Pain Task Research Articles

Fixator-Assisted Femoral Lengthening Following Intramedullary Exchange Nailing for Subtrochanteric Non-union.

Non-unions in the femur can be a severely debilitating condition. When a non-union results in significant shortening and leg length discrepancy, simple activities of daily living become extremely difficult and painful tasks. Here, we present a 36 year-old male who presented three years following a motor vehicle accident, complaining of severe left thigh pain and a short left lower extremity. Initially treated in Egypt with an intramedullary nail (IMN) and distal screws, work-up revealed an aseptic subtrochanteric femoral nonunion with a leg length discrepancy of approximately 6.5 cm. The patient subsequently underwent exchange nail with rail fixator placement and was lengthened over the nail. After achieving adequate length, the patient underwent a second exchange nail, which was complicated by IMN instability. Due to the IMN instability, the patient underwent a third exchange nail with blocking screws, and finally healed. On final follow-up, the patient was pain free and no longer felt the leg length discrepancy, with an overall discrepancy of approximately 1.5 cm.

Mirroring pain in the brain: emotional expression versus motor imitation.

Perception of pain in others via facial expressions has been shown to involve brain areas responsive to self-pain, biological motion, as well as both performed and observed motor actions. Here, we investigated the involvement of these different regions during emotional and motor mirroring of pain expressions using a two-task paradigm, and including both observation and execution of the expressions. BOLD responses were measured as subjects watched video clips showing different intensities of pain expression and, after a variable delay, either expressed the amount of pain they perceived in the clips (pain task), or imitated the facial movements (movement task). In the pain task condition, pain coding involved overlapping activation across observation and execution in the anterior cingulate cortex, supplementary motor area, inferior frontal gyrus/anterior insula, and the inferior parietal lobule, and a pain-related increase (pain vs. neutral) in the anterior cingulate cortex/supplementary motor area, the right inferior frontal gyrus, and the postcentral gyrus. The ‘mirroring’ response was stronger in the inferior frontal gyrus and middle temporal gyrus/superior temporal sulcus during the pain task, and stronger in the inferior parietal lobule in the movement task. These results strongly suggest that while motor mirroring may contribute to the perception of pain expressions in others, interpreting these expressions in terms of pain content draws more heavily on networks involved in the perception of affective meaning.

Social Support Attenuates Physiological Stress Responses and Experimental Pain Sensitivity to Cold Pressor Pain.

Social support improves health and has been shown to attenuate stress and pain. The precise characteristics of social support responsible for these effects, however, remain elusive. The purpose of this study is to examine the relative efficacy of social support versus a neutral non-verbal social presence to attenuate stress and pain. Seventy-six participants provided pain ratings and task assessments during a cold pressor task (CPT) in one of three conditions: verbal social support, neutral non-support, or alone. Reactivity to the CPT was assessed via cardiovascular measures, cortisol, and subjective ratings. Participants receiving social support showed attenuated blood pressure, heart rate, and cortisol reactivity, as well as reduced pain ratings, task difficulty, tension, and effort compared to neutral non-support and alone conditions. Social support, not the mere presence of another individual, attenuated stress and pain during a CPT. Given the negative health consequences of stress and pain, clinical studies incorporating social support into medical procedures and treatments are warranted.

Awareness and Practices of Tax Planning by Salaried Employees: A Case Study of Lecturers in Odisha

Tax is a compulsory extraction and major source of revenue for the Government. Being a citizen of India, paying tax is one of our constitutional duties in return of fundamental rights. But paying tax is always a painful task as it directly impacts on the residual income of the taxpayers. Tax can be reduced either by evasion or avoidance or tax planning. Tax evasion is illegal, tax avoidance is not a crime but tax planning is ethical and legal. Tax planning is important for every assessee to reduce their tax liability and compliance with the income tax rules. Salaried assessee has no exception to it. To enjoy the benefits of tax planning, the assessee must know different provisions of tax planning available in the laws. With this background, this paper is an attempt to analyse the tax planning measures taken by the salaried persons in Odisha. It is found that more than 60% of the lecturers do not have sound ideas about various provisions of income tax. Tax planning measures adopted by different class of lecturers are almost uniform. Class of lecturers, gender, experience and length of service has no significant relationship with the level of awareness about the tax planning measures.

Predictors of task-persistent and fear-avoiding behaviors in women with sexual pain disorders.

Dyspareunia and vaginismus are the most common sexual pain disorders (SPDs). Literature suggests that many women with dyspareunia continue with intercourse despite pain (task persistence), whereas many women with vaginismus avoid penetrative activities that may cause pain (fear avoidance). Both forms of sexual pain behavior may maintain or aggravate complaints. This study examined (i) whether women with SPD differ from pain-free controls in motives for sexual intercourse, sexual autonomy, maladaptive beliefs regarding vaginal penetration, and partner responses to pain; and (ii) which of these factors best predict whether women with SPD stop or continue painful intercourse (attempts). Women with superficial dyspareunia (n = 50), women with lifelong vaginismus (n = 20), and pain-free controls (n = 45) completed questionnaires. For Aim 1, the main outcome measures were (i) motives for intercourse; (ii) sexual autonomy; (iii) maladaptive beliefs regarding vaginal penetration; and (iv) partner responses to pain. For Aim 2, sexual pain behavior (to continue or discontinue with painful intercourse) was the outcome measure. (i) Women with dyspareunia exhibited more mate guarding and duty/pressure motives for intercourse and were less sexually autonomous than controls. (ii) Symptomatic women had more maladaptive penetration-related beliefs than controls, with women with vaginismus reporting the strongest maladaptive beliefs. (iii) Partners of women with dyspareunia self-reported more negative responses to pain than those of women with vaginismus. (iv) The factors that best predicted sexual pain behavior were the partner responses to pain and the woman's maladaptive beliefs regarding vaginal penetration. Our findings reveal support for task persistence in women with dyspareunia and fear avoidance in women with lifelong vaginismus. As such, it is important to consider these distinct types of responding to sexual pain when treating SPD.

Co-morbid pain and opioid addiction: Long term effect of opioid maintenance on acute pain

IntroductionMedication assisted treatment for opioid dependence alters the pain experience. This study will evaluate changes pain sensitivity and tolerance with opioid treatments; and duration of this effect after treatment cessation. Method120 Individuals with chronic pain were recruited in 4 groups (N=30): 1-methadone for opioid addiction; 2-buprenorphine for opioid addiction; 3-history of opioid maintenance treatment for opioid addiction but with prolonged abstinence (M=121 weeks; SD=23.3); and 4-opioid naïve controls. Participants completed a psychological assessment and a cold water task including, time to first pain (sensitivity) and time to stopping the pain task (tolerance). Data analysis used survival analyses. ResultsA Kaplan–Meier–Cox survival analysis showed group differences for both pain sensitivity (log rank=15.50; p<.001) and tolerance (log rank=20.11; p<.001). Current or historical use of opioid maintenance resulted in differing pain sensitivity compared to opioid naïve (p's<.01). However, tolerance to pain was better among those with a history of opioid maintenance compared to active methadone patients (p<.05), with the highest tolerance found among opioid naïve control group participants (p's<.001). Correlations within the prolonged abstinent group indicated pain tolerance was significantly improved as length of opioid abstinence increased (R=.37; p<.05); but duration of abstinence did not alter sensitivity (ns). ConclusionAmong individuals with a history of prolonged opioid maintenance, there appears to be long-term differences in pain sensitivity that do not resolve with discontinuation of opioid maintenance. Although pain sensitivity does not change, pain tolerance does improve after opioid maintenance cessation. Implications for treating co-morbid opioid addiction and pain (acute and chronic) are discussed.

ERGONOMICS-THE LAW OF WORKING

Ergonomics, the science that studies human stress a nd strain related to activities, has one primary ob jective-to prevent work related musculoskeletal disorders, or symptoms that aggravate these disorders. Repeated unnatural, deviated or inadequate working postures, forceful h and movements, inadequate equipment or workplace designs and inappropriate work patterns are likely to be the pa rticular risk factors. The application of ergonomic s to dentistry, or dento-ergonomics, can increase efficiency and preve nt injury. Among the factors that need to be consid ered are the height and reach of staff members, the equipment be ing used and the distribution of tasks. By implemen ting the theories of ergonomics, dental care providers can p rolong their interest and commitment to dentistry b y making difficult or even painful tasks less stressful. Th e paper shows that ergonomics can have a large impact on the effectiveness of dental health care delivery system s. So we suggest the idea that the study of ergonom ics should be included in the dental curriculum.

Cathodal and Anodal Left Prefrontal tDCS and the Perception of Control Over Pain

The prefrontal cortex may be a promising target for the use of transcranial direct current stimulation (tDCS) in the management of pain symptoms. The present study explored the effects of anodal and cathodal tDCS over the left dorsolateral prefrontal cortex on the effects of perceived pain controllability. Forty-one participants received continuous anodal or cathodal tDCS and underwent a laboratory pain task designed to manipulate the perception of pain control. Participants were told that they would be completing a reaction-time task (press keyboard button of corresponding arrow shown on computer screen with either green or red background). A thermal pain stimulus was delivered following each trial by a thermode placed on the participant's left forearm. Although pain stimuli were pseudorandomally ordered and matched for total duration between control (green) and noncontrol (red) trials, participants were told that if they responded correctly and more quickly on green trials than their average reaction times, the thermal pain stimulus duration would be decreased (ie, perceived control). Participants were told they had no control of pain stimulus duration over trials presented with the red background. There was a significant main effect for tDCS condition (anode vs. cathode) on pain unpleasantness ratings (P<0.04). Specifically, individuals receiving cathodal tDCS reported higher pain unpleasantness ratings (least squares mean=69.40, SE=3.72), whereas those receiving anodal tDCS reported lower pain unpleasantness ratings (least squares mean=58.05, SE=3.81). Exploratory analysis revealed a simple main effect for tDCS group at the level of perceived controllability (P<0.02). In addition, participants receiving cathodal tDCS subjectively reported feeling less control of the painful stimuli than those receiving anodal tDCS. Left dorsolateral prefrontal cortex tDCS may play a role in modulating the neurocircuitry involved with the perception of control over pain.

Jimmy Savile: Abuse and a Question of Trust

This paper is about the British disc jockey Jimmy Savile and the scandal that has constellated around him since his death in 2011. I shall be referring to his autobiography Love is an Uphill Thing and Alison Bellamy's authorized biography How's About That, Then? to try and understand how he became a lifelong abuser. I shall make the case that he was able to insinuate himself into a culture, both amongst his friendship group and within organizations, that legitimized his behaviour and the behaviour of others. I shall suggest that this ability to gather others around him is characteristic of groups and institutions where abuse has taken place. I am also making the case that listening to abuse and being able to bear witness is a difficult and painful task in the consulting room and in the wider public sphere.

Prior experience with a pain stimulus as a predictor of placebo analgesia.

Placebo effects are important in pain reduction, but the effects are inconsistent. Prior experience with a pain stimulus may moderate placebo analgesia. The current study tests the effect of prior experience with a pain stimulus on placebo analgesia during a laboratory pain task. Healthy normotensive undergraduates (66 women, 68 men) who either did or did not report prior experience with pain from submerging a limb in cold water were enrolled. In the laboratory, an experimenter applied an inert, medicinal-smelling cream to participants' non-dominant hand. Participants randomized to the no-expectation group were told that the cream was a hand cleanser. Participants randomized to the placebo expectation group were told that the cream would reduce the pain associated with the cold pressor task. Participants then completed the cold pressor task and reported their pain on the short form of the McGill Pain Questionnaire. Analysis of variance revealed a main effect of expectation (p<.05), such that participants in the placebo expectation group reported less pain. An interaction was also found between expectation and prior experience (p<.05), such that participants with prior experience with pain from cold water immersion showed no difference in pain reports between expectation groups. In a pain context, prior experience with the pain stimulus may prevent a placebo expectation from reducing the experience of pain.

The effect of cognitive bias modification for interpretation on avoidance of pain during an acute experimental pain task

Research confirms that patients with chronic pain show a tendency to interpret ambiguous stimuli as pain related. However, whether modifying these interpretive pain biases impacts pain outcomes is unknown. This study aimed to demonstrate that interpretation biases towards pain can be modified, and that changing these biases influences pain outcomes in the cold pressor task. One hundred and six undergraduate students were randomly allocated to receive either threatening or reassuring information regarding the cold pressor. They also were randomly allocated to 1 of 2 conditions in the Ambiguous Scenarios Task, in which they were trained to have either a threatening interpretation of pain (pain bias condition) or a nonthreatening interpretation of pain (no pain bias condition). Therefore, the study had a 2 (threat/reassuring)×2 (pain bias/no pain bias) design. Analyses showed that a bias was induced contingent on condition, and that the threat manipulation was effective. Participants in the pain bias condition hesitated more before doing the cold pressor task than those in the no pain bias condition, as did those in the threat compared with the reassurance condition. The major finding was that interpretive bias mediated the relationship between bias condition and hesitance time, supporting the causal role of interpretive biases for avoidance behaviors in current chronic pain models. No differences were found on other pain outcomes regarding bias or threat, and the efficacy of the bias modification was not impacted by different levels of threat. These results suggest that cognitive bias modification should be further explored as a potential intervention in pain.

Emotion regulatory function of parent attention to child pain and associated implications for parental pain control behaviour

We investigated the function of parental attention to child pain in regulating parental distress and pain control behaviour when observing their child performing a painful (cold pressor) task (CPT); we also studied the moderating role of parental state anxiety. Participants were 62 schoolchildren and one of their parents. Parental attention towards or away from child pain (ie, attend to pain vs avoid pain) was experimentally manipulated during a viewing task pairing unfamiliar children’s neutral and pain faces. Before and after the viewing task, parental distress regulation was assessed by heart rate (HR) and heart rate variability (HRV). In a subsequent phase, parents observed their own child perform a CPT task, allowing assessment of parental pain control behaviour (indexed by latency to stop their child’s CPT performance) and parental distress, which was assessed via self-report before and after observation of child CPT performance. Eye tracking during the viewing task and self-reported attention to own child’s pain confirmed successful attention manipulation. Further, findings indicated that the effect of attentional strategy on parental emotion regulation (indexed by HR, self-report) and pain control behaviour depended on parents’ state anxiety. Specifically, whereas low anxious parents reported more distress and demonstrated more pain control behaviour in the Attend to Pain condition, high anxious parents reported more distress and showed more pain control behaviour in the Avoid Pain condition. This inverse pattern was likewise apparent in physiological distress indices (HR) in response to the initial viewing task. Theoretical/clinical implications and further research directions are discussed.

The Effects of Acceptance of Thoughts, Mindful Awareness of Breathing, and Spontaneous Coping on an Experimentally Induced Pain Task

The current study examined the effects of acceptance of thoughts, mindful awareness of breathing, and spontaneous coping on both pain tolerance and pain threshold during a cold pressor task. Eligible participants (N = 58), 16 males and 42 females (M age = 29.31, SD = 11.21), were randomized into three groups and completed two cold pressor trials. The first cold pressor trial formed a baseline for all three groups. The acceptance of thoughts and mindfulness of breathing groups listened to recorded instructions and then completed a second administration of the cold pressor task. The spontaneous coping group completed the cold pressor task twice with instructions to select their own coping style. Multilevel linear modeling showed significant group differences in pain tolerance. The acceptance of thoughts and mindfulness of breathing conditions resulted in significantly higher pain tolerance in post hoc analysis than spontaneous coping. Results were interpreted to be consistent with Acceptance and Commitment Therapy. Further examination of the effects of ACT processes on experimentally induced pain tolerance is needed.

(325) fcMRI maps during pain tasks vary based on the inclusion of paradigm modeling in analysis

As an alternative to resting state functional connectivity (fcMRI) analysis, block-design fcMRI studies of pain have been increasingly performed. However, the effect of the stimulus-correlated MRI signal changes on fcMRI studies is still unknown. We compared analyses with and without modeling of the stimulation paradigm during a 30 s block-design experiment of electric nerve stimulation (ENS). Our primary hypothesis was that modeling the stimulation paradigm would result in reduced correlation, compared to an un-modeled analysis. fcMRI data was acquired in 14 healthy adults in an IRB-approved 3 T whole brain functional MRI study of ENS-generated pain in the right index finger (intensity self-adjusted to 7/10). A seed region was chosen in the left (contralateral) insula and modeled for each subject as the primary regressor with and without the stimulation paradigm included as an effect of no interest. These were compared to the fcMRI maps of a similar tonic pain task (without cyclic changes). Group average functional correlation maps were generated. Mean and maximum (max) Z-scores were tabulated from regions of interest (ROIs) with significant correlation. The left insula seed time course was found to be correlated to areas of the pain matrix (anterior cingulate cortex, bilateral primary and secondary somatosensory cortices, and right insula), as expected. Modeling the paradigm in this cyclic pain task decreased the strength of correlation in all significant brain areas, giving a map more similar to that of the tonic pain task. Thus, modeling the stimulus timing removed superimposed task-induced activation, giving more accurate fcMRI maps. As an alternative to resting state functional connectivity (fcMRI) analysis, block-design fcMRI studies of pain have been increasingly performed. However, the effect of the stimulus-correlated MRI signal changes on fcMRI studies is still unknown. We compared analyses with and without modeling of the stimulation paradigm during a 30 s block-design experiment of electric nerve stimulation (ENS). Our primary hypothesis was that modeling the stimulation paradigm would result in reduced correlation, compared to an un-modeled analysis. fcMRI data was acquired in 14 healthy adults in an IRB-approved 3 T whole brain functional MRI study of ENS-generated pain in the right index finger (intensity self-adjusted to 7/10). A seed region was chosen in the left (contralateral) insula and modeled for each subject as the primary regressor with and without the stimulation paradigm included as an effect of no interest. These were compared to the fcMRI maps of a similar tonic pain task (without cyclic changes). Group average functional correlation maps were generated. Mean and maximum (max) Z-scores were tabulated from regions of interest (ROIs) with significant correlation. The left insula seed time course was found to be correlated to areas of the pain matrix (anterior cingulate cortex, bilateral primary and secondary somatosensory cortices, and right insula), as expected. Modeling the paradigm in this cyclic pain task decreased the strength of correlation in all significant brain areas, giving a map more similar to that of the tonic pain task. Thus, modeling the stimulus timing removed superimposed task-induced activation, giving more accurate fcMRI maps.

(329) Effect of anti-correlations on statistical comparisons between pain task and resting fcMRI datasets

(329) Effect of anti-correlations on statistical comparisons between pain task and resting fcMRI datasets

“I have paid my dues”: When physical pain reduces interpersonal justice motivations

In this study we show that experiencing physical pain interacts with justice related cognition and serves to reduce justice-restoring behavior in the context of interpersonal moral transgressions. This is because concepts of punishment and justice are embodied within the experience of pain, allowing for a sense of atonement from one's wrongdoings. Two thirds of the participants were induced to feel that their performance in a two player game was unfair. Half of those participants were then asked to engage in a physically painful task, and were afterwards less likely to make amends for past poor performance compared to players who completed a similar, but non-painful task. This effect was only evident for participants who are particularly sensitive to personal injustices and therefore sensitive to the justice restoring qualities of pain.

The Effects of Mindful Attention and State Mindfulness on Acute Experimental Pain Among Adolescents

Attention-based coping strategies for pain are widely used in pediatric populations. The purpose of this study was to test a novel mindful attention manipulation on adolescent's experimental pain responses. Furthermore, the relationship between state mindfulness and experimental pain was examined. A total of 198 adolescents were randomly assigned to a mindful attention manipulation or control group prior to an experimental pain task. Participants completed measures of state mindfulness immediately prior to the pain task, and situational catastrophizing and pain intensity following the task. Overall the manipulation had no effect on pain. Secondary analysis showed that meditation experience moderated the effect of the manipulation. State mindfulness predicted pain outcomes, with reductions in situational catastrophizing mediating this relationship. The mindful attention manipulation was effective among adolescents with a regular meditation practice. State mindfulness was related to ameliorated pain responses, and these effects were mediated by reduced catastrophizing.

Recovery of empathetic function following resection of insular gliomas

The insular cortex is located deep within the Sylvian fissure between multi-functional and structurally-compressed cerebral structures, and has been suggested to play an important role in both basic sensorimotor and complex social-emotional functions. Such structural and functional complexity presents a challenge for neurosurgeons to remove tumors within the insula safely. It has therefore not yet been documented how neurosurgical resection of insular gliomas would impact social-emotional functions. In this study, we examined empathy, a high-level social-emotional function, in four patients with localized insular gliomas pre- and post-operatively. The patients completed an empathy-for others pain task in which they viewed another person's hand or foot in painful or non-painful situations and made judgments about either pain (explicit empathy) or laterality of the hand or foot (implicit empathy). They also completed questionnaires assessing general emotional processing and personality. Deficits in both explicit and implicit empathetic pain processing were found in patients before the operations. However, the operations significantly improved their empathetic ability after surgery, accompanied by unchanged personality traits. These results confirmed previous findings that the insula plays a critical role for empathetic pain perception. Importantly, the current results suggest that surgical resection is not only a suitable treatment for insular gliomas for clinical consideration, but also effective in improving high-level functions such as empathetic pain perception.

Sex differences in experimental pain among healthy children: A systematic review and meta-analysis

Sex differences in response to experimental pain are commonly reported in systematic reviews in the adult literature. The objective of the present research was to conduct a systematic review and meta-analysis of sex differences in healthy children’s responses to experimental pain (eg, cold pressor, heat pain, pressure pain) and, where possible, to conduct analyses separately for children and adolescents. A search was conducted of electronic databases for published papers in English of empirical research using experimental pain tasks to examine pain-related outcomes in healthy boys and girls between 0 and 18years of age. Eighty articles were eligible for inclusion and were coded to extract information relevant to sex differences. The systematic review indicated that, across different experimental pain tasks, the majority of studies reported no significant differences between boys and girls on pain-related outcomes. However, the meta-analysis of available combined data found that girls reported significantly higher cold pressor pain intensity compared to boys in studies where the mean age of participants was greater than 12years. Additionally, a meta-analysis of heat pain found that boys had significantly higher tolerance than girls overall, and boys had significantly higher heat pain threshold than girls in studies where the mean age of participants was 12years or younger. These findings suggest that developmental stage may be relevant for understanding sex differences in pain.

P218 Faecal calprotectin testing reduces need for paediatric colonoscopy

evidenced by lower levels of health-related quality of life (HRQOL) especially in children with high levels of abdominal pain. Research examining psychological and social factors related to IBD and associated HRQOL is critical. For children in particular, the family environment might play a crucial role in the their coping with IBD. Dysfunctional levels of overall functioning have been associated with lower HRQOL in chidlren with IBD, yet the impact of specific aspects of family functioning, such as cohesion (i.e., emotional bond or connectiveness), flexibility (i.e., balance between stability and change) and communication patterns (i.e., postive versus negative) is largely unexplored. The purpose of the present study was to investigate the influence of balanced levels of cohesion and flexbility and positive communication on the child’s pain experience and HRQOL. Methods: Thirty children with IBD (14 girls, 16 boys; N = 20 with Crohn’s disease, N = 10 with Ulcerative colitis; Mage = 13.73, SD = 2.30 years) and one parent (25 mothers, 5 fathersMage = 46.73, SD = 6.47 years) completed questionnaires regarding child’s level of pain and interference, HRQOL (i.e., IMPACT) and family functioning (i.e., Faces IV). Results: Linear regression analyses, controlling for child age, indicated that child report of positive communication and balanced level of cohesion and flexibility were positively associated with their HRQOL. Surprisingly, no significant associations were found between child level of pain and family functioning, while the level of interference in daily functioning due to pain was negatively associated with parent report of balanced cohesion and child report of balanced flexibility and positive communication. Conclusions: The current findings indicate that parent-reported cohesion was only associated with pain-related interference, while child-reported aspects of family functioning were related to HRQOL and pain-related interference. Results also suggest that family functioning is primarily associated with HRQOL and interference in daily functioning rather than the level of pain, adding to our understanding of how family functioning relates to children’s coping with IBD and associated pain. In future research, observational assesment of family functioning (e.g., by means of a conflict-discussion task) and parentchild communication patterns when faced with their child in pain (e.g., observation of parent child interaction during an experimental pain task), will contribute to our understanding of how family functioning influences child functioning and pain experiences.