The journal of pain : official journal of the American Pain Society
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Randomized Controlled Trial
We discount the pain of others when pain has no medical explanation.
The present studies investigated the impact of medical and psychosocial information on the observer's estimations of pain, emotional responses, and behavioral tendencies toward another person in pain. Participants were recruited from the community (study 1: N = 39 women, 10 men; study 2: N = 41 women, 12 men) and viewed videos of 4 patients expressing pain, paired with vignettes describing absence or presence of 1) medical evidence for the pain and 2) psychosocial influences on the pain experience. A similar methodology was used for studies 1 and 2, except for the explicit manipulation of the presence/absence of psychosocial influences in study 2. For each patient video, participant estimations of each patient's pain and their own distress, sympathy, and inclination to help were assessed. In both studies, results indicated lower ratings on all measures when medical evidence for pain was absent. Overall, no effect of psychosocial influences was found, except in study 2 where participants indicated feeling less distress when psychosocial influences were present. The findings suggest that pain is taken less seriously when there is no medical evidence for the pain. The findings are discussed in terms of potential mechanisms underlying pain estimations as well as implications for caregiving behavior. ⋯ The present studies indicate that observers take the pain of others less seriously in the absence of clear medical evidence for the pain. These findings are important to further understand the social context in which pain for which there is no clear medical explanation is experienced.
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Randomized Controlled Trial
Effects of nicotine on spinal cord injury pain vary among subtypes of pain and smoking status: results from a randomized, controlled experiment.
Smoking has been associated with increased pain severity in general chronic pain populations. Less is known about the effects of smoking and nicotine on the multifaceted and often complex subtypes of pain that frequently occur following spinal cord injury (SCI). The purpose of this study was to examine the effects of nicotine on self-reported pain among individuals with SCI and to determine if the effect of nicotine varied by pain subtype. A randomized, placebo-controlled crossover design was used to determine the effect of nicotine exposure on subtypes of SCI-related pain among smokers and nonsmokers. A complex relationship emerged, such that the degree of reported pain with exposure to 2 mg of nicotine compared to placebo varied according to pain type and smoking status of the subject. Pain sites that had characteristics of both neuropathic and musculoskeletal symptoms (deemed complex neuropathic pain sites) exhibited pain reduction after nicotine exposure in nonsmokers. In sharp contrast, smokers with this form of pain exhibited an increase in pain severity. Data were also examined descriptively to determine potentially unique factors associated with complex neuropathic pain that may explain trends associated with clinically relevant changes following nicotine exposure. In sum, smoking or tobacco use history may determine the analgesic (or enhanced pain perception) effect of nicotine on post-SCI pain. ⋯ Pain characterized by both neuropathic and musculoskeletal symptoms decreased in severity after nicotine exposure in nonsmokers with SCI but increased in severity among smokers with SCI. The analgesic (or enhanced nociceptive) effect of nicotine may depend on tobacco use history.