Articles: pain-threshold.
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Curr Opin Neurol Neurosurg · Apr 1993
ReviewThe spinal pharmacology of facilitation of afferent processing evoked by high-threshold afferent input of the postinjury pain state.
Repetitive C afferent input evokes a facilitated state of processing that results in increased receptive fields and exaggerated responses to afferent input ("wind-up"). These phenomena underlie the behavioral phenomena of secondary hyperalgesia and this in turn is an important component of postoperative pain. The initiation of this facilitated component is not well blocked by even higher concentrations of volatile anesthetics, but it can be prevented by pretreatment with agents known to block afferent input (local anesthetics) or C-fiber transmitter release (opiates) or to act at one of several links to block a complex spinal cascade involving the N-methyl-D-aspartate receptor, nitric oxide synthase, and cyclooxygenase. These fundamental mechanisms promise to have an impact on the management of postoperative pain.
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Tenderness and pain thresholds in pericranial muscles were studied in a random sample of 735 adults aged 25-64 years. This study was a part of a multifaceted, epidemiological study of different headache disorders. Manual palpation and pressure pain threshold were performed by observers blinded to the persons' history of headache. ⋯ A significant relation of tenderness to the recency of last episode of headache was detected in both sexes after control for usual frequency and actual headache (males: P < 10(-3); females: P < 10(-4)). Pressure pain thresholds were largely normal indicating normal pain processing and contradicting the idea that tension-type headache mainly is due to generally increased pain sensitivity. This study supports the pathogenetic importance of muscular factors in tension-type headache, while muscular factors are of no primary importance in migraine.
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Psychological state, response to pain and style of interpreting everyday experiences were measured in 32 patients who had suffered a whiplash injury 1-84 months before the study. For comparison, measures were also obtained in 15 general practice attenders. Ratings of depression and anxiety were greater in patients than in controls, and patients reported more cold-induced pain during a cold pressor test. ⋯ The findings demonstrate that, like most patients with chronic pain, whiplash injury sufferers are anxious and depressed. Their psychological distress could be aggravated by litigation. Behavioural assessment and treatment of chronic pain syndromes such as whiplash injury could benefit from early evaluation of the patient's psychological state, and response to standard painful stimuli.
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Individual-differences multidimensional scaling (INDSCAL) determined the dimensions underlying ratings of electrocutaneous stimuli, which ranged from innocuous levels to individual pain intolerance at each of three frequencies. Twenty-five healthy males made pairwise similarity judgments of these 15 stimuli for the INDSCAL procedure, and then rated each stimulus on nine property scales. Signal detection theory indices, as well as ratings on the McGill Pain Questionnaire (MPQ), were also obtained. ⋯ A Frequency dimension ordered the stimuli from lowest to highest frequency; this dimension was related to the Fast-Slow property. Compared to the Frequency dimension, the Sensory Magnitude dimension was more salient to subjects who better discriminated among painful stimulus intensities, set a more stoical pain report criterion, and were less apt to endorse frequency-related MPQ descriptors. Thus, variation of physical intensity and frequency elicited complementary dimensions of subjective judgment, which were related to perceptual and attitudinal differences among individuals.
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The hands of 14 normal humans were used to determine the somatotopic organization of the modulation of warmth sensation and heat pain by different forms of cutaneous stimuli. Test stimuli were 5-sec heat pulses ranging from 36 degrees to 51 degrees C, delivered to the fingerpads of digits 1, 2, 4, and 5 with a contact thermode. Conditioning stimuli (15 sec) bracketed the test stimuli and included vibration, noxious and innocuous heat, cold, and electrical pulses delivered to the fingerpads of digits that were adjacent or nonadjacent to the tested digits. ⋯ Vibratory (120 Hz, 3.5 microns) and cold (15 degrees C) conditioning stimuli were ineffective. The results are consistent with a dermatomal somatotopic organization of tactile and heat modulatory influences on warmth sensation and heat pain. The results further suggest that the neural mechanism subserving warmth mediate a negative feedback influence on heat pain intensity.