European journal of pain : EJP
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The fundamental aspects of bone associated pain in humans are not fully understood. In this study pressure pain applied to the tibia bone was investigated experimentally in humans and by means of computer simulations. In humans, the pressure pain sensitivity and the relation between tissue indentation and pressure intensity were recorded by a computer-controlled pressure algometer with two different probe sizes (0.03 cm(2) and 1.0 cm(2)). ⋯ For both probes the strain peaked in adipose tissue at 0.29, and in the bone interface it was reduced by 3% (0.03 cm(2)) and 15% (1.0 cm(2)), respectively. For both probes the stress peaked at 235 kPa in skin layer, and in the deeper layers it was reduced to 50 kPa. Mechanosensitive nociceptors innervating the periosteum are ideally placed to mediate pain evoked by pressure stimulation on the tibia bone and small diameter probes may be optimal for assessing bone associated pain sensitivity.
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Randomized Controlled Trial
Coping when pain is a potential threat: the efficacy of acceptance versus cognitive distraction.
This experiment investigated the impact of brief training in acceptance versus distraction-based pain management on experimental pain tolerance in conditions of lower and higher potential threats. One hundred fifty-one pain-free Chinese adults (93 women, 58 men) randomly assigned to acceptance, distraction or pain education control conditions engaged in a cold pressor test (CPT) after reading validated orienting information designed to prime either the safety of the CPT (lower threat) or symptoms and damaging effects of exposure to extreme cold (higher threat). ⋯ Supplementary analyses identified catastrophizing as a partial mediator of training group differences in pain tolerance. In summary, findings suggested acceptance-based coping is superior to distraction as a means of managing experimental pain, particularly when pain sensations are viewed as comparatively low in potential threat.
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We investigated the prevalence and intensity of pain, factors associated with having pain, and analgesic medications employed in a population consisting predominantly of Black African and female human immunodeficiency virus (HIV)-positive individuals attending outpatient clinics in a rural (n = 125; 79% female; 100% Black African) and a metropolitan (n = 396; 75% female; 94% Black African) area of South Africa. Pain intensity, interference and treatment were assessed using the Wisconsin Brief Pain Questionnaire. Seventy-two percent of rural participants and 56% of metropolitan participants had pain at the time of the interview, and this pain was moderate to severe in intensity in 60% of rural participants and 59% of metropolitan participants. ⋯ Pharmacological management of pain was poor, with 29% of rural participants and 55% of metropolitan participants with pain not receiving any treatment. Of those receiving treatment, no participants were receiving strong opioids, and only 3% of metropolitan participants were receiving a weak opioid. Thus, HIV-related pain is common and is poorly treated in both the rural and metropolitan setting in South Africa.