scholarly journals The Added Value of Sensitivity to Nonnoxious Stimuli to Predict an Individual’s Sensitivity to Pain

2021 ◽  
Vol 24 (6) ◽  
pp. E783-E794
Keyword(s):  
Postoperative Pain ◽  
Healthy Volunteers ◽  
Pain Score ◽  
Pain Sensitivity ◽  
Pain Catastrophizing ◽  
Light Sensitivity ◽  
Heat Pain ◽  
Cold Pain ◽  
Eye Color ◽  
Anxiety Depression

BACKGROUND: Simple tools are needed to predict postoperative pain. Questionnaire-based tools such as the Pain Sensitivity Questionnaire (PSQ) are validated for this purpose, but prediction could be improved by incorporating other parameters. OBJECTIVES: To explore the potency of sensitivity to nonpainful stimuli and biometric data to improve prediction of pain. STUDY DESIGN: Transversal exploratory study. SETTING: Single clinical investigation center. METHODS. Eighty-five healthy volunteers of both genders underwent a multimodal exploration including biometry, questionnaire-based assessment of anxiety, depression, pain catastrophizing, sensitivity to smell, and the PSQ, followed by a psychophysical assessment of unpleasantness thresholds for light and sound, and sensitivity to mechanical, heat, and cold pain. These last 3 parameters were used to calculate a composite pain score. After a multi-step selection, multivariable analyses identified the explanative factors of experimental pain sensitivity, by including biometric, questionnaire-based, and psychophysical nonnociceptive sensitivity parameters, with the aim of having each domain represented. RESULTS: Female gender predicted mechanical pain, a younger age and dark eyes predicted cold pain, and the PSQ predicted heat pain. Sensitivity to unpleasantness of sound predicted mechanical and heat pain, and sensitivity to unpleasantness of light predicted cold pain. Sensitivity to smell was unrelated. The predictors of the composite pain score were the PSQ, the light unpleasantness threshold, and an interaction between gender and eye color, the score being lower in light-eyed men and higher in all women. The final multivariable multi-domain model was more predictive of pain than the PSQ alone (R2 = 0.301 vs 0.122, respectively). LIMITATIONS: Sensitivity to smell was only assessed by a short questionnaire and could lack relevance. Healthy volunteers were unlikely to elicit psychological risk factors such as anxiety, depression, or catastrophizing. These results have not been validated in a clinical setting (e.g., perioperative). CONCLUSION: The predictive potential of the PSQ can be improved by including information about gender, eye color, and light sensitivity. However, there is still a need for a technique suitable for routine clinical use to assess light sensitivity. KEY WORDS: Personalized medicine, postoperative pain, senses, prediction, photophobia, hyperacusis, eye color, hypervigilance, sensory over-responsivity

scholarly journals Relationships between Psychological Factors and Experimental Pain Outcomes in Healthy Individuals: Results from 8 Studies

2021 ◽  
Author(s):  
Hadas Nahman-Averbuch ◽  
Ian A. Boggero ◽  
Benjamin M. Hunter ◽  
Hannah Pickerill ◽  
James L. Peugh ◽  
...  
Keyword(s):  
Psychological Factors ◽  
Pain Catastrophizing ◽  
Experimental Pain ◽  
Healthy Individuals ◽  
Cold Pain ◽  
Total N ◽  
Pain Outcomes ◽  
Negative Findings ◽  
The Individual ◽  
Anxiety Depression

Psychological factors, such as anxiety, depression, and pain catastrophizing, may affect how healthy individuals experience experimental pain. However, current literature puts forth contradictory results, possibly due to differing study methodologies, such as the type of psychophysical measure or survey. To better understand such results, this paper analyzed the relationships between psychological factors and experimental pain outcomes across eight different studies (total n= 595) conducted in different populations of healthy adult and adolescent participants. Analyses were conducted with and without controlling for sex, age, and race. Each study was analyzed separately and as part of an aggregate analysis. Even without correction for multiple comparisons, only a few significant relationships were found for the individual studies. Controlling for demographic factors had minimal effect on the results. Importantly, even the few statistically significant models showed relatively small effect sizes; psychological factors explained no more than 20% of the variability in experimental pain sensitivity of healthy individuals. The aggregate analyses revealed relationships between anxiety and PPT / cold pain ratings and between pain catastrophizing and PPT. Sample size calculations based on the aggregate analyses indicated that several hundred participants would be required to correctly detect relationships between these psychological factors and pain measures. These overall negative findings suggest that anxiety, depression, and pain catastrophizing in healthy individuals may not be meaningfully related to experimental pain outcomes. Furthermore, positive findings in the literature may be subject to small group effects and publication bias towards positive findings.

scholarly journals Effect of Catechol-o-methyltransferase-gene (COMT) Variants on Experimental and Acute Postoperative Pain in 1,000 Women undergoing Surgery for Breast Cancer

2013 ◽  
Vol 119 (6) ◽  
pp. 1422-1433 ◽  
Author(s):  
Oleg Kambur ◽  
Mari A. Kaunisto ◽  
Emmi Tikkanen ◽  
Suzanne M. Leal ◽  
Samuli Ripatti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Multiple Testing ◽  
Pain Sensitivity ◽  
Breast Cancer Surgery ◽  
Nucleotide Polymorphisms ◽  
Acute Postoperative Pain ◽  
Cold Pain ◽  
Methyltransferase Gene

Abstract Background: Catechol-O-methyltransferase (COMT) metabolizes catecholamines in different tissues. Polymorphisms in COMT gene can attenuate COMT activity and increase sensitivity to pain. Human studies exploring the effect of COMT polymorphisms on pain sensitivity have mostly included small, heterogeneous samples and have ignored several important single nucleotide polymorphisms (SNPs). This study examines the effect of COMT polymorphisms on experimental and postoperative pain phenotypes in a large ethnically homogeneous female patient cohort. Methods: Intensity of cold (+2-4°C) and heat (+48°C) pain and tolerance to cold pain were assessed in 1,000 patients scheduled for breast cancer surgery. Acute postoperative pain and oxycodone requirements were recorded. Twenty-two COMT SNPs were genotyped and their association with six pain phenotypes analyzed with linear regression. Results: There was no association between any of the tested pain phenotypes and SNP rs4680. The strongest association signals were seen between rs165774 and heat pain intensity as well as rs887200 and cold pain intensity. In both cases, minor allele carriers reported less pain. Neither of these results remained significant after strict multiple testing corrections. When analyzed further, the effect of rs887200 was, however, shown to be significant and consistent throughout the cold pressure test. No evidence of association between the SNPs and postoperative oxycodone consumption was found. Conclusions: SNPs rs887200 and rs165774 located in the untranslated regions of the gene had the strongest effects on pain sensitivity. Their effect on pain is described here for the first time. These results should be confirmed in further studies and the potential functional mechanisms of the variants studied.

Thermal Thresholds and Catastrophizing in Individuals with Chronic Pain after Whiplash Injury

2006 ◽  
Vol 8 (2) ◽  
pp. 138-146 ◽  
Author(s):  
Ragnhild Raak ◽  
Mia Wallin
Keyword(s):  
Pain Catastrophizing ◽  
Thermal Sensitivity ◽  
Trapezius Muscle ◽  
Thenar Eminence ◽  
Heat Pain ◽  
Cold Pain ◽  
Pain Thresholds ◽  
Thermal Thresholds ◽  
Thermal Pain ◽  
Background Pain

Thermal sensitivity, thermal pain thresholds, and catastrophizing were examined in individuals with whiplash associated disorders (WAD) and in healthy pain-free participants. Quantitative sensory testing (QST) was used to measure skin sensitivity to cold and warmth and cold and heat pain thresholds over both the thenar eminence and the trapezius muscle (TrM) in 17 participants with WAD (age 50.8± 11.3 years) and 18 healthy participants (age 44.8± 10.2 years). The Pain Catastrophizing Scale (PCS) was used to determine pain coping strategies, and visual analogue scales were used for self-assessment of current background pain in individuals in the WAD group as well as experienced pain intensity and unpleasantness after QST and sleep quality in all participants. There were significant differences in warmth threshold and cold and heat pain thresholds of the TrM site between the WAD and pain-free groups. Significant differences between the two groups were also found for the catastrophizing dimension of helplessness in the PCS and in self-assessed quality of sleep. A correlational analysis showed that current background pain is significantly correlated with both cold discrimination and cold pain threshold in the skin over the TrM in individuals with WAD. These findings imply that thermal sensitivity is an important factor to consider in providing nursing care to individuals with WAD. Because biopsychosocial factors also influence the experience of pain in individuals with WAD, the role of nurses includes not only the description of the pain phenomenon but also the identification of relieving and aggravating factors.

scholarly journals Pain in 1,000 Women Treated for Breast Cancer

2013 ◽  
Vol 119 (6) ◽  
pp. 1410-1421 ◽  
Author(s):  
Mari A. Kaunisto ◽  
Ritva Jokela ◽  
Minna Tallgren ◽  
Oleg Kambur ◽  
Emmi Tikkanen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Chronic Pain ◽  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Pain Sensitivity ◽  
Experimental Pain ◽  
Interindividual Variation ◽  
Weak Correlation ◽  
Acute Postoperative Pain ◽  
Cold Pain

Abstract Background: This article describes the methods and results of the early part (experimental pain tests and postoperative analgesia) of a study that assesses genetic and other factors related to acute pain and persistent pain after treatment of breast cancer in a prospective cohort of 1,000 women. Methods: One thousand consenting patients were recruited to the study. Before surgery (breast resection or mastectomy with axillary surgery), the patients filled in questionnaires about health, life style, depression (Beck Depression Inventory), and anxiety (State-Trait Anxiety Inventory). They were also exposed to experimental tests measuring heat (43° and 48°C, 5 s) and cold (2-4°C) pain intensity and tolerance. Anesthesia was standardized with propofol and remifentanil, and postoperative analgesia was optimized with i.v. oxycodone. Results: The patients showed significant interindividual variation in heat and cold pain sensitivity and cold pain tolerance. There was a strong correlation between the experimental pain measures across the tests. Presence of chronic pain, the number of previous operations, and particularly state anxiety were related to increased pain sensitivity. Previous smoking correlated with decreased heat pain sensitivity. These factors explained 4–5% of the total variance in pain sensitivity in these tests. Oxycodone consumption during 20 h was significantly higher in patients who had axillary clearance. Oxycodone consumption had only a weak correlation with the experimental pain measures. Conclusions: Contact heat and cold pressure tests identify variability in pain sensitivity which is modified by factors such as anxiety, chronic pain, previous surgery, and smoking. High levels of anxiety are connected to increased pain sensitivity in experimental and acute postoperative pain. In a study of 1,000 women undergoing breast surgery for cancer, a small portion of the variance in preoperative response to noxious heat and cold testing could be explained by anxiety, the presence of chronic pain, and the number of previous operations. There was a weak correlation between response to experimental pain testing and acute postoperative pain, with largely similar predictive factors across both.

scholarly journals Clinically Meaningful Interpretation of Quantitative Sensory Testing As a Measure of Pain Sensitivity in Patients with Sickle Cell Disease

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 526-526
Author(s):  
Amanda M Brandow ◽  
Rebecca Farley ◽  
Julie A. Panepinto
Keyword(s):  
Pain Sensitivity ◽  
Pain Threshold ◽  
Control Group ◽  
Prior History ◽  
Heat Pain ◽  
Healthy Controls ◽  
Cold Pain ◽  
Heat Pain Threshold ◽  
Mechanical Pain Thresholds ◽  
Mechanical Pain Threshold

Abstract Patients with sickle cell disease (SCD) display hypersensitivity to thermal and/or mechanical stimuli compared to healthy controls when assessed with quantitative sensory testing (QST) suggesting impaired pain sensitivity. Impaired pain sensitivity is present when a defined stimulus (cold, heat, mechanical) produces exaggerated pain in a patient compared to healthy controls and suggests pain processing abnormalities in the peripheral and/or central nervous system. Existing studies report significant differences in mean/median thermal and/or mechanical pain thresholds between SCD patients and healthy controls. However, for clinical purposes it is important to understand if an individual patient meets criteria for impaired pain sensitivity. To date, thresholds above or below which a patient is defined as having impaired pain sensitivity have not been established in pediatric SCD patients. We sought to: 1) define thresholds for impaired cold, heat, and mechanical pain sensitivity in SCD patients ages ≥7 years and 2) determine the proportion of SCD patients meeting criteria for impaired pain sensitivity with each testing modality. Our secondary objective was to compare age, gender and prior history of pain between patients with and without impaired pain sensitivity. We conducted a cross-sectional study of SCD patients and healthy African American controls ages ≥ 7 years. Using QST we assessed cold, heat, and mechanical pain thresholds via the method of limits on the thenar eminence of the non-dominant hand and lateral dorsum of foot (randomized). Our primary outcome was threshold for impaired pain sensitivity defined as: 1) cold pain threshold that was one standard deviation (SD) above median cold pain threshold in the control group; 2) heat pain threshold that was one SD below median heat pain threshold in the control group; 3) mechanical pain threshold that was one SD below median mechanical pain threshold in the control group. Data were skewed so bootstrap resampling was used to obtain the 95% CI for the median that is congruent with the SD of the median. Mann-Whitney Test and Pearson Chi-square were used to compare age, gender, and prior history of pain (total number of lifetime emergency department visits and/or hospitalizations) between those with and without impaired pain sensitivity. A total of 55 SCD patients and 57 African American controls completed QST. There were no differences in mean±SD age (15.4±6.3 vs. 16.3±10.2 yrs, p=0.59) or gender (60% vs. 56% female, p=0.68) between groups. SCD genotypes were: 67% SS, 18% SC, 11% Sβ+ thal, 4% other. Table 1 displays thresholds for impaired pain sensitivity and proportions of SCD patients meeting criteria for impaired pain sensitivity. We found 21.8% (n=12) of SCD patients had impaired pain sensitivity with all 3 testing modalities and the majority (81.8%, n=45) had impaired pain sensitivity with one or more testing modalities. Only 18.2% (n=20) had no evidence of impaired pain sensitivity. There was no difference in median age, gender, or median number of pain encounters between those with and without impaired pain sensitivity (15 (IQR 10.5-19) vs. 13.5 yrs (IQR 11-21.5), p=0.939; 60% female in both groups; number of pain encounters: 9 (IQR 4-23.5) vs. 3 (IQR 0.25-19.8), p=0.132). Determining a threshold for impaired pain sensitivity is clinically meaningful. Using QST data, we established thresholds for impaired cold, heat and mechanical pain sensitivity. Based on these thresholds, almost a quarter of SCD patients were impaired in all 3 modalities tested and the majority were impaired in at least one modality. Impaired cold pain sensitivity was the most common finding supporting epidemiological data that increased numbers of pain events are associated with colder temperatures. If used clinically, QST could serve as a screening tool to phenotype SCD pain, guide further evaluation of the etiology of pain, guide treatment decisions, or serve as an outcome for an intervention aimed at altering pain sensitivity. Table 1. Thresholds for Impaired Pain Sensitivity and Proportion of SCD Patients with Impaired Pain Sensitivity (n=55) Threshold* Proportion Impaired Hand Cold Pain Threshold >17.01ºC 63.6% (n=35) Heat Pain Threshold <43.91ºC 60% (n=33) Mechanical Pain Threshold <4.42 g 41.8% (n=23) Foot Cold Pain Threshold >21.75ºC 58.2% (n=32) Heat Pain Threshold <42.39ºC 40% (n=22) Mechanical Pain Threshold <7.29 g 54.5% (n=30) *1 SD from Control Median Disclosures Brandow: NIH, ASH: Research Funding. Panepinto:HRSA, NIH: Research Funding; NKT Therapeutics, Inc: Consultancy.

The subjective sensation induced by various thermal pulse stimulation in healthy volunteers

2017 ◽  
Vol 16 (1) ◽  
pp. 177-178
Author(s):  
Y. Oono ◽  
H. Kubo ◽  
T. Imamura ◽  
K. Matsumoto ◽  
S. Uchida ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Thermal Sensation ◽  
Heat Pulse ◽  
Peltier Element ◽  
Cold Pain ◽  
Thermal Pulse ◽  
Heat Sensation ◽  
Thermal Stimulator ◽  
Subjective Sensation ◽  
Pulse Stimulation

AbstractAimsNovel quantitative thermal stimulator devices (QTSDs) have been developed to deliver thermal pulse stimulation with regulated constant temperatures (0–45°C) with a Peltier element probe (16 cm2). The aim of this study was to investigate subjective sensation induced by the interaction between simultaneously applied painful cold and heat stimuli in various sites.MethodsTwenty healthy subjects (12 men and 8 women, age range: 25–45 years) participated. The intensity of cold pain (CP) and heat pain (HP) stimuli were assessed by visual analogue scale (VAS) and adjusted to elicit approximately 70/100 mm. Alternately pulse stimulations (pulse duration of 40 s; 0.025 Hz) which consisted of CP, HP, or neutral temperature (32°C) were applied. Four conditions were tested and subjective sensations were assessed: (1) one QTSD was applied to non-dominant forearm and cold-heat pulse stimulation was applied.Two QTSDs were applied to (2) non-dominant ipsilateral forearm with 5 cm apart, (3) non-dominant and contralateral forearms, (4) non-dominant forearm and ipsilateral thigh, respectively. In conditions of (2)–(4), CP-neutral pulse stimulation (C-Neutral) and neutral-HP pulse stimulation (Neutral-H) were applied simultaneously with opposite phase, respectively.ResultsCP and HP were 3.9±1.0°C (mean±SD) and 43.6±0.9°C (mean±SD), respectively. The VAS values for CP and HP were 73.4±2.0 mm (mean±SD) and 76.4 ±4.8 mm (mean±SD), respectively. Some subjects could not discriminate cold or heat sensation and some felt cold as heat (paradoxical sensation). The number of subjects with such paradoxical sensation in (1), (2), (3), (4) were 9 (45%), 2 (10%), 0 (0%) and 3 (15%), respectively.ConclusionsIn healthy volunteers, simultaneous alternately cold-heat pulse stimulation on one site triggered paradoxical thermal sensation, which to a much less degree is triggered when C-Neutral and Neutral-H were applied to different dermatomes. This suggests that the mechanism is primarily triggered peripherally.

The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: a systematic review and meta-analysis with trial sequential analysis

2021 ◽  
pp. rapm-2020-102427
Author(s):  
Hanns-Christian Dinges ◽  
Thomas Wiesmann ◽  
Berit Otremba ◽  
Hinnerk Wulf ◽  
Leopold H Eberhart ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Pain Score ◽  
Meta Analysis ◽  
End Points ◽  
Liposomal Bupivacaine ◽  
Bupivacaine Hydrochloride ◽  
Pain Scores ◽  
Score Difference ◽  
The Mean

Background/ImportanceLiposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial.ObjectiveThe objective was to determine whether there is a difference in postoperative pain scores and morphine consumption between patients treated with LB and bupivacaine hydrochloride in a systematic review and meta-analysis.Evidence reviewRandomized controlled trials (RCT) were identified in Embase, CENTRAL, MEDLINE and Web of Science up to May 2020. Risk of bias was assessed using Cochrane methodology. Primary end points were the mean pain score difference and the relative morphine equivalent (MEQ) consumption expressed as the ratio of means (ROM) 24 and 72 hours postoperatively.Findings23 RCTs including 1867 patients were eligible for meta-analysis. The mean pain score difference at 24 hours postoperatively was significantly lower in the LB group, at −0.37 (95% CI −0.56 to −0.19). The relative MEQ consumption after 24 hours was also significantly lower in the LB group, at 0.85 (0.82 to 0.89). At 72 hours, the pain score difference was not significant at −0.25 (−0.71 to 0.20) and the MEQ ratio was 0.85 (0.77 to 0.95).ConclusionThe beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.

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