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Pain and (un)pleasantness
Published in Stephen Buetow, Rethinking Pain in Person-Centred Health Care, 2020
Endogenous pain inhibition can occur during and after activities such as intense exercise75 and by applying a pain stimulus to one body part to inhibit pain in a distal region. This phenomenon of “pain inhibits pain” has been demonstrated experimentally to result from conditioned pain modulation (diffuse noxious inhibitory control).76,77 Through activating the descending inhibitory system in the spinal cord,78 localized pain stimulation generates diffuse pain relief. Analgesia results from decreasing the perception of pain and because interrupting the noxious stimulus can produce a strong feeling of pleasantness.79 Cognitive modulation of endogenous pathways is also relevant to managing persistent pain, whose intensity depends less on tissue damage and nociception than on interacting emotional and social influences80 interpreted in a widely distributed neural network.81 Thus, potential increases for pain to be pleasant or at least not unpleasant, and innate aversion to pain may reverse hedonically.82
Physiology of the Pain System
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Some are questioning the specificity of particular regions. Some regions may respond preferentially to painful stimulus, but not specifically (or only) to a pain stimulus where actual or potential tissue damage is occurring.17 There are several examples of regions that initially appeared to be specific for nociception, but on further study respond to more generalized input. In one instance, facial pain elicited the activation of a neuron close to SII, but so did a novel or threatening object approaching the visually receptive field.18 In another example, noxious heat produced a response in several neurons in the ACC, but these same neurons were also activated when subjects watched the experimenter receive painful stimuli.19 Care needs to be taken in assigning nociceptive causation to these brain regions. Nevertheless, if neuroimaging is able to identify target brain regions (or more likely patterns of regions) that show increased activity correlated with increased pain intensity, then this neuroimaging may potentially allow us to predict which interventions might be most impactful to specific groups of people.17
Deep Tissue Hyperalgesia
Published in Robert M. Bennett, The Clinical Neurobiology of Fibromyalgia and Myofascial Pain, 2020
Lars Arendt-Nielsen, Thomas Graven-Nielsen
Ischemic muscle pain is a classical experimental pain model and has been used for many years as an unspecified pain stimulus. The method is found to be reliable (7) and has been used for human analgesic assay (8). This is a very efficient model to induce pain in muscles but skin, periosteum, and other tissues will contribute to the overall pain perception. The model is applicable in experimental studies requiring a general tonic pain stimulus.
Potential Mood Variation Following a Behavioral Analogue of Self-Injurious Behavior
Published in Archives of Suicide Research, 2020
Brooke A. Ammerman, Kristen M. Sorgi, Mitchell E. Berman, Emil F. Coccaro, Michael S. McCloskey
The limitations of the current study should be noted. First, the current study only assessed a history of self-injurious behavior; it will be important for future research to examine the recency and frequency of such behavior as it may have an impact on the participant’s experience of the SAP. The current study only considered a participant’s subjective experience of the SAP immediately prior to and immediately following the task. One way to expand this research is to collect a more established baseline (e.g., longer prior to the start of SAP), in addition to using more objective measures of affect (e.g., startle-blink reactivity). Collecting participant-reported mood ratings throughout the task may also be useful in understanding mood trajectory across task completion. It will also be important for future research to compare the current findings to completion of similar, but less invasive paradigms, such as those that did not use a pain stimulus. Finally, these findings should be replicated in additional samples, including those with high rates of self-injurious behavior, to generalize the findings.
Review of the international hypnosis literature
Published in American Journal of Clinical Hypnosis, 2019
Shelagh Freedman, Ian E. Wickramasekera
This is the largest meta-analysis examining the effectiveness of hypnosis for pain reduction (85 studies; 3632 participants). The authors specifically sought to quantify the reduction in pain with hypnosis, and analyze the effects of hypnotizability and the use of a direct suggestion for relief. All studies included healthy participants, a hypnotic induction, a no-treatment control condition, the administration of a pain stimulus, and pain ratings. Overall, hypnosis was found to produce a moderate to large effect on pain assessment (pain ratings of intensity, affect, tolerance, and threshold). A hypnotic induction without the inclusion of a suggestion for pain relief, reduced pain ratings by 0.5% in Lows, 12% in Mediums, and 25% in Highs. Hypnosis with a direct analgesic suggestion decreased ratings 17%, 29%, and 42% across hypnotizability levels, respectively. Interestingly, Lows showed a 17% reduction with the inclusion of a suggestion for pain relief, compared to a 0.5% reduction with hypnosis alone. The authors point out, a 30% or greater change represents a clinically meaningful result (much improved). Therefore, hypnotic interventions for pain relief are most effective when direct suggestions for analgesia are administered to Medium or High hypnotizables. Together, these findings suggest that the majority of people can benefit from hypnotic interventions to reduce pain. Address correspondence to Trevor Thompson at [email protected]
Effects of Single-Dose Preemptive Pregabalin and Intravenous Ibuprofen on Postoperative Opioid Consumption and Acute Pain after Laparoscopic Cholecystectomy
Published in Journal of Investigative Surgery, 2019
Omer Karaca, Huseyin U. Pınar, Emin Turk, Rafi Dogan, Ali Ahiskalioglu, Sezen K. Solak
In another study, the authors reported that the administration of preoperative IV ibuprofen alleviated inflammation by depressing cortisol, catecholamine, and cytokine levels in patients undergoing laparoscopic cholecystectomy.26 Furthermore, it was noted that ibuprofen inhibited the activation of nuclear factor kappa B, neutrophil activity, and leukocytes intercept inflammatory edema. The elimination half-life of IV ibuprofen is 60 minutes. It has a bioavailability of approximately 100%. Since IV ibuprofen reached effective plasma concentration 30 minutes after administration and provided effective analgesia duration, we applied infusion at the same period.27 In our study, in addition to lower VAS scores and less need for opioid, four patients in the pregabalin and ibuprofen group did not need analgesia. Therefore, we concluded that using preemptive pregabalin and IV ibuprofen together provided an effective analgesia by inhibiting pain stimulus, both at the peripheral and central pathways.