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The main goal of the study was to evaluate Orbach's multidimensional model of mental pain in Italy, while constructing a reliable and valid Italian version of the 40-item Orbach and Mikulincer Mental Pain scale (OMMP) in a non-clinical sample. The sample consisted of 544 Italian adults. Findings indicated that the original 8-factor structure of the OMMP scale was not validated in our Italian version of the scale. Confirmatory factor analyses yielded a 31-item solution, with five main factors (Irreversibility, Lack of control and Freezing, Narcissistic wounds, Emotional flooding, Emptiness). Women scored higher than men in emotional flooding and lack of control, age was inversely related to the reported level of mental pain, and participants who were married or had a long, stable couple relationship showed lesser emotional suffering than singles. This study has shown the OMMP to be a valid and reliable scale for assessing mental pain in the general population. Future studies are needed in order to examine the replicability of the 5-factor model as well as the validity of the OMMP factors in clinical samples in the Italian context., Author(s): Eliana Tossani [sup.1] [sup.2] , Maria Grazia Ricci Garotti [sup.1] , Mario Mikulincer [sup.3] , Sara Giovagnoli [sup.2] , Gloria Calzolari [sup.1] , Giulia Landi [sup.1] [sup.2] , Silvana [...]

Underserved populations experience higher levels of pain. These disparities persist even after controlling for the objective severity of diseases like osteoarthritis, as graded by human physicians using medical images, raising the possibility that underserved patients' pain stems from factors external to the knee, such as stress. Here we use a deep learning approach to measure the severity of osteoarthritis, by using knee X-rays to predict patients' experienced pain. We show that this approach dramatically reduces unexplained racial disparities in pain. Relative to standard measures of severity graded by radiologists, which accounted for only 9% (95% confidence interval (CI), 3-16%) of racial disparities in pain, algorithmic predictions accounted for 43% of disparities, or 4.7× more (95% CI, 3.2-11.8×), with similar results for lower-income and less-educated patients. This suggests that much of underserved patients' pain stems from factors within the knee not reflected in standard radiographic measures of severity. We show that the algorithm's ability to reduce unexplained disparities is rooted in the racial and socioeconomic diversity of the training set. Because algorithmic severity measures better capture underserved patients' pain, and severity measures influence treatment decisions, algorithmic predictions could potentially redress disparities in access to treatments like arthroplasty. An algorithmic, machine-learning approach to measuring severe pain from osteoarthritis applied to X-ray images of knees suggests that reported disparities in knee pain in underserved populations can be reduced by comparison with use of standard radiographic measures of disease severity., Author(s): Emma Pierson [sup.1] [sup.2] , David M. Cutler [sup.3] , Jure Leskovec [sup.4] , Sendhil Mullainathan [sup.5] , Ziad Obermeyer [sup.6] Author Affiliations: (1) Department of Computer Science, Stanford [...]

Sustained pain is a major characteristic of clinical pain disorders, but it is difficult to assess in isolation from co-occurring cognitive and emotional features in patients. In this study, we developed a functional magnetic resonance imaging signature based on whole-brain functional connectivity that tracks experimentally induced tonic pain intensity and tested its sensitivity, specificity and generalizability to clinical pain across six studies (total n = 334). The signature displayed high sensitivity and specificity to tonic pain across three independent studies of orofacial tonic pain and aversive taste. It also predicted clinical pain severity and classified patients versus controls in two independent studies of clinical low back pain. Tonic and clinical pain showed similar network-level representations, particularly in somatomotor, frontoparietal and dorsal attention networks. These patterns were distinct from representations of experimental phasic pain. This study identified a brain biomarker for sustained pain with high potential for clinical translation. The functional magnetic resonance imaging connectivity pattern of tonic experimental orofacial pain can be used as a quantitative and unbiased biomarker of clinical pain., Author(s): Jae-Joong Lee [sup.1] [sup.2] , Hong Ji Kim [sup.1] [sup.2] , Marta Ceko [sup.3] [sup.4] , Bo-yong Park [sup.1] [sup.5] , Soo Ahn Lee [sup.1] [sup.2] , Hyunjin Park [...]

The anterolateral pathway consists of ascending spinal tracts that convey pain, temperature and touch information from the spinal cord to the brain.sup.1-4. Projection neurons of the anterolateral pathway are attractive therapeutic targets for pain treatment because nociceptive signals emanating from the periphery are channelled through these spinal projection neurons en route to the brain. However, the organizational logic of the anterolateral pathway remains poorly understood. Here we show that two populations of projection neurons that express the structurally related G-protein-coupled receptors (GPCRs) TACR1 and GPR83 form parallel ascending circuit modules that cooperate to convey thermal, tactile and noxious cutaneous signals from the spinal cord to the lateral parabrachial nucleus of the pons. Within this nucleus, axons of spinoparabrachial (SPB) neurons that express Tacr1 or Gpr83 innervate distinct sets of subnuclei, and strong optogenetic stimulation of the axon terminals induces distinct escape behaviours and autonomic responses. Moreover, SPB neurons that express Gpr83 are highly sensitive to cutaneous mechanical stimuli and receive strong synaptic inputs from both high- and low-threshold primary mechanosensory neurons. Notably, the valence associated with activation of SPB neurons that express Gpr83 can be either positive or negative, depending on stimulus intensity. These findings reveal anatomically, physiologically and functionally distinct subdivisions of the SPB tract that underlie affective aspects of touch and pain. Two populations of neurons with distinct anatomy and receptor expression that convey information from the spinal cord to the brain have different functional properties with respect to touch and pain., Author(s): Seungwon Choi [sup.1] , Junichi Hachisuka [sup.2] [sup.3] [sup.6] , Matthew A. Brett [sup.1] , Alexandra R. Magee [sup.1] , Yu Omori [sup.2] [sup.3] [sup.7] , Noor-ul-Aine Iqbal [sup.1] [...]

Byline: Atif. Ahmed Shaikh, Monika. Das, Anupama. Roy, Bini. Baby, Dolcy. Dhar, Jebalin. Abigayil, Vitty. Varghese, Vivek. Mathew, Sanjith. Aaron, Ajith. Sivadasan, Paul. Premkumar, Tharan. Suresh, Appaswamy. Prabhakar Introduction: Entrapment [...]

Byline: Gunasekara Vidana. Fernando, Fiona. RawlinsonContext: One of the principle obstacles identified in suboptimal management of pain in worldwide cancer patients is inadequate assessment of pain which in turn leads [...]

Background. Noncancer pain and cognitive impairment affect many older adults and each is associated with functional disability, but their combined impact has yet to be rigorously studied. Methods. This is a cross-sectional analysis of the Canadian Study of Health and Aging. Pain was collapsed from a 5-point to a dichotomous scale (no and very mild vs moderate and greater). Cognitive status was dichotomized from the Modified Mini-Mental State Examination (0-100) to no (>77) or mild-moderate (77-50) impairment. Five Instrumental Activities of Daily Living (IADL) and seven Activities of Daily Living (ADL) were self-rated as 'accomplished without any help' (0), 'with some help' (I), or 'completely unable to do oneself' (2) and then summed to create a composite score of 0-10 and 0-14, respectively. Multivariate linear regression analysis was conducted to determine the associations between self-reported functional status with moderate or greater pain, cognitive impairment, and the interaction of the two. Results. A total of 5,143 (90.2%) participants were eligible, 1,813 (35.6%) reported pain at a moderate intensity or greater and 727 (14.3%) were cognitively impaired. The median 1ADL and ADL summary scores increased among the pain and cognition categories in the following order: no pain and cognitively intact (0.63 SD 1.24, 0.23 SD 0.80), pain and cognitively intact (1.18 SD 1.69.0.57 SD 1.27), no pain and cognitively impaired (1.64 SD 2.22, 0.75 SD 1.57), and pain and cognitively impaired (2.27 SD 2.47, 1.35 SD 2.09), respectively. Multivariate linear regression found IADL summary scores were associated with pain, coefficient. 17 (95% confidence interval [CI] 0.07-0.26), p < .0l; cognitive impairment, coefficient .67 (95% CI 0.51-0.83), p < .01: and an interaction effect of pain with cognitive impairment, coefficient .24 (95% CI 0.01-0.49), p = .05. ADL summary scores were associated with pain coefficient .10 (95% CI 0.04-0.17), p < .01 and cognitive impairment, coefficient .29 (95% CI 0.19-0.39), p < .01, but had a nonsignificant interaction term, coefficient. 12 (95% CI-0.03 to 0.29), p = .12. Conclusions. Noncancer pain and cognitive impairment are independently associated with IADL and ADL impairment and IADL impairment is even greater when both conditions are present. Key Words: Noncancer pain--Cognitive impairment--Function--Dementia--Older adult. doi: 10.1093/gerona/glq039

Central poststroke pain (CPSP) syndrome is a rare complication of stroke but a common cause of central pain. CPSP is best managed in a well-coordinated interdisciplinary pain management program. Pharmacological [...]

Due to multiple neurological and musculoskeletal factors, stroke patients are at significant risk for the development of disabling pain syndromes. This article provides examples of two commonly encountered clinical situations, [...]

The purpose of the present study was to examine whether changes in experimentally induced pain perception after acute resistance exercise (RE) are influenced by the time of day that RE is performed. Twenty-one recreationally trained (>1 year of regular recreational RE participation) young men (mean age = 21 years) completed 2 acute RE sessions at different times of day. One RE session was performed between 6:00 and 8:00 in the morning, and the other was performed between 6:00 and 8:00 in the evening. The RE sessions consisted of completing 3 sets of 10 repetitions for 4 different exercises at 75% of each individual's 1 -repetition maximum. Assessments of pain threshold and pain ratings were obtained during exposure to an experimentally induced pressure pain stimulus before and after (1 and 15 minutes) each bout of RE. The results revealed that, irrespective of the time of day RE was performed, pain threshold increased significantly (p < 0.01) at 1 minute after exercise. Pain ratings were also found to be significantly (p < 0.01) lower at 1 minute after RE in both the morning and evening. It is concluded that acute RE results in alterations in the perception of experimentally induced pressure pain and that this hypoalgesic response is not influenced by the time of day that RE is performed. KEY WORDS acute exercise, diurnal variations, hypoalgesia, strength training

Background. We examined whether questions addressing the effect of pain on day-to-day function add unique information to the standardized verbal descriptor scale for pain severity in nursing homes (NHs). Methods. Interviews were conducted with 123 residents in two Veterans Affairs NHs. All participants were asked about pain presence. Residents reporting pain were asked about severity of worst pain (mild, moderate, severe, very severe/horrible), degree of bother (not at all, a little, a moderate amount, a great deal), and the effect of pain on daily function (whether pain made it hard to 'sleep,' 'get out of bed,' or 'spend time with other people' and whether activities were limited because of pain). Results. Fifty-one percent of participants reported pain. The correlation between pain severity report and overall count of activity interference was significant (Spearman's rho = .449, p = .001). In general, for each activity, the proportion reporting interference increased as severity increased. Fischer's exact test showed significant association only for 'hard to get out of bed' (p = .0175) and 'hard to sleep' (p = .0211). As expected, residents reporting 'mild' pain reported less activity interference than those reporting 'very severe' pain. The association between pain and activity interference was more variable and less predictable among residents with 'moderate' or 'severe' pain. Conclusion. Questions addressing the effect of pain on day-to-day functions are an important addition to standardized pain assessments, particularly for persons who report intermediate levels of pain severity because the perceived effect on daily function may vary most among individuals at these levels. Key Words: Pain--Nursing home--Activity limitation.

Byline: Suresh. Yadav, Geetha. Desai, Santosh. Chaturvedi Aim: This study assessed the influence of pain behaviors on pain estimation by nurses and psychiatrists. Materials and Methods: Pain ratings performed by [...]

Factor analysis is useful for examining relationships among large numbers of variables and understanding the conceptual structure of an instrument. The Brief Pain Inventory (BPI), which measures pain in terms [...]

Byline: James Elander (1,6), Malgorzata Marczewska (2), Roger Amos (3), Aldine Thomas (4), Sekayi Tangayi (5) Keywords: vignette study; pain judgments; addiction; pseudoaddiction; analgesics; sickle cell disease. Abstract: Judgments about people with pain are influenced by contextual factors that can lead to stigmatization of patients who present in certain ways. Misplaced staff perceptions of addiction may contribute to this, because certain pain behaviors superficially resemble symptoms of analgesic addiction. We used a vignette study to examine hospital staff judgments about patients with genuine symptoms of analgesic addiction and those with pain behaviors that merely resemble those symptoms. Nurses and doctors at hospitals in London, UK, judged the level of pain, the likelihood of addiction, and the analgesic needs of fictitious sickle cell disease patients. The patient descriptions included systematic variations to test the effects of genuine addiction, pain behaviors resembling addiction, and disputes with staff, which all significantly increased estimates of addiction likelihood and significantly decreased estimates of analgesic needs. Participants differentiated genuine addiction from pain behaviors resembling addiction when making judgments about addiction likelihood but not when making judgments about analgesic needs. The treatment by staff of certain pain behaviors as symptoms of analgesic addiction is therefore a likely contributory cause of inadequate or problematic hospital pain management. The findings also show what a complex task it is for hospital staff to make sensitive judgments that incorporate multiple aspects of patients and their pain. There are implications for staff training, patient education, and further research. Author Affiliation: (1) Thames Valley University, London, UK (2) Newham Primary Care Trust, London, UK (3) Homerton University Hospital, London, UK (4) Barts and the Royal London Hospital, London, UK (5) Newham University Hospital, London, UK (6) Psychology Department, Thames Valley University, St Mary's Road, London W5 5RF, UK Article History: Registration Date: 02/11/2005 Accepted Date: 02/11/2005 Online Date: 22/02/2006

Byline: Stephen Bruehl (1,3), Ok Y. Chung (1), Brian S. Donahue (1), John W. Burns (2) Keywords: anger regulation; anger-in; anger-out; pain; opioid; genetic; A118G. Abstract: Greater trait anger-out is associated with elevated pain responsiveness. Previous work suggests this effect may be mediated by deficient endogenous opioid analgesia, possibly reflecting diminished opioid receptor sensitivity. The A118G single nucleotide polymorphism (SNP) of the mu opioid receptor gene influences both opioid receptor sensitivity and clinical responsiveness to opioid analgesics. Therefore, this study tested whether this SNP either mediated or moderated the effects of anger-out on postsurgical pain outcomes. Forty-eight patients undergoing coronary artery bypass graft surgery provided genetic samples, and completed measures of anger-out and postsurgical pain. Postsurgical opioid analgesic use was also recorded. Anger-out was positively associated with postsurgical pain ratings (p &lt 0.05). Anger-out was not associated with A118G SNP status (p &gt 0.10), suggesting the latter is unlikely to mediate anger-out's pain-related effects. A significant anger-out x A118G interaction was observed on analgesic use (p &lt 0.05), due to a much stronger positive relationship between anger-out and analgesic demands in patient with the A118G SNP (b = 0.53) than those with the wild-type receptor (b = 0.07). These results suggest that the A118G SNP may moderate but not mediate the effects of anger-out on postoperative pain responses. Author Affiliation: (1) Department of Anesthesiology, Vanderbilt University School of Medicine, Tennessee, Nashville, USA (2) Department of Psychology, Rosalind Franklin University of Medicine and Science, Illinois, North Chicago, USA (3) Vanderbilt University Medical Center, 701 Medical Arts Building, 1211 Twenty-First Avenue South, Nashville, USA Article History: Registration Date: 23/09/2005 Received Date: 23/06/2005 Accepted Date: 01/09/2005 Online Date: 07/01/2006

Concept: Drug seeking behavior (DSB) is often mixed in illicit drug diversion confounding legitimate attempts to control acute and chronic pain. Objective: To review the literature of acute and chronic pain control against the medical and legal context of DSB. Design: Retrospective literature review from National Library of Medical Computerized Data Base 1990-2004. Patients: Preference to human prospective on retrospective clinical trials. Results: Drug use and abuse have significant adverse consequences. Pain control is desirable and necessary with chronic pain syndromes more prone to DSB. This behavior can be accurately profiled and information used to assist recovery, Conclusion: It is desirable to address DSB stressing acceptance and a multidisciplinary approach to recovery. Key Words: Narcotic; Drug seeking, behavior; Drug abuse; Addiction; Pain control; Analgesia., INTRODUCTION The understanding of pain has progressed through the 1960s when pain was first considered a direct sensory response to tissue damage, without modification by genetic differences, experiences, anxiety, or [...]

A case study of a 76-year-old woman, suffering from pain and numbness in feet and legs due to a small-fiber neuropathy, is presented.

An experiment was conducted to determine whether providing children with information about the time remaining in each of 9 cold pressor trials would modify their pain reports. The study design included an experimental group and 2 control groups. The experimental group was given visual information about time remaining in each cold pressor trial using cartoon images presented on a computer screen. Control groups viewed either no images or randomly presented images. Temporal information reduced children's self-reported pain during short (10 to 15 s) duration cold pressor trials, but did not increase the number of trials completed. This study suggests that providing time-remaining information during brief clinical procedures may decrease children's discomfort.

The objectives of the present study were to evaluate the validity of answers given in a questionnaire on musculoskeletal pain and conditions by means of a clinical assessment, and to get some understanding of the subject's perception of reported pain. This was performed by using measures of sensitivity and specificity comparing data from the questionnaire with the clinical diagnoses of conditions in the neck, shoulders and thoracic spine. Subjective perception of pain was obtained by the use of visual analogue scale (VAS) and pain drawings. For the combination of neck and shoulders, both sensitivity (95%) and specificity (88%) were high for current pain. The results of the study confirm the validity of the subjective reports of the respondents. A 'pain assessment instrument' including a questionnaire, VAS and pain drawings may be useful to reveal conditions in the neck and shoulders and thoracic spine, common sites of work related musculoskeletal disorders. Keywords: Questionnaire; Validation; Diagnoses; Musculoskeletal