Transient Analgesia Evoked by Noxious Stimulus Offset

2002 ◽  
Vol 87 (4) ◽  
pp. 2205-2208 ◽  
Author(s):  
Joshua D. Grill ◽  
Robert C. Coghill
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Relative Proportion ◽  
Noxious Stimulus ◽  
Temporal Contrast ◽  
Nociceptive Processing ◽  
Perceived Pain ◽  
Pain Ratings ◽  
Stimulus Offset ◽  
Escape Behaviors

Pain has long been thought to wax and wane in relative proportion to fluctuations in the intensity of noxious stimuli. Dynamic aspects of nociceptive processing, however, remain poorly characterized. Here we show that small decreases (±1–3°C) in noxious stimulus temperatures (47–50°C) evoked changes in perceived pain intensity that were as much as 271% greater than those of equal magnitude increases. These decreases in perceived pain intensity were sufficiently large to be indistinguishable from those evoked by 15°C decreases to clearly innocuous levels. Furthermore, decreases in pain ratings following noxious stimulus offset were significantly greater than those occurring during adaptation to constant temperature stimuli. Together, these findings indicate that an analgesic mechanism is activated during noxious stimulus offset. This analgesic phenomenon may serve as a temporal contrast enhancement mechanism to amplify awareness of stimulus offset and to reinforce escape behaviors. Disruption of this mechanism may contribute importantly to chronic pain.

scholarly journals Onset hyperalgesia and offset analgesia: Transient increases or decreases of noxious thermal stimulus intensity robustly modulate subsequent perceived pain intensity

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0231124
Author(s):  
Benedict J. Alter ◽  
Mya Sandi Aung ◽  
Irina A. Strigo ◽  
Howard L. Fields
Keyword(s):  
Pain Intensity ◽  
Stimulus Intensity ◽  
Noxious Stimulus ◽  
Thermal Stimulus ◽  
Experienced Pain ◽  
Perceived Pain ◽  
Subjective Pain ◽  
Higher Temperature ◽  
Absolute Magnitudes ◽  
Lower Temperature

Reported pain intensity depends not only on stimulus intensity but also on previously experienced pain. A painfully hot temperature applied to the skin evokes a lower subjective pain intensity if immediately preceded by a higher temperature, a phenomenon called offset analgesia. Previous work indicated that prior pain experience can also increase subsequent perceived pain intensity. Therefore, we examined whether a given noxious stimulus is experienced as more intense when it is preceded by an increase from a lower temperature. Using healthy volunteer subjects, we observed a disproportionate increase in pain intensity at a given stimulus intensity when this intensity is preceded by a rise from a lower intensity. This disproportionate increase is similar in magnitude to that of offset analgesia. We call this effect onset hyperalgesia. Control stimuli, in which a noxious temperature is held constant, demonstrate that onset hyperalgesia is distinct from receptor or central sensitization. The absolute magnitudes of offset analgesia and onset hyperalgesia correlate with each other but not with the noxious stimulus temperature. Finally, the magnitude of both offset analgesia and onset hyperalgesia depends on preceding temperature changes. Overall, this study demonstrates that the perceptual effect of a noxious thermal stimulus is influenced in a bidirectional manner depending upon both the intensity and direction of change of the immediately preceding thermal stimulus.

How can the Alexithymia and Behavioural Inhibition predict the perceived pain intensity in patients with chronic pain?

2020 ◽  
Vol 178 (10) ◽  
pp. 996-1001
Author(s):  
Marzieh Pahlevan ◽  
Mohammad Ali Besharat ◽  
Ahmad Borjali ◽  
Morteza Naghipoor
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Behavioural Inhibition ◽  
Perceived Pain

scholarly journals Pain-Related and Negative Semantic Priming Enhances Perceived Pain Intensity

2014 ◽  
Vol 19 (2) ◽  
pp. 69-74 ◽  
Author(s):  
Maria Richter ◽  
Christoph Schroeter ◽  
Theresa Puensch ◽  
Thomas Straube ◽  
Holger Hecht ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Semantic Priming ◽  
Moderate Intensity ◽  
Dependent Manner ◽  
Negative Valence ◽  
Experimental Parameters ◽  
Perceived Pain ◽  
Pain Ratings ◽  
Subjective Pain ◽  
Noxious Stimuli

BACKGROUND: Negative affective and pain-related cues, such as pictures or words, have been shown to act as primes and enhance the perceived intensity of subsequent painful events. For pain-related semantic primes, it remains unclear whether this effect depends on negative valence itself or, specifically, on the pain-relatedness of the words.OBJECTIVES: To investigate the effect of pain-related, negative affective (pain-unrelated) and neutral semantic primes on the perception of subsequent noxious target stimuli.METHODS: Pain ratings in response to noxious electrical stimulation of light and moderate intensity were examined in 39 healthy subjects after subjects were exposed to semantic primes of different meaning and valence (pain-related, negative, positive and neutral adjectives) presented with different interstimulus intervals (0 ms, 500 ms and 1500 ms).RESULTS: Increased pain ratings of noxious stimuli were observed following pain-related and negative compared with neutral primes.DISCUSSION: The results support the motivational priming theory for semantic stimuli, indicating that affectively negative semantic primes increase subjective pain intensity. However, a specific pain-related priming effect was not reliably demonstrated. Additionally, it is shown that experimental parameters (ie, stimulus intensity and interstimulus interval) modify the extent of negative and pain-related semantic priming.CONCLUSIONS: Verbal priming plays a role for the perception of noxious stimuli in a time-dependent manner.

scholarly journals Effects of Flotation-REST on Muscle Tension Pain

2001 ◽  
Vol 6 (4) ◽  
pp. 181-189 ◽  
Author(s):  
Anette Kjellgren ◽  
Ulf Sundequist ◽  
Torsten Norlander ◽  
Trevor Archer
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Muscle Tension ◽  
Control Group ◽  
Water Tank ◽  
Perceived Pain ◽  
Environmental Stimulation ◽  
Circulating Levels ◽  
Stimulation Technique ◽  
Experimental Group

The purpose of the present study was to investigate whether the floating form of the restricted environmental stimulation technique (REST) may be applied within the field of pain relief. Flotation-REST consists of a procedure whereby an individual is immersed in a tank filled with water of an extremely high salt concentration. Thirty-seven patients (14 men and 23 women) suffering from chronic pain consisting of aching muscles in the neck and back area participated in the study. They were randomly assigned to either a control group (17 participants) or an experimental group (20 participants). The experimental group received nine opportunities to use the flotation-REST technique in the water tank over a three-week period. The results indicated that the most severe perceived pain intensity was significantly reduced, whereas low perceived pain intensity was not influenced by the floating technique. Further, the results indicated that circulating levels of the noradrenaline metabolite 3-methoxy-4-hydroxyphenylethyleneglycol were reduced significantly in the experimental group but not in the control group following treatment, whereas endorphin levels were not affected by flotation. Flotation-REST treatment also elevated the participants' optimism and reduced the degree of anxiety or depression; at nighttime, patients who underwent flotation fell asleep more easily. The present findings describe possible changes, for the better, in patients presenting with chronic pain complaints.

scholarly journals Temporal properties of painful contrast enhancement using repetitive stimulation

2021 ◽  
Author(s):  
Tibor M. Szikszay ◽  
Waclaw M. Adamczyk ◽  
Juliette L. M. Levenez ◽  
Philip Gouverneur ◽  
Kerstin Luedtke
Keyword(s):  
Contrast Enhancement ◽  
Electrodermal Activity ◽  
Repetitive Stimulation ◽  
Temporal Contrast ◽  
Temporal Properties ◽  
Heat Stimulus ◽  
Control Paradigm ◽  
Perceived Pain ◽  
Pain Ratings ◽  
Surrogate Measure

Offset analgesia is characterized by a disproportionately large reduction in pain following a small decrease in a heat stimulus and is based on the phenomenon of temporal pain contrast enhancement (TPCE). The aim of this study is to investigate whether this phenomenon can also be induced by repetitive stimulation, i.e., by stimuli that are clearly separated in time. With this aim, the repetitive TPCE paradigm was induced in healthy, pain-free subjects (n=33) at the volar non-dominant forearm using heat stimuli. This paradigm was performed applying three different interstimulus intervals (ISIs): 5, 15, and 25 seconds. All paradigms were contrasted with a control paradigm without temperature change. Participants continuously rated the perceived pain intensity. In addition, electrodermal activity was recorded as a surrogate measure of autonomic arousal. Temporal pain contrast enhancement was confirmed for both ISI 5 seconds (p < 0.001) and ISI 15 seconds (p = 0.005), but not for ISI 25 seconds (p = 0.07), however the magnitude of TPCE did not differ between ISIs (p = 0.11). Electrodermal activity was consistent previous pain ratings, but showing significantly higher autonomic activity being measured. Thus, the phenomenon of temporal contrast enhancement of pain can also be induced by repetitive stimulation. Both the involvement of the autonomic nervous system and the involvement of habituation processes are conceivable, which consequently points to both central and peripheral mechanisms of TPCE.

Collecting patient reported outcomes to facilitate prescription opioid management: Development and testing of the Opioid Management App (OM-App) (Preprint)

2020 ◽  
Author(s):  
Jessica Robinson-Papp ◽  
Gabriela Cedillo ◽  
Richa Deshpande ◽  
Mary Catherine George ◽  
Qiuchen Yang ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Risk Behaviors ◽  
Digital Health ◽  
Monitoring Program ◽  
Prescription Opioid ◽  
Research Database ◽  
Cross Sectional ◽  
Study Duration ◽  
Patient Reported

BACKGROUND Collecting patient-reported data needed by clinicians to adhere to opioid prescribing guidelines represents a significant time burden. OBJECTIVE We developed and tested an opioid management app (OM-App) to collect these data directly from patients. METHODS OM-App used a pre-existing digital health platform to deliver daily questions to patients via text-message and organize responses into a dashboard. We pilot tested OM-App over 9 months in 40 diverse participants with HIV who were prescribed opioids for chronic pain. Feasibility outcomes included: ability to export/integrate OM-App data with other research data; patient-reported barriers and adherence to OM-App use; capture of opioid-related harms, risk behaviors and pain intensity/interference; comparison of OM-App data to urine drug testing, prescription drug monitoring program data, and validated questionnaires. RESULTS OM-App data was exported/integrated into the research database after minor modifications. Thirty-nine of 40 participants were able to use OM-App, and over the study duration 70% of all OM-App questions were answered. Although the cross-sectional prevalence of opioid-related harms and risk behaviors reported via OM-App was low, some of these were not obtained via the other measures, and over the study duration all queried harms/risks were reported at least once via OM-App. Clinically meaningful changes in pain intensity/interference were captured. CONCLUSIONS OM-App was used by our diverse patient population to produce clinically relevant opioid- and pain-related data, which was successfully exported and integrated into a research database. These findings suggest that OM-App may be a useful tool for remote monitoring of patients prescribed opioids for chronic pain. CLINICALTRIAL NCT03669939 INTERNATIONAL REGISTERED REPORT RR2-doi:10.1016/j.conctc.2019.100468

scholarly journals The Pain Situation of Older Home-Care Recipients and Influencing Factors

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 204-205
Author(s):  
Dagmar Dräger ◽  
Reinhold Kreutz ◽  
Adelheid Kuhlmey ◽  
Andrea Budnick ◽  
Dagmar Draeger
Keyword(s):  
Chronic Pain ◽  
Home Care ◽  
Older People ◽  
Pain Intensity ◽  
Prevalence Rate ◽  
Severe Pain ◽  
Self Report ◽  
Primary Data ◽  
Common Symptom ◽  
Care Recipients

Abstract Chronic pain is a common symptom among older people. The international prevalence rate reaches 50% for older home-care recipients (aged ≥60). The most common causes of pain among older people are degenerative arthropathy and musculoskeletal diseases. Care recipients (81% aged ≥65) constitute a specific sub-group among pain patients, due to the restrictions they experience. In Germany, the prevalence rate in this group is 70%. Currently, no comprehensive information on the pain situation of older home-care recipients exists in Germany. The findings presented are based on a cross-sectional study of older (aged ≥65) home-care recipients (SGB XI) in Berlin, with chronic pain (n=225), capable of self-report (MMST≥18). Structured interviews comprised the primary data source. The pain situation was determined using the German Brief Pain Inventory (BPI-NH). Multiple regression analysis was applied to test how the most severe pain (dependent variable) was influenced by socio-demographic and medical parameters, mental and physical restrictions and pain medication. Analyses of the pain situation show a value of M=4.81 (SD±1.88) on the BPI intensity index, and a BPI pain interference index of M=5.47 (SD±2.15). The most intense pain averaged 6.96 (SD±2.15). On average, respondents reported 16.20 (SD±13.25) pain locations (range: 0-65). The number of pain locations, alongside other factors, had a significant influence, R²=0.038 (corrected R²=0.034), F (1.219) = 8.760, p&lt;0.01), on pain intensity. The findings show severe pain intensity among older home-care recipients not reported in previous findings (e.g. in long-term in-patient care). Action in medical care, nursing care and educational aspects is urgently needed.

Sleep disturbance in patients attending specialized chronic pain clinics in Denmark: a longitudinal study examining the relationship between sleep and pain outcomes

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Henrik Bjarke Vaegter ◽  
Mette Terp Høybye ◽  
Frederik Hjorth Bergen ◽  
Christine E. Parsons
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Sleep Quality ◽  
Pain Intensity ◽  
Sleep Disturbances ◽  
Pain Disability ◽  
Pain Clinics ◽  
Pain Outcomes

Abstract Objectives Sleep disturbances are highly prevalent in patients with chronic pain. However, the majority of studies to date examining sleep disturbances in patients with chronic pain have been population-based cross-sectional studies. The aims of this study were to 1) examine the frequency of sleep disturbances in patients referred to two interdisciplinary chronic pain clinics in Denmark, 2) explore associations between sleep disturbances and pain intensity, disability and quality of life at baseline and follow-up, and 3) explore whether changes in sleep quality mediated the relationships between pain outcomes at baseline and pain outcomes at follow-up. Methods We carried out a longitudinal observational study, examining patients enrolled in two chronic pain clinics assessed at baseline (n=2,531) and post-treatment follow-up (n=657). Patients reported on their sleep disturbances using the sleep quality subscale of the Karolinska Sleep Questionnaire (KSQ), their pain intensity using 0–10 numerical rating scales, their pain-related disability using the Pain Disability Index (PDI), and quality of life using the EuroQol-VAS scale. The average time between baseline and follow-up was 207 days (SD=154). Results At baseline, the majority of patients reported frequent sleep disturbances. We found a significant association at baseline between self-reported sleep disturbances and pain intensity, pain-related disability, and quality of life, where greater sleep disturbance was associated with poorer outcomes. At follow-up, patients reported significant improvements across all pain and sleep outcomes. In two mediation models, we showed that changes in sleep disturbances from baseline to follow-up were significantly associated with (i) pain intensity at follow-up, and (ii) pain disability at follow-up. However, baseline pain intensity and disability scores were not associated with changes in sleep disturbances and, we did not find evidence for significant mediation of either pain outcome by changes in sleep disturbances. Conclusions Self-reported sleep disturbances were associated with pain outcomes at baseline and follow-up, with greater sleep disturbances associated with poorer pain outcomes. Changes in sleep quality did not mediate the relationships between baseline and follow-up scores for pain intensity and disability. These findings contribute to a growing body of evidence confirming an association between sleep and chronic pain experience, particularly suggestive of a sleep to pain link. Our data following patients after interdisciplinary treatment suggests that improved sleep is a marker for a better outcome after treatment.

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