Pain
-
Comparative Study Clinical Trial Controlled Clinical Trial
Electrically evoked itch in humans.
We compared itch sensations and axon reflex flare induced by transcutaneous electrical (0.08-8 ms, 2-200 Hz) and chemical (histamine iontophoresis; 100 microC) stimulation. Stimuli were applied to non-lesional volar wrist skin in 20 healthy human subjects and 10 patients with atopic dermatitis. Intensity of evoked itch and pain sensations were rated on a numerical rating scale (NRS) of 0 (no sensation) to 10 (the maximum sensation imaginable). ⋯ Healthy subjects and patients with atopic dermatitis did not differ significantly in their response to either stimulation. We conclude that C-fiber activation underlies the electrically evoked itch sensation. The low electrical thresholds and the absence of an axon reflex flare suggest that these fibers are not identical with the previously described mechano-insensitive histamine responsive C fibers, but represent a separate peripheral neuronal system for the induction of itch.
-
Comparative Study
Ethnic differences in responses to multiple experimental pain stimuli.
A growing body of literature suggests that the experience of clinical pain differs across ethnocultural groups. Additionally, some evidence indicates greater sensitivity to experimentally induced pain among African Americans; however, most studies have included only one pain modality. This study examined ethnic differences in responses to multiple experimental pain stimuli, including heat pain, cold pressor pain, and ischemic pain. ⋯ These findings demonstrate differences in laboratory pain responses between African Americans and whites across multiple stimulus modalities, and effect sizes for these differences in pain tolerance were moderate to large for suprathreshold measures. Hypervigilance partly accounted for group differences. Additional research to determine the mechanisms underlying these effects is warranted.
-
Comparative Study
The joint contribution of physical pathology, pain-related fear and catastrophizing to chronic back pain disability.
The present study examined the contribution of physical pathology, pain-related fear and catastrophizing cognitions to pain intensity and disability in 100 patients with non-specific low back pain. Self-report instruments were completed as part of the intake procedure of patients, while physical pathology was quantified from medical charts using the MEDICS procedure. ⋯ However, pain-related fear and catastrophizing contributed 4-10% additional explained variance to the regression models for pain intensity and disability. Thus, this study confirms the relationship between biological and psychological variables in determining the severity of low back pain complaints, and underscores the necessity for a multidisciplinary approach to diagnostics and intervention.
-
A hallmark symptom of irritable bowel syndrome (IBS) is a lower pain threshold during rectal distension, but the mechanism underlying this disorder remains unclear. Examining the relationship between physiological and perceptual responses to rectal distension can provide insight into the underlying peripheral or central dysfunction in IBS. Therefore, we carried out a study of the rectal sensations of urge to defecate, pain and unpleasantness in relation to the varying states of the rectum. ⋯ Abnormalities in IBS patients included: (1) higher incidence of distensions where unpleasantness is greater than pain intensity, (2) significantly longer persistence of ratings after stimulus termination during phasic distensions eliciting either moderate urge or moderate pain, (3) significantly smaller ratings fluctuations during tonic distensions, and (4) significantly higher MPQ scores for painful tonic distensions. Our study demonstrates that IBS patients have abnormal temporal and intensity properties of rectal sensation. These can be accounted for by either altered peripheral neuromuscular processing and/or processing of ascending rectal input in the central nervous system.
-
Comparative Study
The development and preliminary validation of a brief measure of chronic pain impact for use in the general population.
From a biopsychosocial perspective, assessing chronic pain's psychological impact should involve at minimum the measurement of pain severity, functional interference, and pain-related emotional burden. This article details the development of a brief instrument, the 15-item Profile of Chronic Pain: Screen (PCP:S), designed to address these three key elements in a national (US) sample of over 2400 individuals recruited via random digit dialing. Retest reliability, internal consistency, and preliminary validity were excellent. ⋯ A series of confirmatory factor analyses on several distinct samples revealed a stable, 3-factor solution reflecting pain severity, interference, and emotional burden. Finally, national norms were developed by gender and three age groups. In view of its strong psychometric properties, the PCP:S has the potential to serve as a brief, cost-effective assessment tool for identifying individuals whose chronic pain merits more detailed psychosocial evaluation.