Pain
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The lack of pain alarm in painless myocardial infarction (MI) leads to increased morbidity and mortality, since patients do not seek medical treatment in a timely manner. We aimed to explore whether reduced systemic pain perception in response to experimental stimuli and pain related personality variables characterizes painless MI patients. ⋯ This study suggests that reduced systemic pain perception as well as cognitive personality variables play an important role in the etiology of painless MI.
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Previous findings that reactive oxygen species (ROS) are involved in neuropathic pain, mainly through spinal mechanisms, suggest that ROS may be involved in central sensitization. To investigate the possible role of ROS in central sensitization, we examined in rats the effects of ROS scavengers on capsaicin-induced secondary hyperalgesia, which is known to be mediated by central sensitization. We used two different ROS scavengers: phenyl N-tert-butylnitrone (PBN) and 4-hydroxy-2,2,6,6-tetramethylpiperidine 1-oxyl (TEMPOL). ⋯ Intrathecal injection of PBN (1mg inof veterinary Surgery/anesthesiology, College of veterinary Medic 50 microl saline) greatly reduced hyperalgesia, whereas intracerebroventricular or intradermal injection of PBN produced only a minor analgesic effect, suggesting that PBN takes effect mainly through the spinal cord. Electrophysiological recordings from wide dynamic range (WDR) neurons in the dorsal horn showed that intradermal capsaicin enhanced the evoked responses to peripheral stimuli; systemic PBN or TEMPOL restored the responses to normal levels. Removal of ROS thus restored the responsiveness of spinal WDR neurons to normal levels, suggesting that ROS is involved in central sensitization, at least in part by sensitizing WDR neurons.
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Little is known about the relationship between pain and aberrant use of prescription analgesics in persons living with HIV. We examined the predictive and concurrent associations among pain, aberrant use of opioids, and problem drug use history in a nationally representative longitudinal sample of 2267 HIV+ persons. Covariance structure analyses tested a conceptual model wherein HIV+ patients with a history of problematic drug use (n=870), compared to those without such history (n=1397), were hypothesized to report more pain and aberrant opioid use, as well as use of opioids specifically for pain at baseline and 6- and 12-month follow-ups, after controlling for key sociodemographic characteristics. ⋯ We also found a trend toward greater stability of aberrant opioid use over time in problem drug users compared with non-problem users suggesting a persistent pattern of inappropriate medication use in the former group. Our findings suggest that even though HIV+ persons with a history of problematic drug use report on-going patterns of using prescription analgesics specifically for pain, these patients continued to experience persistently higher levels of pain, relative to non-problem users. Among non-problem users, pain was not linked to aberrant use of opioids, but was linked to the use of such medications specifically for pain.
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In several types of chronic pain, catastrophizing has been related to higher pain intensity, and health care utilization but it has not been explored extensively in sickle cell disease (SCD). The objective of the study was to identify the role of catastrophizing in SCD, specifically in relation to painful crises, non-crisis pain, and responses to pain. Two hundred and twenty SCD adults were enrolled in a prospective cohort study of pain and completed between 30 and 188 daily diaries in 6 months. ⋯ Adults with SCD had a higher mean catastrophizing score than found in studies of other chronic pain conditions that are not lifelong and life-threatening. CAT scores were not correlated with pain parameters or utilization. The role of catastrophizing in other conditions cannot be generalized to SCD.
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Pain is a common symptom in the general population. While most subjects experience pain in more than one body site, most epidemiologic and clinical studies focus on single pain sites. Limited evidence on spatial pain pattern reporting is available to date. ⋯ The seven pain classes differed substantially with regard to sociodemographic characteristics, and showed meaningful associations to self-reported medical diseases. Spatial pain patterns predicted physical functioning better than social functioning. The results suggest that a meaningful classification of complex pain patterns may be based on a very simple measure of pain symptoms.