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Linking interpretation bias to individual differences in pain sensitivity. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03793-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Krimmel SR, Keaser ML, Speis D, Haythornthwaite JA, Seminowicz DA. Migraine disability, pain catastrophizing, and headache severity are associated with evoked pain and targeted by mind-body therapy. Pain 2022; 163:e1030-e1037. [PMID: 35297801 PMCID: PMC9288557 DOI: 10.1097/j.pain.0000000000002578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Meta-analysis suggests that migraine patients are no more sensitive to experimentally evoked pain than healthy control subjects. At the same time, studies have linked some migraine symptoms to quantitative sensory testing (QST) profiles. Unfortunately, previous studies associating migraine symptoms and QST have important methodological shortcomings, stemming from small sample sizes, and frequent use of univariate statistics for multivariate research questions. In the current study, we seek to address these limitations by using a large sample of episodic migraine patients (n = 103) and a multivariate analysis that associates pain ratings from many thermal intensities simultaneously with 12 clinical measures ranging from headache frequency to sleep abnormalities. We identified a single dimension of association between thermal QST and migraine symptoms that relates to pain ratings for all stimulus intensities and a subset of migraine symptoms relating to disability (Headache Impact Test 6 and Brief Pain Inventory interference), catastrophizing (Pain Catastrophizing Scale), and pain severity (average headache pain, Brief Pain Inventory severity, and Short-Form McGill Pain Questionnaire 2). Headache frequency, allodynia, affect, and sleep disturbances were unrelated to this dimension. Consistent with previous research, we did not observe any difference in QST ratings between migraine patients and healthy control subjects. Additionally, we found that the linear combination of symptoms related to QST was modified by the mind-body therapy enhanced mindfulness-based stress reduction (MBSR+). These results suggest that QST has a selective relationship with pain symptoms even in the absence of between-subjects differences between chronic pain patients and healthy control subjects.
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Affiliation(s)
- Samuel R. Krimmel
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
- Program in Neuroscience, University of Maryland School of
Medicine, Baltimore, MD, 21201 USA
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
| | - Darrah Speis
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
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Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet 2021; 397:2098-2110. [PMID: 34062144 DOI: 10.1016/s0140-6736(21)00392-5] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/26/2020] [Accepted: 09/24/2020] [Indexed: 12/26/2022]
Abstract
Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented CNS pain and sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. It is important to recognise this type of pain, since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections.
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Affiliation(s)
- Mary-Ann Fitzcharles
- Department of Rheumatology and Alan Edwards Pain Management Unit, McGill University, Montreal, QC, Canada.
| | - Steven P Cohen
- Department of Psychiatry and Behavioral Sciences and Department of Anesthesiology and Critical Care Medicine, Neurology and Physical Medicine and Rehabilitation at Johns Hopkins Hospital, Baltimore, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Daniel J Clauw
- Departments of Anesthesiology, Medicine, and Psychiatry, Chronic Pain and Fatigue Research Center, the University of Michigan Medical School, Ann Arbor, MI, USA
| | - Geoffrey Littlejohn
- Department of Rheumatology and Department of Medicine, Monash Health and Monash University, Clayton, Melbourne, VIC, Australia
| | - Chie Usui
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Winfried Häuser
- Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
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Fillingim RB. In memoriam William Maixner: 1952 to 2020. Pain 2021; 162:989-992. [PMID: 37595617 DOI: 10.1097/j.pain.0000000000002200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
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Suarez-Roca H, Mamoun N, Sigurdson MI, Maixner W. Baroreceptor Modulation of the Cardiovascular System, Pain, Consciousness, and Cognition. Compr Physiol 2021; 11:1373-1423. [PMID: 33577130 DOI: 10.1002/cphy.c190038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Baroreceptors are mechanosensitive elements of the peripheral nervous system that maintain cardiovascular homeostasis by coordinating the responses to external and internal environmental stressors. While it is well known that carotid and cardiopulmonary baroreceptors modulate sympathetic vasomotor and parasympathetic cardiac neural autonomic drive, to avoid excessive fluctuations in vascular tone and maintain intravascular volume, there is increasing recognition that baroreceptors also modulate a wide range of non-cardiovascular physiological responses via projections from the nucleus of the solitary tract to regions of the central nervous system, including the spinal cord. These projections regulate pain perception, sleep, consciousness, and cognition. In this article, we summarize the physiology of baroreceptor pathways and responses to baroreceptor activation with an emphasis on the mechanisms influencing cardiovascular function, pain perception, consciousness, and cognition. Understanding baroreceptor-mediated effects on cardiac and extra-cardiac autonomic activities will further our understanding of the pathophysiology of multiple common clinical conditions, such as chronic pain, disorders of consciousness (e.g., abnormalities in sleep-wake), and cognitive impairment, which may result in the identification and implementation of novel treatment modalities. © 2021 American Physiological Society. Compr Physiol 11:1373-1423, 2021.
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Affiliation(s)
- Heberto Suarez-Roca
- Department of Anesthesiology, Center for Translational Pain Medicine, Duke University, Durham, North Carolina, USA
| | - Negmeldeen Mamoun
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Martin I Sigurdson
- Department of Anesthesiology and Critical Care Medicine, Landspitali, University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - William Maixner
- Department of Anesthesiology, Center for Translational Pain Medicine, Duke University, Durham, North Carolina, USA
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Females have greater susceptibility to develop ongoing pain and central sensitization in a rat model of temporomandibular joint pain. Pain 2020; 160:2036-2049. [PMID: 31430262 DOI: 10.1097/j.pain.0000000000001598] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Temporomandibular joint osteoarthritis (TMJOA) is a prevalent source of temporomandibular joint disorder (TMD). Women are more commonly diagnosed with TMD and are more likely to seek care at tertiary orofacial pain clinics. Limited knowledge regarding mechanisms underlying temporomandibular joint (TMJ) pain impairs development of improved pain management strategies. In a rat model of unilateral TMJOA, monosodium iodoacetate (MIA) produces joint pathology in a concentration-dependent manner. Unilateral MIA produces alterations in meal patterns in males and females without altering overnight time spent eating or weight across 2 weeks. Monosodium iodoacetate (80 mg/mL)-treated males develop ongoing pain within 2 weeks after MIA injection. Females develop ongoing pain at a 5-fold lower MIA concentration (16.6 mg/m). Monosodium iodoacetate (80 mg/mL)-treated males show spread of tactile hypersensitivity across the face during the first week after injection and then to the fore paws and hind paws during the second week after injection, indicating development of central sensitization. At the lower dose, female rats demonstrate a similar spread of tactile hypersensitivity, whereas male rats do not develop ongoing pain or spread of tactile hypersensitivity outside the area of the ipsilateral temporomandibular joint. These observations indicate that females have a higher susceptibility to development of ongoing pain and central sensitization compared with male rats that is not due to differences in MIA-induced joint pathology. This model of TMJOA pain can be used to explore sex differences in pain processes implicated in development of neuropathic pain, ongoing pain, and central sensitization, allowing for development of individualized strategies for prevention and treatment of TMD joint pain.
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Abstract
Baroreceptors are mechanosensitive elements of the peripheral nervous system that maintain homeostasis by coordinating physiologic responses to external and internal stimuli. While it is recognized that carotid and cardiopulmonary baroreceptor reflexes modulate autonomic output to mitigate excessive fluctuations in arterial blood pressure and to maintain intravascular volume, increasing evidence suggests that baroreflex pathways also project to key regions of the central nervous system that regulate somatosensory, somatomotor, and central nervous system arousal. In addition to maintaining autonomic homeostasis, baroreceptor activity modulates the perception of pain, as well as neuroimmune, neuroendocrine, and cognitive responses to physical and psychologic stressors. This review summarizes the role that baroreceptor pathways play in modulating acute and chronic pain perception. The contribution of baroreceptor function to postoperative outcomes is also presented. Finally, methods that enhance baroreceptor function, which hold promise in improving postoperative and pain management outcomes, are presented.
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Evidence for Somatic Hypersensitivity in Veterans With Gulf War Illness and Gastrointestinal Symptoms. Clin J Pain 2019; 34:944-949. [PMID: 29570102 DOI: 10.1097/ajp.0000000000000611] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Over 25% of Persian Gulf War (PGW) veterans with Gulf War Illness (GWI) (chronic health symptoms of undetermined etiology) developed gastrointestinal (GI) (diarrhea and abdominal pain) and other somatic symptoms. OBJECTIVES Our study objective was to determine if veterans with GWI and GI symptoms exhibit heightened patterns of somatic pain perception (hypersensitivity) across nociceptive stimuli modalities. METHODS Participants were previously deployed GW Veterans with GWI and GI symptoms (n=53); veterans with GWI without GI symptom (n=47); and veteran controls (n=38). We determined pain thresholds for contact thermal, cold pressor, and ischemic stimuli. RESULTS Veterans with GWI and GI symptoms showed lower pain thresholds (P<0.001) for each stimulus. There was also overlap of somatic hypersensitivities among veterans with GI symptoms with 20% having hypersensitivity to all 3 somatic stimuli. Veterans with GWI and GI symptoms also showed a significant correlation between mechanical visual analog scale abdominal pain ratings and heat pain threshold, cold pressor threshold, and ischemic pain threshold/tolerance. DISCUSSION Our findings show that there is widespread somatic hypersensitivity in veterans with GWI/GI symptoms that is positively correlated with abdominal pain ratings. In addition, veterans with somatic hypersensitivity that overlap have the greatest number of extraintestinal symptoms. These findings may have a translational benefit: strategies for developing more effective therapeutic agents that can reduce and/or prevent somatic and GI symptoms in veterans deployed to future military conflicts.
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Ho KWD, Wallace MR, Sibille KT, Bartley EJ, Cruz-Almeida Y, Glover TL, King CD, Goodin BR, Addison A, Edberg JC, Staud R, Bradley LA, Fillingim RB. Single Nucleotide Polymorphism in the COL11A2 Gene Associated with Heat Pain Sensitivity in Knee Osteoarthritis. Mol Pain 2018; 13:1744806917724259. [PMID: 28741447 PMCID: PMC5562334 DOI: 10.1177/1744806917724259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pain is one of the most prominent symptoms of osteoarthritis. However, there is often discordance between the pain experienced by individuals with osteoarthritis and the degree of articular pathology. This suggests that individual differences, including genetic variability in the central processing of nociceptive stimuli, may impact the presentation of osteoarthritis. Here, we show that the single nucleotide polymorphism rs16868943 in the collagen gene COL11A2 is significantly associated with lowered heat pain tolerance on the arm in participants with knee osteoarthritis (P = 1.21 × 10−6, P = 0.0053 after Bonferroni correction, beta = −3.42). A total of 161 knee osteoarthritis participants were included and evaluated for heat, punctate and pressure pain sensitivity of the affected knee and the ipsilateral arm. Each participant was genotyped for 4392 single nucleotide polymorphisms in genes implicated in pain perception, inflammation and mood and tested for association with pain sensitivity. The minor A allele of single nucleotide polymorphism rs16868943 was significantly associated with lower arm heat pain tolerance after correction for age, gender, race, and study site. This single nucleotide polymorphism was also nominally associated with other measures of heat pain sensitivity, including lowered knee heat pain tolerance (P = 1.14 × 10−5, P = 0.05 after Bonferroni correction), lowered arm heat pain threshold (P = 0.0039, uncorrected) and lowered knee heat pain threshold (P = 0.003, uncorrected). Addition of genotypes from 91 participants without knee pain produced a significant interaction between knee osteoarthritis status and the rs16868943 single nucleotide polymorphism in heat pain tolerance (P = 1.71 × 10−5), such that rs16868943 was not associated with heat pain tolerance in participants without knee pain (P = 0.12, beta = 1.3). This is the first study to show genetic association with heat pain tolerance in individuals with osteoarthritis. The association is specific to participants who have already developed knee osteoarthritis, suggesting that the COL11A2 gene, which has previously been associated with familial osteoarthritis, may play a role in pain sensitization after the development of osteoarthritis.
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Affiliation(s)
| | - Margaret R Wallace
- Department of Molecular Genetics & Microbiology, University of Florida, Gainesville, FL
| | - Kimberly T Sibille
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL
| | - Yenisel Cruz-Almeida
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
| | - Toni L Glover
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Christopher D King
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Adriana Addison
- Division of Clinical Immunology & Rheumatotology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey C Edberg
- Division of Clinical Immunology & Rheumatotology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Roland Staud
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Laurence A Bradley
- Division of Clinical Immunology & Rheumatotology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL
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Affiliation(s)
- Steven E. Harte
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Richard E. Harris
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Daniel J. Clauw
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
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Hemington KS, Cheng JC, Bosma RL, Rogachov A, Kim JA, Davis KD. Beyond Negative Pain-Related Psychological Factors: Resilience Is Related to Lower Pain Affect in Healthy Adults. THE JOURNAL OF PAIN 2017; 18:1117-1128. [DOI: 10.1016/j.jpain.2017.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 11/29/2022]
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12
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Increased risk of tinnitus in patients with temporomandibular disorder: a retrospective population-based cohort study. Eur Arch Otorhinolaryngol 2015; 273:203-8. [DOI: 10.1007/s00405-015-3491-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
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Haddad DS, Brioschi ML, Vardasca R, Weber M, Crosato EM, Arita ES. Thermographic characterization of masticatory muscle regions in volunteers with and without myogenous temporomandibular disorder: preliminary results. Dentomaxillofac Radiol 2014; 43:20130440. [PMID: 25144605 DOI: 10.1259/dmfr.20130440] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aims to conduct a non-invasive measurement of the cutaneous temperature of selected masticatory muscle regions of volunteers with and without myogenous temporomandibular disorder (TMD), using infrared thermography. METHODS 23 females (10 myogenous TMD volunteers and 13 controls) were recruited and studied. The temperature at the surface of the facial area over the anterior temporalis and masseter muscles was assessed by medical thermography, using regional lateral views and clinical examination. RESULTS The temperature levels measured at the masseter and anterior temporalis muscle regions in myogenous TMD volunteers (32.85 ± 0.85 and 34.37 ± 0.64 ºC, respectively) were significantly lower (p < 0.05) than those measured in controls (33.49 ± 0.92 and 34.78 ± 0.44 ºC, respectively). Medical infrared imaging indicated a mean difference of 1.4 ºC between the masseter and anterior temporalis regions. Analysis of the comparison between the absolute and normalized mean temperatures was performed using the pairwise comparison of receiver operating characteristic curves, and no statistically significant difference was observed (p > 0.05). The sensitivity and specificity of the thermographic assessment for the masseter region was of 70% and 73%, respectively and for the anterior temporalis region was of 80% and 62%, respectively. CONCLUSIONS This method of evaluating masticatory muscle regions of this preliminary study seems to indicate that it can be used as an aid in complimentary diagnosing of TMDs.
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Affiliation(s)
- D S Haddad
- 1 Discipline of Radiology, Department of Stomatology, School of Dentistry, University of São Paulo (FOUSP), São Paulo, São Paulo, Brazil
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Cruz-Almeida Y, Sibille KT, Goodin BR, Petrov ME, Bartley EJ, Riley JL, King CD, Glover TL, Sotolongo A, Herbert MS, Schmidt JK, Fessler BJ, Staud R, Redden D, Bradley LA, Fillingim RB. Racial and ethnic differences in older adults with knee osteoarthritis. Arthritis Rheumatol 2014; 66:1800-10. [PMID: 24729357 DOI: 10.1002/art.38620] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/04/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) contributes significantly to disability in older individuals, and racial/ethnic minorities are disproportionately affected. The present study aimed to characterize differences in clinical and experimental pain, including pain inhibition, among older African American (AA) and non-Hispanic white (NHW) subjects with knee OA. METHODS AA and NHW subjects with knee OA (n = 267) completed clinical and functional pain assessments, including quantitative sensory testing (QST). We hypothesized that, when compared to NHW subjects, AA subjects would display 1) lower pain tolerance and higher ratings of heat-, mechanical-, and cold-induced pain, 2) greater temporal summation of pain, 3) reduced pain inhibition, and 4) greater clinical pain and poorer function. In addition, we hypothesized that the findings from QST would significantly predict the severity of clinical pain within each race/ethnicity. RESULTS AA subjects with knee OA displayed increased pain sensitivity, greater temporal summation, and reduced pain inhibition when compared to NHW subjects with knee OA. Moreover, AA subjects reported greater clinical pain and poorer function. Racial/ethnic differences in clinical pain became nonsignificant when the analyses were controlled for education and annual income, whereas differences in QST findings remained highly significant. Although the extent of pain inhibition predicted the severity of clinical pain in both groups, different QST measures were additionally predictive of clinical pain within each group. CONCLUSION The results of this study establish that there are racial/ethnic differences in experimental and clinical pain and function in older individuals with knee OA. Our findings indicating that different QST measures were associated with clinical pain within the 2 racial/ethnic groups, whereas reduced pain inhibition was important in all participants, warrant further study in order to elucidate the common and group-specific pathophysiologic mechanisms contributing to clinical pain in OA.
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Pickering ME, Bunna P, Rat P, Madeline G, Lebost C, Serrie A, Pereira B. Acute Pain Evaluation with Algoplus®Scale in Cambodian Patients. PAIN MEDICINE 2013; 14:1971-6. [DOI: 10.1111/pme.12174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reddy KSK, Rani PU, Naidu MUR, Rao TRK. A simple cold pressure technique for the evaluation of analgesic drugs in healthy subjects. Indian J Pharmacol 2013; 44:571-5. [PMID: 23112415 PMCID: PMC3480786 DOI: 10.4103/0253-7613.100375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 05/10/2012] [Accepted: 07/01/2012] [Indexed: 11/13/2022] Open
Abstract
Aim: An experimental pain model which is sensitive and reproducible would be a useful pharmacological tool both for existing and new drugs. The aim of the present study was to establish a simple and reliable method of producing experimental pain which can be used for screening of analgesic agents. Materials and Methods: The method was standardized by recording pain threshold and pain tolerance values in 24 healthy volunteers. Reproducibility of the test procedure was evaluated by recording the pain threshold and pain tolerance values by a single observer on two sessions (inter-day reproducibility), and second observer in one session (inter-observer reproducibility), separately. Validity of the model was further tested by evaluating the analgesic effect of tramadol in 12 healthy volunteers. Results: Cold pain model was found to produce low variability with coefficient of variation less than 15%. Inter-observer and inter-day reproducibility was very good as shown by Bland – Altman plot with most of the values within ± 2SD. Analgesic activity by Tramadol was statistically different from placebo (P < 0.05). Conclusion: The newly developed pain model offers a stable and sensitive method for the early assessment of analgesic activity.
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Affiliation(s)
- K Sunil Kumar Reddy
- Department of Clinical Pharmacology and Therapeutics, ICMR Advance Centre for Clinical Pharmacodynamic, Nizam's Institute of Medical Sciences, Hyderabad, India
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King CD, Sibille KT, Goodin BR, Cruz-Almeida Y, Glover TL, Bartley E, Riley JL, Herbert MS, Sotolongo A, Schmidt J, Fessler BJ, Redden DT, Staud R, Bradley LA, Fillingim RB. Experimental pain sensitivity differs as a function of clinical pain severity in symptomatic knee osteoarthritis. Osteoarthritis Cartilage 2013; 21:1243-52. [PMID: 23973137 PMCID: PMC3831366 DOI: 10.1016/j.joca.2013.05.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 05/14/2013] [Accepted: 05/20/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pain in knee osteoarthritis (OA) has historically been attributed to peripheral pathophysiology; however, the poor correspondence between objective measures of disease severity and clinical symptoms suggests that non-local factors, such as altered central processing of painful stimuli, also contribute to clinical pain in knee OA. Consistent with this notion, recent evidence demonstrates that patients with knee OA exhibit increased sensitivity to painful stimuli at body sites unaffected by clinical pain. DESIGN In order to further investigate the contribution of altered pain processing to knee OA pain, the current study tested the hypothesis that symptomatic knee OA is associated with enhanced sensitivity to experimental pain stimuli at the knee and at remote body sites unaffected by clinical pain. We further anticipated that pain sensitivity would differ as a function of the OA symptom severity. Older adults with and without symptomatic knee OA completed a series of experimental pain assessments. A median split of the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) was used to stratify participants into low vs high OA symptom severity. RESULTS Compared to controls and the low symptom group, individuals in the high symptom group were more sensitive to suprathreshold heat stimuli, blunt pressure, punctuate mechanical, and cold stimuli. Individuals in the low symptomatic OA group subgroup exhibited experimental pain responses similar to the pain-free group on most measures. No group differences in endogenous pain inhibition emerged. CONCLUSIONS These findings suggest that altered central processing of pain is particularly characteristic of individuals with moderate to severe symptomatic knee OA.
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Affiliation(s)
- Christopher D. King
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Kimberly T. Sibille
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Burel R. Goodin
- University of Alabama-Birmingham, Department of Psychology, Birmingham, AL 35294, USA
| | - Yenisel Cruz-Almeida
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Toni L. Glover
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
- University of Florida College of Nursing, Gainesville, FL 32610, USA
| | - Emily Bartley
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Joseph L. Riley
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Matthew S. Herbert
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Adriana Sotolongo
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Jessica Schmidt
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Barri J. Fessler
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - David T. Redden
- University of Alabama at Birmingham, School of Public Health, Department of Biostatistics, Birmingham AL 35294, USA
| | - Roland Staud
- University of Florida, College of Medicine, Gainesville, FL 32610, USA
| | - Laurence A. Bradley
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Roger B. Fillingim
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
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Uçar D, Dıraçoğlu D, Karan A. Temporomandibular dysfunction syndrome: A prospective study of 255 consecutive patients. J Int Med Res 2013; 41:804-8. [DOI: 10.1177/0300060513487628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To determine the relationship between temporomandibular dysfunction syndrome (TMDS), sex and pain severity. Methods Data were collected prospectively from consecutive patients with TMDS. Patients were divided into four subgroups according to signs and symptoms: myofascial pain; intra-articular disorders; extra-articular disorders; degenerative disorders. Intergroup sex distribution differences were evaluated, the pain severity between the four subgroups was compared, and the rates of bruxism and inco-ordination were measured. A visual analogue scale was used to rate the pain. Results A total of 255 patients with TMDS were included in the study. A significantly higher rate of extra-articular disorders was found in male patients. Bruxism was found to be significantly more common in females than in males. There was no significant difference in the prevalence of inco-ordination based on sex. The overall pain score was higher in females than in males, but there was no significant difference. The pain score was significantly higher in patients in the degenerative disorders subgroup, compared with other subgroups. Conclusions There was no relationship between TMDS and pain and sex. Pain scores were significantly higher in the degenerative disorders subgroup, compared with other subgroups.
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Affiliation(s)
- Demet Uçar
- Department of Physical Treatment and Rehabilitation, Medical Faculty, Dicle University, Diyarbakir, Turkey
- Department of Physical Treatment and Rehabilitation, Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Demirhan Dıraçoğlu
- Department of Physical Treatment and Rehabilitation, Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ayşe Karan
- Department of Physical Treatment and Rehabilitation, Medical Faculty, Istanbul University, Istanbul, Turkey
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Lu Q, Zeltzer L, Tsao J. Multiethnic differences in responses to laboratory pain stimuli among children. Health Psychol 2013; 32:905-14. [PMID: 23668844 DOI: 10.1037/a0032428] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE A growing body of literature suggests ethnic differences in experimental pain. However, these studies largely focus on adults and the comparison between Caucasians and African Americans. The primary aim of this study is to determine ethnic differences in laboratory-induced pain in a multiethnic child sample. METHOD Participants were 214 healthy children (mean age = 12.7, SD = 3.0 years). Ninety-eight Caucasian, 58 Hispanic, 34 African American, and 24 Asian children were exposed to four trials of pressure and radiant heat pain stimuli. Pain responses were assessed with self-report measures (i.e., pain intensity and unpleasantness) and behavioral observation (i.e., pain tolerance). RESULTS Asians demonstrated more pain sensitivity than Caucasians, who evidenced more pain sensitivity than African Americans and Hispanics. The results hold even after controlling for age, sex, SES, and experimenter's ethnicity. Asians also showed higher anticipatory anxiety compared with other ethnic groups. Anticipatory anxiety accounted for some ethnic differences in pain between Asians, Hispanics, and African Americans. CONCLUSIONS By examining response to laboratory pain stimuli in children representing multiple ethnicities, an understudied sample, the study reveals unique findings compared to the existing literature. These findings have implications for clinicians who manage acute pain in children from diverse ethnic backgrounds. Future investigations should examine mechanisms that account for ethnic differences in pain during various developmental stages.
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Affiliation(s)
- Qian Lu
- Department of Psychology, University of Houston, Houston, TX 77204-5022, USA.
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Abstract
OBJECTIVES Affect is neurobiologically based, influences emotions, contributes to temperamental characteristics, and can be evaluated from both state and trait perspectives. Associations between state-related positive affect (PA), negative affect (NA), and chronic pain have been investigated. However, little is known about the relationship between trait affect patterns and pain-related experiences. Affect balance style (ABS) provides a framework to assess the combined contribution of trait PA and NA. Psychological factors and experimental pain sensitivity are indicated as predictors of chronic pain onset. The current study investigated the relationship between ABS, pain sensitivity, and pain-related measures in healthy adults. METHODS Participants (n=372) completed quantitative sensory testing, pain-related questionnaires, and the Positive and Negative Affect Scale. ABS groups were categorized as Healthy (high PA, low NA), Low (low PA, low NA), Depressive (low PA, high NA), and Reactive (high PA, high NA). Z-scores were computed for 3 experimental pain measures: ischemic, pressure, and heat. RESULTS ABS groups significantly differed on ischemic pain sensitivity and pain-related measures. Specifically, the Healthy group demonstrated lower ischemic pain sensitivity compared with the Reactive group (P=0.02); the Depressive and Reactive groups endorsed higher somatic symptoms compared with the Healthy group (P<0.02); the Low and Depressive groups reported more physical stimuli sensitivity than the Healthy group (P<0.02); and the Reactive group indicated more passive coping strategies then the Low and Healthy groups (P=0.001). DISCUSSION Findings from the study suggest that among healthy adults, trait affect patterns are associated with ischemic experimental pain sensitivity and other pain-related measures.
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Maixner W, Diatchenko L, Dubner R, Fillingim RB, Greenspan JD, Knott C, Ohrbach R, Weir B, Slade GD. Orofacial pain prospective evaluation and risk assessment study--the OPPERA study. THE JOURNAL OF PAIN 2012; 12:T4-11.e1-2. [PMID: 22074751 DOI: 10.1016/j.jpain.2011.08.002] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 07/19/2011] [Indexed: 12/01/2022]
Affiliation(s)
- William Maixner
- Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, North Carolina 27599-7455, USA.
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White matter brain and trigeminal nerve abnormalities in temporomandibular disorder. Pain 2012; 153:1467-1477. [DOI: 10.1016/j.pain.2012.04.003] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/22/2012] [Accepted: 04/05/2012] [Indexed: 12/12/2022]
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Velly AM, Look JO, Carlson C, Lenton PA, Kang W, Holcroft CA, Fricton JR. The effect of catastrophizing and depression on chronic pain – a prospective cohort study of temporomandibular muscle and joint pain disorders. Pain 2011; 152:2377-2383. [DOI: 10.1016/j.pain.2011.07.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Revised: 05/07/2011] [Accepted: 07/08/2011] [Indexed: 10/17/2022]
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Zhou Q, Verne GN. New insights into visceral hypersensitivity--clinical implications in IBS. Nat Rev Gastroenterol Hepatol 2011; 8:349-55. [PMID: 21643039 PMCID: PMC3437337 DOI: 10.1038/nrgastro.2011.83] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A subset of patients with IBS have visceral hypersensitivity and/or somatic hypersensitivity. Visceral hypersensitivity might have use as a clinical marker of IBS and could account for symptoms of urgency for bowel movements, bloating and abdominal pain. The mechanisms that lead to chronic visceral hypersensitivity in patients who have IBS are unclear. However, several working models may be considered, including: nociceptive input from the colon that leads to hypersensitivity; increased intestinal permeability that induces a visceral nociceptive drive; and alterations in the expression of microRNAs in gastrointestinal tissue that might be delivered via blood microvesicles to other target organs, such as the peripheral and/or central nervous system. As such, the chronic visceral hypersensitivity that is present in a subset of patients with IBS might be maintained by both peripheral and central phenomena. The theories underlying the development of chronic visceral hypersensitivity in patients with IBS are supported by findings from new animal models in which hypersensitivity follows transient inflammation of the colon. The presence of somatic hypersensitivity and an alteration in the neuroendocrine system in some patients who have IBS suggests that multisystemic factors are involved in the overall disorder. Thus, IBS is similar to other chronic pain disorders, such as fibromyalgia, chronic regional pain disorder and temporomandibular joint disorder, as chronic nociceptive mechanisms are activated in all of these disorders.
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Asians differ from non-Hispanic Whites in experimental pain sensitivity. Eur J Pain 2011; 15:764-71. [PMID: 21561793 DOI: 10.1016/j.ejpain.2010.11.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 11/01/2010] [Accepted: 11/29/2010] [Indexed: 11/21/2022]
Abstract
This study examined differences between Asians and non-Hispanic Whites (Whites) in pain sensitivity, and its relationship to mean arterial pressure (MAP) and heart rate (HR). In 30 Whites (50% female) and 30 Asians (50% female), experimental pain sensitivity was assessed with a hand cold pressor task, yielding measures of pain threshold, tolerance, intensity, and unpleasantness. Mean arterial pressure and HR measurements taken at rest and in response to speech stress were assessed. Perceived stress, anxiety, perfectionism, parental criticism, parental expectations and depressive symptoms were also measured. The results indicated that for the cold pain test, Asians demonstrated significantly lower pain threshold and tolerance levels than Whites. Although no ethnic differences were seen for MAP or HR responses to stress, for Whites higher stress MAP levels were correlated with reduced pain sensitivity, while for Asians higher baseline and stress HR levels were correlated with reduced pain sensitivity. Asians reported higher parental expectations and greater parental criticism than Whites. For Asians only, higher levels of perfectionism were related to more depressive symptoms, anxiety and perceived stress. These results indicate that Asian Americans are more sensitive to experimental pain than Whites and suggest ethnic differences in endogenous pain regulatory mechanisms (e.g. MAP and HR). The results may also have implications for understanding ethnic differences in clinical pain.
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Mohn C, Vassend O, Knardahl S. Psychophysiological responses to pain stimulation and cognitive tasks in female temporomandibular disorder patients. Scand J Pain 2011; 2:72-82. [PMID: 29913733 DOI: 10.1016/j.sjpain.2010.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
Abstract
Background and purpose Psychophysiological factors may contribute to the development of temporomandibular disorders (TMD). Both local orofacial and systemic responses have been investigated. However, most studies have concentrated on physiological responding during cognitive challenges, while responses during painful tasks may be highly relevant for the development of chronic pain conditions. Moreover, the relationship between experimental challenges and physiological responding may be influenced by affective responses during the experimental tasks, an issue not often considered in the literature. Methods This study compared electromyography (EMG) of the left masseter and left trapezius muscles, orofacial and digital skin blood-flow (SBF), mean arterial pressure (MAP), and heart rate (HR) at rest, during orofacial isometric contraction, electrocutaneous pain stimulation of the left hand, pressure pain stimulation of the masseter muscle and the sternum, and three cognitive tasks (reading aloud, a simulated job interview, and visuomotoric tracking). The participants were 25 TMD patients and 25 matched pain-free controls, all females. Affective responses were assessed with the State part of the State-Trait Personality Inventory and with Visual Analogue Scales. Results Masseter EMG levels were significantly lower in the TMD group relative to the control group during jaw contraction, pressure pain stimulation, the relaxation periods, and cognitive tasks. SBF, MAP, and HR responses were largely similar in the two groups, with SBF responses to pain stimulation evident at lower levels of stimulation than previously found. The TMD patients reported significantly higher levels of negative affect during the experiment. Conclusions and implications The low EMG responses in the TMD group may be taken in support of the Pain Adaptation Model of musculoskeletal pain, in which reduced muscular activity serves to protect a painful area. However, it may also be supportive of the Integrated Pain Adaptation Model, where higher central nervous structures influence local muscular output. The group similarities in systemic physiological responding in combination with the elevated levels of negative state affect in the TMD patients confirm previous reports of psychosocial differences being more reliable indicators of TMD than generalized physiological responding.
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Affiliation(s)
- Christine Mohn
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Olav Vassend
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Stein Knardahl
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Work-Related Musculoskeletal Disorders, National Institute of Occupational Health, Oslo, Norway
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Weissman-Fogel I, Moayedi M, Tenenbaum HC, Goldberg MB, Freeman BV, Davis KD. Abnormal cortical activity in patients with temporomandibular disorder evoked by cognitive and emotional tasks. Pain 2011; 152:384-396. [DOI: 10.1016/j.pain.2010.10.046] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 10/28/2010] [Accepted: 10/28/2010] [Indexed: 12/19/2022]
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Mechlin B, Heymen S, Edwards CL, Girdler SS. Ethnic differences in cardiovascular-somatosensory interactions and in the central processing of noxious stimuli. Psychophysiology 2010; 48:762-73. [PMID: 21039586 DOI: 10.1111/j.1469-8986.2010.01140.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ethnic differences in central sensitization of pain processing and stress-relevant endogenous pain regulatory mechanisms were examined. Forty-four African Americans (AAs; 50% women) and 44 non-Hispanic Whites (nHWs; 50% women) matched for socioeconomic status, were tested for pain responses to the temporal summation of heat pulses and ischemic and cold pain. Resting and stress blood pressure (BP) and norepinephrine (NE) were assessed. AAs had heightened pain responses to all 3 pain tasks relative to nHWs. In nHWs, higher BP and NE were related to reduced pain. In AAs, there was no relationship between BP and pain, but higher NE was related to increased pain. This study provides evidence for ethnic differences in centrally mediated pain and extends prior research demonstrating ethnic differences in endogenous pain regulatory mechanisms. These results have implications for understanding biobehavioral factors contributing to ethnic disparities in clinical pain.
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Affiliation(s)
- Beth Mechlin
- Department of Psychology, Washington and Lee University, Lexington, Virginia 24450, USA.
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Zhou Q, Fillingim RB, Riley JL, Verne GN. Ischemic hypersensitivity in irritable bowel syndrome patients. PAIN MEDICINE 2010; 11:1619-27. [PMID: 21029350 DOI: 10.1111/j.1526-4637.2010.00954.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Mixed evidence exists regarding whether irritable bowel syndrome (IBS) patients show increased somatic pain perception compared with controls. The current study used a deep, tonic somatic pain stimulus (ischemic pain) to evaluate somatic hypersensitivity in IBS patients. METHODS A total of 27 diarrhea-predominant and 15 constipation-predominant IBS patients, and 29 controls participated in the study. The modified submaximal effort tourniquet procedure was performed to induce ischemic arm pain, and the time required to reach pain threshold and pain tolerance were recorded in seconds. All subjects completed the Functional Bowel Disease Severity Index (FBDSI) scale as well as several psychosocial instruments. Group differences for threshold and tolerance were determined using a series of one-way anova tests followed by Tukey comparisons. RESULTS IBS patients had a shorter time to ischemic threshold (F = 34.606, P < 0.001) and tolerance (F = 38.656, P < 0.001) compared with controls; however, the groups did not differ on ratings of pain at the time of tolerance. IBS patients had a higher rating on the FBDSI scale compared with controls (P < 0.001), and ischemic pain threshold was negatively correlated with the FBDSI score. CONCLUSIONS The results of this study suggest that a widespread alteration in central pain processing in IBS patients may be present as they display hypersensitivity to ischemic arm pain, and ischemic pain threshold was associated with clinical symptoms. These findings could reflect a dysfunction in inhibitory pain systems in IBS patients, as ischemic (deep) pain may be under tonic inhibitory control.
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Affiliation(s)
- Qiqi Zhou
- Department of Medicine, The Ohio State University, Columbus, Ohio 43212, USA
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Effect of catechol-O-methyltransferase polymorphism on response to propranolol therapy in chronic musculoskeletal pain: a randomized, double-blind, placebo-controlled, crossover pilot study. Pharmacogenet Genomics 2010; 20:239-48. [PMID: 20216107 DOI: 10.1097/fpc.0b013e328337f9ab] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Three common haplotypes in the gene encoding catechol-O-methyltransferase (COMT) have been associated with pain modulation and the risk of developing chronic musculoskeletal pain, namely temporomandibular disorder (TMD). Haplotypes coding for higher enzymatic activity were correlated with lower pain perception. Rodent studies showed that COMT inhibition increases pain sensitivity through beta2/3-adrenergic receptors. We hypothesized that the nonselective beta-adrenergic antagonist propranolol will reduce clinical and experimental pain in TMD patients in a manner dependent on the individuals' COMT diplotype. METHODS Forty Caucasian female participants meeting the Research Diagnostic Criteria for TMD were genotyped for COMT polymorphisms and completed a randomized, double-blind, placebo-controlled, two-period crossover pilot study. Each period consisted of a baseline assessment week followed by an intervention week (propranolol or placebo). Changes in clinical pain ratings, psychological status, and responses to heat and pressure stimuli between baseline and intervention weeks were compared across periods. RESULTS The number of patients reporting a reduction in pain intensity rating was greater during propranolol treatment (P=0.014) compared with placebo. Propranolol significantly reduced a composite pain index (P=0.02) but did not decrease other clinical and experimental pain ratings. When stratified by the COMT high activity haplotype, a beneficial effect of propranolol on pain perception was noted in patients not carrying this haplotype, a diminished benefit was observed in the heterozygotes, and no benefit was noted in the homozygotes. CONCLUSION COMT haplotypes may serve as genetic predictors of propranolol treatment outcome, identifying a subgroup of TMD patients who will benefit from propranolol therapy.
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Zhou Q, Fillingim RB, Riley JL, Malarkey WB, Verne NG. Central and peripheral hypersensitivity in the irritable bowel syndrome. Pain 2010; 148:454-461. [PMID: 20074857 DOI: 10.1016/j.pain.2009.12.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 11/28/2009] [Accepted: 12/08/2009] [Indexed: 12/14/2022]
Abstract
Previous investigations of somatic hypersensitivity in IBS patients have typically involved only a single stimulus modality, and little information exists regarding whether patterns of somatic pain perception vary across stimulus modalities within a group of patients with IBS. Therefore, the current study was designed to characterize differences in perceptual responses to a battery of noxious somatic stimuli in IBS patients compared to controls. A total of 78 diarrhea-predominant and 57 controls participated in the study. We evaluated pain threshold and tolerance and sensory and affective ratings of contact thermal, mechanical pressure, ischemic stimuli, and cold pressor stimuli. In addition to assessing perceptual responses, we also evaluated differences in neuroendocrine and cardiovascular responses to these experimental somatic pain stimuli. A subset of IBS patients demonstrated the presence of somatic hypersensitivity to thermal, ischemic, and cold pressor nociceptive stimuli. The somatic hypersensitivity in IBS patients was somatotopically organized in that the lower extremities that share viscerosomatic convergence with the colon demonstrate the greatest hypersensitivity. There were also changes in ACTH, cortisol, and systolic blood pressure in response to the ischemic pain testing in IBS patients when compared to controls. The results of this study suggest that a more widespread alteration in central pain processing in a subset of IBS patients may be present as they display hypersensitivity to heat, ischemic, and cold pressor stimuli.
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Affiliation(s)
- QiQi Zhou
- Department of Medicine, Ohio State University, Columbus, OH, USA College of Dentistry, University of Florida, Gainesville, FL, USA North Florida/South Georgia Veteran Health System, USA Research Service, Cincinnati VAMC, Cincinnati, OH, USA Institute of Behavioral Medicine Research, Columbus, OH, USA
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Pfau DB, Rolke R, Nickel R, Treede RD, Daublaender M. Somatosensory profiles in subgroups of patients with myogenic temporomandibular disorders and fibromyalgia syndrome. Pain 2009; 147:72-83. [DOI: 10.1016/j.pain.2009.08.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 07/08/2009] [Accepted: 08/13/2009] [Indexed: 10/20/2022]
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Tashiro A, Okamoto K, Bereiter DA. NMDA receptor blockade reduces temporomandibular joint-evoked activity of trigeminal subnucleus caudalis neurons in an estrogen-dependent manner. Neuroscience 2009; 164:1805-12. [PMID: 19799971 DOI: 10.1016/j.neuroscience.2009.09.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/23/2009] [Accepted: 09/25/2009] [Indexed: 01/10/2023]
Abstract
Estrogen status is a risk factor in painful temporomandibular disorders (TMJD). Previously we reported that estradiol (E2) enhanced nociceptive processing of TMJ input by neurons in superficial laminae at the spinomedullary (Vc/C(1-2)) region; however, the mechanisms for this enhancement are not known. The present study determined if ionotropic glutamate receptors contribute to TMJ nociceptive processing in an E2-dependent manner. Ovariectomized (OvX) female rats were treated with high E2 (HE2) or low dose E2 (LE2) for 2 days and neural activity was recorded in laminae I-II at the Vc/C(1-2) region. TMJ-responsive units were activated by ATP injections into the joint space. ATP-evoked unit responses in HE2 rats were reduced significantly by topical application of the N-methyl-D-aspartate receptor antagonist, D(-)-2-amino-5-phosphonopentanoic acid (AP5) in a dose-related manner, while units from LE2 were not affected. Application of the non-NMDA receptor antagonist, 6,7-dinitroquinoxaline-2,3-dione (DNQX), inhibited the ATP-evoked responses in both groups. Spontaneous activity of TMJ units was not influenced by AP5, whereas it was reduced by DNQX similarly in both groups. The high threshold convergent cutaneous receptive field area of TMJ units was not changed by AP5, whereas DNQX caused a significant reduction in both groups. These results suggest that NMDA-dependent mechanisms contribute to the enhanced ATP-evoked responses of TMJ units in superficial laminae at the Vc/C(1-2) region under high E2 conditions, while non-NMDA-dependent mechanisms modify the encoding properties of TMJ units independent of E2 status.
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Affiliation(s)
- A Tashiro
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, 18-214 Moos Tower, 515 Delaware Street Southeast, Minneapolis, MN 55455, USA.
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Nixdorf DR, Hemmaty A, Look JO, Schiffman EL, John MT. Electric toothbrush application is a reliable and valid test for differentiating temporomandibular disorders pain patients from controls. BMC Musculoskelet Disord 2009; 10:94. [PMID: 19643013 PMCID: PMC2728093 DOI: 10.1186/1471-2474-10-94] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 07/30/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Current methods for identifying patients with pain hypersensitivity are sufficiently complex to limit their widespread application in clinical settings. We assessed the reliability and validity of a simple multi-modal vibrotactile stimulus, applied using an electric toothbrush, to evaluate its potential as a screening tool for central sensitization. METHODS Fourteen female temporomandibular disorders (TMD) subjects with myofascial pain (RDC/TMD Ia or Ib) and arthralgia (RDC/TMD IIIa) were compared to 13 pain-free controls of matched age and gender. Vibrotactile stimulus was performed with an electric toothbrush, applied with 1 pound pressure for 30 seconds in four locations: over the lateral pole of the temporomandibular joint, masseter, temporalis, and mid-ventral surface of forearm. Pain intensity (0-10) was recorded following the stimulus at 0, 15, 30, and 60 seconds. Test-retest reliability was assessed with measurements from 8 participants, taken 2-12 hours apart. Case versus control differentiation involved comparison of area under the curve (AUC). A receiver operating characteristic (ROC) curve was used to determine cutoff AUC scores for maximum sensitivity and specificity for this multi-modal vibrotactile stimulus. RESULTS Test-retest reliability resulted in an ICC of 0.87 for all 4 pooled sites. ROC-determined AUC cutoff scores resulted in a sensitivity of 57% and specificity of 92% for all 4 pooled sites. CONCLUSION The electric toothbrush stimulus had excellent test-retest reliability. Validity of the scores was demonstrated with modest sensitivity and good specificity for differentiating TMD pain patients from controls, which are acceptable properties for a screening test.
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Affiliation(s)
- Donald R Nixdorf
- Department of Diagnostic & Biological Sciences, School of Dentistry, Minneapolis, MN, 55455, USA
- Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Azar Hemmaty
- Department of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - John O Look
- Department of Diagnostic & Biological Sciences, School of Dentistry, Minneapolis, MN, 55455, USA
| | - Eric L Schiffman
- Department of Diagnostic & Biological Sciences, School of Dentistry, Minneapolis, MN, 55455, USA
| | - Mike T John
- Department of Diagnostic & Biological Sciences, School of Dentistry, Minneapolis, MN, 55455, USA
- Department of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
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Zhou Q, Fillingim RB, Riley III JL, Verne GN. Thermal hypersensitivity in a subset of irritable bowel syndrome patients. World J Gastroenterol 2009; 15:3254-60. [PMID: 19598301 PMCID: PMC2710781 DOI: 10.3748/wjg.15.3254] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To characterize thermal hypersensitivity in patients with constipation- and diarrhea-predominant irritable bowel syndrome (IBS).
METHODS: Thermal pain sensitivity was tested among patients with diarrhea-predominant IBS (D-IBS) and constipation-predominant IBS (C-IBS) compared to healthy subjects. A total of 42 patients (29 female and 13 male; mean age 27.0 ± 6.4 years) with D-IBS; 24 patients (16 female and eight male; mean age 32.5 ± 8.8 years) with C-IBS; and 52 control subjects (34 female and 18 male; mean age 27.3 ± 8.0 years) participated in the study. Thermal stimuli were delivered using a Medoc Thermal Sensory Analyzer with a 3 cm × 3 cm surface area. Heat pain threshold (HPTh) and heat pain tolerance (HPTo) were assessed on the left ventral forearm and left calf using an ascending method of limits. The Functional Bowel Disease Severity Index (FBDSI) was also obtained for all subjects.
RESULTS: Controls were less sensitive than C-IBS and D-IBS (both at P < 0.001) with no differences between C-IBS and D-IBS for HPTh and HPTo. Thermal hyperalgesia was present in both groups of IBS patients relative to controls, with IBS patients reporting significantly lower pain threshold and pain tolerance at both test sites. Cluster analysis revealed the presence of subgroups of IBS patients based on thermal hyperalgesia. One cluster (17% of the sample) showed a profile of heat pain sensitivity very similar to that of healthy controls; a second cluster (47% of the sample) showed moderate heat pain sensitivity; and a third cluster (36% of the sample) showed a very high degree of thermal hyperalgesia.
CONCLUSION: A subset of IBS patients had thermal hypersensitivity compared to controls, who reported significantly lower HPTh and HPTo. All IBS patients had a higher score on the FBDSI than controls. Interestingly, the subset of IBS patients with high thermal sensitivity (36%) had the highest FBDSI score compared to the other two groups of IBS patients.
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Klatzkin RR, Mechlin B, Girdler SS. Menstrual cycle phase does not influence gender differences in experimental pain sensitivity. Eur J Pain 2009; 14:77-82. [PMID: 19217329 DOI: 10.1016/j.ejpain.2009.01.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 12/31/2008] [Accepted: 01/13/2009] [Indexed: 11/17/2022]
Abstract
Influence of menstrual cycle phase on experimental pain sensitivity in women and on gender differences in pain sensitivity was examined in 48 men and 49 women in response to cold pressor, heat, and ischemic pain. Each woman was tested at three points in their menstrual cycle in randomized order, the early follicular, late follicular, and luteal phases, while men were also tested three times, controlling for number of days between test sessions. Cycle phase was confirmed via serum hormone levels. As expected, women were significantly more sensitive to cold pain (p<.01), to heat pain (p<.0001), and to ischemic pain (p<.01) than men. However, pain perception during each task was not influenced by the menstrual cycle in women, nor did the menstrual cycle influence the magnitude of the gender differences in pain sensitivity. These results indicate that although women are more sensitive to a variety of noxious stimuli than men, menstrual cycle phase does not appear to moderate those differences in healthy men and women.
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Affiliation(s)
- Rebecca R Klatzkin
- Department of Psychology, University of North Carolina at Chapel Hill, Medical Research Bldg A, Chapel Hill, NC 27599-7175, USA
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Slade GD, Diatchenko L, Ohrbach R, Maixner W. Orthodontic Treatment, Genetic Factors and Risk of Temporomandibular Disorder. Semin Orthod 2008; 14:146-156. [PMID: 18663384 DOI: 10.1053/j.sodo.2008.02.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traditionally, four groups of factors have been identified in the etiology of temporomandibular disorder (TMD): anatomical variation in the masticatory system; psychosocial characteristics; pain in other body regions; and demographics. Orthodontic treatment has been variously cited both as a protective and harmful factor in TMD etiology. Recently, a search has begun for a genetic influence on TMD etiology. Genetic markers can be of additional value in identifying gene-environment interactions, that is, isolating population sub-groups, defined by genotype in which environmental influences play a relatively greater or lesser etiological role. This paper reviews concepts and study design requirements for epidemiological investigations into TMD etiology. Findings are presented from a prospective cohort study of 186 females that illustrate an example of gene-environment interaction in TMD onset. Among people with a variant of the gene encoding catechol-O-methyl-transferase, an enzyme associated with pain responsiveness, risk of developing TMD was significantly greater for subjects who reported a history of orthodontic treatment compared with subjects who did not (P=0.04). While further studies are needed to investigate TMD etiology, this genetic variant potentially could help to identify patients whose risk of developing TMD is heightened following orthodontic treatment, hence serving as a risk marker useful in planning orthodontic care.
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Affiliation(s)
- Gary D Slade
- Gary D. Slade, BDSc, DDPH, PhD, Professor of Oral Epidemiology, Dental School, University of Adelaide, Australia
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Grewen KM, Light KC, Mechlin B, Girdler SS. Ethnicity is associated with alterations in oxytocin relationships to pain sensitivity in women. ETHNICITY & HEALTH 2008; 13:219-41. [PMID: 18568974 PMCID: PMC4624387 DOI: 10.1080/13557850701837310] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED It is well established that African Americans (AA) experience greater pain associated with a variety of clinical conditions, and greater pain sensitivity to experimental pain tasks relative to non-Hispanic Whites (W). Notably, African Americans do not show the same relationships involving endogenous pain regulatory mechanisms and pain sensitivity documented in Caucasians, including positive associations between blood pressure, norepinephrine, cortisol and greater pain tolerance. OBJECTIVES The purpose of this study was to examine the relationship between plasma oxytocin (OT) and pain sensitivity and to explore the relation of OT to other factors known to influence pain perception. DESIGN OT concentration and sensitivity to ischemic, cold pressor, and thermal pain tasks were assessed in African American (n=25) and non-Hispanic White (n=23) pre-menopausal women. RESULTS African American women demonstrated significantly lower pain tolerance across tasks compared with Whites (F(1,46)=6.31, p=0.0156) and also exhibited lower plasma OT levels (AA: 3.90, W: 7.05 pg/mL; p=0.0014). Greater OT levels were correlated with greater tolerance to ischemic pain (r=0.36, p=0.013) and accounted for a marginally significant portion of the ethnic difference in ischemic pain tolerance (B=+0.29, p=0.06). Greater OT was also correlated with greater tolerance of cold pressor pain (r=0.31, p=0.03); however, this association was no longer seen after the variance due to ethnicity was accounted for. CONCLUSION These data suggest that reduced oxytocinergic function may be one of multiple biological factors contributing to the greater sensitivity to experimental ischemic pain, and to the greater burden of some types of clinical pain experienced by African Americans compared with Whites.
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Affiliation(s)
- Karen M Grewen
- Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, USA.
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39
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Gender-specific adaptations of upper trapezius muscle activity to acute nociceptive stimulation. Pain 2008; 138:217-225. [PMID: 18485595 DOI: 10.1016/j.pain.2008.04.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 04/01/2008] [Accepted: 04/07/2008] [Indexed: 11/20/2022]
Abstract
This study examined gender differences in the effect of experimental muscle pain on changes in the relative activation of regions of the upper trapezius muscle during a sustained contraction. Surface electromyographic (EMG) signals were recorded from multiple locations over the upper trapezius muscle with a 10 x 5 grid of electrodes from nine women and nine men during 90 degrees shoulder abduction sustained for 60s. Measurements were performed before and after the injection of 0.4 ml hypertonic (painful) and isotonic (control) saline into the cranial region of the upper trapezius muscle. The EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG amplitude distribution. The peak pain intensity following the injection of hypertonic saline was greater for women (numerical rating scale 0-10: women 6.0+/-2.1, men 4.2+/-0.9; P<0.01). For both genders, upper trapezius RMS averaged across the grid decreased following the injection of hypertonic saline (P<0.0001). Moreover, there was a relatively larger pain-induced decrease in RMS in the cranial region compared to the caudal region of the muscle for both genders. During the non-painful sustained contractions, the EMG RMS progressively increased more in the cranial than the caudal region, for both men and women, due to fatigue. This mechanism was maintained in men but not in women during the painful condition. The results demonstrate that muscle pain alters the normal adaptation of upper trapezius muscle activity to fatigue in women but not in men.
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Experimental Pain Sensitivity in Women With Temporomandibular Disorders and Pain-free Controls: The Relationship to Orofacial Muscular Contraction and Cardiovascular Responses. Clin J Pain 2008; 24:343-52. [DOI: 10.1097/ajp.0b013e318162eaf4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Klatzkin RR, Mechlin B, Bunevicius R, Girdler SS. Race and histories of mood disorders modulate experimental pain tolerance in women. THE JOURNAL OF PAIN 2007; 8:861-8. [PMID: 17644044 PMCID: PMC2174960 DOI: 10.1016/j.jpain.2007.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 05/28/2007] [Accepted: 06/01/2007] [Indexed: 11/18/2022]
Abstract
UNLABELLED Thirty-two African American and 23 non-Hispanic white women were compared for experimental pain threshold and tolerance to thermal, ischemic, and cold pressor pain. Approximately half of each group had prior mood disorders (17 African Americans, 13 non-Hispanic whites), though all were free of current mood disturbance. Women with prior mood disorders were less sensitive to ischemic pain than women with no prior mood disorders (P < .05), whereas African Americans were more sensitive to ischemic pain than non-Hispanic whites, though only at pain tolerance (P < .001). For cold pressor pain, the effects of race were only seen in women with prior mood disorders, since African Americans with prior mood disorders were more sensitive than non-Hispanic whites with prior mood disorders (P < .05). These results indicate that experimental pain sensitivity in women is influenced by both race and histories of mood disorders. PERSPECTIVE We examined the association of race and histories of mood disorders with experimental pain sensitivity in an exclusively female sample. Our findings for racial differences in pain sensitivity may have implications for greater clinical pain in African American women. Persistent disturbance in pain modulatory mechanisms in women with a history of mood disorders may also have implications for the development of subsequent mood disturbances.
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Affiliation(s)
- Rebecca R Klatzkin
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7175, USA
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Abstract
Several pain conditions localized to the craniofacial region show a remarkable sex-related difference in their prevalence. These conditions include temporomandibular disorders and burning mouth syndrome as well as tension-type, migraine, and cluster headaches. The mechanisms that underlie sex-related differences in the prevalence of these craniofacial pain conditions remain obscure and likely involve both physiological and psychosocial factors. In terms of physiological factors relevant to the development of headache, direct evidence of sex-related differences in the properties of dural afferent fibers or durally activated second-order trigeminal sensory neurons has yet to be provided. There is, however, evidence for sex-related differences in the response properties of afferent fibers and second-order trigeminal sensory neurons that convey nociceptive input from other craniofacial tissues associated with sex-related differences in chronic pain conditions, such as those that innervate the masseter muscle and temporomandibular joint. Further, modulation of craniofacial nociceptive input by opioidergic receptor mechanisms appears to be dependent on biological sex. Research into mechanisms that may contribute to sex-related differences in trigeminal nociceptive processing has primarily focused on effect of the female sex hormone estrogen, which appears to alter the excitability of trigeminal afferent fibers and sensory neurons to noxious stimulation of craniofacial tissues. This article discusses current knowledge of potential physiological mechanisms that could contribute to sex-related differences in certain craniofacial pain conditions.
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Affiliation(s)
- Brian E Cairns
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
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Al-Khabbaz AK, Griffin TJ, Al-Shammari KF. Assessment of Pain Associated With the Surgical Placement of Dental Implants. J Periodontol 2007; 78:239-46. [PMID: 17274712 DOI: 10.1902/jop.2007.060032] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite increasing popularity and established predictability, limited information is available on the pain experience associated with the surgical placement of dental implants. The aim of this study was to assess patient-reported pain during and after implant insertion and to evaluate factors associated with this pain. METHODS This was a prospective, two-center study of adult patients scheduled for the surgical placement of one or more implants. Surgery was performed by an experienced periodontist or periodontal graduate students. Mean pain scores were evaluated with the use of a 0 to 10 scale during surgery and 24 hours and 1, 6, and 12 weeks after surgery and compared between the two centers. The association of pain scores at each time-point with patient-, operator-, and surgery-related factors was examined through univariate and multiple logistic regression analyses. RESULTS Five hundred ten implants were placed in 234 patients during the study. Mean pain scores were highest at 24 hours after surgery (2.01 +/- 0.11) and decreased gradually thereafter. Pain intensity was mild for the majority of patients at all time-points, and only a few patients had moderate or severe pain. Regression analysis revealed that factors significantly associated with pain after 24 hours included operator experience (odds ratio [OR] = 24.86), pain during surgery (OR = 2.81), and female gender (OR = 2.51). After 1 week, pain levels were associated significantly with having pain after 24 hours (OR = 38.69) and having a surgical template used during surgery (OR = 1.11). CONCLUSIONS Pain experienced by patients following the surgical placement of dental implants was generally mild and gradually decreased with time. Operator experience, female gender, surgical difficulty, and pain at earlier time-points were associated significantly with patient reports of pain.
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Affiliation(s)
- Areej K Al-Khabbaz
- Department of Surgical Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait.
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Shinal RM, Fillingim RB. Overview of orofacial pain: epidemiology and gender differences in orofacial pain. Dent Clin North Am 2007; 51:1-18, v. [PMID: 17185057 DOI: 10.1016/j.cden.2006.09.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Chronic orofacial pain is a prevalent problem that encompasses numerous disorders with diverse causes and presenting symptoms. Compared with men, women of reproductive age seek treatment for orofacial pain conditions, as well as other chronic pain disorders more frequently. Important issues have been raised regarding gender and sex differences in genetic, neurophysiologic, and psychosocial aspects of pain sensitivity and analgesia. Efforts to improve our understanding of qualitative sex differences in pain modulation signify a promising step toward developing more tailored approaches to pain management.
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Affiliation(s)
- René M Shinal
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, P.O. Box 103628 Gainesville, FL 32610-3628, USA
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Andreu Y, Galdon MJ, Durá E, Ferrando M, Pascual J, Turk DC, Jiménez Y, Poveda R. An examination of the psychometric structure of the Multidimensional Pain Inventory in temporomandibular disorder patients: a confirmatory factor analysis. Head Face Med 2006; 2:48. [PMID: 17169143 PMCID: PMC1764727 DOI: 10.1186/1746-160x-2-48] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 12/14/2006] [Indexed: 11/29/2022] Open
Abstract
Background This paper seeks to analyse the psychometric and structural properties of the Multidimensional Pain Inventory (MPI) in a sample of temporomandibular disorder patients. Methods The internal consistency of the scales was obtained. Confirmatory Factor Analysis was carried out to test the MPI structure section by section in a sample of 114 temporomandibular disorder patients. Results Nearly all scales obtained good reliability indexes. The original structure could not be totally confirmed. However, with a few adjustments we obtained a satisfactory structural model of the MPI which was slightly different from the original: certain items and the Self control scale were eliminated; in two cases, two original scales were grouped in one factor, Solicitous and Distracting responses on the one hand, and Social activities and Away from home activities, on the other. Conclusion The MPI has been demonstrated to be a reliable tool for the assessment of pain in temporomandibular disorder patients. Some divergences to be taken into account have been clarified.
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Affiliation(s)
- Yolanda Andreu
- Department of Personality, Assessment, and Psychological Treatment, University of Valencia, Spain
| | - Maria J Galdon
- Department of Personality, Assessment, and Psychological Treatment, University of Valencia, Spain
| | - Estrella Durá
- Department of Personality, Assessment, and Psychological Treatment, University of Valencia, Spain
| | - Maite Ferrando
- Department of Personality, Assessment, and Psychological Treatment, University of Valencia, Spain
| | - Juan Pascual
- Department of Methodology, Psychobiology and Social Psychology, University of Valencia, Spain
| | - Dennis C Turk
- Department of Anaesthesiology, University of Washington, US
| | - Yolanda Jiménez
- Service of Stomatology, University of Valencia General Hospital, Spain
| | - Rafael Poveda
- Service of Stomatology, University of Valencia General Hospital, Spain
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Hermann C, Hohmeister J, Demirakça S, Zohsel K, Flor H. Long-term alteration of pain sensitivity in school-aged children with early pain experiences. Pain 2006; 125:278-285. [PMID: 17011707 DOI: 10.1016/j.pain.2006.08.026] [Citation(s) in RCA: 286] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Revised: 07/17/2006] [Accepted: 08/21/2006] [Indexed: 11/21/2022]
Abstract
While animal studies suggest that neonatal pain experiences induce long-term alterations in pain sensitivity, no such data exist in humans. Changes in pain sensitivity in school-aged children (9-14 years) who were born preterm or fullterm, had been hospitalized for a prolonged period of time after birth and had undergone repeated painful procedures while being treated in a Neonatal Intensive Care Unit (NICU) were determined. A retrospective cohort study of 19 preterm (<or=31 weeks gestational age) and 20 fullterm children (>or=37 weeks gestational age) treated at least 3 days in a NICU at a University Hospital and 20 fullterm control children without NICU experience was performed. Perceptual sensitization to tonic heat and repetitive mechanical stimuli as well as heat pain and mechanical pain thresholds were obtained at the thenar and a trigeminal site. Length of hospitalization and NICU treatment was significantly higher in preterm than fullterm children. Nonetheless, both preterm and fullterm children with NICU experience showed greater perceptual sensitization to tonic heat and elevated heat pain thresholds at both sites. Mechanical pain threshold and perceptual sensitization did not differ between groups. Consistent with findings in animals, repeated pain experiences during the neonatal period were associated with alterations in thermal pain responsivity in school-aged preterm and fullterm children that was characterized by enhanced perceptual sensitization to prolonged painful stimulation and hypoalgesia to brief heat pain stimuli. Our findings suggest that repeated pain experiences in neonates may induce activity-induced changes in the functioning of pain pathways that persist well beyond infancy.
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Affiliation(s)
- Christiane Hermann
- Department of Clinical and Cognitive Neuroscience, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany Children's Hospital, Department of Clinical Medicine Mannheim, University of Heidelberg, Germany
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Bruehl S, Burns JW, McCubbin JA. Altered cardiovascular/pain regulatory relationships in chronic pain. Int J Behav Med 2006; 5:63-75. [PMID: 16250716 DOI: 10.1207/s15327558ijbm0501_5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In healthy individuals, there is an inverse relationship between resting blood pressure (BP) and pain sensitivity. This study examined possible dysregulation of this adaptive relation in chronic pain patients, and tested whether the extent of this dysregulation is a function of pain duration. Continuous resting BP's were assessed for 5 min after a 5-min rest period in 121 chronic benign pain patients. Unlike the inverse relationship observed previously in normals, mean resting diastolic. BPs during the assessment period were correlated positively with ratings of pain severity. A Pain Duration x Systolic BP interaction emerged (p < .05) such that the magnitude of the BP-pain relation was greatest in patients with the longest duration of pain, r(38) = .50, p < .001. A hypothesized progressive alteration in endogenous pain regulatory systems in chronic pain patients was supported. A possible role of endogenous opioid dysfunction in accounting for these alterations is discussed.
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Affiliation(s)
- S Bruehl
- Center for Pain Studies, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
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Gazerani P, Arendt-Nielsen L. The impact of ethnic differences in response to capsaicin-induced trigeminal sensitization. Pain 2006; 117:223-9. [PMID: 16098662 DOI: 10.1016/j.pain.2005.06.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Revised: 05/27/2005] [Accepted: 06/13/2005] [Indexed: 11/22/2022]
Abstract
Ethnic differences in the experience of pain, pain-related health care utilization and pain-reducing activities have been reported. Thus, evaluating of such variations is important in clinical and experimental pain. Since clinical pain is greatly influenced by disease-specific factors (severity, duration, type and treatment), evaluating ethnic differences in experimental pain models may not only provide some information about underlying mechanisms but also may predict or explain group differences in clinical pain. Migraine prevalence within ethnic populations is varied. Capsaicin injection to the forehead of healthy volunteers induces the state of an experimental trigeminal sensitization, which is one of the proposed mechanisms of migraine. The aim of the present study was to investigate ethnic differences between Caucasians and South Indians in this model of trigeminal sensitization. Thirty-two healthy male volunteers (16 South Indians and 16 Danish Caucasians) were included. Capsaicin (100 microg/0.1 ml) was injected intradermally to the right forehead skin. Pain sensitivity, secondary hyperalgesic area, and pressure pain threshold were assessed. Overall, the model showed significant greater pain responses in South Indians (8.75+/-1.25 cm pain intensity and 9.33+/-2.32 cm2 hyperalgesic area) compared to Caucasians (6.25+/-1.95 cm pain intensity and 6.25+/-1.41 cm2 hyperalgesic area). The model may provide important information for further clinical research, e.g. migraine or differences in mechanisms underlying trigeminal sensitization.
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Affiliation(s)
- Parisa Gazerani
- Department of Health Science and Technology, Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7D-3, DK-9220 Aalborg, Denmark
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Mechlin MB, Maixner W, Light KC, Fisher JM, Girdler SS. African Americans show alterations in endogenous pain regulatory mechanisms and reduced pain tolerance to experimental pain procedures. Psychosom Med 2005; 67:948-56. [PMID: 16314600 DOI: 10.1097/01.psy.0000188466.14546.68] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine ethnic differences in pain sensitivity and relationship of pain tolerance to blood pressure and neuroendocrine factors. METHODS Fifty-one African Americans (24 men, 27 women) and 55 people from other ethnic groups (primarily Caucasian; 26 men, 29 women) were tested twice for pain sensitivity to tourniquet ischemia, thermal heat, and cold pressor tests, once following mental stress and once following rest control. Resting and stress-induced blood pressure (BP), plasma norepinephrine (NE), and cortisol were assessed. RESULTS In response to all three pain tests, African Americans had lower pain tolerance relative to Caucasian/Others after both rest and stress. Only the non-African American group showed the expected inverse relationship between BP and pain sensitivity. African Americans had lower cortisol concentrations at rest and stress and showed blunted NE and systolic BP responses to stress. Only in Caucasians/Others was the relationship seen between higher stress-induced BP, cortisol, and NE levels and greater pain tolerance. CONCLUSIONS The results suggest that there are alterations in endogenous pain regulatory mechanisms involving BP, cortisol, and NE in African Americans. Such dysregulation may contribute to the greater rate of clinical pain symptoms they experience. It is hypothesized that greater chronic stress in African Americans may be a contributing factor to the alterations in pain regulation.
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Affiliation(s)
- M Beth Mechlin
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7175, USA
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Gazerani P, Andersen OK, Arendt-Nielsen L. A human experimental capsaicin model for trigeminal sensitization. Gender-specific differences. Pain 2005; 118:155-63. [PMID: 16202522 DOI: 10.1016/j.pain.2005.08.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Revised: 07/14/2005] [Accepted: 08/08/2005] [Indexed: 11/16/2022]
Abstract
Migraine is much more common in women (18%) than in men (6%). Menstrual migraine in female migraineurs also varies from 7 to 19%. The main goals of the present study were (1) to investigate gender specific differences in an experimental capsaicin model of trigeminal sensitization (a proposed mechanism of migraine) and (2) to explore the influence of menstrual cycle phases. Twenty-eight healthy female and male volunteers were studied. Capsaicin (100 microg/0.1 ml) was injected intradermally to the forehead. Pain intensity and distribution together with the visual flare and allodynic area (central sensitization) were assessed for females (during their menstrual and luteal phases) and for males. Pain area significantly changed across the menstrual cycle with 19.2+/-2.0 cm x min at menstrual and 16.4+/-0.9 cm x min at luteal phase (P<0.001). The area was significantly larger in both phases for females compared to males (14.2+/-1.3 cm x min, P<0.0001). Flare area at menstrual phase (69.2+/-4.2 cm(2)) was significantly (P<0.0001) larger than luteal phase (58.6+/-2.1 cm(2)). Females, in both phases, showed larger flare area compared to males (44.9+/-3.6 cm(2), P<0.0001). Area of brush-evoked allodynia was also larger at the menstrual phase compared to the luteal phase (P<0.0001) and males (P<0.0001). A significant difference was found in the capsaicin-evoked pain distribution with a greater response in menstrual phase compared to the luteal phase (P<0.01) and men (P<0.0001). Capsaicin induced trigeminal sensitization and evoked gender specific sensory and vaso-motor responses, with menstruating females generally showing the strongest manifestations. The model may be further applied to explore mechanisms of human trigeminal sensitization.
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Affiliation(s)
- Parisa Gazerani
- Laboratory for Experimental Pain Research, Center for Sensory-Motor Interaction SMI, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D-3, DK-9220, Aalborg, Denmark
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