Pain
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Multiple aspects of family functioning were assessed when mothers experienced either chronic pain, a chronic illness (diabetes), or no illness. Mothers' and fathers' self-report measures of depression, anxiety, and family environment were collected. Children's self-report measures of depression and anxiety, as well as information about their overall adjustment, were collected. ⋯ Children from chronic pain families also appeared to be adversely affected. The data suggest that level of disability appeared more salient than the type of chronic illness. Implications of the findings are discussed in light of the fact that mothers with chronic pain in the present sample reported relatively mild disability and were not actively seeking treatment for their condition.
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This research was designed to identify and validate facial expressions of pain occurring in a clinical chronic pain condition. Facial expressions of 28 patients with chronic temporomandibular disorder pain were videotaped during a painful clinical examination procedure and coded using an anatomically based system. ⋯ A small number of facial expressions of specific negative emotions were also observed; pain report and pain facial expressions were higher for persons showing a greater number of negative affects. These findings support the promise of facial expressions as measures of clinical pain.
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Two theories about the relationship between anxiety and pain were compared: (1) the attribution theory that relevant but not irrelevant anxiety intensifies pain, and (2) the perceptual disruption theory that all anxiety influences pain. Three types of instructions were presented to randomly selected groups of male university students immediately before nociception: (1) a standard set of instructions, (2) the standard instructions plus a pain warning (relevant anxiety condition), and (3) the standard instructions plus a warning about a stressful interview (irrelevant anxiety condition). Pain and stress intensity ratings, heart rate, frontalis electromyographic activity, and facial expressions were recorded continuously, and pain threshold and pain tolerance were recorded once. ⋯ In addition, the relevant but not the irrelevant anxiety instructions increased electromyographic activity and facial grimaces during nociception. However, tolerance, threshold, and post-experimental ratings did not differ among groups. These results are interpreted as supporting the perceptual disruption theory.
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In order to determine which classes of spinal neurons are capable of mediating sympathetically maintained pain, recordings were made from single somatosensory neurons in spinal cords of anesthetized cats. Each neuron was functionally identified with mechanical stimuli, and its responses to electrical stimulation of the sympathetic trunk were recorded. Nearly half (45%) of the wide-dynamic-range (WDR) neurons tested were activated by sympathetic stimulation, but none of the high threshold (nociceptor-specific) neurons and only 17% of the low threshold neurons were activated. ⋯ Therefore, WDR neurons, rather than high threshold neurons, are most likely to mediate the spinal component of sympathetically maintained pain. These results provide supporting evidence for our previous hypothesis that sympathetically maintained pain is mediated by myelinated mechanoreceptors acting on sensitized WDR neurons. Our results also demonstrate that sympathetic activation of WDR neurons is mediated by an alpha-adrenergic mechanism in the skin.
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This paper describes a new approach to the neurolytic block of the celiac plexus through the anterior abdominal wall using CT guidance. In 5 patients, CT guidance was used for needle placement and visualization of the spread of the injection. ⋯ No serious complications were observed. The anterior approach is simple and is useful in those patients with upper chronic abdominal pain scheduled for biopsy of the pancreas, and in those terminally ill patients who cannot tolerate the prone position.