The journal of pain : official journal of the American Pain Society
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This study investigated the association between effectiveness of ED pain treatment and race of patients, race of providers, and the concordance of patient and provider race, with a prospective, multicenter study of patients presenting to 1 of 20 US and Canadian EDs with moderate to severe pain. Primary outcome is a 2-point or greater reduction in pain intensity, measured with an 11-point verbal scale, considered the minimum clinically important reduction in pain intensity. A total of 776 patients were enrolled. The sample included 57% female, 44% white, 26% black, and 26% Hispanic. The physician was white in 85% of encounters. Arrival pain score (adjusted odds ratio, 1.14; 95% CI 1.06, 1.24), receipt of any ED analgesia (1.59; 95% CI 1.17, 2.17), and physician nonwhite race (1.68; 95% CI 1.10, 2.55) were significant predictors of clinically significant reduction in pain intensity in multivariate analysis. Nonwhite physicians achieved better pain control without using more analgesics. Future research should explore the determinants of this difference in patient response to pain treatment related to provider race including provider characteristics and training that were not measured in this study. This study provided no evidence supporting an effect of racial concordance on the primary outcome. ⋯ This article presents analysis of predictors of clinically important reduction in pain intensity among emergency department patients, finding nonwhite physicians achieving better pain relief with less analgesia. This finding should encourage researchers to investigate elements of the therapeutic relationship that may be enhanced to achieve better pain relief for patients.
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The functions of small fibers can be impaired in peripheral neuropathies, and screening tests for clinical use are required. To verify whether intraepidermal stimulation (IES) is useful for assessing the functions of Adelta fibers in the superficial layer, we investigated sensory thresholds and evoked cortical responses in healthy volunteers before and after a transdermal administration of lidocaine. Pain and tactile thresholds were studied using IES and transcutaneous electrical stimulation (TS), respectively, in 10 healthy volunteers before, and 1 hour, 3 hours, and 5 hours after a local anesthesia with lidocaine. Cortical potentials evoked with IES and TS were also studied in 12 healthy volunteers before and 5 hours after the anesthesia. Although the local anesthesia had no effect on the evoked potentials or the tactile threshold for TS, it markedly increased the pain threshold and almost abolished the evoked potentials for IES. These results suggest that IES is a sensitive tool for detecting functional changes of cutaneous Adelta fibers. ⋯ Compared with other methods of stimulation used to investigate Adelta fiber function, our method is easy to apply and less invasive and can stimulate any site of the body. Therefore, it should be useful as a screening test for patients with neuropathy.
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Chronic pain and obesity, and their associated impairments, are major health concerns. We estimated the association of overweight and obesity with 5 distinct pain conditions and 3 pain symptoms, and examined whether familial influences explained these relationships. We used data collected from 3,471 twins in the community-based University of Washington Twin Registry. Twins reported sociodemographic data, current height and weight, chronic pain diagnoses and symptoms, and lifetime depression. Overweight and obese were defined as body mass index of 25.0 to 29.9 kg/m(2) and >or= 30.0 kg/m(2), respectively. Generalized estimating equation regression models, adjusted for age, gender, depression, and familial/genetic factors, were used to examine the relationship between chronic pain, and overweight and obesity. Overall, overweight and obese twins were more likely to report low back pain, tension-type or migraine headache, fibromyalgia, abdominal pain, and chronic widespread pain than normal-weight twins after adjustment for age, gender, and depression. After further adjusting for familial influences, these associations were diminished. The mechanisms underlying these relationships are likely diverse and multifactorial, yet this study demonstrates that the associations can be partially explained by familial and sociodemographic factors, and depression. Future longitudinal research can help to determine causality and underlying mechanisms. ⋯ This article reports on the familial contribution and the role of psychological factors in the relationship between chronic pain, and overweight and obesity. These findings can increase our understanding of the mechanisms underlying these 2 commonly comorbid sets of conditions.
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Pain is a debilitating condition affecting millions each year, yet what predisposes certain individuals to be more sensitive to pain remains relatively unknown. Several psychological factors have been associated with pain perception, but the structural relations between multiple higher- and lower-order constructs and pain are not well understood. Thus, we aimed to examine the associations between pain perception using the cold pressor task (CPT), higher-order personality traits (neuroticism, negative affectivity, trait anxiety, extraversion, positive affectivity, psychoticism), and lower-order pain-related psychological constructs (pain catastrophizing [pre- and post-], fear of pain, anxiety sensitivity, somatosensory amplification, hypochondriasis) in 66 pain-free adults. Factor analysis revealed 3 latent psychological variables: pain- or body-sensitivity, negative affect/neuroticism, and positive affect/extraversion. Similarly, pain responses factored into 3 domains: intensity, quality, and tolerance. Regression and correlation analyses demonstrated that: 1) all the lower-order pain constructs (fear, catastrophizing, and hypochondriasis) are related through a single underlying latent factor that is partially related to the higher-order negative-valence personality traits; 2) pain- or body-sensitivity was more strongly predictive of pain quality than higher-order traits; and 3) the form of pain assessment is important-only qualitative pain ratings were significantly predicted by the psychological factors. ⋯ Consistent with the biopsychosocial model, these results suggest multiple pain-related psychological measures likely assess a common underlying factor, which is more predictive of qualitative than intensity pain ratings. This information may be useful for the development and advancement of pain assessments and treatments while considering the multidimensional nature of pain.
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The aim of this present study is to test the hypotheses that the 18 predetermined sites of examination for tender points (TP sites) in fibromyalgia syndrome (FMS) are myofascial trigger points (MTrPs), and that the induced pain from active MTrPs at TP sites may mimic fibromyalgia pain. Each TP site was evaluated with manual palpation followed by intramuscular electromyographic (EMG) registration of spontaneous electrical activity to confirm or refute the existence of an MTrP in 30 FMS patients. Overall spontaneous pain intensity and pain pattern were recorded before manual identification of MTrPs. Local and referred pain pattern from active MTrPs were drawn following manual palpation at TP sites. ⋯ This article underlies the importance of active MTrPs in FMS patients. Most of the TP sites in FMS are MTrPs. Active MTrPs may serve as a peripheral generator of fibromyalgia pain and inactivation of active MTrPs may thus be an alternative for the treatment of FMS.