The journal of pain : official journal of the American Pain Society
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The mechanism of music effects on pain perception remains to be elucidated. To determine which component (mood or valence) of music is more important in music-induced hypoalgesia, we compared the effects of 2 melodies with different moods (happy vs sad) but with the same degree of valence (pleasant vs unpleasant) to an affective neutral lecture and a control (baseline) on the objective and subjective responses to tonic heat pain. Our hypothesis was that if mood was the key component, the happy melody would reduce pain, whereas the sad one would exacerbate pain; and if valence is the key component, the 2 melodies would both alleviate pain. Twenty females participated in this study which consisted of 4 conditions (baseline, happy melody, sad melody, and lecture). Pain tolerance time (PTT), pain intensity, and distress dynamics and the characteristics of pain were measured. A newly devised multiple affective rating scale (MARS) was employed to assess the subjective experience of auditory perception. Both happy and sad melodies of equal valence resulted in significant lower pain ratings during the pain test and were in contrast to the mood prediction. These results indicate that the valence of music, rather than the mood it induced, appears to be the most likely mediator of the hypoalgesic effect of the different music. ⋯ This article provides new evidence that the valence of music is more crucial than mood in affective pain modulation. This finding gives impetus for health professionals to manage pain more effectively in patients with proper music.
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This study examined the occurrence of alcohol use to manage pain in community-dwelling adults with tooth pain, jaw joint/face pain, and arthritis. Race/ethnicity, sex, and age were examined to determine their associations with alcohol use for pain. Community-dwelling adults from South Florida with tooth pain (n = 1,767), jaw joint/face pain (n = 1,199), or arthritis pain (n = 1,355) completed a structured telephone interview. Logistic regression models indicted that, similar to population rates, nonHispanic whites and males were the most likely to use alcohol to manage pain. In addition, alcohol use for pain was highest in younger adults. Individuals who self-managed oral pain with alcohol were more likely to use prescription and over-the-counter pain medications, but this association was not found for arthritis. Additional characteristics of individuals who self-medicated regardless of pain condition included greater pain frequency, depression, and higher levels of education. Being married was protective against the use of alcohol to manage pain symptoms. Use of alcohol for pain should be assessed during treatment evaluation so that physicians and other health care providers are aware of their patient's concomitant use of alcohol and pain medication, assess for psychosocial impairment, and make the appropriate referrals and adjustment to treatment. ⋯ Self-medication of pain with alcohol is most common among younger nonHispanic white males and associated with pain frequency, depression, and use of pain medications. Alcohol use for pain needs to be assessed so that health care providers can make appropriate referrals and adjustments to treatment.
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Calcitonin gene-related peptide (CGRP) is a key player in migraine. To address the role of CGRP in mechanical allodynia, which is a common feature of migraine, we used CGRP-sensitized transgenic mice. These mice have elevated nervous-system expression of the human receptor activity-modifying protein-1 (hRAMP1) subunit of the CGRP receptor. Under baseline conditions, the nestin/hRAMP1 mice and control littermates had similar hindpaw withdrawal thresholds to von Frey filaments. The effect of CGRP was tested using a filament that elicited a withdrawal response on 20% of its presentations. Following intrathecal injection of 1 nmol CGRP in the nestin/hRAMP1 mice, the response frequency was 80% within 30 minutes. The antagonist CGRP(8-37) blocked the increased response. In control littermates, a 5-fold higher dose of CGRP was required to elicit a similar response. In contrast to intrathecal injection, peripheral CGRP did not increase the mechanical responses. Intraplantar injection of capsaicin was used to test the efficacy of endogenous CGRP. Capsaicin increased mechanical responses in the nestin/hRAMP1 and control mice, although a higher dose was required in controls. In contrast to control mice, there was also a contralateral paw response in nestin/hRAMP1 mice, which is consistent with central sensitization. ⋯ In this study we show central CGRP-induced mechanical allodynia that is enhanced by overexpression of RAMP1 in nervous system. These data suggest that hypersensitivity to CGRP could be a potential mechanism underlying central sensitization in migraine and point to CGRP-receptor antagonists as a possible therapy for other pain disorders.
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Randomized Controlled Trial
Effects of intramuscular anesthesia on the expression of primary and referred pain induced by intramuscular injection of hypertonic saline.
Intramuscular injection of hypertonic saline produces pain in the belly of the injected muscle (primary pain) and, often, pain that projects distally (referred pain). While it is known that referred pain can be induced during complete sensory block of the distal site, there is little evidence as to whether the perception of referred pain depends on ongoing input from the primary stimulus. We assessed whether blocking the noxious input following the induction of pain blocks the primary but not the referred pain. A cannula was inserted into the tibialis anterior muscle in 15 subjects (8 male, 7 female). In a quasi-random crossover design conducted over 2 experimental sessions, each subject received a bolus intramuscular injection of .5 mL of 5% hypertonic saline, followed 90 seconds later by either: A) A second bolus injection or; B) An injection of 2 mL lignocaine through the same cannula. Protocol A was followed 60 seconds later by either a sham injection or an injection of lignocaine, while protocol B was followed 60 seconds later by either a sham injection or an injection of hypertonic saline. Subjects mapped the areas of primary and referred pain, and rated the intensities at these sites every 30 seconds until the cessation of pain. In all subjects, the area and intensity of primary pain rapidly disappeared within 7.5 minutes of intramuscular lignocaine injection (P < .02 relative to the nonanesthesia condition). With the exception of 2 subjects, in whom the referred pain continued in the absence of primary pain, the referred pain declined in parallel with local pain: the mean total pain intensity declined by 74% in both regions. We conclude that the maintenance of referred muscle pain usually depends on ongoing noxious inputs from the site of primary muscle pain. ⋯ Referred pain is a significant clinical problem, and commonly occurs with pain originating in muscle but not from skin. It is important to know the primary source of the pain so that treatment can be directed to this site rather to the site of referral.
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Randomized Controlled Trial
Personal values and pain tolerance: does a values intervention add to acceptance?
Previous research suggests that acceptance is a promising alternative to distraction and control techniques in successfully coping with pain. Acceptance interventions based upon Acceptance and Commitment Therapy (ACT) have been shown to lead to greater tolerance of acute pain as well as increased adjustment and less disability among individuals with chronic pain. However, in these previous intervention studies, the ACT component of values has either not been included or not specifically evaluated. The current study compares the effects of an ACT-based acceptance intervention with and without the values component among individuals completing the cold-pressor task. Results indicate that inclusion of the values component (n = 34) of ACT leads to significantly greater pain tolerance than acceptance alone (n = 30). Consistent with previous research, both conditions were associated with greater pain tolerance than control (n = 35). Despite the difference in tolerance, pain threshold did not differ, and participants in the control condition provided lower ratings of pain severity. The findings from this study support the important role of values and values clarification in acceptance-based interventions such as ACT, and provide direction for clinicians working with individuals with chronic pain conditions. ⋯ This article evaluates the additive effect of including a personalized-values exercise in an acceptance-based treatment for pain. Results indicate that values interventions make a significant contribution and improvement to acceptance interventions, which may be of interest to clinicians who provide psychological treatment to individuals with chronic pain.