There Is Association between Type of Pain and Hematologic Disorders

Abstract Background: Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage according to the International Association for the Study of Pain. Aim: To estimate distinguishing features of the pain in patients with blood disorders. Patients and Methods: The prospective exploratory study was conducted in the National Research Center for Hematology, Moscow from 11/2015 to 01/2021. In total, 40 patients (pts) with blood disorders who had a difficult-to-control pain syndrome were included in the study. There were 21 men (median age of 41.5, IQR 35.0-56.3 years) and 19 women (median age of 40, IQR 34.3-56.0 years). The pain types were determined according to clinical symptoms and the use of special questionnaires (i.e., the Douleur Neuropathique 4 Questions questionnaire for neuropathic pain). Pressure algometry was used to assess pain tolerance of the non-dominant hand by evaluating the pressure pain threshold (PPT, kg/cm 2), which is the minimum pressure required to induce pain. Results: Four types of pain were identified: neuropathic in 9 pts (22.5%), nociceptive in 9 pts (22.5%), their mix (summing up to a half of the total number of cases ‒ 52.5%, 21 pts) and dysfunctional pain in only 1 patient (2.5%). The distribution based on the pain types was uneven (Kolmogorov test, p = 0.05). The different pain types were related with various distributions of blood disorders: lymphoid tumor (44.5%), myeloid tumor (33.3%) and not tumor (22.2%) (associated with neuropathic pain) and myeloid tumor (88.9%) and not tumor (11.1%) (associated with nociceptive pain) (Figs. 1 and 2) . The tolerance of neuropathic and nociceptive pain types turned out to be significantly different (PPT medians with 95% CI): 2.2 kg/cm 2 (1.6-3.1) vs. 4.6 kg/cm 2 (3.9-5.5), respectively, and (found in ROC-analysis) the cut-off was 3.2 kg/cm 2,AUC (the area under ROC curve) 96.3%, sensitivity and specificity 88.8% (Fig. 3 and 4). PPT cut-off points, that shares the mixed pain (median 2.7 kg/cm 2, 95 CI 1.9-3.6) on the neuropathic and nociceptive pain are: 3.2 kg/cm 2 (AUC 67.0%) and 3.8 kg/cm 2 (AUC 86.7%), respectively. Several measurements of PPT (with taking into account the cut-off) in patient, suffering from pain, can help identify with a high probability his type of pain, and accordingly (indirectly), his blood type disorder. Conclusions: Measuring PPT in a pts with blood disorders allows to identify the type of pain (neuropathic, nociceptive, or combined), which can serve as an additional source of information for accurate diagnosis and treatment. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Can Injuries Have a Lasting Effect on the Perception of Pain in Young, Healthy Women and Men?

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120953165 ◽

2020 ◽

pp. 194173812095316

Author(s):

Agnieszka Maciejewska-Skrendo ◽

Maciej Pawlak ◽

Agata Leońska-Duniec ◽

Alina Jurewicz ◽

Mariusz Kaczmarczyk ◽

...

Keyword(s):

Physical Activity ◽

Pain Threshold ◽

Pain Perception ◽

Emotional Experience ◽

Pressure Pain Threshold ◽

Pain Tolerance ◽

Female Group ◽

Pressure Pain ◽

Left Hand ◽

Healthy Women

Background: Pain is a characteristic, unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is a subjective sensation, modulated by many factors such as age, sex, emotional state, national origin, or physical activity. Moreover, it is closely associated with intense physical activity, injuries, and traumas, which can significantly modulate pain tolerance. Hypothesis: We postulate that there are correlations between past injuries, physical activity, and intensity of pain perception (pain threshold and pain tolerance) in a population of healthy men and women. Study Design: Retrospective cohort study. Level of Evidence: Level 4. Methods: A total of 302 participants aged 18 to 32 years were included. The participants were divided into 2 groups (active and inactive individuals), in accordance with the scope of physical activity they had indicated. The test of pressure pain threshold and pressure pain tolerance was performed using an algometer. Results: Active women achieved significantly higher pain threshold and pain tolerance values in all measurements on the upper limb (except for the pain threshold on the left hand) compared with inactive women. In mediation analysis, the effect of injury remained significant only for the pressure pain tolerance in the dominant arm and the left hand in the female group. In the case of men, there were no significant differences in all measurements in view of the threshold and tolerance for pain between the groups of active and inactive and between men with injuries and without injuries. Conclusion: Intense, regular physical activity is a factor modulating the perception of pain. This was demonstrated as lowered sensitivity to pain stimuli in a population of healthy women. Clinical Relevance: Injuries should be treated as an important factor modulating the perception of pain. We recommend detailed monitoring of injuries during treatment and control of pain sensation.

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Chronic postsurgical pain and complex regional pain syndrome

10.1093/med/9780199682874.003.0043 ◽

2021 ◽

pp. 289-291

Author(s):

Lesley A. Colvin ◽

Sebastian Bourn

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Complex Regional Pain Syndrome ◽

International Association ◽

Emotional Experience ◽

Adult Population ◽

Clinical Signs ◽

Pain Syndrome ◽

Postsurgical Pain ◽

Chronic Postsurgical Pain

Pain is defined by the International Association for the Study of Pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. Acute pain is predictable following surgical intervention; chronic pain is less so. Chronic pain, persisting for longer than 3 months, or beyond expected wound healing, is a worldwide problem affecting around 20% of the adult population. Chronic postsurgical pain is multifactorial, although it often involves some form of nerve damage, with clinical signs consistent with this. Neuropathic pain may have a greater impact on quality of life than other chronic pain syndromes. It is important, therefore, to identify neuropathic pain as early as possible, in order to initiate appropriate management and reduce longer-term impact. This chapter focuses on two types of neuropathic pain: chronic postsurgical pain and complex regional pain syndrome.

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Static mechanical allodynia in post-surgical neuropathic pain after breast cancer treatments

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0013 ◽

2020 ◽

Vol 20 (4) ◽

pp. 683-691

Author(s):

Laura Mustonen ◽

Tommi Aho ◽

Hanna Harno ◽

Eija Kalso

Keyword(s):

Breast Cancer ◽

Neuropathic Pain ◽

Psychological Factors ◽

Mechanical Allodynia ◽

Cold Pressor Test ◽

Pain Tolerance ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Cold Pain ◽

Static Mechanical

AbstractObjectivesStatic mechanical allodynia (SMA), i. e., pain caused by normally non-painful static pressure, is a prevalent manifestation of neuropathic pain (NP). Although SMA may significantly affect the patient’s daily life, it is less well studied in the clinical context. We aimed to characterize SMA in women with chronic post-surgical NP (CPSNP) after breast cancer surgery. Our objective was to improve understanding of the clinical picture of this prevalent pain condition. This is a substudy of a previously published larger cohort of patients with intercostobrachial nerve injury after breast cancer surgery (Mustonen et al. Pain. 2019;160:246–56).MethodsWe studied SMA in 132 patients with CPSNP after breast cancer surgery. The presence, location, and intensity of SMA were assessed at clinical sensory examination. The patients gave self-reports of pain with the Brief Pain Inventory (BPI). We studied the association of SMA to type of surgery, oncological treatments, BMI, other pains, and psychological factors. General pain sensitivity was assessed by the cold pressor test.ResultsSMA was prevalent (84%) in this cohort whereas other forms of allodynia were scarce (6%). Moderate-to-severe SMA was frequently observed even in patients who reported mild pain in BPI. Breast and the side of chest were the most common locations of SMA. SMA was associated with breast surgery type, but not with psychological factors. Severe SMA, but not self-reported pain, was associated with lower cold pain tolerance.ConclusionsSMA is prevalent in post-surgical NP after breast cancer surgery and it may represent a distinct NP phenotype. High intensities of SMA may signal the presence of central sensitization.ImplicationsSMA should be considered when examining and treating patients with post-surgical NP after breast cancer surgery.

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The Challenge of Chronic Pain Management by PM&R Specialist

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/ijpmr.v7i01.114 ◽

2018 ◽

Vol 7 (01) ◽

pp. 1

Author(s):

Maria Regina Rachmawati

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

International Association ◽

Emotional Experience ◽

Rehabilitation Medicine ◽

Low Back ◽

Chronic Pain Management ◽

Prevalence Of Pain ◽

Sedentary Life ◽

Sedentary Life Style

According to the definition from international association for the study of pain (IASP), pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Besides, there are many term of unpleasant sensory that complaint by patient as a pain, such as allodynia, hyperalgesia, and hyperesthesia. The pain is one of the most cases that came to seeking a doctor. The data from Indonesian National Health Insurance (JKN) from 2014-2017 have revealed that pain cases were the most frequent in Rehabilitation Medicine Services, i.e. low back pain, knee pain, and shoulder pain. The prevalence of pain is increasing along with ageing, sedentary life style, obesity and chronic diseases.

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Effect of interactive vs. passive virtual reality on pain threshold and tolerance

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0046 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Juliann Saquib ◽

Haneen A. AlMohaimeed ◽

Sally A. AlOlayan ◽

Nora A. AlRebdi ◽

Jana I. AlBulaihi ◽

...

Keyword(s):

Virtual Reality ◽

Repeated Measures ◽

Pain Threshold ◽

Scientific Evidence ◽

Random Order ◽

Pain Tolerance ◽

Dominant Hand ◽

Interactive Games ◽

Within Subjects ◽

Order Sequence

Abstract Objectives Scientific evidence suggests that virtual reality (VR) could potentially help patients tolerate painful medical procedures and conditions. The aim of this study was to evaluate the efficacy of virtual reality on pain tolerance and threshold. Methods A within-subjects experimental study design was conducted on 53 female students at Qassim University in Saudi Arabia. Each participant completed three rounds of assessment: one baseline (no VR) and two VR immersion (passive and interactive) in random order sequence. During each round, participants submerged their non-dominant hand into an ice bath; pain threshold and tolerance were measured as outcomes and analyzed using repeated measures ANOVA. Results Participants had both higher pain threshold and tolerance during interactive and passive VR rounds in comparison to the non-VR baseline assessment (p<0.05). Participants had greater pain tolerance during the interactive VR condition compared to the passive VR condition (p<0.001). Conclusions VR experiences increase pain threshold and tolerance with minimal side effects, and the larger effects were demonstrated using interactive games. Interactive VR gaming should be considered and tested as a treatment for pain.

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Managing Pain

Adult Nursing Practice ◽

10.1093/oso/9780199697410.003.0036 ◽

2012 ◽

Author(s):

Nick Allcock ◽

Ruth Day

Keyword(s):

International Association ◽

Emotional Experience ◽

Individual Characteristics ◽

Self Report ◽

Evidence Based ◽

Nursing Management ◽

Patient’S Experience ◽

Emotional Component ◽

Individual Nature ◽

The Individual

This chapter aims to provide you with the knowledge to be able to take an evidence-based approach to the nursing management of people who are experiencing pain. As a practising nurse, pain will be something that many of your patients will experience; however, one individual’s pain may be very different from another person’s. Pain can vary depending on the circumstances in which it is experienced and the individual characteristics of the person experiencing it. Understanding someone’s pain experience is therefore challenging because you cannot see someone’s pain or easily judge how bad it is, what it feels like, or how it affects him or her. This chapter provides you with knowledge and skills to recognize, assess, and manage the patient’s experience of pain effectively with evidence-based strategies. The variability of the experience of pain makes defining pain difficult. Pain is something that we have all experienced at some point in our lives and therefore, through these experiences, we have developed an understanding of what we consider to be pain. One of the most widely accepted definitions is that of the International Association for the Study of Pain (IASP), which defines pain as:…An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. (Merskey and Bogduk,1994)…Although this definition is often quoted, the difficulty in defining pain is illustrated by the fact that the IASP added a note (go to http://www.iasp-pain.org/ and search for ‘pain definitions’) to highlight the individual nature of pain and the fact that pain is a sensory experience with an emotional component. The individual nature of pain is also highlighted by another commonly used definition:…Pain is whatever the experiencing person says it is and happens whenever he/she says it does. (McCaffery, 1972)…This definition highlights the fact that pain is an individual experience and that measuring pain objectively is difficult. Therefore asking the person and actively listening to the self-report of the experience is the best way in which to understand another person’s pain. A common criticism of McCaffery’s definition is that some people cannot say what they are experiencing.

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Reliability of the conditioned pain modulation paradigm across three anatomical sites

Scandinavian Journal of Pain ◽

10.1515/sjpain-2019-0080 ◽

2020 ◽

Vol 20 (2) ◽

pp. 283-296

Author(s):

Rania Nuwailati ◽

Michele Curatolo ◽

Linda LeResche ◽

Douglas S. Ramsay ◽

Charles Spiekerman ◽

...

Keyword(s):

Cold Pressor Test ◽

Pressure Pain Threshold ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Dominant Hand ◽

Pain Mechanisms ◽

Relative Reliability ◽

Contralateral Hand ◽

The Face ◽

Absolute Reliability

AbstractBackground and aimsConditioned Pain Modulation (CPM) is a measure of pain inhibition-facilitation in humans that may elucidate pain mechanisms and potentially serve as a diagnostic test. In laboratory settings, the difference between two pain measures [painful test stimulus (TS) without and with the conditioning stimulus (CS) application] reflects the CPM magnitude. Before the CPM test can be used as a diagnostic tool, its reliability on the same day (intra-session) and across multiple days (inter-session) needs to be known. Furthermore, it is important to determine the most reliable anatomical sites for both the TS and the CS. This study aimed to measure the intra-session and inter-session reliability of the CPM test paradigm in healthy subjects with the TS (pressure pain threshold-PPT) applied to three test sites: the face, hand, and dorsum of the foot, and the CS (cold pressor test-CPT) applied to the contralateral hand.MethodsSixty healthy participants aged 18–65 were tested by the same examiner on 3 separate days, with an interval of 2–7 days. On each day, testing was comprised of two identical experimental sessions in which the PPT test was performed on each of the three dominant anatomical sites in randomized order followed by the CPM test (repeating the PPT with CPT on the non-dominant hand). CPM magnitude was calculated as the percent change in PPT. The Intraclass Correlation Coefficient (ICC), Coefficient of Variation (CV), and Bland-Altman analyses were used to assess reliability.ResultsPPT relative reliability ranged from good to excellent at all three sites; the hand showed an intra-session ICC of 0.90 (0.84, 0.94) before CPT and ICC of 0.89 (0.83, 0.92) during CPT. The PPT absolute reliability was also high, showing a low bias and small variability when performed on all three sites; for example, CV of the hand intra-session was 8.0 before CPT and 8.1 during CPT. The relative reliability of the CPM test, although only fair, was most reliable when performed during the intra-session visits on the hand; ICC of 0.57 (0.37, 0.71) vs. 0.20 (0.03, 0.39) for the face, and 0.22 (0.01, 0.46) for the foot. The inter-session reliability was lower in all three anatomical sites, with the best reliability on the hand with an ICC of 0.40 (0.23, 0.55). The pattern of absolute reliability of CPM was similar to the relative reliability findings, with the reliability best on the hand, showing lower intra-session and inter-session variability (CV% = 43.5 and 51.5, vs. 70.1 and 73.1 for the face, and 75.9 and 78.9 for the foot). The CPM test was more reliable in women than in men, and in older vs. younger participants.DiscussionThe CPM test was most reliable when the TS was applied to the dominant hand and CS performed on the contralateral hand. These data indicate that using the CS and TS in the same but contralateral dermatome in CPM testing may create the most reliable results.

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Effect of Biological Sex Differences on the Perception of Acute Pain Stimulation in the Dental Setting

Pain Research and Management ◽

10.1155/1996/149823 ◽

1996 ◽

Vol 1 (4) ◽

pp. 201-206 ◽

Cited By ~ 11

Author(s):

Ilana Eli ◽

Yoram Bar-Tal ◽

Zvi Fuss ◽

Ethan Korff

Keyword(s):

Acute Pain ◽

Emotional Experience ◽

Subjective Evaluation ◽

Dental Anxiety ◽

Pain Tolerance ◽

Tooth Pulp ◽

Biological Sex ◽

Dental Patients ◽

Pain Stimulation ◽

As Stress

BACKGROUND:Pain is a subjective sensory and emotional experience that is influenced by variables such as stress, anxiety and sex.OBJECTIVE:To investigate the interrelationship among sex, state and dental anxiety, and the patient's reaction to diagnostic tooth pulp stimulation.SUBJECTS AND DESIGN:The study was conducted on 64 dental patients (age 18 to 78 years, 50% were female). All subjects were evaluated twice. At time 1, subjects were requested to fill out questionnaires concerning their state and dental anxiety, and participants underwent diagnostic tooth pulp stimulation by an electric pulp tester. Four variables of the experience were recorded: sensation threshold, pain threshold, pain tolerance and the subjective evaluation of the painful experience on a visual analogue scale (VAS). At time 2, subjects were requested to record their memory of the previous experience on a VAS, and the whole procedure was repeated including record of state and dental anxiety, sensation and pain thresholds, pain tolerance and its subjective evaluation on a VAS.RESULTS:No direct correlations were found between sex and any other variable. However, there were significant differences in the relationship among the different pain and anxiety measures between both sexes.CONCLUSIONS:A man's reaction to acute pain stimulation may be more affected by psychological factors than a woman's.

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Assessment of pain quality in chronic neuropathic and nociceptive pain clinical trials with the Neuropathic Pain Scale

Journal of Pain ◽

10.1016/j.jpain.2004.11.002 ◽

2005 ◽

Vol 6 (2) ◽

pp. 98-106 ◽

Cited By ~ 65

Author(s):

Mark P. Jensen ◽

Robert H. Dworkin ◽

Arnold R. Gammaitoni ◽

David O. Olaleye ◽

Napoleon Oleka ◽

...

Keyword(s):

Clinical Trials ◽

Neuropathic Pain ◽

Pain Scale ◽

Nociceptive Pain

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Pain neurophysiology

10.1093/med/9780199642489.003.0059 ◽

2013 ◽

Author(s):

Hans-Georg Schaible ◽

Rainer H. Straub

Keyword(s):

Neuropathic Pain ◽

Central Sensitization ◽

Cell Activation ◽

Warning Signal ◽

Nociceptive Pain ◽

Neural Function ◽

Peripheral Sensitization ◽

Nerve Fibres ◽

Glial Cell Activation ◽

Ectopic Discharges

Physiological pain is evoked by intense (noxious) stimuli acting on healthy tissue functioning as a warning signal to avoid damage of the tissue. In contrast, pathophysiological pain is present in the course of disease, and it is often elicited by low-intensity stimulation or occurs even as resting pain. Causes of pathophysiological pain are either inflammation or injury causing pathophysiological nociceptive pain or damage to nerve cells evoking neuropathic pain. The major peripheral neuronal mechanism of pathophysiological nociceptive pain is the sensitization of peripheral nociceptors for mechanical, thermal and chemical stimuli; the major peripheral mechanism of neuropathic pain is the generation of ectopic discharges in injured nerve fibres. These phenomena are created by changes of ion channels in the neurons, e.g. by the influence of inflammatory mediators or growth factors. Both peripheral sensitization and ectopic discharges can evoke the development of hyperexcitability of central nociceptive pathways, called central sensitization, which amplifies the nociceptive processing. Central sensitization is caused by changes of the synaptic processing, in which glial cell activation also plays an important role. Endogenous inhibitory neuronal systems may reduce pain but some types of pain are characterized by the loss of inhibitory neural function. In addition to their role in pain generation, nociceptive afferents and the spinal cord can further enhance the inflammatory process by the release of neuropeptides into the innervated tissue and by activation of sympathetic efferent fibres. However, in inflamed tissue the innervation is remodelled by repellent factors, in particular with a loss of sympathetic nerve fibres.

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