Pain Sensitivity Questionnaire Research Articles

The short- and long-term effect of osteopathic manipulative treatment on pain, and psychosocial factors in adults with chronic low back pain.

Chronic low back pain (CLBP) has long plagued mankind, but little progress has been made in finding a rational and effective treatment, letalone a common cause. This study is an attempt to fill that void by measuring short- and long-term effects of osteopathic manipulative treatment (OMT), including psychosocial and pain reduction in CLBP patients. The objectives of this study were to investigate the effectiveness of neuromusculoskeletal medicine/osteopathic manipulative medicine (OMM) in treating CLBP, with a focus on biopsychosocial (pain sensitivity questionnaire [PSQ]) and pain control in chronic conditions. The study involved a large, single cohort observational design of 101 patients. The inclusion criteria for selecting patients targeted those with "nonspecific" CLBP. The National Institutes of Health (NIH) Minimum Dataset for Chronic Low Back Pain (NMD) was the measurement tool and was administered at consent (baseline), 2, 4, and 8weeks and at 6 and 12months. Time trends were analyzed as overall mean. Pairwise differences were compared between time points. Mixed-effects models were utilized to test the association of time with pain and biopsychosocial scores. Pain and PSQ scores decreased over the study timeline. The most significant change for both pain and biopsychosocial scores occurred at 6months compared to baseline, with a further reduction at 12months. OMT has been demonstrated to significantly reduce pain and psychosocial factors related to CLBP in both the short and long term.

Translation, cross-cultural adaptation, and measurement properties of the Arabic version of the pain sensitivity questionnaire.

The Pain Sensitivity Questionnaire (PSQ) is a reliable and valid self-reported tool for the assessment of pain sensitivity in clinical practice. The PSQ has been translated, validated, and cross-culturally adapted into multiple languages. However, a validated Arabic version of the PSQ is not available. Thus, this study aims to translate, validate, and cross-culturally adapt the English version of the PSQ into the Arabic language. The English version of the PSQ was translated and culturally adapted into Arabic following international guidelines. The psychometric properties of the final version of the PSQ-Arabic (PSQ-A) were tested among 119 patients with different persistent musculoskeletal (MSK) pain. The Cronbach's α for the PSQ-A-total, PSQ-A-moderate, and PSQ-C-minor were 0.81, 0.79, and 0.76, respectively. The means for the PSQ-A-total, PSQ-A-moderate, and PSQ-C-minor scores were 5.07 (±1.28), 5.64 (±2.07), and 4.50 (±0.50). The test-retest reliability measured with the interclass correlation coefficient for 68 subjects was 0.80 for the PSQ-A-total, 0.74 for the PSQ-A-moderate, and 0.77 for the PSQ-A-minor. The PSQ-A-total and the PSQ-A-minor showed positive significant correlations with pain catastrophizing scale (PCS) (r = 0.15, 0.17); P ≤ 0.05), respectively. The PSQ-A-total, PSQ-A-moderate, and PSQ-A-minor showed positive significant correlations with the Brief Pain Inventory (BPI)-pain scores (r = 0.47, 0.43, 0.45; P ≤ 0.01), respectively and with the BPI-pain interference scores (r = 0.37, 0.33, 0.34; P ≤ 0.01), respectively. This study shows that the PSQ-A is a reliable and valid tool to assess individuals with pain sensitivity in Arabic populations. Further studies are recommended to examine the concurrent validity of the PSQ-A against experimental pain sensitivity measures.

The Relationship of Pain Sensitivity and Severity with Quality of Life in Patients with Chronic Low Back Pain

Aim: To evaluate the relationship of pain sensitivity and pain severity with pain-related quality of life in patients with chronic low back pain. Methods: This descriptive study was conducted with individuals who applied to the Family Medicine Outpatient Clinic of a tertiary hospital, and who had low back pain for at least 3 months. To obtain data, Patient Information Form, Dallas Pain Questionnaire, Graded Chronic Pain Scale-Revised, and Pain Sensitivity Questionnaire were used. Results: While the total pain sensitivity of the 196 participants was detected to be moderate, 46.9% were Grade-3 according to Chronic Pain Scale-Revised. A significant correlation was found between the grade groups and age, presence of chronic disease, low back pain duration, treatment status, and compliance to advice. A significant relationship was found between grade groups and daily activities and work and leisure activities subgroups of Dallas Pain Questionnaire. The total Pain Sensitivity Questionnaire score was higher in women and those who did not receive any treatment for low back pain. Conclusion: A number of socio-demographic and low back pain related variables were associated with pain severity and sensitivity. Daily activity, and work and leisure activities, which indicate the quality of life, were negatively affected by the increase in the severity of low back pain. High pain sensitivity also negatively affects the emotional situation. Keywords: chronic pain, low back pain, pain severity, quality of life

Pain sensitivity and quality of life of patients with burning mouth syndrome: a preliminary study in a Chinese population

BackgroundBurning mouth syndrome (BMS) is an oral-facial pain disorder involving the central and peripheral nervous systems, but the evidence for altered pain sensitivity remains inconclusive. The aim of this study was to investigate pain sensitivity and oral health-related quality of life (OHRQoL) in patients with BMS and to assess the relationship between them.MethodsFifty Chinese patients with BMS (57.82 ± 11.2 years) and fifty age- and gender-matched healthy subjects (55.64 ± 10.1 years) participated in the study. The Pain Sensitivity Questionnaire (PSQ) was used to assess participants’ pain sensitivity. The Oral Health Impact Profile (OHIP-14) was used to evaluate participants’ OHRQoL.ResultsThe PSQ total score (p = 0.009), the PSQ minor score (p = 0.003) and the OHIP-14 score (p<0.05) of patients with BMS were significantly higher than those of the healthy subjects. Simple linear regression showed that the PSQ minor score was significantly associated with the OHIP-14 score in patients with BMS (β = 0.338, p = 0.016).ConclusionPatients with BMS have higher pain sensitivity than healthy subjects. Reducing pain sensitivity might help to improve the quality of life of patients with BMS.

Association Between Nurses' Personal Pain Sensitivity Towards Knowledge and Attitude of Pain Management

Effective pain management requires the right attitudes, judgments, skills, and knowledge that have an impact on pain treatment outcomes. A careful assessment of each individual’s pain sensitivity is invaluable for the prevention, evaluation, and treatment of pain. This study aimed to determine the relationship of pain sensitivity of professional nurses to pain management knowledge and attitudes. The method used in this research is cross-sectional study with a survey design that provides a quantitative picture of pain sensitivity, knowledge, and attitudes towards pain management in a population, by studying a sample of 160 nurses. Pain Sensitivity Questionnaire (PSQ) and Attitudes of Nurses Regarding Pain. The frequency and percentage of knowledge and attitude regarding pain in category lack (96.87%). Pain sensitivity question score are PSQ Minor score in average value 4.63 and PSQ Moderate score in average score 6.15. There is a significant relationship between attitudes and education with a sig 0.017 (P&lt;0.050. There is a significant relationship between knowledge and attitudes with a sig value of 0.022 (P&lt;0.05), there is no significant relationship between knowledge and pain sensitivity with a sig value 0f 0.689 (p&lt;0.05), there is no significant relationship between attitudes and pain sensitivity with a sig 0.0640 (p&lt;0.05). Efforts to improve knowledge, attitudes, skills and pain sensitivity among healthcare professionals are needed, monitored and evaluated by the hospital administration to improve nurses’ skill in paint management for better patient outcomes

Influence of Pain Sensitivity on Surgical Outcomes of Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study

Background: The Pain Sensitivity Questionnaire (PSQ) has been found to be a valid tool, and PSQ scores have been shown to be predictive of outcomes after surgery for lumbar stenosis. The effect of pain sensitivity on outcomes of rotator cuff repair (RCR) surgery has not been examined. Hypothesis: PSQ scores would be associated with surgical outcomes after arthroscopic RCR surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Patients 18 to 80 years old scheduled for RCR were consecutively enrolled. Patients with glenohumeral arthritis grade ≥2 or RCR revision surgery were excluded. PSQ was completed preoperatively. The Disabilities of the Arm, Shoulder and Hand score and American Shoulder and Elbow Surgeons score were used as patient-reported outcome measurements (PROMs), and visual analog scale pain score was documented as well. Active shoulder external rotation (ER), internal rotation, and anterior forward elevation range of motion (ROM) were recorded. PROMs and ROM measurements were recorded preoperatively and at 3 months, 6 months, and 1 year after surgery. Rotator cuff tear size, type of repair, and concomitant procedures were documented. Patients were classified as having high or normal pain sensitivity based on PSQ scores. Results: Of 100 enrolled patients, 38 patients were classified as having high pain sensitivity. Patients with high pain sensitivity had worse American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand scores preoperatively, 6 months postoperatively, and 1 year postoperatively (P < .01). From the preoperative assessment to 3 months postoperatively, PROMs improved more in patients with high versus normal pain sensitivity. However, for patients with high pain sensitivity, PROMs plateaued after 3 months but continued to improve for patients with normal pain sensitivity (P < .01). Visual analog scale pain scores were higher at all time points for patients with high pain sensitivity (P < .05). Preoperatively, patients with high pain sensitivity had restricted active ROM compared with patients who had normal pain sensitivity for anterior forward elevation, ER, and internal rotation (P = .009, P = .012, and P = .006, respectively). By 1 year after surgery, ER ROM was still restricted in patients with high pain sensitivity. Conclusion: Pain sensitivity is an important factor influencing RCR outcomes. Patients with high pain sensitivity undergoing RCR showed less improvement in active ROM and worse PROMs after surgery compared with patients who had normal pain sensitivity. Preoperative PSQ may predict postoperative improvements.

Breastfeeding-related Pain, Sensory Over-responsiveness, and Exclusive Breastfeeding at 6 Months: A Prospective Cohort Study

BackgroundExclusive breastfeeding (EBF) is recommended for the first 6 months of life, yet EBF rates at 6 months (T3) in most developed countries are low. Painful and nonpainful sensory stimuli processing is linked, and while pain has been suggested to restrict breastfeeding, its coupling with sensory over-responsiveness (SOR) in relation to breastfeeding has not yet been reported. ObjectiveWe aimed to explore whether breastfeeding-related pain, SOR, and general pain sensitivity predict nonexclusive breastfeeding (NEBF) at T3. Study DesignIn this prospective study, participants were recruited at 2 days postpartum (enrollment). For the assessment of breastfeeding-related pain, participants completed the visual analogue scale and the Short-Form McGill Pain Questionnaire at enrollment, and at 6 weeks after birth. At T3, they completed the Pain Sensitivity Questionnaire and the Sensory Responsiveness Questionnaire-Intensity Scale and then provided information about their breastfeeding status. Participants were divided into two groups accordingly: EBF and NEBF. ResultsA total of 164 participants were reached at T3: EBF (n = 105) and NEBF (n = 59). The incidence of SOR was significantly higher among NEBF compared with EBF participants (25.4% vs. 11.4%; p = .020). Between enrollment and 6 weeks after birth, 72.3% of the EBF participants had reported a ≥30% pain reduction, compared with 44.8% of the NEBF participants (p = .001). Logistic regression modeling revealed that both breastfeeding-related pain reduction and SOR predicted NEBF at T3 (p < .001), indicating a 3.2 times (p = .001) and 2.5 times (p = .041) odds ratio for NEBF, respectively. ConclusionsSOR and sustained breastfeeding-related pain predict NEBF at T3 and may emerge as substantial breastfeeding barriers.

Pain control and subconjunctival haemorrhage after intravitreal injection using cooled anaesthetic eyedrops and antiseptics: A prospective, double-blind, randomized controlled trial.

To evaluate whether cooled anaesthetic eyedrops and antiseptics alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection. A prospective, double-masked, randomised controlled trial of 100 participants receiving either cooled (n = 50) or room temperature (n = 50) topical anaesthetic eyedrops and antiseptics before receiving an injection of bevacizumab. Baseline tolerability was estimated using a self-reported pain sensitivity questionnaire. Overall tolerability was comparable between the study group and the control group (0.75 ± 0.13 vs. 0.74 ± 0.14, respectively, p = 0.99). Subconjunctival haemorrhage incidence was similar in both groups (80% vs. 86%, respectively, p = 0.113), as was subconjunctival haemorrhage size (2.75 ± 5.51 mm2 vs. 5.53 ± 10.72 mm2 , respectively, p = 0.11). Sub-group analysis demonstrated that the participants taking daily ocular eyedrops who received cooled anaesthetic eyedrops and antiseptics reported less pain at 10 min and less burning sensation at 24 h compared with matched controls (0.67 ± 1.50 vs. 2.50 ± 3.03, respectively, p = 0.040 and 0.00 ± 0.00 vs. 1.44 ± 2.96, respectively, p = 0.045). Participants who received cooled eyedrops and did not use antithrombotic therapy had smaller-sized subconjunctival haemorrhages compared with matched controls (1.55 ± 1.87 mm2 vs. 8.29 ± 14.61 mm2 , respectively, p = 0.038). Participants with hypertension who received cooled eyedrops had smaller-sized subconjunctival haemorrhage compared with matched controls (2.33 ± 4.99 mm2 vs. 6.89 ± 12.41 mm2 , respectively, p = 0.045). The benefit of using cooled anaesthetic eyedrops and antiseptics to alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection was not proven in the general population. It may be beneficial in part for some patients, such as those who regularly use eyedrops, patients with hypertension or those not on antithrombotic therapy.

Exploring the Effect of Pain Sensitive Questionnaire on Guiding Intravenous Analgesia After Cesarean Section: A Randomised Double Blind Controlled Trial.

This study investigates the effect of the Pain Sensitivity Questionnaire (PSQ) in guiding patient controlled intravenous analgesia (PCIA) on postoperative analgesia in women undergoing cesarean section. A total of 160 women who were to undergo a cesarean section under combined spinal and epidural anaesthesia were included in this study. Women with a preoperative PSQ <4 were randomly divided into a low pain-sensitive control group (LC group), and a low pain-sensitive observation group (LO group), and women with preoperative PSQ >6 were randomly divided into a high pain-sensitive control group (HC group) and a high pain-sensitive observation group (HO group). After the surgery, patients received the pump butorphanol concentration was 3.5 µg·kg-1·h-1 in the LC and HC groups, 3.0 µg·kg-1·h-1 in the LO group and 4.0 µg·kg-1·h-1 in the HO group.To compare the analgesic effects of postoperative PCIA and postoperative recovery in women. Wound pain and uterine contraction pain VAS scores at rest and activity were significantly lower in the LC group than in the LO group at 4 and 8 h postoperatively (P<0.05). Similarly, wound pain and uterine contraction pain VAS scores at rest and activity were significantly lower in the HO group than in the HC group at 8, 12, and 24 h postoperatively (P<0.05). The Ramsay scores were significantly higher in the LC than in the LO groups at 4, 8, 12, 24, and 48 h postoperatively (P<0.05), but there was no statistically significant difference between the Ramsay scores in the HC group and the HO group. There was no statistical difference in any of the post-operative recoveries (P>0.05). Compared to the weight-based postoperative PCIA, the PSQ-based postoperative PCIA has better analgesic effects and can improve maternal satisfaction with postoperative analgesia.

The Value of Pain Sensitivity Questionnaire in Predicting Postoperative Pain in Living Kidney Donors: A Prospective Observational Study.

This study aimed to investigate the value of the Pain Sensitivity Questionnaire (PSQ) for the prediction of postoperative pain and the relationship between pain sensitivity and postoperative pain in kidney donors undergoing living-related kidney transplantation. A total of 148 kidney donors were selected and the preoperative pain sensitivity questionnaire was administered the day before surgery. Kidney donors were assigned to low PSQ group (PSQ < 6.5, n = 76) or high PSQ group (PSQ ≥ 6.5, n = 72). The primary endpoint was the number of patient-controlled analgesia (PCA). Other outcomes included: the incidence of acute pain, flurbiprofen axetil remediation rate, the incidence of chronic pain, neuropathic pain assessment scale (Douleur Neuropathique 4 Questions, DN4), visual analog scale (VAS) at rest after surgery as well as the correlation between PSQ and QST (Quantitative Sensory Testing). The low PSQ group had a significantly lower number of PCA than high PSQ group (P < 0.0001). The incidence of acute pain was 75% in low PSQ group and 100% in high PSQ group (P < 0.0001). Furthermore, flurbiprofen axetil remediation rate was lower in low PSQ group than that in high PSQ group (P = 0.042). The incidence of chronic pain was significantly lower in low PSQ group than in high PSQ group (6.6% vs 61.1%, P < 0.001). Moreover, DN4 was significantly lower in low PSQ group than that in high PSQ group (P < 0.001). The PSQ-mean was significantly negatively correlated with QST in kidney donors. VAS at rest for the low PSQ group were lower than those of the high PSQ group. The PSQ was found to be associated with the intensity or postoperative pain and might be used to screen patients prior to living-kidney transplantation.

Does the pain sensitivity questionnaire correlate with tourniquet pain in patients undergoing ankle surgery?

Tourniquet pain is the most prominent problem in ankle surgery, and there is no proper method to predict it. It was reported that pain sensitivity questionnaires could evaluate the pain sensitivity of subjects. Its potential to predict tourniquet pain in ankle surgery is constructive and meaningful. One hundred and twenty patients undergoing ankle surgery were included in this study. The pain sensitivity questionnaire (PSQ) and self-rating anxiety scale (SAS) were completed before the operation. The methods included an ultrasound-guided popliteal sciatic, a femoral nerve block, and a proximal thigh tourniquet. The pressure of the tourniquet was set according to the systolic blood pressure (SBP + 100 mmHg). A visual analogue scale (VAS) was used to assess the tourniquet pain. Also, the onset time of tourniquet pain ≥4 VAS units was recorded. The PSQ-total and PSQ-minor scores were significantly correlated with the onset time when the tourniquet pain ≥4 VAS units (r = -0.763, r = -0.731, P < 0.001). The PSQ-total score <6.5 group gave significantly lower ratings for items 3, 4, 14, and 16 in the PSQ survey compared to the PSQ-total score ≥6.5 group (P < 0.05). Patients with high pain sensitivity have a higher need for analgesic drugs (P < 0.001). PSQ-total score ≥6.5 (OR = 185.8, 95% CI = 39.8-1,437.6, P < 0.001), sex (male, OR = 0.11, 95% CI = 0.018-0.488, P < 0.05), and age (OR = 0.92, 95% CI = 0.842-0.995, P < 0.05) were risk factors for reporting a tourniquet pain ≥4 VAS units within 30 min. The PSQ score is found to be correlated with intraoperative tourniquet pain. In addition, sex and age also affect the time of having intraoperative tourniquet pain.

Predictors of acute postoperative pain in patients with breast cancer

To date, modern medicine does not have reliable tools for objectifying and measuring pain. In order to avoid the development of chronic pain, we must effectively treat intraoperative and postoperative acute pain. In this prospective study, we wanted to estimate whether and to what extent algometer and PSQ (Pain Sensitivity Questionnaire) and CSQ (Coping Strategies Questionnaire) predict the intensity and strength of postoperative pain. Accordingly, we wanted to adjust the analgesia protocol. The study was conducted from February to April 2019, at the University Hospital for Tumors in Zagreb, and included 100 patients who were admitted to the hospital for breast cancer surgery. Preoperatively all patients completed PSQ and CSQ questionnaires and pain sensitivity was measured with the algometer. The same analgesic protocol was applied to all patients. The pain was measured postoperatively by NRS (numeric rating scale) 2, 6, 12, 18, 24, 48 and 72 hours after the operation. According to the obtained results, the patients were grouped into the group of slightly sensitive, medium sensitive, or very sensitive. Correlation between PSQ and NRS was statistically significant in the group of very sensitive patients. Research has shown that algometer can identify very sensitive patients and enables planning the analgesic protocol prior the operation. We can conclude that the analgesic protocol applied during the study was successful in preventing postoperative pain.

Do "central sensitization" questionnaires reflect measures of nociceptive sensitization or psychological constructs? A systematic review and meta-analyses.

Central sensitization (CS) is defined as an increased nociceptive responsiveness due to sensitization of neurons in the central nervous system, usually the result of prolonged nociceptive input or a disease state associated with noxious inputs (eg, polyarthritis). The concept of CS has recently been adopted in clinical assessments of chronic pain, but its diagnosis in humans may now include a wide range of hypervigilant responses. The purpose of this review is to ascertain whether self-report questionnaires linked with CS are associated with enhanced nociceptive responses or whether they measure sensitivity in a broader sense (ie, emotional responses). According to our published, PROSPERO-registered review protocol (CRD42021208731), a predefined search of studies that involve the Central Sensitization Inventory (CSI) or Pain Sensitivity Questionnaire (PSQ), correlated with either nociceptive sensory tests or emotional hypervigilance was conducted on MEDLINE, PsycINFO, and Web of Science. Correlations between the CSI or PSQ with our primary outcomes were extracted and meta-analysed. A review of 66 studies totalling 13,284 participants found that the CSI (but not the PSQ) strongly correlated with psychological constructs: depression, anxiety, stress, pain catastrophising, sleep, and kinesiophobia. The CSI and PSQ showed weak or no correlations with experimental measures of nociceptive sensitivity: pain thresholds, temporal summation, or conditioned pain modulation. The PSQ did, however, correlate strongly with phasic heat and tonic cold pain tests. The studies reviewed did not provide sufficient evidence that self-report measures reflect a canonical understanding of CS. The CSI more closely reflects psychological hypervigilance than increased responsiveness of nociceptive neurons.

Structural brain connectivity predicts early acute pain after mild traumatic brain injury.

Mild traumatic brain injury (mTBI), is a leading cause of disability worldwide, with acute pain manifesting as one of its most debilitating symptoms. Understanding acute postinjury pain is important because it is a strong predictor of long-term outcomes. In this study, we imaged the brains of 157 patients with mTBI, following a motorized vehicle collision. We extracted white matter structural connectivity networks and used a machine learning approach to predict acute pain. Stronger white matter tracts within the sensorimotor, thalamiccortical, and default-mode systems predicted 20% of the variance in pain severity within 72 hours of the injury. This result generalized in 2 independent groups: 39 mTBI patients and 13 mTBI patients without whiplash symptoms. White matter measures collected at 6 months after the collision still predicted mTBI pain at that timepoint (n = 36). These white matter connections were associated with 2 nociceptive psychophysical outcomes tested at a remote body site-namely, conditioned pain modulation and magnitude of suprathreshold pain-and with pain sensitivity questionnaire scores. Our findings demonstrate a stable white matter network, the properties of which determine an important amount of pain experienced after acute injury, pinpointing a circuitry engaged in the transformation and amplification of nociceptive inputs to pain perception.

Pain and masochistic behaviour: The role of descending modulation.

The mechanisms of pain perception in individuals with masochistic behaviour (MB) remain poorly documented. We hypothesized that MB is associated with context-specific changes in descending pain modulation. We compared the effects of four standardized sets of images with positive (erotic), negative (mutilations), masochistic or neutral emotional valences on the RIII nociceptive reflex evoked by electrical stimulation of the sural nerve and recorded on the ipsilateral biceps femoris in 15 controls and 15 men routinely engaging in MB. We systematically assessed the RIII reflex threshold and recruitment curves (up to the tolerance threshold), thermal (heat and cold) pain thresholds measured on the upper and lower limbs and responses to the pain sensitivity questionnaire, to compare basal pain perception between our two groups of participants. We also assessed anxiety, depression, empathy, alexithymia, high sensation seeking and catastrophizing, to investigate their potential influence on the emotional modulation of pain. Thermal pain thresholds, RIII reflex recruitment curves, and responses to the psychological and pain sensitivity questionnaires were similar in the two groups. Neutral, positive and negative images modulated the RIII reflex similarly in the two groups. By contrast, masochistic images induced a significant (p&lt; 0.01) decrease in RIII reflex responses in subjects with MB, whereas it tended to increase these responses in control subjects. Our data suggest that psychological profile, basal pain sensitivity and the emotional modulation of pain are normal in individuals with MB but that these subjects selectively engage descending pain inhibition in the masochistic context. Decrease pain perception related to masochistic behaviours is associated with specific activation of descending pain inhibition.

Pain sensitivity is modulated by affective temperament: Results from the population-based CHRIS Affective Disorder (CHRIS-AD) study

BackgroundNociceptive pain modulation is related to psychological and psychiatric conditions. Evidence from clinical studies backs innate temperaments as potential precursors of mood symptoms and disorders, and pain sensitivity. Our study examines the modulation effect of affective temperaments on pain sensitivity in a general population adult sample, accounting for possible intervening mood symptoms, lifetime anxiety and depression, and pain treatments. MethodsThe sample is part of the CHRIS-AD study, Italy. Primary outcomes were the pain sensitivity questionnaire PSQ-total intensity score and the experimental pressure pain threshold (PPT). Affective temperaments were evaluated with the TEMPS-M. Lifetime depression, anxiety, current mood disorders, and treatments were self-reported via rating-scales. Directed acyclic graphs theory guided linear and mixed linear regression model analyses. ResultsAmong 3804 participants (aged 18–65; response rate 78.4 %, females 53.3 %, mean age 38.4 years) for any given temperament, both the PSQ-total and the PPT were associated with temperament. The TEMPS-M four cyclothymic-related temperaments aligned on the pain-sensitive pole and the hyperthymic on the pain-resilient pole. The inclusion of current or lifetime mood symptoms, or pain drug use, as possible intervening pathways only partly diluted these associations, with stronger evidence for an effect of trait anxiety. LimitationsThe main limitations were the lack of experimental measures of suprathreshold pain intensity perception, and detailed information on affective disorders in the study population. ConclusionsThese findings support the hypothesis of a biological dichotomous diathesis of affective temperaments towards pain sensitivity; hyperthymic suggesting protection, whereas cyclothymic suggesting predisposition.

Effect of Sensory Sensitivity on Pain Processing Following Noxious Electrical Stimulation in Healthy Participants

The purpose of this study was to investigate the influence of sensitivity to sensory input, including pain, on the conditioned pain modulation (CPM) effect of oxious Electrical Stimulation (NxES). Seventeen healthy participants (24.8 (+/- 2) years) were enrolled in this study that was approved by the IRB. Each person participated in a familiarization session, and 2 testing sessions 24 hours apart. Sensory sensitivity was assessed with the Sensory Hypersensitivity Scale, touch and heat/cold detection thresholds. Pain sensitivity was assessed with the Pain Sensitivity Questionnaire, heat/cold pain thresholds, and pressure pain threshold (PPT). Pain modulation was assessed with temporal summation (TS) and CPM involved a test stimulus of PPT and conditioning stimulus was immersion in a cold water bath for 2 min. The NxES: 20 min of electrical stimulation (400 μs pulse duration, 50 pulses/s; 10s on:10s off; intensity was maximum tolerated). The difference between PPT before and after the NxES comprised the treatment effect. Neither Sensitivity to touch or temperature sensations nor pain sensitivity related to the treatment effect of the NxES. A higher the amplitude of pain perception of NxES was associated with greater treatment effect. The NxES was effective in inhibiting pain and reduced the extent of pain facilitation 24 hours after the treatment. CPM was no different after the NxES. The finding suggests that people who are more sensitive to sensations also experience pain inhibition from NxES. The nervous system is not as “reactive” to pain after a treatment of NxES and the lack of change in the CPM after the treatment of NXES suggests that artificially inducing pain inhibition with NXES does not interfere with the normal pain inhibitory function of the nervous system. Thus, any inhibition due to NXES treatment could augment that which is produced by a patient's own nervous system. The purpose of this study was to investigate the influence of sensitivity to sensory input, including pain, on the conditioned pain modulation (CPM) effect of oxious Electrical Stimulation (NxES). Seventeen healthy participants (24.8 (+/- 2) years) were enrolled in this study that was approved by the IRB. Each person participated in a familiarization session, and 2 testing sessions 24 hours apart. Sensory sensitivity was assessed with the Sensory Hypersensitivity Scale, touch and heat/cold detection thresholds. Pain sensitivity was assessed with the Pain Sensitivity Questionnaire, heat/cold pain thresholds, and pressure pain threshold (PPT). Pain modulation was assessed with temporal summation (TS) and CPM involved a test stimulus of PPT and conditioning stimulus was immersion in a cold water bath for 2 min. The NxES: 20 min of electrical stimulation (400 μs pulse duration, 50 pulses/s; 10s on:10s off; intensity was maximum tolerated). The difference between PPT before and after the NxES comprised the treatment effect. Neither Sensitivity to touch or temperature sensations nor pain sensitivity related to the treatment effect of the NxES. A higher the amplitude of pain perception of NxES was associated with greater treatment effect. The NxES was effective in inhibiting pain and reduced the extent of pain facilitation 24 hours after the treatment. CPM was no different after the NxES. The finding suggests that people who are more sensitive to sensations also experience pain inhibition from NxES. The nervous system is not as “reactive” to pain after a treatment of NxES and the lack of change in the CPM after the treatment of NXES suggests that artificially inducing pain inhibition with NXES does not interfere with the normal pain inhibitory function of the nervous system. Thus, any inhibition due to NXES treatment could augment that which is produced by a patient's own nervous system.

Mechanism underlying painful radiculopathy in patients with lumbar disc herniation.

Painful lumbar radiculopathy is a neuropathic pain condition, commonly attributed to nerve root inflammation/compression by disc herniation. The present exploratory study searched for associations between pain intensity and inflammatory markers, herniated disc size, infection, psychological factors and pain modulation in patients with confirmed painful lumbar radiculopathy scheduled for spine surgery. Prior to surgery, 53 patients underwent the following evaluation: pain intensity measured on a 0-10 numeric rating scale (NRS) and the Short-Form McGill Pain Questionnaire; sensory testing (modified DFNS protocol); pain processing including temporal summation and conditioned pain modulation (CPM); neurological examination; psychological assessment including Spielberger's Anxiety Inventory, Pain Sensitivity Questionnaire and the Pain Catastrophizing Scale. Pro-inflammatory cytokine levels (IL-1b, IL-6, IL-8, IL-17, TNFα, IFNg) and microbial infection (ELISA and rt-PCR) in blood and disc samples obtained during surgery. MRI scans assessments for disc herniation size/volume (MSU classification/ three-dimensional volumetric analysis). Complete data were available from 40 (75%) patients (15 female) aged 44.8±16.3years. Pain intensity (NRS) positively correlated with pain catastrophizing and CPM (r=0.437, p=0.006; r=0.421, p=0.007; respectively), but not with disc/blood cytokine levels, bacterial infection or MRI measures. CPM (p=0.001) and gender (p=0.029) were associated with average pain intensity (adjusted R2 =0.443). This exploratory study suggests that pain catastrophizing, CPM and gender, seem to contribute to pain intensity in patients with painful lumbar radiculopathy. The role of mechanical compression and inflammation in determining the intensity of painful radiculopathy remains obscure. Pain catastrophizing, CPM and gender rather than objective measures of inflammation and imaging seem to contribute to pain in patients with painful radiculopathy.

Pain catastrophizing, pain sensitivity and fear of pain are associated with early life environmental unpredictability: a path model approach

BackgroundSocioeconomic disadvantages in the childhood environment might strongly influence beliefs and behavior characterizing the adult years. When children experience unpredictable and adverse situations, they develop an unpredictability schema with the core belief that situations are unpredictable.MethodsIn two studies, we examined the association of childhood socioeconomic disadvantages with self-reported pain sensitivity, pain catastrophizing, and pain-related fear. Multidimensional survey measures were used to assess environmental conditions experienced in childhood. In addition, participants completed the Pain Catastrophizing Scale, Pain Sensitivity Questionnaire, Body Awareness Questionnaire, Unpredictability Schema Questionnaire, and Fear of Pain Questionnaire. In Study 1 (N = 252), in separate models, we examined pain sensitivity and pain catastrophizing of a community sample of pain-free young individuals in association with their childhood experiences. In Study 2 (N = 293), in a new sample, but with a wider age range, we examined the association of early life socioeconomic disadvantages with pain-related fear. In both studies, the predictions were tested with Structural Equation Modeling. Our models constituted a path from childhood socioeconomic status and household unpredictability to pain variables via the factors of family resources, unpredictability schemas, and body awareness.Results and conclusionsThe findings converged on the conclusion that individuals experiencing disadvantageous early life conditions tended to have an elevated level of pain catastrophizing, higher perceived sensitivity to pain, and higher level of pain-related fear. These associations were mediated by an unpredictability schema and body awareness.

Dispositional and situational personal features and acute post-collision head and neck pain: Double mediation of pain catastrophizing and pain sensitivity.

Pain variability can be partially attributed to psycho-cognitive features involved in its processing. However, accumulating research suggests that simple linear correlation between situational and dispositional factors may not be sufficiently explanatory, with some positing a role for mediating influences. In addition, acute pain processing studies generally focus on a post-operative model with less attention provided to post-traumatic injury. As such, this study aimed to investigate a more comprehensive pain processing model that included direct and indirect associations between acute pain intensity in the head and neck, pain catastrophizing (using pain catastrophizing scale (PCS)), and pain sensitivity (using the pain sensitivity questionnaire (PSQ)), among 239 patients with post-motor vehicle collision pain. The effect of personality traits (using Ten Items Personality Inventory (TIPI)) and emotional status (using Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS)) on that model was examined as well. To this end, three Structural Equation Modeling (SEM) analyses were conducted. Overall, the data had good fit to all the models, with only PSQ found to have a direct correlation with acute pain intensity. The SEM analyses conversely revealed several mediations. Specifically, that: first, PSQ fully mediated the relationship between PCS and pain intensity; second, PCS and PSQ together fully mediated the relationship between conscientiousness (personality trait) and pain intensity; and finally, emotional status had direct and indirect links with PSQ and pain intensity. In conclusion, these models suggest that during the acute post-collision phase, pain sensitivity intermediates between emotional states and personality traits, partially via elevated pain catastrophizing thoughts.