Gamma Band Oscillations Reflect Sensory and Affective Dimensions of Pain

Pain is a multidimensional process, which can be modulated by emotions; however, the mechanisms underlying this modulation are unknown. We used pictures with different emotional valence (negative, positive, and neutral) as primes and applied electrical painful stimuli as targets to healthy participants. We assessed pain intensity and unpleasantness ratings and recorded electroencephalograms (EEGs). We found that pain unpleasantness and not pain intensity ratings were modulated by emotion, with increased ratings for negative and decreased ratings for positive pictures. We also found two consecutive gamma band oscillations (GBOs) related to pain processing from time frequency analyses of the EEG signals. The early GBO had a cortical distribution contralateral to the painful stimulus and its amplitude was positively correlated with intensity and unpleasantness ratings, but not with prime valence. The late GBO had a centroparietal distribution and its amplitude was larger for negative compared to neutral and positive pictures. The emotional modulation effect (negative vs. positive) of the late GBO amplitude was positively correlated with pain unpleasantness. The early GBO might reflect the overall pain perception, possibly involving the thalamocortical circuit, while the late GBO might be related to the affective dimension of pain and top-down-related processes.

The importance of cultural psychological perspectives in pain research: Towards the palliation of Cartesian anxiety

Despite widespread awareness of the psychological dimensions of pain, researchers often and easily slip into essentializing understandings that treat pain as a purely physiological experience that can be isolated within experimental research. This drive towards scientific objectivity, while at times of tremendous utility, can also limit our understanding of pain to reductionistic conceptualizations that in effect deny the subjective and even the psychological dimensions of pain. In other words, researchers often attempt to understand pain by means of empirical, scientific explanations, while being simultaneously aware that such an approach cannot grasp the phenomenon in its entirety. This yearning for deeper, ontological understanding in a world that admits of only empirical, scientific explanations has been called Cartesian anxiety. In the current study, it is argued that cultural psychology can help to alleviate this Cartesian anxiety by helping us to appreciate the psychological aspects of pain as dynamic processes of meaning making.

SymptomSpeak: Women’s Struggle for History and Health in Kosovo

What are the linguistic dimensions of pain, and what kind of articulations arise from these painful experiences? How does the language of pain circulate, connect, and reach across histories, gendered realities, and social politics? In what ways might the language of pain act on and transform the world by shaping and changing socio-political agendas? I explored these questions among women in Kosovo and discovered a unique symptomatic language which I call SymptomSpeak. SymptomSpeak is a powerful language evoked, shared, and exchanged by women to articulate political, social, and economic grievances, to challenge societal norms, and to demand justice. The language itself consists of a detailed symptom vocabulary which is variously assembled into meaning complexes. Such assemblages shift depending on the social context in which they are conveyed and are referred to as nervoz (nervousness), mërzitna (worried, sad), mzysh (evil eye), and t’bone (spell). I describe in detail how women variously combine and exchange components of SymptomSpeak and, thereby, question dominant framings of reality. Thereby, my intention is to contribute to a new understanding of pain as language which straddles the fine line between socio-political commentary and illness; produces gendered political realities; and challenges the status quo through its communicative power.

Exploration of Hospital Inpatients' Use of the Verbal Rating Scale of Pain

Background: Assessment of pain largely relies on self-report. Hospitals routinely use pain scales, such as the Verbal Rating Scale (VRS), to record patients' pain, but such scales are unidimensional, concatenating pain intensity and other dimensions of pain with significant loss of clinical information. This study explored how inpatients understand and use the VRS in a hospital setting.Methods: Forty five participants were interviewed, with data analysed by thematic analysis, and completed a task concerned with the VRS and communication of other dimensions of pain.Results: Participants anchored their pain experience in the physical properties of pain, its tolerability, and its impact on functioning. Their relationship to analgesic medication, personal coping styles, and experiences of staff all influenced how they used the VRS to communicate their pain.Conclusion: Participants grounded and explained their pain in semantically similar but idiosyncratic ways. The VRS was used to combine pain intensity with multiple other elements of pain and often as a way to request analgesic medication. Pain scores need to be explored and elaborated by patient and staff, content of which will imply access to non-pharmacological resources to manage pain.

Patient-reported outcome measures for pain in autosomal dominant polycystic kidney disease: A systematic review

Pain is a common symptom in people with autosomal dominant polycystic kidney disease (ADPKD), but it is assessed and reported inconsistently in research, and the validity of the measures remain uncertain. The aim of this study was to identify the characteristics, content, and psychometric properties of measures for pain used in ADPKD. We conducted a systematic review including all trials and observational studies that reported pain in people with ADPKD. Items from all measures were categorized into content and measurement dimensions of pain. We assessed the general characteristics and psychometric properties of all measures. 118 studies, we identified 26 measures: 12 (46%) measures were developed for a non-ADPKD population, 1 (4%) for chronic kidney disease, 2 (8%) for polycystic liver disease and 11 (42%) specifically for ADPKD. Ten anatomical sites were included, with the lower back the most common (10 measures [39%]), four measurement dimensions (intensity (23 [88%]), frequency (3 [12%]), temporality (2 [8%]), and sensory (21 [81%]), two pain types, nociceptive including visceral (15 [58%]) and somatic (5 [20%]), and neuropathic (2 [8%]), and twelve impact dimensions, where the most frequent was work (5 [31%]). The validation data for the measures were variable and only the ADPKD Impact Scale reported all psychometric domains. The measures for pain in ADPKD varied in terms of content and length, and most had not been validated in ADPKD. A standardized psychometrically robust measure that captures patient-important dimensions of pain is needed to evaluate and manage this debilitating complication of ADPKD.

Evaluation of Different Types of Pain in Patients with Breast Cancer

Background: Cancer, a common disease in the world, is considered the second cause of mortality in developed countries. In the management of symptoms created by breast cancer (BC), pain is the most important. So, this study aimed to evaluate different dimensions of pain in patients using the McGill Pain Questionnaire. In this way, physicians could perform effective treatment for patients. Methods: This case study was done on BC patients aged 30-60 years old in some specialized cancer hospitals in Tehran. The utilized research instrument in this study was the McGill Pain Questionnaire. Data were analyzed by SPSS Software. Conclusion: According to these results, it is possible to use effective and better treatment to reduce BC patients’ pain.

Cellular Circuits in the Brain and Their Modulation in Acute and Chronic Pain

Chronic, pathological pain remains a global health problem and a challenge to basic and clinical sciences. A major obstacle to preventing, treating, or reverting chronic pain has been that the nature of neural circuits underlying the diverse components of the complex, multidimensional experience of pain is not well understood. Moreover, chronic pain involves diverse maladaptive plasticity processes, which have not been decoded mechanistically in terms of involvement of specific circuits and cause-effect relationships. This review aims to discuss recent advances in our understanding of circuit connectivity in the mammalian brain at the level of regional contributions and specific cell types in acute and chronic pain. A major focus is placed on functional dissection of sub-neocortical brain circuits using optogenetics, chemogenetics, and imaging technological tools in rodent models with a view towards decoding sensory, affective, and motivational-cognitive dimensions of pain. The review summarizes recent breakthroughs and insights on structure-function properties in nociceptive circuits and higher order sub-neocortical modulatory circuits involved in aversion, learning, reward, and mood and their modulation by endogenous GABAergic inhibition, noradrenergic, cholinergic, dopaminergic, serotonergic, and peptidergic pathways. The knowledge of neural circuits and their dynamic regulation via functional and structural plasticity will be beneficial towards designing and improving targeted therapies.

The Assessment of Pain and Barriers to Pain Management: A Content Analysis From a National Sample of Hospice Psychosocial Assessments Completed by Social Workers

Pain is a multidimensional symptom frequently experienced by hospice patients that is physical, psychological, social, emotional, and spiritual. Medicare regulations require hospices to complete a psychosocial assessment with content such as patient/family adjustment to illness. Furthermore, pain barriers such as concerns about addiction, and fatalism are recognized impediments to high quality pain management. National data concerning whether hospice social workers are paying attention to issues related to patient pain is minimal. Addressing this gap, we randomly sampled 248 hospices nationally and requested a blank copy of their social work psychosocial assessment and reviewed its pain-related content. A total of 105 hospices (response rate 42.3%) provided an assessment for review. Descriptive statistics summarize agency characteristics and whether pain assessment content and pain barrier content were present. Analyses examined whether pain assessment content was included based on agency characteristics. Of the 105 participating agencies, most were non-profit (60%) and located in the South (30.5%). Less than half (47.6%) of the agencies included pain assessment content in their assessment. No associations were observed between having pain assessment content and agency characteristics. None of the assessments included content about 3 barriers to pain management: tolerance, overdose, stigma, and fatalism. Few agencies included other barriers to pain management: addiction (1%), burden (1%), non-adherence (3.8%) and stoicism (18.1%). Agencies which had pain assessment content mostly included other dimensions of pain: psychological (80%), emotional (74%), and social (78%). Hospice social workers can do more to assess and address pain concerns—especially psychological, social, and emotional dimensions.

Comparison of pain assessments made by patients and nurses in emergency services

Aim: This research aimed to compare pain assessments made by patients and by nurses. Method: This descriptive and comparative research was conducted in a state, a university and a private hospital emergency service monitoring unit that had the highest number of patient admissions in Ankara, Turkey. The research sample consisted of 175 patients and 35 nurses. For the collection of data, the following sources were consulted: the patient information form, the nurse information form and the McGill Pain Questionnaire. For evaluation of the data, number and percentage calculations, chi-square analysis, kappa compliance analysis and the Wilcoxon sign test were used. Written consent was received from the ethical council and hospitals as well as from nurses and patients. Results: 74.3% of nurses stated that they do not think that the pain level expressed by the patient is always right. While the point average given by patients related to all dimensions define the characteristics of pain was 20.48 ± 10.10, the average given by nurses was 14.35 ± 8.46. There is a statistically significant difference between the point averages given by patients and nurses related to total dimensions of pain characteristics (p<0.05). Conclusion: As a result, pain evaluations of nurses were found to be significantly lower than those of patients. It is suggested that the policies and procedures used in health personnel education institutes and health institutes related to pain management should be improved.

The Satisfaction Of Jkn Participants Using The Indicator Of Hospital Consumer Assement Of Healthcare Providers And System (HCAHPS) At Undata General Hospital

Based on the Regulation of the Minister of Health of the Republic of Indonesia number: 129 / Menkes / Sk / II / 2008 concerning hospital minimum service standards (SPM) regarding inpatient satisfaction has a standard of> 90%. While for the BPJS patient satisfaction standard based on the JKN road map BPJS patient satisfaction> 75. The purpose of this study was to determine the Satisfaction of JKN Participants About the Quality of Health Services Using HCAHPS Indicators in the Inpatient Installation of Central Sulawesi Province Hospital. This type of quantitative research with a descriptive approach. The population in the study amounted to 7,083 respondents and the sampling used probability sampling with a total sample of 95 respondents. The results showed JKN participants' satisfaction with the HCAHPS method as follows: doctor's communication dimensions, satisfied (85.5%) and dissatisfied (10.5%). Dimensions of communication of nurses, satisfied (88.4%) and not satisfied (11.6%). Dimensions of the hospital environment, satisfied (84.2%) and dissatisfied (15.8%). Dimensions of pain management, satisfied (83.2%) and dissatisfied (16.8%). Dimensions of treatment communication, satisfied (83.2%) and dissatisfied (16.8%). Dimensions of recommendations to friends and family recommend (91.6%) and not recommend (8.4%). In conclusion, JKN participants were satisfied with all HCAHPS components studied.