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The Journal of Pain Sep 2016Accurate classification of chronic pain conditions requires reliable and valid pain assessment. Moreover, pain assessment serves several additional functions, including... (Review)
Review
UNLABELLED
Accurate classification of chronic pain conditions requires reliable and valid pain assessment. Moreover, pain assessment serves several additional functions, including documenting the severity of the pain condition, tracking the longitudinal course of pain, and providing mechanistic information. Thorough pain assessment must address multiple domains of pain, including the sensory and affective qualities of pain, temporal dimensions of pain, and the location and bodily distribution of pain. Where possible, pain assessment should also incorporate methods to identify pathophysiological mechanisms underlying the pain. This article discusses assessment of chronic pain, including approaches available for assessing multiple pain domains and for addressing pathophysiological mechanisms. We conclude with recommendations for optimal pain assessment.
PERSPECTIVE
Pain assessment is a critical prerequisite for accurate pain classification. This article describes important features of pain that should be assessed, and discusses methods that can be used to assess the features and identify pathophysiological mechanisms contributing to pain.
Topics: Chronic Pain; Electronics; Humans; Pain Measurement; Pain Threshold
PubMed: 27586827
DOI: 10.1016/j.jpain.2015.08.010 -
Journal of Applied Oral Science :... 2020This study aimed to evaluate whether the presence of awake bruxism was associated with temporomandibular dysfunction symptoms, pain threshold at pressure, pain... (Observational Study)
Observational Study
The association of self-reported awake bruxism with anxiety, depression, pain threshold at pressure, pain vigilance, and quality of life in patients undergoing orthodontic treatment.
INTRODUCTION
This study aimed to evaluate whether the presence of awake bruxism was associated with temporomandibular dysfunction symptoms, pain threshold at pressure, pain vigilance, oral health-related quality of life (OHRQoL), and anxiety and depression symptoms in patients undergoing orthodontic treatment.
METHODOLOGY
This observational study followed patients who had started receiving orthodontic treatment for six months. The following variables were measured three times (at baseline, one month, and six months): pressure pain threshold (PPT) in the right and left masseter, anterior temporalis, and temporomandibular joint (TMJ), and right forearm; pain vigilance and awareness questionnaire; and shortened form of the oral health impact profile (OHIP-14). Anxiety and depression symptoms were measured using the Beck anxiety inventory and the Beck depression inventory, respectively. The patients were divided into two main groups according to the presence (n=56) and absence (n=58) of possible awake bruxism. The multi-way analysis of variance (ANOVA) was applied on the date (p=0.050).
RESULTS
TMJ and/or muscle pain were not observed in both groups. Time, sex, age group, and awake bruxism did not affect the PPT in the masticatory muscles and pain vigilance (p>0.050). However, the primary effect of awake bruxism was observed when anxiety (ANOVA: F=8.61, p=0.004) and depression (ANOVA: F=6.48, p=0.012) levels were higher and the OHRQoL was lower (ANOVA: F=8.61, p=0.004).
CONCLUSION
The patients with self-reported awake bruxism undergoing an orthodontic treatment did not develop TMJ/masticatory muscle pain. The self-reported awake bruxism is associated with higher anxiety and depression levels and a poorer OHRQoL in patients during the orthodontic treatment.
Topics: Adolescent; Adult; Analysis of Variance; Anxiety; Bruxism; Depression; Female; Humans; Male; Middle Aged; Myalgia; Pain Threshold; Psychiatric Status Rating Scales; Psychometrics; Quality of Life; Self Report; Severity of Illness Index; Statistics, Nonparametric; Temporomandibular Joint Disorders; Young Adult
PubMed: 32236355
DOI: 10.1590/1678-2019-0407 -
Agri : Agri (Algoloji) Dernegi'nin... Apr 2017Men and women are different in response to experimental painful stimulation, in pain attitude such as reporting pain and pain coping behavior, in symptoms and signs of... (Review)
Review
Men and women are different in response to experimental painful stimulation, in pain attitude such as reporting pain and pain coping behavior, in symptoms and signs of painful disorders and in response to pain treatment. Both acute and chronic pain conditions have diverse prevalence among the sexes. Overall, women have more than twice higher prevalence in painful disorders compared to men. Here I review putative mechanisms underlying sex differences in pain, including genetic factors that have sex-specific or sex-biased effects controlling pain and analgesia.
Topics: Female; Humans; Pain; Pain Management; Pain Threshold; Sex Characteristics; Women's Health
PubMed: 28895988
DOI: 10.5505/agri.2017.87369 -
Current Opinion in Supportive and... Jun 2015Conditioned pain modulation (CPM) paradigms have been increasingly used over the past few years to assess endogenous analgesia capacity in healthy individuals and pain... (Review)
Review
PURPOSE OF REVIEW
Conditioned pain modulation (CPM) paradigms have been increasingly used over the past few years to assess endogenous analgesia capacity in healthy individuals and pain patients. The current review concentrates on selected recent literature advancing our understanding and practice of CPM.
RECENT FINDINGS
The main themes covered by the present CPM review include underlying mechanisms, approaches to experimental investigation, practicality in clinical practice, neurophysiological and psychophysiological correlates, and pharmacological solutions to pain modulation dysfunction.
SUMMARY
The reviewed literature refines the methodology used for eliciting CPM responses and characterizing their physiological attributes in healthy individuals and pain patients, and exemplifies the materializing concept of individualized pain medicine through targeting impaired mechanisms of pain modulation by designated drugs for optimal pain alleviation.
Topics: Analgesia; Conditioning, Psychological; Hot Temperature; Humans; Neuropharmacology; Pain Management; Pain Threshold; Precision Medicine
PubMed: 25699686
DOI: 10.1097/SPC.0000000000000126 -
Neuroscience and Biobehavioral Reviews Oct 2022It is well-established that a single bout of exercise can reduce pain sensitivity (i.e., exercise-induced hypoalgesia) in healthy individuals. However, exercise-induced... (Review)
Review
It is well-established that a single bout of exercise can reduce pain sensitivity (i.e., exercise-induced hypoalgesia) in healthy individuals. However, exercise-induced hypoalgesia is often impaired in individuals with chronic pain. This might suggest that repeated bouts of exercise (i.e., exercise training) are needed in order to induce a reduction in pain sensitivity (i.e., training-induced hypoalgesia) among individuals with chronic pain, given that a single bout of exercise seems to be insufficient to alter pain. However, the effect of repeated bouts of exercise on pain sensitivity and its underlying mechanisms remain poorly understood. Therefore, the purpose of this review was to provide an overview of the existing literature on training-induced hypoalgesia, as well as discuss potential mechanisms of training-induced hypoalgesia and offer considerations for future research. Existing literature suggests that training interventions may induce hypoalgesic adaptations potentially driven by central nervous system and immune system factors. However, the limited number of randomized controlled trials available, along with the lack of understanding of underlying mechanisms, provides a rationale for future research.
Topics: Chronic Pain; Exercise; Humans; Pain Measurement; Pain Perception; Pain Threshold
PubMed: 36096206
DOI: 10.1016/j.neubiorev.2022.104858 -
Pain Aug 2015
Topics: Chronic Pain; Female; Humans; Male; Pain Perception; Pain Threshold; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 26176807
DOI: 10.1097/j.pain.0000000000000144 -
Journal of Affective Disorders Oct 2016A growing body of research has explored altered physical pain threshold and tolerance in non-suicidal self-injury (NSSI) and suicidal self-harm. The evidence, however,... (Review)
Review
BACKGROUND
A growing body of research has explored altered physical pain threshold and tolerance in non-suicidal self-injury (NSSI) and suicidal self-harm. The evidence, however, is inconsistent such that the nature of the relationship is unclear, and whether or not this effect is also present in suicidal self-harm is equivocal.
METHODS
A keyword search of three major psychological and medical databases (PsycINFO, Medline and Web of Knowledge) was conducted, yielding 1873 records. Following duplicate removal and screening, 25 articles were quality assessed, and included in the final systematic review.
RESULTS
There is strong evidence for increased pain tolerance in NSSI, and some evidence for this in suicidal individuals, but notably, there were no prospective studies. The review found a lack of substantive focus on psychological correlates of altered pain tolerance in this population. Several candidate explanatory mechanisms were proposed within the reviewed studies.
LIMITATIONS
The current review was a narrative systematic review; methods used to assess pain were considered too heterogeneous to conduct a meta-analysis.
CONCLUSIONS
The evidence suggests that there is elevated pain tolerance among those who engage in NSSI. Future prospective research should determine if altered pain tolerance is a cause or a consequence of the behaviour. The identification of psychological correlates of increased pain tolerance is a neglected area of research. It could provide opportunities for treatment/intervention development, if mediating or moderating pathways can be identified. Too few studies have directly investigated candidate explanatory mechanisms to draw definitive conclusions.
Topics: Humans; Pain; Pain Threshold; Self-Injurious Behavior; Suicidal Ideation
PubMed: 27323296
DOI: 10.1016/j.jad.2016.05.068 -
American Journal of Physical Medicine &... Jul 2021In chronic pain conditions, the pressure pain threshold has been used to investigate the presence of central sensitization. (Comparative Study)
Comparative Study Meta-Analysis
INTRODUCTION
In chronic pain conditions, the pressure pain threshold has been used to investigate the presence of central sensitization.
METHODS
A systematic review and meta-analysis were conducted to compare the threshold in chronic pain patients and healthy individuals. Ovid MEDLINE and Embase up to July 2019 were used to conduct the search. Search strategy included terms and sets of terms that describe the concepts "sensory testing" and "pain measurement."
RESULTS
The included studies consisted of 24 were case-control studies and 12 cross-sectional studies. The pooled total sample size was 1280 cases of patients with different diagnoses of chronic pain and 1463 healthy controls. Among the included studies, 32 reported a significant decrease of the pressure pain threshold among patients compared with the controls and four reported no statistically significant difference. The pooled pressure pain threshold mean difference was -1.17 (95% confidence interval = -1.45 to -0.90). There was, however, evidence of significant heterogeneity across the studies (I2 = 87.42%, P < 0.001).
CONCLUSIONS
Patients who experience chronic pain have a significantly lower pressure pain threshold compared with healthy controls. Future research is needed to elucidate factors attributed to the change in pressure pain threshold among patients with chronic pain, as well as the time that the central sensitization occurs.
Topics: Central Nervous System Sensitization; Chronic Pain; Humans; Pain Measurement; Pain Threshold
PubMed: 33002911
DOI: 10.1097/PHM.0000000000001603 -
Modern Trends in Pharmacopsychiatry 2015Pain processing in patients with borderline personality disorder (BPD) is abnormal primarily with respect to pain thresholds which are typically elevated or perception... (Review)
Review
Pain processing in patients with borderline personality disorder (BPD) is abnormal primarily with respect to pain thresholds which are typically elevated or perception of phasic nociceptive stimuli which is reduced. In spite of this common finding, nonsuicidal self-injury (NSSI), often expressed as cutting, is a hallmark sign of the disease and serves to release aversive inner tension. The question thus arises, how does a painful stimulus release inner tension when these patients feel less pain than healthy people? However, intensity discrimination is normal in these patients. Imaging data have provided evidence that inhibitory top-down modulation is increased in BPD patients, and that processing of the affective-emotional pain component is altered. Recent studies have focused on the role of pain, tissue injury and seeing blood in the context of NSSI. Preliminary findings suggest a significant role of pain irrespective of concomitant tissue injury, and of seeing blood expressed as a stronger immediate stress release. Taken together, BPD patients exhibit altered pain processing that can be assigned to altered processing of nociceptive stimuli in prefrontal and limbic brain areas, which may help to mechanistically explain the clinical behavior.
Topics: Borderline Personality Disorder; Humans; Pain; Pain Perception; Pain Threshold; Self Mutilation
PubMed: 26437258
DOI: 10.1159/000435940 -
The Journal of Manual & Manipulative... Apr 2023Pain-inducing massage produces comparable changes in pain sensitivity as a cold pressor task, suggesting shared neurophysiological mechanisms of conditioned pain... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pain-inducing massage produces comparable changes in pain sensitivity as a cold pressor task, suggesting shared neurophysiological mechanisms of conditioned pain modulation. Manual therapy and conditioned pain modulation are influenced by positive and negative expectations. Therefore, the purpose of this study was to examine the effects of positive and negative expectations on pain-free and pain-inducing massage.
METHODS
56 healthy participants were randomly assigned to receive a positive or negative expectation instructional set followed by a pain-inducing or a pain-free massage. Pressure pain threshold (PPT) was measured followed by each interval of massage. A repeated measures ANCOVA controlling for post-randomization differences in sex tested for massage x expectation set x PPT interaction effects, as well as two-way interaction effects.
RESULTS
A significant three-way interaction effect (p = 0.04) and time x expectation interaction effect was observed for individuals receiving pain inducing massage (p = 0.02). Individuals who received the positive expectation instructional set demonstrated significantly higher PPT at minutes 3 and 4 of massage compared to individuals who received the negative expectation instructional set.
CONCLUSIONS
Expectations impact pain sensitivity changes produced during massage. Clinicians planning to provide pain-inducing massage should consider the role of expectations in modulating pain sensitivity changes.
Topics: Humans; Pain Threshold; Motivation; Pain; Pain Measurement; Massage
PubMed: 36069038
DOI: 10.1080/10669817.2022.2118449