The impact of gender of the examiner on orofacial pain perception and pain reporting among healthy volunteers

Objectives Pain on palpation of jaw muscles is a commonly used diagnostic criterion when examining patients with orofacial pain. It is not known, however, if pain reports are affected by the gender of the examiner. Our aim was to investigate if pressure pain threshold (PPT), pressure pain tolerance (PTol), and pain intensity assessed over the masseter muscles in healthy individuals are affected by the gender of the examiner. Materials and methods Healthy, pain-free individuals were recruited on a voluntary basis. PPT and PTol were assessed using pressure algometry. At the PTol level, participants also rated pain intensity on a 0–10 numeric rating scale. Assessments of PPT and PTol were conducted with six repeated measurements performed twice, separately by one female and one male examiner, on each participant. Results In total, 84 participants (43 women; median age 24, IQR 6) were included. With a female examiner, women reported higher pain intensity than men (Mann Whitney U, p = 0.005). In the multivariable analysis, significantly higher PTol was predicted by male examiner. Also, a higher ratio between PTol and reported pain intensity was predicted by male examiner. Conclusions The gender of the examiner influences pain reporting and perception in an experimental setting. This effect on pain perception related to gender of the examiner is probably related to normative gender behaviors rather than to biological alterations within the examined individual. Clinical relevance In clinical and experimental settings, gender of the examiner may affect not only pain perception but also pain reporting, with potential implications for diagnostics in patients with pain.

How and Why Patient Concerns Influence Pain Reporting: A Qualitative Analysis of Personal Accounts and Perceptions of Others’ Use of Numerical Pain Scales

Complex factors influence how people report and interpret numerical pain ratings. Such variability can introduce noise and systematic bias into clinical pain assessment. Identification of factors that influence self-rated pain and its interpretation by others may bolster utility of these scales. In this qualitative study, 338 participants described motivations for modulating their own pain reports relative to a numerical pain scale (0–10), as well as perceptions of others’ pain reporting modulation. Responses indicated that people over-report pain to enhance provider belief/responsiveness or the likelihood of pain relief, and out of fear of future pain or potential illness. Concerns of how one’s pain affects and is perceived by others, and financial concerns motivated pain under-reporting. Unprompted, many participants reported never modulating their pain ratings, citing trust in providers and personal ethics. Similar reasons were assumed to motivate others’ pain ratings. However, participants often attributed others’ over-reporting to internal causes, and their own to external. This bias may underlie common assumptions that patients over-report pain for nefarious reasons, distort interpretation of pain reports, and contribute to pain invalidation. Recognition of patient concerns and one’s own personal biases toward others’ pain reporting may improve patient-provider trust and support precision of numerical pain ratings.

Cooled (4ºC) lidocaine during office cystoscopy improves patient satisfaction and comfort: A prospective, randomized, double-blind, controlled study

Introduction: Office-based flexible cystoscopy is often associated with considerable discomfort in male patients. We devised this study to prospectively evaluate the efficacy of cooling intraurethral lidocaine jelly to 4ºC prior to use in office-based cystoscopy in an effort to reduce male patient discomfort. Methods: A total of 600 male patients scheduled for office diagnostic cystoscopy were enrolled and randomized into three groups for a prospectively controlled, double-blind study. Each group received one of the three methods of intraurethral lubrication: plain room temperature lubricant (control) (CON), room temperature lidocaine (LI), or lidocaine at 4ºC (LI4ºC). Perceived pain was recorded on a Likert visual analog scale (VAS) of 1–10 where 0=no pain and 10=excruciating pain. Kruskal-Wallis test assessed the efficacy of cooling lidocaine compared to room temperature lidocaine and control. Subjective pain reporting was corroborated with instantaneous objective pulse rate recording eliminating perception bias. Results: There was no significant difference in cystoscopy duration between all groups. Mean pain scores (mean ± standard deviation) were 4.05±0.91, 2.74±1.01, and 1.8±0.84, respectively, for groups CON, LI, and LI4ºC (p=0.02). There was a 32.34% reduction in the mean pain score of LI and a further reduction of 34.3% was achieved in LI4ºC when compared to CON. Body mass index (BMI) and prostate weight had a significant positive correlation with pain score, whereas no such correlation was found with age. Conclusions: Cooling lidocaine to 4ºC provides additional analgesic benefit in men undergoing office cystoscopy and increases compliance.

Transcranial direct current stimulation in pain modulation in fibromyalgia: systematic review with bibliometric analysis

Background: Fibromyalgia (FM) affects the population’s physical and mental health and is characterized by changes in brain activity and pain reporting. Objectives: To systematize and discuss the effects of tDCS on pain improvement in patients with FM as well as the “state of the art”. Design and setting: Systematic review with bibliometric. Methods: Articles were searched in the databases: MEDLINE / PubMed, Web of Science, Scopus and Physiotherapy Evidence Database. Randomized clinical trials, published between 1996 and 2021, that used tDCS to treat pain in patients with fibromyalgia were included. Studies that used tDCS associated with another technique (except pharmacological) were excluded. Methodological quality and risk of bias were assessed using the PEDro and Rob 2.0 scale. Software R. was used to perform bibliometrics. Results: Nine articles were included, totaling 306 participants. The main stimulated areas were the primary death cortex (M1) (6 studies) and left dorsalateral prefrontal cortex (CPFDL) (4 studies). Eight studies used the intensity of 2 mA and application for 20 minutes. Both stimulation of M1 and CPFDL showed effects on pain improvement greater than tDCS sham. As for the research institutes, Havard Medical School and the Federal University of Rio Grande do Sul lead the ranking. The author with the greatest impact was Fregni, F. (index h: 12, index g: 17, index m: 0.800, total publications 17, beginning: 2006). Conclusions: tDCS proved to be effective for the treatment of pain in FM. The production of studies is limited.

Management of a metal foreign body entering the thyroid via the esophagus: a case report

The entry of a metallic foreign body into the thyroid gland via the esophagus is a rare occurrence, with no previously reported cases. We present a 42-year-old woman who was admitted to hospital with right-sided neck pain, reporting that she had inadvertently swallowed a fish bone. She underwent laryngoscopy, which showed no fish bone in the throat, and no obvious bleeding in the bilateral tonsils and pear-shaped fossa. X-ray examination showed a needle-shaped foreign body in the neck, and a computed tomography scan of her neck showed a 0.1-cm diameter, 2.0-cm long foreign body in the right thyroid. She underwent emergency surgery and a needle of the corresponding size was found in the thyroid gland. This case demonstrates the importance of adequate preoperative assessment and an appropriate surgical approach for thyroid metallic foreign bodies.