Paradoxical differences in pain ratings of the same stimulus intensity

2017 ◽  
Vol 16 (1) ◽  
pp. 181-181
Author(s):  
M.E. McPhee ◽  
K.K. Petersen ◽  
M.S. Hoegh ◽  
T. Graven-Nielsen
Keyword(s):  
Stimulus Intensity ◽  
Analogue Scale ◽  
Temporal Summation ◽  
Pain Tolerance ◽  
Pain Rating ◽  
Baseline Assessment ◽  
Identical Stimulus ◽  
Pain Ratings ◽  
Pain Detection ◽  
Stimulation Paradigm

Abstract Aims Stimulus intensity used for assessing temporal summation of pain (TSP) is commonly set at the participants’ pain tolerance. Yet pain ratings during TSP rarely reach that initial pain tolerance pain rating. This study aimed to explore the differences between baseline pain tolerance assessed by cuff algometry and subsequent pain ratings of the same stimulus intensity, and the reliability of these ratings over 2 sessions. Methods In two sessions, separated by one week, 24 healthy, pain-free males had their pressure pain detection (PDT) and tolerance threshold (PTT) recorded using a staircase inflation paradigm (5 kPa increments, 1sec-ON:4sec-OFF) with a cuff algometry system. The pain intensity was assessed during cuff stimulation using an electronic visual analogue scale (VAS, 0–10 cm). Three different inflation paradigms were then performed, using the PTT level as stimulation intensity, and a 1-s duration for each stimulus: PEAKS: 3 inflations at 0.17 Hz, SLOW: 10 inflations at 0.01 Hz, FAST: 10 inflations at 0.5 Hz). Approximately 5-min was kept between the staircase assessment and the first stimulation paradigm, and between each of the 3 inflation paradigms. The PTT and first inflation VAS rating from each paradigm was extracted. Results The VAS rating of PTT pressure was higher in the staircase (VAS: 8.5±2.1 cm) than the first PPT stimulus in any other paradigm (PEAKS: 5.4±2.0; SLOW: 4.6±2.1; FAST: 4.0±2.3, P < 0.05). VAS ratings were also lower in each subsequent paradigm (i.e. PEAKS > SLOW > FAST, P < 0.05). Intra-class coefficients demonstrated excellent reliability for each paradigm (all ICC > 0.79) between sessions. Conclusions PTT, as assessed with the staircase inflation paradigm, was rated more painful during baseline assessment than when the identical stimulus profile (PPT intensity for 1-s) was applied afterwards and this finding is considered reliable.

Epidural Epinephrine and Clonidine 

1997 ◽  
Vol 87 (4) ◽  
pp. 785-794 ◽  
Author(s):  
Michele Curatolo ◽  
Steen Petersen-Felix ◽  
Lars Arendt-Nielsen ◽  
Alex M. Zbinden
Keyword(s):  
Electrical Stimulation ◽  
Sural Nerve ◽  
Temporal Summation ◽  
Pain Tolerance ◽  
Pain Rating ◽  
Double Blind ◽  
Pressure Pain ◽  
Different Types ◽  
Painful Area ◽  
Stimulation Of

Background It is not known whether epidural epinephrine has an analgesic effect per se. The segmental distribution of clonidine epidural analgesia and its effects on temporal summation and different types of noxious stimuli are unknown. The aim of this study was to clarify these issues. Methods Fifteen healthy volunteers received epidurally (L2-L3 or L3-L4) 20 ml of either epinephrine, 100 microg, in saline; clonidine, 8 microg/kg, in saline; or saline, 0.9%, alone, on three different days in a randomized, double-blind, cross-over fashion. Pain rating after electrical stimulation, pinprick, and cold perception were recorded on the dermatomes S1, L4, L1, T9, T6, T1, and forehead. Pressure pain tolerance threshold was recorded at S1, T6, and ear. Pain thresholds to single and repeated (temporal summation) electrical stimulation of the sural nerve were determined. Results Epinephrine significantly reduced sensitivity to pinprick at L1-L4-S1. Clonidine significantly decreased pain rating after electrical stimulation at L1-L4 and sensitivity to pinprick and cold at L1-L4-S1, increased pressure pain tolerance threshold at S1, and increased thresholds after single and repeated stimulation of the sural nerve. Conclusions Epidural epinephrine and clonidine produce segmental hypoalgesia. Clonidine bolus should be administered at a spinal level corresponding to the painful area. Clonidine inhibits temporal summation elicited by repeated electrical stimulation and may therefore attenuate spinal cord hyperexcitability.

Attenuation of Experimental Pain by Tactile Stimulation: Effect of Vibration at Different Levels of Noxious Stimulus Intensity

1964 ◽  
Vol 19 (1) ◽  
pp. 311-316 ◽  
Author(s):  
Bernard Blitz ◽  
Albert J. Dinnerstein ◽  
Milton Lowenthal
Keyword(s):  
Stimulus Intensity ◽  
Tactile Stimulation ◽  
Experimental Pain ◽  
Pain Tolerance ◽  
Noxious Stimulus ◽  
Noxious Stimulation ◽  
Vibratory Stimulus ◽  
Vibratory Stimulation ◽  
Electric Shocks ◽  
Different Levels

The present study was concerned with the masking and pain-attenuating effect of vibration at different levels of intensity of noxious stimulation. Forty Ss were given noxious stimulation in the form of increasingly painful electric shocks in trials where such shocks were presented with and without concurrent vibratory stimulation. The masking or pain-attenuating effect of the vibration was greatest at the lowest level of noxious stimulus intensity and decreased as the noxious stimulation intensity increased. At the highest level of noxious stimulation the effect of vibration was not significant although there was a tendency for Ss with higher pain tolerance to show summation. The possible relevance of the intensity of the vibratory stimulus to this pattern of results was discussed.

scholarly journals Tswana speaking South Africans’ understanding of pain scales

2009 ◽  
Vol 65 (1) ◽  
Author(s):  
M. Yazbek ◽  
A. Stewart ◽  
P. Becker
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Rating Scale ◽  
Pain Scale ◽  
Pain Tolerance ◽  
Future Research ◽  
Validity And Reliability ◽  
Cross Sectional ◽  
Pressure Threshold ◽  
Pain Scales

Aim: The aim of this study was to establish the validity and reliability of the Tswanatranslations of three pain scales.Design: This was a cross–sectional study to validate and test the reliability of threepain scales.Participants:   One hundred subjects participated in the study. They were selectedfrom the back schools of five hospitals in the North -West Province of South A frica andfrom workers in these hospitals who were employed as kitchen workers, laundryworkers and cleaners.Method: Translation of the pain scales and the stages of cross-cultural adaptation were followed as recommended byBeaton et al (2000). Pain tolerance of the subjects was measured using a P.T.M. (pressure threshold meter). The painscales used were the V.A .S. (visual analogue scale) one (nought and ten only), the V.A .S. (visual analogue scale) two(nought through to ten), the W.B.F. (Wong-Baker Faces pain measure) and the V.R.S. (verbal rating scale).  The V.R.S.used came in two forms. The first form was written on cue cards which the subjects arranged in order and the second form was the questionnaire version of the V.R.S.The subjects were interviewed and asked five questions relating to their back pain. Upon completion of the interviewthe pressure threshold of the painful area (back) was tested. Subjects then filled in the three pain scales, namely the (V.A .S. one, V.A .S. two, the V.R.S. and lastly the W.B.F. pain scale). Approximately a third of the sample (37) was retested the following day following the same procedure asdescribed above. Results: There was no correlation between the pressure threshold meter readings and the pain scale measurements.  Conclusion: From the statistical analysis of the results, it became apparent that the subjects tested did not have anunderstanding of any of the three pain scales. Future research needs to be done in developing entirely different scales for peoples of low literacy and differentlanguage and cultural groups in South Africa.

scholarly journals Gender Differences in Response to Experimental Pain among Medical Students from a Western State of India

2014 ◽  
Vol 2 (1) ◽  
pp. 13-17
Author(s):  
Pratik Akhani ◽  
Samir Mendpara ◽  
Bhupendra Palan
Keyword(s):  
Blood Pressure ◽  
Gender Differences ◽  
Medical Students ◽  
Pain Sensitivity ◽  
Pain Threshold ◽  
Experimental Pain ◽  
Pain Tolerance ◽  
Medical Attention ◽  
Pain Rating ◽  
Western State

Background: Pain is one of the most common reasons for patients to seek medical attention and it causes considerable human suffering. Pain is a complex perception that differs enormously among individual patients. Gender plays an important role in how pain is experienced, coped with and treated. Even young healthy individuals often differ in how they perceive and cope with pain. This study was done to investigate gender differences in response to experimental pain among medical students from a western state in India. Methods: A total of 150 medical students (86 males and 64 females) participated in this interventional study. The Cold Pressor Test was used to exert experimental pain. To study the response, cardiovascular measures (radial pulse, systolic blood pressure and diastolic blood pressure) and pain sensitivity parameters (pain threshold, pain tolerance and pain rating) were assessed. Results: No significant difference was found in cardiovascular response to experimental pain between both the genders (p>0.05). Pain threshold and pain tolerance were found to be significantly higher in males whereas pain rating was found to be significantly higher in females (p<0.01). Pulse reactivity showed a negative relationship with pain threshold and pain tolerance whereas a positive relationship with pain rating, however no statistically significant relation was found between these measures. Conclusion: Females display greater pain sensitivity than males. Different pain perception might account for gender difference in pulse reactivity.

scholarly journals A Comparison of Two Pain Scales in the Assessment of Dental Pain in East Delhi Children

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Amit Khatri ◽  
Namita Kalra
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Pain Perception ◽  
Rating Scale ◽  
Measurement Techniques ◽  
Dental Extraction ◽  
Common Symptom ◽  
Pain Rating ◽  
Cross Sectional ◽  
Pain Rating Scale

Pain is the most common symptom of oral diseases. Pain perception in children is highly variable and unreliable due to poor communication. Therefore we designed a study to compare pain measurement techniques, that is, visual analogue scale (VAS) and Wong-Baker faces pain rating scale (WBFPS) among Delhi children aged 3 to 14 years undergoing dental extraction. Method. A cross-sectional study was conducted on 180 patients aged 3 to 14 years who had undergone dental extraction. Children were assessed for their pain sensitivity using visual analogue scale (VAS) and Wong-Baker faces pain rating scale (WBFPS ). Result and Conclusion. Pain threshold tends to decline, and the self-management of pain becomes more effective with increasing age. Genderwise result shows that communication ability of boys and girls is similar in all age groups.

Distraction and Redefinition in the Reduction of Low and High Intensity Experimentally-Induced Pain

1987 ◽  
Vol 7 (2) ◽  
pp. 155-164 ◽  
Author(s):  
Debora L. Dubreuil ◽  
Norman S. Endler ◽  
Nicholas P. Spanos
Keyword(s):  
Short Duration ◽  
High Intensity ◽  
Pain Tolerance ◽  
Pressure Pain ◽  
Low Intensity ◽  
Pain Ratings ◽  
Lower Pain ◽  
Intensity Condition ◽  
Experimentally Induced

Subjects underwent either low intensity or high intensity acute focal pressure pain of relatively short duration on a baseline and posttest trial. On the posttest subjects in each intensity condition either engaged in distraction (shadowing letters), attended to sensations (redefinition) or were given no treatment (controls). Distraction was more effective than redefinition at reducing rated pain and at enhancing pain tolerance for subjects in the high intensity condition. Subjects who scored as repressors gave lower pain ratings than sensitizers. Moreover, in the high intensity condition repressors given distraction reported significant increases in pain tolerance while sensitizers given distraction showed no changes in tolerance.

Normal and radiculopathic cutaneous pain tolerance levels evaluated by heat-beam dolorimetry

1990 ◽  
Vol 72 (6) ◽  
pp. 883-888 ◽  
Author(s):  
Jonathan J. Lipman ◽  
Bennett Blumenkopf ◽  
Patricia L. Lawrence
Keyword(s):  
Stimulus Intensity ◽  
Reference Data ◽  
Pain Tolerance ◽  
Lateral Asymmetry ◽  
Content Type ◽  
Left Hand ◽  
Cutaneous Pain ◽  
Normal Reference ◽  
Lower Pain ◽  
The Right

✓ The heat-beam dolorimeter has previously been used to obtain cutaneous pain tolerance measures in normal volunteers and patients with chronic pain. In the present study, normal reference data were collected at two stimulus intensities for 24 volunteers, and the stimulus-effect relationship (decreasing tolerance latency with increasing stimulus intensity) was found significant (p < 0.001) for all body sites tested. No overall sex differences were found; males behaved slightly more stoically than females, with differences significant only at the T3 site over the breasts. At the second evaluation at the higher stimulus intensity, females exhibited lower pain tolerance (greater pain sensitivity) at the right breast than males (p < 0.05). No significant lateral asymmetry was found in cutaneous pain tolerance except at the dorsum of the hand: the right hand evinced elevated pain tolerance compared with the left hand in both right- and left-handed subjects. Eight radiculopathic pain patients with clinically involved left L5 nerve roots were evaluated and their responses were compared with the volunteer normal reference data. The radiculopathic group evinced elevated tolerance levels in both the radiculopathic dermatome and noninvolved sites compared with normal individuals (p < 0.05).

Effects of suggestion on d' and Cx for pain detection and pain tolerance.

1974 ◽  
Vol 83 (4) ◽  
pp. 364-372 ◽  
Author(s):  
W. Crawford Clark ◽  
Janet S. Goodman
Keyword(s):  
Pain Tolerance ◽  
Pain Detection

scholarly journals Central inhibition of pain is augmented in women with self-injurious behavior

2021 ◽  
Author(s):  
Maria Lalouni ◽  
Jens Fust ◽  
Johan Bjureberg ◽  
Granit Kastrati ◽  
Robin Fondberg ◽  
...  
Keyword(s):  
Temporal Summation ◽  
Pain Modulation ◽  
Pain Tolerance ◽  
Conditioned Pain Modulation ◽  
Heat Pain ◽  
Healthy Controls ◽  
Down Regulation ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds

Individuals who engage in nonsuicidal self-injury (NSSI) have demonstrated higher pain thresholds and tolerance compared with individuals without NSSI. The objective of the study was to assess which aspects of the pain regulatory system that account for this augmented pain perception. In a cross-sectional design, 81 women, aged 18-35 (mean [SD] age, 23.4 [3.9]), were included (41 with NSSI and 40 healthy controls). A quantitative sensory testing protocol, including heat pain thresholds, heat pain tolerance, pressure pain thresholds, conditioned pain modulation (assessing central down-regulation of pain), and temporal summation (assessing facilitation of pain signals) was used. Thermal pain stimuli were assessed during fMRI scanning and NSSI behaviors and clinical symptoms were self-assessed. NSSI participants demonstrated higher pain thresholds during heat and pressure pain compared to controls. During conditioned pain modulation, NSSI participants showed a more effective central down-regulation of pain for NSSI participants. Temporal summation did not differ between the groups. There were no correlations between pain outcomes and NSSI behaviors or clinical characteristics. The fMRI analyses revealed increased activity in the primary and secondary somatosensory cortex in NSSI participants, compared to healthy controls, which are brain regions implicated in sensory aspects of pain processing. The findings suggest segregated inhibitory mechanisms for pain and emotion in NSSI, as pain insensitivity was linked to enhanced inhibitory control of pain in spite of significant impairments in emotion regulation. This may represent an endophenotype associated with a greater risk for developing self-injurious behavior.

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