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Assessing and managing pain
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Lindsey Pollard, Harriet Barker
In pain management, ‘threshold’ refers to the level at which the population at large perceives a stimulus as painful, rather than uncomfortable. In theory, we all feel pain at about the same level. Therefore, pain threshold is essentially a physiological measurement. It is common for practitioners to believe that people with cognitive impairment have a higher threshold to pain than those in the general population; however, it is argued that this may actually be the opposite (Barney et al. 2020). What makes us feel pain differently is pain ‘tolerance’. This refers to the amount of pain an individual can tolerate, or put up with, at any given time. It is not affected by age, gender or culture, but rather by the thoughts and feelings we are experiencing at that point in time, and it is thus an outcome of the combination of sensory, cognitive and emotional input and processing. In struggling to communicate her pain, Maria may have a lower tolerance than Thomas whose surgery could be seen as an improvement in his condition. Pain with a negative emotional connotation is more difficult to tolerate than pain related to a positive emotional experience.
Neuroanatomy and Brain Perfusion in Functional Somatic Syndromes
Published in Peter Manu, The Psychopathology of Functional Somatic Syndromes, 2020
Pain threshold levels were measured using a standardized direct pressure technique at a total of ten paired anatomical sites. Five of these sites were traditional tender points (e.g., the second rib at the costochondral junction and the medial fat pad of the knee). The other five were control points above and below the waist (e.g., the mid-shaft of the ulna and anteromedial surface of the tibia). One hour after the examination, the patients completed a questionnaire assessing their pain perception. Psychological distress was assessed with self-administered instruments measuring depression and anxiety. Single photon emission computerized tomographic brain scans were obtained after intravenous injection with 99m technetium hexamethylpropylene amine oxime. The scans were obtained after all discomfort caused by the intravenous canullation had ceased.
Anaesthesia and resuscitation
Published in Jan de Boer, Marcel Dubouloz, Handbook of Disaster Medicine, 2020
Joost J. L. M. Bierens, Francois P. Gijsenbergh, Marc Sabbe
Every person has a pain threshold, which is about the same for most persons, and a pain tolerance, which depends on a large number of factors and is therefore different for every person under different circumstances. Pathophysiological reactions to pain depend on the pain threshold, not the pain tolerance.
Do expectations influence pain? Recognizing Irving Kirsch’s contribution to our understanding of pain
Published in American Journal of Clinical Hypnosis, 2023
In the area of both acute and chronic pain, Irving Kirsch’s work has made a substantial and clinically relevant impact. In this text, a fractional amount of his rich research portfolio will be described by taking a closer look at several studies and by discussing their impact on future research and clinical practice. First and foremost, Kirsch is a pioneer when it comes to the experimental induction of pain, and early on, Irving Kirsch made use of the experimental heat paradigm to study placebo effects, which allows to determine an individual’s pain threshold and tolerance. In the heat pain experiment, a Peltier element, i.e., a thermal control module in the form of a small disk, is placed on participants’ forearm. Patients can then increase the magnitude of the heat stimulus with a mouse-click. For each click, the temperature increases by 0.5°C. Pain threshold is reached as soon as participants’ feeling changes from hot to painful (Locher et al., 2017; Rief & Glombiewski, 2012). Pain tolerance, in contrast, is defined as the time from the onset of the pain stimulus to a participant’s withdrawal from the stimulus, while participants are instructed to continue with the task for as long as they can (Granot, Sprecher, & Yarnitsky, 2003).
BDSM: Does it Hurt or Help Sexual Satisfaction, Relationship Satisfaction, and Relationship Closeness?
Published in The Journal of Sex Research, 2022
Jenna Marie Strizzi, Camilla Stine Øverup, Ana Ciprić, Gert Martin Hald, Bente Træen
Consistent with previous research (Botta et al., 2019; Joyal & Carpentier, 2017), the findings indicated that having engaged in role-play and BDSM behaviors were associated with higher levels of sexual satisfaction. Other research found similar reports involving pain during sexual activity for increased pleasure, and quality/intensity of orgasm (Silva, 2015). Although this study does not directly assess the integration of pain in BDSM behaviors, a mechanism for the increased sexual satisfaction among participants may be related to the findings of the induction of analgesia during sexual activity (particularly vaginal/cervical stimulation). The pain threshold is raised yet tactile sensitivity is not altered (Komisaruk et al., 1997; Komisaruk & Wallman, 1977; Komisaruk et al., 2004; Whipple & Komisaruk, 1985; Whipple et al., 1992). However, more research is needed to understand the potential neural basis of the relationships between pain, pleasure, and BDSM.
Assessing Physical Pain Perception and Psychological Distress Tolerance through the MMPI-2-RF: A Comparison of Multimethod Measures
Published in Journal of Personality Assessment, 2022
Joye C. Anestis, Tiffany M. Harrop, Olivia C. Preston, Brian A. Bulla, Taylor R. Rodriguez
The present study used a pressure algometer to behaviorally assess physical pain tolerance and persistence. This method is widely used for experimental pain induction, provides standardized and efficient assessment of pain, and has acceptable reliability and validity (see Edens & Gil, 1995, for a review). The pressure algometer was applied below the first knuckle on the second finger of each participant’s right hand, and administrators applied an increasing amount of pressure at a uniform rate across participants. The participant was initially instructed to say “pain” when they first experienced the sensation of pain (threshold). After a 90-s break, the administrator again applied the algometer, and the participant was instructed to say “stop” when the sensation of pain became too much to continue (tolerance). Five trials each of threshold and tolerance were administered, with the mean level of tolerance across the five trials used as an overall pain tolerance index. The internal consistency across the five trials was excellent (α = .96), which indicates a lack of habituation. Pain persistence was calculated by subtracting pain threshold (mean across all five trials) from pain tolerance (mean across all five trials).