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Racial and ethnic differences in experimental pain sensitivity: systematic review and meta-analysis.Pain Feb 2017Our objective was to describe the racial and ethnic differences in experimental pain sensitivity. Four databases (PubMed, EMBASE, the Cochrane Central Register of... (Meta-Analysis)
Meta-Analysis Review
Our objective was to describe the racial and ethnic differences in experimental pain sensitivity. Four databases (PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and PsycINFO) were searched for studies examining racial/ethnic differences in experimental pain sensitivity. Thermal-heat, cold-pressor, pressure, ischemic, mechanical cutaneous, electrical, and chemical experimental pain modalities were assessed. Risk of bias was assessed using the Agency for Healthcare Research and Quality guideline. Meta-analysis was used to calculate standardized mean differences (SMDs) by pain sensitivity measures. Studies comparing African Americans (AAs) and non-Hispanic whites (NHWs) were included for meta-analyses because of high heterogeneity in other racial/ethnic group comparisons. Statistical heterogeneity was assessed by subgroup analyses by sex, sample size, sample characteristics, and pain modalities. A total of 41 studies met the review criteria. Overall, AAs, Asians, and Hispanics had higher pain sensitivity compared with NHWs, particularly lower pain tolerance, higher pain ratings, and greater temporal summation of pain. Meta-analyses revealed that AAs had lower pain tolerance (SMD: -0.90, 95% confidence intervals [CIs]: -1.10 to -0.70) and higher pain ratings (SMD: 0.50, 95% CI: 0.30-0.69) but no significant differences in pain threshold (SMD: -0.06, 95% CI: -0.23 to 0.10) compared with NHWs. Estimates did not vary by pain modalities, nor by other demographic factors; however, SMDs were significantly different based on the sample size. Racial/ethnic differences in experimental pain sensitivity were more pronounced with suprathreshold than with threshold stimuli, which is important in clinical pain treatment. Additional studies examining mechanisms to explain such differences in pain tolerance and pain ratings are needed.
Topics: Databases, Bibliographic; Ethnicity; Humans; Pain; Pain Threshold; United States
PubMed: 27682208
DOI: 10.1097/j.pain.0000000000000731 -
Pain Apr 2017
Review
Topics: Animals; Cancer Pain; Humans; Pain Management; Pain Threshold
PubMed: 28151836
DOI: 10.1097/j.pain.0000000000000825 -
Pain Management 2016Multiple epidemiologic studies have demonstrated an increased prevalence for women in several chronic pain disorders. Clinical and experimental investigations have... (Review)
Review
Multiple epidemiologic studies have demonstrated an increased prevalence for women in several chronic pain disorders. Clinical and experimental investigations have consistently demonstrated sex-specific differences in pain sensitivity and pain threshold. Even though the underlying mechanisms responsible for these differences have not yet been elucidated, the logical possibility of gonadal hormone influence on nociceptive processing has garnered recent attention. In this review, we evaluated the complex literature regarding gonadal hormones and their influence on pain perception. We reviewed the numerous functions of gonadal hormones, discussed the influence of these hormones on several common chronic pain syndromes (migraine, tension and cluster headaches, fibromyalgia, temporomandibular syndrome, rheumatoid arthritis and back pain, among others), and have attempted to draw conclusions from the available data.
Topics: Chronic Pain; Female; Gonadal Steroid Hormones; Humans; Male; Nociception; Pain; Pain Threshold; Sex Characteristics; Sex Factors
PubMed: 26983893
DOI: 10.2217/pmt-2015-0002 -
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 -
The Journal of Pain Jun 2024The evidence that athletes respond to and report indices of experimental pain differently to non-athlete populations was analysed. Databases screened were SPORTDiscus,... (Meta-Analysis)
Meta-Analysis Review
The evidence that athletes respond to and report indices of experimental pain differently to non-athlete populations was analysed. Databases screened were SPORTDiscus, PubMED, PsycArticles, the Cochrane Library (Cochrane Database of Systematic Reviews), Web of Science, Scopus, and CINAHL. Studies that compared experimentally induced pain responses (threshold, tolerance, intensity, unpleasantness, bothersomeness, and effect on performance) in athletes and controls were included. Meta-analyses were performed where appropriate and effects were described as standardised mean differences, pooled using random effects models. Thirty-six studies (2,492 participants) met the inclusion criteria comprising 19 pain tolerance, 17 pain threshold, 21 pain intensity, 5 pain unpleasantness, 2 performance in pain and 1 bothersomeness study. Athletes demonstrated greater pain tolerance (g = .88 [95% confidence interval [CI] .65, .13]) and reported less pain intensity (g = -.80, [95% CI -1.13, -.47]) compared to controls; they also had higher pain threshold but with smaller effects (g = .41, [95% CI .08, .75]). Differences for unpleasantness did not reach statistical significance but the effects were large (g = -1.23 [95% CI -2.29, .18]). Two studies reported that performance in pain was better in contact athletes than non-athletes, and one concluded that athletes find pain less bothersome than controls. There were considerable inconsistencies in the methods employed that were reflected in the meta-analyses' findings. Sub-group analyses of tolerance and intensity were conducted between endurance, contact, and other athlete groups, but were not significant. The data suggest that athletic participation is associated with altered pain responses, but mechanisms remain unclear and more transparent methods are recommended.This study was registered on the PROSPERO site in January 2019 (ref ID: CRD42019119611). PERSPECTIVE: This review examined differences in pain outcomes (threshold, tolerance, intensity, unpleasantness, bothersomeness) and the effect of pain on performance, in athletes versus controls. Meta-analyses revealed athletes had higher threshold and tolerance and found pain less intense than controls; there was some evidence of differences in bothersomeness and performance.
Topics: Humans; Athletes; Pain Threshold; Pain
PubMed: 38154623
DOI: 10.1016/j.jpain.2023.12.007 -
Brazilian Oral Research 2015A systematic review was conducted to identify reliable somatosensory evaluation methods for atypical odontalgia (AO) patients. The computerized search included the main... (Review)
Review
A systematic review was conducted to identify reliable somatosensory evaluation methods for atypical odontalgia (AO) patients. The computerized search included the main databases (MEDLINE, EMBASE, and Cochrane Library). The studies included used the following quantitative sensory testing (QST) methods: mechanical detection threshold (MDT), mechanical pain threshold (MPT) (pinprick), pressure pain threshold (PPT), dynamic mechanical allodynia with a cotton swab (DMA1) or a brush (DMA2), warm detection threshold (WDT), cold detection threshold (CDT), heat pain threshold (HPT), cold pain detection (CPT), and/or wind-up ratio (WUR). The publications meeting the inclusion criteria revealed that only mechanical allodynia tests (DMA1, DMA2, and WUR) were significantly higher and pain threshold tests to heat stimulation (HPT) were significantly lower in the affected side, compared with the contralateral side, in AO patients; however, for MDT, MPT, PPT, CDT, and WDT, the results were not significant. These data support the presence of central sensitization features, such as allodynia and temporal summation. In contrast, considerable inconsistencies between studies were found when AO patients were compared with healthy subjects. In clinical settings, the most reliable evaluation method for AO in patients with persistent idiopathic facial pain would be intraindividual assessments using HPT or mechanical allodynia tests.
Topics: Adult; Facial Pain; Female; Humans; Male; Middle Aged; Pain Measurement; Pain Threshold; Physical Stimulation; Randomized Controlled Trials as Topic; Toothache
PubMed: 25627886
DOI: 10.1590/1807-3107BOR-2015.vol29.0020 -
Conditioned pain modulation and pain sensitivity in functional somatic disorders: The DanFunD study.European Journal of Pain (London,... Jan 2022Disrupted pain regulation has been proposed as a component in functional somatic disorders (FSD). The objective of this study was to examine a general population sample,...
BACKGROUND
Disrupted pain regulation has been proposed as a component in functional somatic disorders (FSD). The objective of this study was to examine a general population sample, encompassing three delimitations of FSD while assessing pain sensitivity and conditioning pain modulation (CPM).
METHODS
Pressure pain thresholds (PPTs) at the tibialis and trapezius muscles were recorded at baseline. During cold pressor stimulation of the hand, the tibialis PPTs were re-assessed and the difference from baseline measures defined the CPM effect. Participants (n = 2,198, 53% females) were randomly selected from the adult Danish population. FSD was established by self-reported symptom questionnaires.
RESULTS
With a few exceptions, only weak associations were seen between PPTs and CPM in cases with FSD (p > .1). A high PPT was associated with lower odds of having multi-organ bodily distress syndrome (OR : 0.66, 95% CI: 0.49-0.88, p = .005), with the symptom profile characterized by all symptoms (OR : 0.72, 95% CI: 0.58-0.90, p = .003 and OR : 0.75, 95% CI: 0.62-0.91, p = .004), and with multiple chemical sensitivity (OR : 0.81, 95% CI: 0.67-0.97, p = .022). High CPM was associated with high odds of having irritable bowel (OR : 1.22, 95% CI: 1.04-1.43, p = .013 and OR = 2.66, 95% CI: 1.07-6.45, p = .033).
CONCLUSION
However, only PPT measured over the trapezius muscle were still significant after correction for multiple testing for the symptom profile characterized by all symptoms. Findings from this study do not support altered pain regulation in questionnaire-based FSD which is in contrast with the existing presumption. Further epidemiological studies in this field are needed.
SIGNIFICANCE
Disrupted pain regulation as measured by abnormal pain thresholds has been hypothesized as a central mechanism in Functional Somatic Disorders (FSD). The hypothesis has been raised in clinical setting where patients presented subjective and objective features of hypersensitivity. The present population-based study does not support this notion. This points to the importance of further studies into the underlying pathophysiology mechanisms of FSD.
Topics: Adult; Female; Hand; Humans; Male; Pain; Pain Measurement; Pain Threshold; Somatoform Disorders
PubMed: 34309927
DOI: 10.1002/ejp.1847 -
Sleep Medicine Feb 2019Insufficient sleep increases pain sensitivity in healthy individuals. Additionally, extending sleep (eg, increasing nocturnal sleep time or adding a mid-day nap) has...
INTRODUCTION
Insufficient sleep increases pain sensitivity in healthy individuals. Additionally, extending sleep (eg, increasing nocturnal sleep time or adding a mid-day nap) has been shown to restore pain sensitivity to baseline levels in sleep deprived/restricted individuals. Whether sleep extension can reduce pain sensitivity beyond baseline levels in non-sleep restricted/deprived individuals remains unknown.
METHODS
In a sample of 27 healthy, pain-free, normally-sleeping individuals (17 males, mean age ∼24 yrs), we examined the impact of five nights of sleep extension on pain sensitivity. Pain threshold (elapsed time until the participant reported pain) and pain tolerance (total time the participant kept the hand submerged in the cold water) were measured using the Cold Pressor Task. Furthermore, we assessed the extent to which self-reported sleep amount in relation to the minimal subjective sleep requirement for adequate performance (sleep credit) was associated with pain sensitivity changes.
RESULTS
On average individuals slept almost 2 extra hours per night. Our results indicate that sleep extension increases pain tolerance beyond baseline levels. However, sleep extension did not impact pain threshold. We also found that individuals with a smaller sleep credit (ie, those who habitually obtain less sleep than they feel they need) experienced greater increases in pain tolerance after extending sleep.
CONCLUSIONS
The present findings suggest that sleep extension may increase pain tolerance but not pain threshold in healthy individuals who normally sleep the recommended amount. Our findings also support the idea that sleep credit may be a strong indicator of sleep debt in the context of pain sensitivity.
Topics: Actigraphy; Adult; Female; Humans; Male; Pain Measurement; Pain Threshold; Self Report; Sleep; Time Factors; Young Adult
PubMed: 30580190
DOI: 10.1016/j.sleep.2018.10.023 -
Pain Apr 2015Development and application of psychophysical test paradigms to assess endogenous pain modulation in healthy controls and in patients yielded large body of data over the... (Review)
Review
Development and application of psychophysical test paradigms to assess endogenous pain modulation in healthy controls and in patients yielded large body of data over the last 2 decades. These tests can assist in predicting pain acquisition, in characterizing pain syndromes and related dysfunctions of pain modulation, and in predicting response to treatment. This chapter reviews the development of thought on pain modulation in the clinical setup, focusing on conditioned pain modulation, and update on accumulated data regarding the mechanism, protocols of administration, and applications in the clinic.
Topics: Animals; Central Nervous System Sensitization; Chronic Pain; Conditioning, Psychological; Humans; Pain Measurement; Pain Threshold
PubMed: 25789433
DOI: 10.1097/01.j.pain.0000460343.46847.58 -
The Journal of Sports Medicine and... Oct 2019The objective of the study is to determine whether higher pain thresholds are associated with better performance in long-distance runners.
BACKGROUND
The objective of the study is to determine whether higher pain thresholds are associated with better performance in long-distance runners.
METHODS
Seventy participants, divided into groups of fast and non-fast runners according to peak results in a 10km run. Main Outcome Measures, Cold pressor test.
RESULTS
Of the 70 participants, 28 were in the fastest group (less than 39 minutes in a 10km run) and 42 in the non-fast group. The faster group was characterized with older age (34.0±8.5 vs. 29.5±5.7, P=0.01), greater mean weekly running time (5.5 [0-17]) vs. 2 [0-10], P<0.001), and more years of running (10 [1.5-34.0] vs. 7 [0-20, P=0.05]). In a multivariable analysis longer cold pressor time was associated with faster 10Km run (OR 1.01, 95% CI 1.00-1.01).
CONCLUSIONS
It seems that higher pain thresholds play an important role in the superior ability of long distance runners.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Male; Pain Threshold; Physical Endurance; Running
PubMed: 31219256
DOI: 10.23736/S0022-4707.19.09791-3