Pain
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Randomized Controlled Trial
Reliability and validity of observer ratings of pain using the visual analog scale (VAS) in infants undergoing immunization injections.
We tested the reliability and validity of observer-rated pain in infants undergoing immunization using the visual analog scale (VAS). Pain was assessed in real time and later, from videotapes, in 120 1-year-old infants participating in a double-blind randomized controlled trial of amethocaine vs. placebo. Altogether, 2 (1 physician, 1 non-physician) of 4 raters [2 physicians, 2 non-physicians (nurse and graduate student)] independently assessed baseline and vaccine injection pain using a 100mm unmarked VAS line. ⋯ Together, these results provide initial support for the VAS as an outcome measure for acute procedural pain in infants. However, different conclusions may be reached about the effectiveness of analgesic interventions depending on the rater. Sources of variability include use of multiple raters, rater focus (procedure vs. child) and experience level.
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Studies on the determinants of pain-related support are needed to enhance couples-based treatments for pain. The purpose of this study was to determine the extent to which pain catastrophizing and perceived entitlement to pain-related support (i.e., support entitlement) were associated with perceived and observed social support. Participants were 106 chronic pain couples recruited from the community. ⋯ Among those with a greater entitlement to support, catastrophizing was associated with greater punishing spouse responses and observed invalidation by the spouse. These results suggest that support entitlement plays an important role in couples' supportive interactions about pain. Continued research is needed to determine how a desire for pain-related attention and support and catastrophizing translate into behaviors that affect support provision and receipt.
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The generalized hypersensitivity associated with fibromyalgia syndrome (FMS) may in part be driven by peripheral nociceptive sources. The aim of the study was to investigate whether local and referred pain from active myofascial trigger points (MTrPs) contributes to fibromyalgia pain. FMS patients and healthy controls (n=22 each, age- and gender-matched) were recruited. ⋯ The local and referred pain pattern induced from active MTrPs bilaterally in the upper trapezius muscle were similar to the ongoing pain pattern in the neck and shoulder region in FMS. In conclusion, active MTrPs bilaterally in the upper trapezius muscle contribute to the neck and shoulder pain in FMS. Active MTrPs may serve as one of the sources of noxious input leading to the sensitization of spinal and supraspinal pain pathways in FMS.
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Tibia fracture followed by limb immobilization in rats evokes nociceptive and vascular changes resembling complex regional pain syndrome type I (CRPS I). Previously we observed that substance P (SP) and interleukin-1beta (IL-1beta) signaling contribute to chronic regional nociceptive sensitization in this model. It is known that inflammasome multi-protein complexes containing caspase-1 and NALP1 are involved in the activation of the IL-1beta family of pro-nociceptive cytokines expressed in skin and other tissues. ⋯ Using this model we observed that: (1) inflammasome components and products NALP1, caspase-1, IL-1beta and IL-18 were present in low levels in normal skin, but expression of all these was strongly up-regulated after fracture, (2) NALP1, caspase-1 and IL-1beta were co-expressed in keratinocytes, and the number of NALP1, caspase-1, and IL-1beta positive cells dramatically increased at 4 weeks post-fracture, (3) LY303870, an NK1 receptor antagonist, effectively blocked fracture-induced up-regulation of activated inflammasome components and cytokines, (4) IL-1beta and IL-18 intraplantar injection induced mechanical allodynia in normal rats, and (5) both a selective caspase-1 inhibitor and an IL-1 receptor antagonist attenuated fracture-induced hindpaw mechanical allodynia. Collectively, these data suggest that NALP1 containing inflammasomes activated by NK1 receptors are expressed in keratinocytes and contribute to post-traumatic regional nociceptive sensitization. These findings highlight the possible importance of neuro-cutaneous signaling and innate immunity mechanisms in the development of CRPS.
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Cognitive factors such as catastrophic thoughts regarding pain, and conversely, one's acceptance of that pain, may affect emotional functioning among persons with chronic pain conditions. The aims of the present study were to examine the effects of both catastrophizing and acceptance on affective ratings of experimentally induced ischemic pain and also self-reports of depressive symptoms. Sixty-seven individuals with chronic back pain completed self-report measures of catastrophizing, acceptance, and depressive symptoms. ⋯ Acceptance did not show any significant associations, when catastrophizing was also in the model, with any form of ratings of the induced pain. Catastrophizing, but not acceptance, was also significantly associated with self-reported depressive symptoms when these two variables were both included in a regression model. Overall, results indicate negative thought patterns such as catastrophizing appear to be more closely related to outcomes of perceived pain severity and affect in persons with chronic pain exposed to an experimental laboratory pain stimulus than does more positive patterns as reflected in measures of acceptance.