion and frequently require subjects to retrospectively evaluate the pain experience that occurred in a preceding interval of time. In order to determine which components of the real-time experience of pain contribute to static pain ratings, we obtained real-time (dynamic) and post-stimulus (static) ratings using a visual analogue scale during various of durations (5-30 s) of noxious thermal stimulation (43-49 degrees C). ⋯ Regression analyses examining both pain-intensity and pain-unpleasantness revealed that the mean response and the peak response of real-time ratings significantly contributed to post-stimulus ratings, while temporal components such as perceived duration of pain contributed minimally. Additional regression analyses revealed that mean and peak responses of real-time intensity ratings accounted for much of the variability of post-stimulus unpleasantness ratings whereas real-time unpleasantness ratings accounted for somewhat less of the variability of post-stimulus intensity ratings. Taken together, the close relationship between real-time and post-stimulus ratings of pain across stimulus conditions evoking both adaptation and temporal summation further confirms that post-stimulus, retrospective ratings of pain are valid measures of the real-time experience of pain.
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Cannabinoid receptor agonists produce analgesia for pains of non-cranial origin. However, their effectiveness for craniofacial pains is currently unclear. In the present study, the cannabinoid CB1/CB2 receptor agonist, WIN 55,212-2 (WIN), was bath applied to the brainstem while activity of spinal trigeminal nucleus caudalis (Vc) neurons evoked by transcutaneous electrical stimulation was recorded in isoflurane anesthetized rats. ⋯ SR141716A, a CB1 receptor antagonist, prevented the effects of WIN on WDR PDC and LTM Abeta evoked activity. These results indicate that cannabinoid receptor agonists may be effective agents for craniofacial pain. Furthermore, the particular sensitivity of PDC activity, a measure of neuronal hyperexcitability, to cannabinoid receptor agonists may be relevant to the treatment of persistent craniofacial pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Communicative dimensions of pain catastrophizing: social cueing effects on pain behaviour and coping.
The study was designed to assess whether the social context of a pain experience impacted on the relation between catastrophizing and duration of pain behaviour. Based on a communal coping model, the prediction was that the presence of an observer during a pain procedure would differentially influence the display of pain behaviour in high and low catastrophizers. University undergraduates taking part in a cold pressor procedure were randomly assigned to one of two conditions: (1) participant alone (n=30), or (2) observer present (n=34). ⋯ When the observer was present, high catastrophizers also reported using fewer cognitive coping strategies than low catastrophizers. The pattern of findings suggests that in the presence of an observer, high pain catastrophizers show a propensity to engage in strategies that more effectively communicate their pain, and are less likely to engage in strategies that might minimize pain. Theoretical implications of the findings are discussed.