Pain
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The objective of our study is to evaluate the detection capacity of Colour Duplex Scanning (CDS) in helping to diagnose Pudendal Neuralgia (PNa) by Pudendal Nerve Entrapment (PNE). This technique is being compared to complete Neurological Criteria (NC) based on Diagnostic Score (DS) and Electroneuromyography (ENMG) and secondly, to the results of surgery. This is a prospective study, on a consecutive series of 96 unselected patients evaluated by both CDS and NC. ⋯ Currently, there is no gold standard that can diagnose PNa by PNE with certainty. CDS is a non-invasive technique, demonstrating high diagnostic value to confirm PNE. In this study, we determined a new objective diagnostic criterion, the Pudendal Artery Ratio (PAR), which is very strong at diagnosing PNE but needs to be validated by further studies.
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The present study investigated the effect of the child's pain catastrophizing and self-reported pain upon the child's facial expression of pain and parental inferences of their child's pain. School children (n=62) experienced pain by taking part in a cold water procedure. Analyses revealed that more intense pain was associated with higher levels of facial pain expression in children who reported a low frequency of catastrophizing. ⋯ A similar pattern was obtained for the pain inferences by the parent: pain intensity as reported by the child was positively related to pain inferences by the parent in children who reported a low frequency of catastrophizing, but such relationship was not significant for children with high catastrophizers. Further analyses revealed that when pain intensity was low, parents of high catastrophizing children judged the pain of their child to be higher than parents of low catastrophizing children. The implications of the findings are discussed in terms of the importance of assessing different dimensions of pain encoded in expression, different types of pain expression, and its differential effects upon others.
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Evidence that patients with chronic pain selectively attend to pain-related stimuli presented in modified Stroop and dot-probe paradigms is mixed. The pain-related stimuli used in these studies have been primarily verbal in nature (i.e., words depicting themes of pain). The purpose of the present study was to determine whether patients with chronic pain, relative to healthy controls, show selective attention for pictures depicting painful faces. ⋯ The results of these analyses revealed that while chronic pain patients with high and low levels of fear both shifted attention away from happy faces, those with low fear shifted attention away from painful faces, whereas those with high fear shifted attention towards painful faces. These results suggest that patients with chronic pain selectively attend to facial expressions of pain and, importantly, that the tendency to shift attention towards such stimuli is positively influenced by high fear of pain/(re)injury. Implications of the findings and future research directions are discussed.
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Many studies have investigated the highly relevant association between pain and disability in clinical groups using the Pain Disability Index (PDI). To interpret these results, knowledge of disability in the general population is crucial. Moreover, to investigate criterion validity of the PDI, the influence on health care utilisation (HCU) is of special interest. ⋯ The PDI is an economical, reliable and valid self-rating instrument for assessing disability caused by physical symptoms. HCU in the general population is determined by the number and severity of somatic complaints and also by disability. Symptoms and disability play a crucial but somewhat independent role.
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We have developed a model in which inflammation contiguous to and within a dorsal root ganglion (DRG) was generated by local application of complete Freund's adjuvant (CFA) to the L4 lumbar spinal nerve as it exits from the intervertebral foramen. The periganglionic inflammation (PGI) elicited a marked reduction in withdrawal threshold to mechanical stimuli and an increase in heat pain sensitivity in the ipsilateral hindpaw in the absence of any hindpaw inflammation. The pain sensitivity appeared within hours and lasted for a week. ⋯ We also show that IL-1beta induces COX-2 expression and prostaglandin release in DRG neurons in vitro in a MAP kinase-dependent fashion. The COX-2 induction was prevented by ERK and p38 inhibitors. We conclude that periganglionic inflammation increases cytokine levels, including IL-1beta, leading to the transcription of COX-2 and prostaglandin production in the affected DRG, and thereby to the development of a dermatomally distributed pain hypersensitivity.