Painful Situations Research Articles

Guidelines for Bystander First Aid 2016.

Cardiac life support is a form of first aid for cardiac emergencies. However, research and evidence in this field is lacking compared with other forms of first aid. Having identified the common emergencies that are encountered in the hospital, based on the available evidence, we have put together what could be an evidence-based approach to the first aid management of some of these common emergencies, viz. breathlessness, chest pain, allergies, stroke, heat injury, poisoning, unconsciousness, seizures, and trauma situations such as bleeding, wounds, contusions, head injury, burns and fractures. Educating the public is the key to developing a first responder bystander. These guidelines could become the basis for training of the public.

La Gestion D'une Patiente Ayant Hypertension Pulmonaire Thromboembolique Chronique

The profession of Physiotherapy has been defined by the "World Confederation for Physical Therapy" (WCPT) as the services provided to individuals and populations to develop, maintain or restore an optimal functioning throughout the life. This includes services facing all the circumstances which may take place and which are caused by the age, musculoskeletal disorders, pain, diseases, disorders, environmental conditions and many other situations. The physiotherapists are thus called upon to identify and maximize the quality of life of individuals by focusing on the promotion of health, the prevention, treatment, intervention and the adaptation or even the rehabilitation. For this, in the clinical environment, the physiotherapist is confronted by a variety of clinical cases which can be very simple or having a level of complexity increased. This project presents a case that can be considered rare but requires the implementation and the integration of multiple skills to be able to manage it. It is a case of pulmonary hypertension chronic thromboembolic which has gone unnoticed for several years and which is complicated by the existence of a sociocultural component which adds to this case an additional challenge when it is supported. The success in the management of this case relies on of the establishment of a good communication with the patient and on the establishment of a relationship of trust which requires of the physiotherapist to detach from social prejudice and to present themselves as an impartial person in dealing with the individuals.

Selfies de vítimas: imagem e autenticidade em postagens de redes sociais

Este texto procura refletir sobre a exposição crescente que o autorretrato, nomeadamente, as selfies, de pessoas que se enunciam vítimas têm adquirido em sites de redes sociais. As vítimas de violência se declaram e se apresentam em fotografias que expõem situações marcadas pela dor e sofrimento. Pensadas como gesto que configura uma forma de relato de si, estes materiais indicam os aspectos que participam do processo de visibilidade no contexto on-line. Deste modo, dois pontos se destacam no exame deste material: a) funcionam como recurso à afirmação da autenticidade como um dos índices culturais da moral que define o que seria aceitável à declaração daquele que se diz vítima; b) promovem formas de interação afetiva com os demais usuários. O exercício de análise privilegia exemplares recentes veiculados através de uma hashtag de campanha, pelo Instagram.

Relationship of Parental Responses to Pain Catastrophization, Pain Intensity and Functional Limitations in Children with Functional Pain

Introduction: Pain is primarily a psychological experience. Based on social learning theory, studies have examined association between parental behaviours and child’s functioning in various pain situations. Objectives: 1) to examine relationship of parental responses to pain catastrophization, functional disability and pain intensity in children with functional pain complaints. 2) to explore psychosocial problems associated with functional pain. Methodology: Participants were 43 children diagnosed with functional pain, referred from Paediatric units of Kasturba Hospital, Manipal. Measures examining parental responses to pain, pain catastrophization, pain intensity, functional limitations and psychosocial problems were administered. Results: Analyses revealed significant associations between pain catastrophization and some of its types and functional disability. On the whole, statistically significant relationship between parental responses and pain catastrophization was not observed. But, on gender based analysis, solicitous parental response predicted pain rumination aspect of pain catastrophization in females. Among psychosocial problems, school and family problems were predominant. Conclusions: This study highlighted the role of pain catastrophization in predicting functional limitations in children and role of parental attention in increasing pain rumination in females. Hence, intervention should target the exaggerated pain perceptions, parental attention and psychosocial problems to ameliorate the functional limitations.

Social contexts modulate neural responses in the processing of others' pain: An event-related potential study.

Two hypotheses have been proposed regarding the response that is triggered by observing others' pain: the "empathizing hypothesis" and the "threat value of pain hypothesis." The former suggests that observing others' pain triggers an empathic response. The latter suggests that it activates the threat-detection system. In the present study, participants were instructed to observe pictures that showed an anonymous hand or foot in a painful or non-painful situation in a threatening or friendly social context. Event-related potentials were recorded when the participants passively observed these pictures in different contexts. We observed an interaction between context and picture in the early automatic N1 component, in which the painful pictures elicited a larger amplitude than the non-painful pictures only in the threatening context and not in the friendly context. We also observed an interaction between context and picture in the late P3 component, in which the painful pictures elicited a larger amplitude than the non-painful pictures only in the friendly context and not in the threatening context. These results indicate that specific social contexts can modulate the neural responses to observing others' pain. The "empathic hypothesis" and "threat value of pain hypothesis" are not mutually exclusive and do not contradict each other but rather work in different temporal stages.

Dissociable Roles of Cerebral μ-Opioid and Type 2 Dopamine Receptors in Vicarious Pain: A Combined PET-fMRI Study.

Neuroimaging studies have shown that seeing others in pain activates brain regions that are involved in first-hand pain, suggesting that shared neuromolecular pathways support processing of first-hand and vicarious pain. We tested whether the dopamine and opioid neurotransmitter systems involved in nociceptive processing also contribute to vicarious pain experience. We used in vivo positron emission tomography to quantify type 2 dopamine and μ-opioid receptor (D2R and MOR, respectively) availabilities in brains of 35 subjects. During functional magnetic resonance imaging, the subjects watched short movie clips depicting persons in painful and painless situations. Painful scenes activated pain-responsive brain regions including anterior insulae, thalamus and secondary somatosensory cortices, as well as posterior superior temporal sulci. MOR availability correlated negatively with the haemodynamic responses during painful scenes in anterior and posterior insulae, thalamus, secondary and primary somatosensory cortices, primary motor cortex, and superior temporal sulci. MOR availability correlated positively with orbitofrontal haemodynamic responses during painful scenes. D2R availability was not correlated with the haemodynamic responses in any brain region. These results suggest that the opioid system contributes to neural processing of vicarious pain, and that interindividual differences in opioidergic system could explain why some individuals react more strongly than others to seeing pain.

Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery.

BackgroundClinical experience teaches us that patients are willing to accept postoperative pain, despite high pain intensity scores. Nevertheless, relationships between pain scores and other methods of pain assessment, e.g. acceptability of pain or its interference with physical functioning, are not fully established. Our aims were to examine these relationships.MethodsA cross-sectional study was conducted on patients who underwent major surgery between January 2008 and August 2013. Using logistic regression, we quantified the relationships between movement-evoked pain scores on the numerical rating scale (NRS-MEP) and three dichotomous dependent variables: patient’s opinion on acceptability of pain (PO: acceptable or unacceptable pain); nurses’ observation of patient’s performance of necessary activities to expedite recovery (NO: good or bad performance); a compound measure judging the presence of the clinically desirable situation of acceptable pain associated with good patients’ performance (PONO: present or not). Using Receiver Operating Characteristics (ROC) analysis, NRS cut-off points were determined such that they best discriminate between patients having one versus the other outcome for PO, NO and PONO.Results15,394 assessments were obtained in 9,082 patients in the first three postoperative days. Nine percent of the patients had unacceptable pain while having an NRS-MEP of 0–4. An estimated 47% (95%CI = 45%-49%) of patients with an NRS-MEP of 7 described their pain as acceptable on day one. Moreover, 33% (31%-35%) performed all required physical activities, and 22% (21%-24%) combined acceptable pain with appropriate movement. NRS cut-off points for PO, NO and PONO were five, four and four, respectively, but had insufficient discriminatory power.ConclusionsOur results suggest pain management should be guided by the many dimensions of the patient’s pain experience, not solely by NRS cut-off points. Future research should evaluate the impact of such multidimensional pain assessment on patients’ functional outcome.

Long-Time Exposure to Violent Video Games Does Not Show Desensitization on Empathy for Pain: An fMRI Study.

As a typical form of empathy, empathy for pain refers to the perception and appraisal of others’ pain, as well as the corresponding affective responses. Numerous studies investigated the factors affecting the empathy for pain, in which the exposure to violent video games (VVGs) could change players’ empathic responses to painful situations. However, it remains unclear whether exposure to VVG influences the empathy for pain. In the present study, in terms of the exposure experience to VVG, two groups of participants (18 in VVG group, VG; 17 in non-VVG group, NG) were screened from nearly 200 video game experience questionnaires. And then, the functional magnetic resonance imaging data were recorded when they were viewing painful and non-painful stimuli. The results showed that the perception of others’ pain were not significantly different in brain regions between groups, from which we could infer that the desensitization effect of VVGs was overrated.

Frequency-dependent changes in sensorimotor and pain affective systems induced by empathy for pain.

BackgroundEmpathy for pain helps us to understand the pain of others indirectly. To better comprehend the processing of empathic pain, we report the frequency-dependent modulation of cortical oscillations induced by watching movies depicting pain using high-density electroencephalography (EEG), magnetoencephalography (MEG), and motor evoked potentials (MEP).MethodsEvent-related desynchronization of EEG and MEG was assessed while participants viewed videos of painful (needle) or neutral (cotton swab) situations. The amplitudes of MEPs were also compared between the needle and cotton swab conditions.ResultsThe degree of suppression in α/β band power was significantly increased, whereas that of γ band power was significantly decreased, in the needle condition compared with the cotton swab condition. EEG revealed that significant differences in α/β band were distributed in the right frontocentral and left parietooccipital regions, whereas significant γ band differences were distributed predominantly over the right hemisphere, which were confirmed by source estimation using MEG. There was a significant positive correlation between the difference in γ power of the two conditions and the visual analog scale subjective rating of aversion, but not in the α/β band. The amplitude of MEPs decreased in the needle condition, which confirmed the inhibition of the primary motor cortex.ConclusionMEP suppression supports that modulation of cortical oscillations by viewing movies depicting pain involves sensorimotor processing. Our results suggest that α/β oscillations underlie the sensory qualities of others’ pain, whereas the γ band reflects the cognitive aspect. Therefore, α/β and γ band oscillations are differentially involved in empathic pain processing under the condition of motor cortical suppression.

Pain and Pain Management Among University Students: Online Survey and Web-Based Education.

Pain is common among university students. Unrelieved pain has adverse impacts on their quality of life. In this study, a pain management Web site was developed to distribute an online survey and provide Web-based pain education to university students. Participants were recruited from eight universities in Hong Kong using snowball sampling. The online survey included 37 items examining pain situations, pain management strategies, knowledge about self-medication, and demographic data of the participants. A total of 387 students participated and over 90 percent of them reported pain in the past 6 months. Around one-third of participants did not take any action to manage their pain. Pharmacological method was the most common strategy for students to relieve pain (37.2 percent). The use of over-the-counter (OTC) drug for pain relief was high (n = 214). However, OTC drug knowledge score was significantly higher among health-related group than nonhealth-related group (p < 0.001). There were 188 students who also read the Web-based pain education and completed the evaluation on its usefulness. Nonhealth-related students reported significantly higher scores of self-perceived usefulness for the online education than the health-related students (p < 0.001). Findings suggested the need to consider the service users' background when developing online education program in the future.

The impact of mood on empathy for pain: Evidence from an EEG study.

The current work investigated whether the neural correlates of empathy for pain are altered by mood valence of observers. Following mood induction, participants watched pictures representing painful or nonpainful situations. We used EEG to record neural activity and assessed event-related desynchronization at central sites during pain observation. Greater mu desynchronization was observed during painful relative to nonpainful situations in positive and neutral mood but not in negative mood. We also found that the pain empathy effect, indexed by mu suppression differences between painful and nonpainful conditions, was smaller in negative than in neutral and positive mood, while this effect was similar between neutral and positive mood. The current study demonstrates that observers' mood states influence the motoric component of empathy for pain, and specifically the negative mood suppresses the motoric empathic resonance for others' pain.

Plate osteosynthesis after patellar fracture: 1-year results of a prospective study

Aims and Objectives:Tension band wiring after patellar fractures is associated to a high number of implant related complications (22-53%). Revision surgery is necessary in 10-55% of the patients with mostly unsatisfactory results. The patella plate is an alternative treatment with the advantages of a locked plating implant. Biomechanical studies have shown a significant higher stability compared to tension band wiring. Therefore an immediate full weight bearing after surgery is allowed with the prophylaxis of knee-stiffness. The purpose of this study was to evaluate the first time clinical prospective results and complications of this new implant.Materials and Methods:Between April 2013 and May 2015 all patients that were treated with locked plating for patella fractures were included in this prospective study. Patients were examined after 6 weeks, 6 and 12 months. Information about patient satisfaction, pain situation and the functional result were collected. Additionally subjective scores (Tegner activity score, Lysholm-score, Kujala-score) were determined and compared to their value before trauma. Complications and revision surgeries were recorded and analysed.Results:17 patients, 6 women and 11 men, with a mean age of 58 (19-87) years were included in this study. The range of motion of the injured knee was 120° after 6 weeks and improved to 138° after 6 months, corresponding to 84% and 97% of the range of motion of the healthy opposite knee. The Tegner activity scale increased from 2,5 to 3,5 (initial value: 4), the Lysholm score from 78 to 92 points (initial value: 97) and the Kujala score from 72 to 88 points (initial value: 96). Two complications occurred: one patient had a reactive bursitis praepatellaris and one patient sustained a loss of reduction. Another two patients had their implants removed. Patient satisfaction reached 94% after one year.Conclusion:Locked plating of patella fractures is a reliable alternative treatment with good functional outcomes, low complication rates and high patient satisfaction. Already 6 months after surgery the functional results and subjective scores reached results as before trauma. Furthermore the aftercare with immediate full-weight bearing and motion exercise improves quality of life through an early return to daily life.

Working memory load modulates the neural response to other’s pain: Evidence from an ERP study

The present study investigated the time course of processing other’s pain under different conditions of working memory (WM) load. Event-related potentials (ERPs) were recorded while the participants held two digits (low WM load) or six digits (high WM load) in WM and viewed pictures that showed others who were in painful or non-painful situations. Robust WM-load×Picture interactions were found for the N2 and LPP components. In the high WM-load condition, painful pictures elicited significantly larger amplitudes than non-painful pictures. In the low WM load condition, the difference between the painful and non-painful pictures was not significant. These ERP results indicate that WM load can influence both the early automatic N2 component and late cognitive LPP component. Compared with high WM load, low WM load reduced affective arousal and emotional sharing in response to other’s pain and weakened the cognitive evaluation of task irrelevant stimuli. These findings are explained from the load theory perspective.

Alexithymia and depression in the recovery of chronic pain patients: a follow-up study

Background: Childhood adversities and emotional dysregulation are connected with chronic pain, alexithymia, and depression. Longitudinal studies exploring the impact of their co-occurrence on the pain situation are rare.Aims: The influence of alexithymia, depression, baseline pain situation, and treatment options on the course of chronic pain in a clinical sample was studied.Methods: The baseline data was collected from chronic pain patients (n = 154) before their first pain clinic visit, and the follow-up data after 1 year by self-report questionnaires. Study variables consisted of pain intensity, pain disability, alexithymia (TAS-20), depression (BDI-II), and treatment interventions. Statistical analyses were performed to find out differences between baseline and follow-up, as well as between alexithymic and non-alexithymic patients, and to estimate the effect of the treatment provided.Results: At follow-up, the majority of the patients had pain intensity and disability severe enough to disrupt with their daily living. None of treatment interventions was related to better outcome. Alexithymic patients reported more pain disability and depression at both baseline and at follow-up. The effect of alexithymia on pain disability was mediated by depression. The use of opioids was connected to alexithymia and depressiveness. Alexithymia and depression made a substantial contribution to poorer outcome.Conclusions: Severe pain intensity and disability with depression and alexithymia predicted difficulties in achieving improvement. Depression and alexithymia probably impair compliance with treatment and adherence to interventions. Their co-occurrence with a more severe pain situation and with the use of opioids indicates psychological problems underlying the pain experience.

Can fear conditioning repel California sea lions from fishing activities?

AbstractMarine mammal interactions with fisheries create conflicts that can threaten human safety, economic interests and marine mammal survival. A deterrent that capitalizes on learning mechanisms, like fear conditioning, may enhance success while simultaneously balancing welfare concerns and reduce noise pollution. During fear conditioning, individuals learn the cues that precede the dangerous stimuli, and respond by avoiding the painful situations. We tested the efficacy of fear conditioning using acoustic stimuli for reducing California sea lion Zalophus californianus interactions from two fishing contexts in California, USA; bait barges and recreational fishing vessels. We performed conditioning trials on 24 individual sea lions interacting with bait barges. We tested for acquisition of conditioned fear by pairing a neutral tone with a startle stimulus. Avoidance was strongest in response to the startle stimulus alone, but low when paired with a neutral tone. From actively fishing vessels, we tested for fear conditioning by exposing sea lions to a neutral tone followed by a startle pulse, a startle pulse alone or a no sound control. We conducted playbacks from 146 (including 48 no sound control) stops over two summer fishing seasons (2013, 2014). The startle stimulus decreased surfacing frequency, reduced bait foraging and increased surfacing distance from the vessel while the conditioned stimulus only caused a mild reduction in surfacing frequency with no other behavioral change. Exposing animals to a pair of a conditioned stimulus with a startle pulse did not achieve the intended management outcome. Rather, it generated evidence (in two study contexts) of immediate learning that led to the reduction of the unconditioned response. Taken together, our results suggest that for fear conditioning to be applied as a non‐lethal deterrent, careful consideration has to be given to individual behavior, the unconditioned/conditioned responses and the overall management goals.

Altered Empathy for Psychological and Physical Pain in Borderline Personality Disorder.

Many patients with borderline personality disorder (BPD) experience difficulties in empathizing with others and are sensitive to social exclusion. Accordingly, the authors developed a novel Social Interaction Empathy Task to examine empathy for physical and psychological pain from first- and third-person perspectives. Fifty female patients with BPD and forty-eight controls matched for age and gender were included. Alexithymia was also measured. Patients with BPD rated neutral and psychologically painful situations as more painful than healthy controls, and patients with BPD rated psychological pain as more intense in the first-person perspective than in the third-person perspective. In contrast, controls did not differentiate between the perspectives and rated physical pain as most intense. The impact of early adversity on empathy for psychological pain was mediated by alexithymia. Increased sensitivity for psychological pain in BPD correlated with symptom severity. BPD is associated with altered empathy for pain, which is related to difficulties in reflecting emotional states.

The use of oxytocin and relaxin in the treatment of refractory chronic pain with mixed characteristics (neuropathic and myofascial pain). Case report

ABSTRACT BACKGROUND AND OBJECTIVES: Some studies have related the use of synthetic oxytocin for the treatment of painful syndromes that relies on central and peripheral modulation mechanisms of pain. Thus, the objective of this study was to report a case of a patient with a refractory chronic pain of mixed characteristics (myofascial and neuropathic pain) who responded to the treatment with synthetic oxytocin and relaxin. CASE REPORT: Female patient, 41 years old, presenting a 10-year history of right hemifacial pain after dental surgery, with neuropathic characteristics, diagnosed as atypical facial pain (atypical trigeminal neuralgia). Later, she developed pain in the right cervical region, radiating to the shoulder, with several muscle trigger points in the pericranial region, suggestive of myofascial pain. After treatment with antidepressants, neuromodulators, anesthetic blockade, capsaicin and topical lidocaine, with partial results and pain recurrence, she started treatment with intramuscular oxytocin and oral relaxin. Over the year she followed the proposed treatment, she presented light pain, greater pain-free intervals, reduced need of pain blockade, improved tolerance to physical exercise and of the local face allodynia. CONCLUSION: Despite the new drugs, procedures, and protocols to treat chronic pain, the patients often present unsatisfactory outcomes. Many times, there are situations of mixed pain (neuropathic and myofascial pain) with central and peripheral sensitization, resulting in worse prognostic and refractoriness. In this case, synthetic oxytocin and relaxin presented a satisfactory response.

How to Understand the Complexity of Endometriosis-Related Pain

Pain is the most important symptom in patients with endometriosis, and its management is truly challenging. Due to the different localization of the endometriotic lesions in the pelvis, patients suffer from visceral and somatic pain or both at the same time. There are specific and unspecific symptoms characterized by endometriosis. Specific symptoms include dysmenorrhea, cyclic and acyclic pelvic pain, dyschezia, dysuria and dyspareunia. There is also a wide range of unspecific symptoms, such as unspecific bowel and bladder complaints, the emission of pain in the legs, vegetative concomitants like vomiting, emesis, gastric disorders, headaches, dizziness, painful ovulation, irregular pelvic pain, lower back pain, chronic fatigue. These symptoms can be both cyclic and acyclic, and in most cases, they are permanent. Visceral and somatic pain are completely different pain subtypes and can therefore be an explanation for the wide variety of symptoms. The close interaction between visceral sensory nerve fibers and the autonomic ganglia explain the high rate of concomitant vegetative reactions, such as vomiting and orthostatic dysregulation. In general, pain generation is a complex interplay of peripheral and central sensitization mechanisms. Accordingly, the pain produced in endometriotic lesions is the result of mediating substances, nerve fibers, cytokine-releasing immune cells and macrophages synthesis. These interactions seem to stimulate the neurogenic inflammatory process and sensitization of the peripheral nerves. Furthermore, the disruption of the input on the level of the spinal cord and the recognition of the pain in the brain may lead to exaggerated responses known as central hyperalgesia. Hormones and psychological factors influence the pain sensation and make the status of each patient very individual. Consequently, the involvement of professional pain management along with an implementation of pain-coping strategies in the patient's everyday life are obligatory in chronic pain situations. An additional osteopathic treatment with a manual resolve of muscle blockades to avoid secondary “pain intensifying” changes of the pelvic floor (tension) or malposition through relieving posture, is also recommended. Pain management in patients with endometriosis is very complex and requires an individual treatment strategy for each patient to avoid unnecessary surgical procedures. This information proves that it is hard to break the cycle of pain when chronic pain syndrome is already apparent.

The impact of conflict in the Democratic Republic of Congo on women and their response to peace-building

The unprecedented brutality, and the widespread sexual assault perpetrated against women during the conflict in the Democratic Republic of Congo (hereafter the DRC) have caught the attention of the world, to the extent that many observers are raising the question as to why Congolese women are so cruelly treated. To answer this question this paper discusses the complexity of causes behind the conflict and the various reasons leading to the atrocities prevailing in the country. Notwithstanding the painful situation of women in the DRC, there is a strong endeavour among women to transform the society and build a lasting peace.

Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents

Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. The primary objective of reducing the mean pain intensity by 2points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543.