Pain
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Comparative Study
Widespread pain as a risk factor for dysfunctional temporomandibular disorder pain.
Widespread pain has been found to be a risk factor for onset and persistence of temporomandibular disorder (TMD) pain. The aim of this cohort study was to determine if widespread pain is associated with interference and disability related to TMD pain. Three hundred and ninety-seven TMD patients were interviewed at 1 and 2 years following enrollment. ⋯ Among women without dysfunctional TMD pain at baseline, widespread pain was a risk factor for development of dysfunctional TMD pain (odds ratio (OR): 1.9, 95% confidence interval (CI): 1.2-2.8, P=0.003). However, there was no association between widespread pain and onset of dysfunctional TMD pain among men (OR: 1.0, 95% CI: 0.4-2.8, P=0.95) or maintenance of dysfunctional TMD among either women (OR: 1.0, 95% CI: 0.8-1.4, P=0.85) or men (OR: 0.4, 95% CI: 0.1-3.2, P=0.40). Widespread pain was independently and highly associated with risk of developing pain-related disability among women who did not have pain dysfunction at baseline, but was not predictive of risk of onset of dysfunctional TMD pain among men or maintenance of dysfunctional pain among either women or men.
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The Neck Disability Index (NDI) and Northwick Park Neck Pain Questionnaire (NPQ) were developed to measure self-perceived disability from neck pain, including that which may arise from whiplash injury. However, there is little data specifically concerning their validity for whiplash-associated disorders (WAD). The aim of this study was to assess the validity of the NDI and NPQ as measures of outcome in WAD by comparing them to a patient preference questionnaire, the problem elicitation technique (PET), which identifies problems that are of most importance to the individual patient. ⋯ Only three of these problems are included in the NDI (work, driving, and sleeping) and only four are included in the NPQ (work, driving, sleeping, and social activities). While both the NDI and NPQ include some problems that are common in patients with WAD, frequently identified problems, such as emotional and social items are absent. In contrast to the PET, neither instrument captures the full spectrum of disabilities judged to be important by the patient.
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Comparative Study
Pain rating by patients and physicians: evidence of systematic pain miscalibration.
This study is an investigation of the existence and potential causes of systematic differences between patients and physicians in their assessments of the intensity of patients' pain. In an emergency department in France, patients (N=200) and their physicians (N=48) rated the patients' pain using a visual analog scale, both on arrival and at discharge. ⋯ The extent of 'miscalibration' was greater with expert than novice physicians and depended on interactions among physician gender, patient gender, and the obviousness of the cause of pain. Thus physicians' pain ratings may have been affected by non-medical factors.
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Comparative Study
Perception of noxious and innocuous heat stimulation among healthy women and women with fibromyalgia: association with mood, somatic focus, and catastrophizing.
Recent studies have demonstrated that persons with fibromyalgia display abnormal processing of different types of painful stimulation, suggesting the disorder is characterized by a central pain-processing deficit not limited specifically to muscle pain. In the present study, 20 women with fibromyalgia and 20 normal, healthy women were compared on measures of pressure pain stimulation and response to contact thermal heat at both noxious and innocuous intensities. Women with fibromyalgia displayed significantly lower pressure pain thresholds at 18 tender point locations as defined by the American College of Rheumatology criteria, as well as lower pressure pain thresholds at five control sites. ⋯ Self-report of somatic symptoms was not associated with these measures. These findings indicate that persons with fibromyalgia display altered perception of both pressure and thermal stimulation, even at innocuous levels. They also suggest that catastrophic thoughts about pain may play a role in increased pain perception in this population.
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Hormonal cycling may be related to a higher incidence of pain syndrome in female. As tachykinins are pivotal in stress-induced colonic dysfunction, we investigated whether ovarian steroids influence stress-induced visceral hypersensitivity to rectal distension (RD) in female rats and further, whether this influence involves NK1 receptors. Female Wistar rats, either intact or ovariectomized (OVX), were equipped for abdominal muscle electromyography and submitted to 2-h partial restraint stress (PRS) or sham-PRS. ⋯ OVX rats treated with 17beta-estradiol or 17beta-estradiol-plus-progesterone, but not progesterone alone, exhibited visceral hypersensitivity after PRS similar to that of intact rats. Both stress-induced visceral hypersensitivity in intact rats and the hormonally-restored visceral hyper-responsiveness of OVX rats were antagonized by SR140333. It is concluded, therefore, that stress-induced visceral hypersensitivity in female rats is estrogens-dependent and mediated through NK1 receptor activation.