Previous Pain Experience Research Articles

Fears and their Manifestation in 10-12 Year-old Girls’ Paintings in Zanjan County

The general aim of this study is to investigate the factors that generate fear in children's life. The applied methodology in this survey is qualitative. 8 students aged 10-12 years were purposefully selected, interviewed and asked to draw pictures of fear-generating cases. The fears observed in the children can be categorized into several classes. Some fears are more common in specific periods of development; therefore, children more or less have identical fears and can illustrate their fears in drawings, even in the colours they choose for them. In essence, fears are acquired. Environmental factors, previous painful experiences and observation of a relative have a significant effect in forming individuals’ fears. More deeply psychoanalytical research is recommended

Associations between psychological variables and pain in experimental pain models. A systematic review.

The association between pain and psychological characteristics has been widely debated. Thus, it remains unclear whether an individual's psychological profile influences a particular pain experience, or if previous pain experience contributes to a certain psychological profile. Translational studies performed in healthy volunteers may provide knowledge concerning psychological factors in healthy individuals as well as basic pain physiology. The aim of this review was to investigate whether psychological vulnerability or specific psychological variables in healthy volunteers are predictive of the level of pain following experimental pain models. A systematic search on the databases, PubMed, Embase, Cochcrane library, and Clinicaltrials.gov was performed during September 2014. All trials investigating the association between psychological variables and experimental pain in healthy volunteers were considered for inclusion. Twenty-nine trials met the inclusion criteria, with a total of 2637 healthy volunteers. The included trials investigated a total of 45 different psychological tests and 27 different types of pain models. The retrieved trials did not present a sufficiently homogenous group to perform meta-analysis. The collected results were diverse. A total of 16 trials suggested that psychological factors may predict the level of pain, seven studies found divergent results, and six studies found no significant association between psychological variables and experimental pain. Psychological factors may have predictive value when investigating experimental pain. However, due to substantial heterogeneity and methodological shortcomings of the published literature, firm conclusions are not possible.

Women's greater fear of pain is mediated by neuroticism

Fear of pain is an emotional state linked to a host of negative events, including exaggerated pain perception, distress, and chronic pain. Although many studies have shown that women experience fear of pain more than men do, little is known about the factors that might explain these sex differences. According to an individual-difference approach, it seems valuable to examine the contribution of personality factors, which are considered as major antecedents of cognitions and emotions, including fear. The present study focuses on the potential mediating role of neuroticism – and its six specific facets –in the sex-fear of pain relationship for fear of severe pain, fear of minor pain, and fear of medical pain. Given that neuroticism is greater in women and that this personality trait contributes to the fear of pain, we hypothesized that neuroticism would mediate the sex-fear of pain relationship. Due to the previously established link between experience of pain and the fear of pain, we controlled for the previous experience of pain in the mediation model. Participants (n=133 women; 96 men) completed measures of previous experiences of pain, neuroticism, and fear of pain. Using Preacher and Hayes’ SPSS script, we used a bootstrapping method with n=5000 bootstrap resamples to test the model. Bootstrapped mediation analyses revealed that neuroticism significantly (within a 95% confidence interval) mediated the sex-fear of severe pain relationship. Working within a 90% confidence interval, neuroticism also significantly mediated the sex-fear of pain relationship for fear of minor pain and fear of medical pain. Although the global trait of neuroticism contributed to sex differences in fear of minor pain, it was specifically the neuroticism facet of anxiety that mediated the relationship between sex and fear of severe pain and sex and fear of medical pain. The results suggest that women experience more fear of pain partly because they are more neurotic than men and provide the first evidence that neuroticism in an integral part of the process that differentiates the sexes in fear of pain. Given that the proportion of variance accounted for in each of the mediation models (8% at most), there is a clear need for further research to elucidate more fully the mechanisms that underlie sex differences in the fear of pain.

Predictors of Nurses’ Knowledge and Attitudes Toward Postoperative Pain in Greece

Undertreatment of postoperative pain can aggravate patient outcomes and is associated with attending nurses’ knowledge deficits or negative attitudes toward pain. The aim of this study was to investigate knowledge and attitudes toward postoperative pain of surgical department nurses and to identify predictors of their knowledge and attitudes. This was a descriptive, cross-sectional survey that took place in the departments of general surgery, orthopedics, neurosurgery, ear-nose-throat surgery, and obstetrics/gynecology at five Greek hospitals. Participants were a convenience sample of registered and assistant nurses. Nurses were asked to complete a three-section questionnaire, which included demographics, a Knowledge and Attitudes Survey Regarding Pain (KASRP) tool modified for postoperative pain, and seven questions capturing personal characteristics, working conditions, and feelings about work. One hundred eighty-two questionnaires were completed. Average scores were 45.35% for modified KASRP tool; 28.57% for pain assessment; 55.44% for general pain management; and 47.13% for use of analgesics. Four of the five most commonly missed items referred to use of analgesics. More previous personal experience of postoperative pain (p = .002) and being a registered nurse (p = .015) predicted higher modified KASRP tool score. Participation in continuing education programs and department of employment were also associated with differences in the modified tool score. The knowledge deficits and negative attitudes of the nurses toward postoperative pain highlight the role of pregraduate and continuing education, appropriately specialized for each surgical department, in the development of empathy toward patients in pain and of clinical competency regarding pain assessment and administration of analgesics.

The pain truth: recognizing the influence of pain on cosmetic outcomes.

Anxiety is an under recognized and major obstacle among patients seeking cosmetic procedures. The ability to alleviate it may be essential for achieving high patient satisfaction and better outcomes. Key initiators leading to anxiety include the fear of appearing unnatural and the fear of pain. Pain perception can be mitigated or augmented by psychological factors. Based on patient expectations, they may experience diminished pain perception through the placebo effect or catastrophized pain due to previous painful experiences. It is also important to recognize the influence of religion, cultural, ethnic, and gender bias on pain perception. In recent years, the aesthetic medical community has responded to patient demand for more minimally invasive procedures with more natural appearing result, resulting in a dramatic increase in the number of cosmetic procedures performed each year. Achieving pain and anxiety-free aesthetic medicine will likely result in a pronounced increase in the demand for cosmetic treatments.

The interference of low back pain on everyday functions of life in care workers for persons with intellectual, autistic, and associated multiple disabilities: The Brief Pain Inventory short form (BPI-SF) survey

Low back pain is a critical public health problem; this condition significantly affects the quality of life and has a major socioeconomic impact. The present study aimed to investigate the interference of low back pain with everyday functions of life in disability care workers, and to examine the influencing factors of the interference, such as workers’ demographic, lifestyle habits, self-reported health status, working conditions and previous pain experience. The Wong-Baker FACES Pain Rating Scale and Brief Pain Inventory – Short Form were used to identify the pain severity and life interference of 677 participants who had experienced low back pain conditions in the previous year. The results indicated that the mean score of the pain severity was 3.78±1.82, 78.9% subjects experienced mild pain (score 2–4), 13.7% subjects experienced moderate pain, and 5.3% subjects experienced severe pain. More than twenty percent of the respondents reported that low back pain moderately or severely interfered with their daily functions. Many working conditions and pain experienced significantly correlated with the score of pain interference in the care workers after controlling for factors of healthy lifestyle and health status (R2=41.7%). These findings may garner attention from health welfare authorities and lead to improvements in health promotion initiatives to prevent low back pain from interfering with the daily activities of care workers for people with intellectual, autistic and associated disabilities.

Postoperative Analgesic Effect of Transcranial Direct Current Stimulation in Lumbar Spine Surgery

Ultimately, the experience of pain derives from changes in brain excitability. Therefore, modulating the excitability of cortical areas involved in pain processing may become an attractive option in the context of multimodal analgesia during the postoperative period. Repetitive transcranial magnetic stimulation (rTMS) can reduce morphine consumption during the postoperative period after gastric bypass surgery. We tested the potential of another method of noninvasive brain stimulation, transcranial direct current stimulation (tDCS), to reduce morphine consumption or pain perception during the postoperative period. Fifty-nine ASA I to II patients undergoing lumbar spine surgery were randomized to receive anodal (n=20), cathodal (n=20), or sham (n=19) tDCS in the recovery room in a double-blind manner. Morphine consumption administrated through patient-controlled analgesia (PCA) was the primary outcome; pain perception as measured by visual analog scale was the secondary outcome. There were no statistically significant differences between the 3 groups of patients, either for PCA morphine consumption or for pain scores. Several factors may explain the observed lack of impact of tDCS on PCA morphine consumption and pain perception: the method of brain stimulation (tDCS/rTMS), potential interactions with anesthetic drugs, differences in patients population (gastric bypass surgery/lumbar spine surgery), and the previous experience of pain and chronic consumption of analgesic drugs. Further studies with tDCS should be performed before concluding that tDCS is inefficient for postoperative pain control, because noninvasive brain stimulation methods, such as rTMS and tDCS, may become attractive in the setting of multimodal analgesia.

Effects of Light Activation, Agent Concentration, and Tooth Thickness on Dental Sensitivity After Bleaching

Examining three bleaching systems, this in vivo clinical trial evaluated the relationship among tooth sensitivity, light activation, and agent concentration, and it correlated dental sensitivity with tooth thickness. Eighty-seven volunteer patients were included. Inclusion criteria were the presence of anterior teeth without restorations as well as the absence of a previous bleaching experience and absence of noncarious cervical lesions or dental pain. Exclusion criteria included pregnancy or breastfeeding, a maximum of TF3 hypoplasia, tetracycline-fluorosis stains, malpositioned teeth, orthodontic treatment, periodontal disease, and/or analgesic/anti-inflammatory intake. Patients were randomly assigned to three bleaching groups: Group A (n=25) was treated with 15% H2O2 and nitrogenous-titanium-dioxide and was light activated (Lase Peroxide Lite, DMC, SaoCarlos, Sao Paulo, Brazil); Group B (n=27) was treated with 35% H2O2 and was light activated (Lase Peroxide Sensy, DMC); and Group C (n=35) was treated with 35% H2O2 (White Gold Office, Dentsply, 38West Clark Ave., Milford, USA) without light activation. Tooth sensitivity (TS) was self-reported by the patients using the visual analog scale (VAS) at baseline (TS0), immediately after treatment (TSI), and at seven days after treatment (TS7). In 46 patients, tooth thickness was determined by computed tomography. TS0, TSI, and TS7 were compared between the A and B groups to determine the effect of concentration and between the B and C groups to determine the effect of light using analysis of covariance. The correlation between tooth thickness and TSI was determined by Spearman Rho test (SPSS 15). Eighty-seven patients were evaluated at baseline, and 61 were evaluated at seven days. Separated by groups, tooth sensitivity, expressed as VAS value at the time points TS0, TSI, and TS7, respectively, were as follows: Group A: 13.76 ± 13.53, 24.40 ± 25.24, and 5.94 ± 5.5; Group B: 15.07 ± 18.14, 42.4 ± 31.78, and 8.68 ± 17.99; and Group C: 10.80 ± 14.83, 31.51 ± 29.34, and 7.24 ± 9.2. Group A showed significantly lower tooth sensitivity than group B at TSI (p=0.032). No differences were observed in the tooth sensitivities between groups B and C. No correlation was encountered between tooth thickness and tooth sensitivity immediately after treatment (Rho=-0.088, p=0.563). The median tooth thickness was 2.78 ± 0.21 mm. Increases in the concentration of bleaching agents directly affect tooth sensitivity, and LED/laser activation and tooth thickness are not correlated with tooth sensitivity after dental bleaching.

Maternal Expectations and Experiences of Labor Analgesia With Nitrous Oxide

BackgroundAlthough there are various methods for painless delivery such as using entonox gas, most of the people are unfamiliar or concerned about it yet.ObjectivesThe purpose of this study was to assess maternal expectations and experience of labor analgesia with nitrous oxide.Patients and MethodsIn a clinical trial study, 98 pregnant women in active phase of delivery were studied randomly in two groups (intervention group = 49, control group = 49) after obtaining written consent. Efficacy, experience satisfaction, and also expectation of pregnant women about entonox gas in two groups were compared, likewise in intervention group before and after using entonox gas.ResultsMost of the pregnant women receiving entonox gas had less labor pain (91.8%), and were satisfied with it (98%). The severity of pain in the most of entonox user was moderate level (46.94%), while for the control group it was severe (55.10%) which was significant, 40.82% of the mother in entonox group had a severe pain and 10.20% had a very severe pain, whereas in the control group (55.10%) of the mother had a severe pain and 26.53% of the had very severe pain (P = 0.004). efficacy of labor pain was in moderate level in most cases. 49% of pregnant women receiving gas described their experience as a good and excellent. 80.9% indicated that they will request the mentioned painless method in the future. The amount of suffering from gas side effects was mild in most patients of intervention group (63%). Expectations of the majority of pregnant women in intervention group (before receiving gas) and control group for painless delivery were weak (65.3%, 40.9%). The percentage of positive expectations had increased after receiving entonox gas (P = 0.01). There was a difference between the expectations of intervention group receiving entonox gas and control group (P = 0.001). Positive expectations were more in intervention group than the control group. Most differences of expectations in intervention group before and after receiving the gas were about higher efficacy (P = 0.001), more satisfaction (P = 0.001), fewer complications (P = 0.001), information about gas as painless delivery method (P = 0.02), and also previous experience of intolerable labor pain (P = 0.04).ConclusionsThis study has shown that using entonox gas caused less labor pain, favorable expectations and experiences and also more maternal satisfaction.

Anesthesia Literature Review

Anesthesia Literature Review

Pain and behaviour changes in children following surgery

ObjectivesTo quantify postoperative pain and problematic behaviour (PB) in children at home following day-case (same day admission and discharge) or inpatient (≥1 night in hospital) surgery, to identify factors associated...

Dental anxiety and symptoms of general anxiety and depression in 15‐year‐olds

The objective of the study was to analyse the relationship between dental anxiety and symptoms of general anxiety and depression among 15-year-old individuals. The sample analysed included 221 randomly selected 15-year-old individuals living in the city of Jönköping, Sweden. One questionnaire captured sociodemography and dental history, while dental anxiety was assessed by the Dental Fear Survey (DFS) and symptoms of general anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). About 6% of the adolescents were classified as dentally anxious. Symptoms of general anxiety and depression were significantly correlated with dental anxiety in both the bivariate and multivariate analyses. The latter analyses were adjusted for gender and previous painful experiences of dental care. Individuals with high dental anxiety showed general anxiety scores on a clinical level (mean=9.8, SD=4.3). Symptoms of general anxiety and depression were shown to be significantly correlated with dental anxiety among 15-year-old individuals.

Pain from intramuscular vaccine injection in adults

Vaccine use has been increasing worldwide, and adult populations are presented with more opportunities to experience pain from vaccine injection. The insertion of a needle through the skin is the most common source of iatrogenic pain, and needle phobia is a major concern in medical practice. However, it is unclear which factors play major roles in the perception of pain from vaccine injection in adults. To evaluate the influences of patient characteristics on pain perception due to intramuscular vaccine injection in healthy adult volunteers. The injection of hepatitis B vaccine using a 24 mm, 24-G needle was performed as a uniform stimulus, and the intensity of injection pain was measured immediately after the injection using a 100-mm visual analogue scale (VAS). The influences of patient characteristics on pain intensity were investigated. One hundred sixty volunteers (65 males, 95 females) were enrolled in this study. The average VAS score was 20.8 ± 17.1 (range 0 to 67) in males and 34.4 ± 19.7 (range 2 to 76) in females (P < 0.001). However, there were no correlations between VAS score and age, body mass index or maximal pain score from previous painful experiences. The VAS score was also not affected by the experience of previous vaccine injections, a history of childbirth in females, or religion. Gender appears to be the only major factor that influences the pain of intramuscular vaccine injection. Therefore, pain-reducing methods will be needed when performing injection procedures, particularly in women.

Dental anxiety and temperament in 15-year olds

Objective. The aim of the present study was to analyze the prevalence of dental anxiety and its association with temperament, sociodemographic factors and previous painful and unpleasant experiences of dental care among 15-year old individuals. Materials and methods. The sample included 263 randomly selected 15-year old individuals living in the municipality of Jönköping, Sweden. The school, parental and adolescent consent was acquired. Three self-reported questionnaires were used, one included items of sociodemography, while the others dealt with dental anxiety assessed by the Dental Fear Survey (DFS) and temperament assessed by an adapted version of The EAS Temperament Survey for Children modified for adults, the EASI temperament survey. Results. The results showed that 6.5% of the adolescents were classified as dentally anxious and with girls proportionally more fearful than boys. The three temperaments activity, impulsivity and emotionality were significantly correlated with dental anxiety. A hierarchical multiple linear regression analysis showed that pain at the last dental appointment or previous pain experiences during dental care treatment were the strongest predictors regarding dental anxiety in 15-year olds. The temperament dimensions activity and impulsivity were also significantly predictive of dental anxiety. Conclusions. Although some of the temperament dimensions are correlated with dental anxiety, which may emphasize an important finding with regard to personality, this study showed that previous pain experiences during dental care treatment is a strong predictor for high dental anxiety in 15-year olds.

Sedation and the VCUG

A voiding cystourethrogram is frequently a stressful procedure for pediatric patients, parents and occasionally the radiology staff. I believe most radiologists would agree with that statement but if doubt exists, there is research that supports it [1, 2]. I have been a pediatric radiologist for more than 25 years. During the first half of my career I never offered sedation to patients undergoing voiding cystourethrography. The occasional patient had the procedure cancelled due to inability to cooperate or inability of our staff to safely restrain the patient. The occasional referring physician ordered preprocedural sedating medications or performed cystography under general anesthesia for patients they knew could not tolerate a routine VCUG while awake. I was taught during residency and fellowship that the patient needs to be conscious for voiding and that the procedure is not painful. I believed it. I took pride in my ability to calmly wait and offer reassurance to parents that though their child was crying and screaming the child was not really in pain and that it would be over in a few minutes. Sometimes, those minutes seemed like forever to everyone in the room. During those years no drugs were known to be safe and effective and readily available for administering in a radiology department. There was minimal nursing presence in most radiology departments, with the exception of those used for sedation for CTor interventional procedures. The times, however, have changed. Some things we were taught in medical school or postgraduate training turn out not to be true. A new procedure, further knowledge or a new drug changes the way we practice medicine. In recent years, far more emphasis has been placed on alleviating patient pain and discomfort. Nurses are required to routinely assess and document patients’ level of pain. Physicians are able to consult with other physicians specialty-trained in pain medicine and palliative care. Sedation and pain relief are being offered for other minor procedures in hospitals such as intravenous access, lumbar punctures and suture placement. Radiology departments need to make similar changes as medical care evolves. Current knowledge in pain management suggests that pain associated with medical procedures should be avoided when possible and that fear and anxiety will intensify the perception of pain. Pre-operative anxiety in young children is associated with a more painful and difficult post-operative course [3]. I see fear and anxiety daily when performing VCUGs. In addition, the memory of previous painful experiences has effects on pain experience during subsequent procedures. The amount of pain and anxiety experienced during a child’s second visit to the dentist is best predicted by the amount of anxiety and pain experienced the first time [4]. About one-third of VCUG patients will have vesicoureteral reflux and will need to have follow-up imaging studies or surgical procedures. Inadequate analgesia for initial procedures may diminish the effect of adequate analgesia in subsequent procedures. The level of effectiveness of topical anesthetics for intravenous catheter insertion can be partially predicted by the number of previous painful medical procedures experienced by the child [5, 6]. In the past physicians including radiologists tended to avoid the use of sedation for procedures thought to cause relatively little physical pain though there might have been large amounts of anxiety associated with them for children. The VCUG is a good example of such procedures, along Pediatr Radiol (2012) 42:290–292 DOI 10.1007/s00247-011-2323-9

Self-Reported Dental Fear among Dental Students and Their Patients

The aim of the present study was to compare self-reported dental fear among dental students and patients at a School of Dentistry in Belo Horizonte, Brazil. Eighty students ranging in age from 20 to 29 years and 80 patients ranging in age from 18 to 65 years participated in the study. A self-administered pre-tested questionnaire consisting of 13 items was used for data acquisition. The city of Belo Horizonte Social Vulnerability Index (SVI) was employed for socioeconomic classification. The chi-square test and binary and multinomial logistic regression were employed in the statistical analysis, with the significance level set at 0.05. The majority of dental students (76.5%) sought the dentist for the first time for a routine exam, while patients (77.3%) mostly sought a dentist for the treatment of dental pain. Dental fear was more prevalent among the patients (72.5%) than the students (27.5%). A total of 47.1% of the students and 52.9% of the patients reported having had negative dental experiences in childhood. The logistic model revealed an association between dental fear and a pain-related experience (OR: 1.8; 95%CI: 1.3–2.6). Patients were more prone to dental fear (OR: 2.2; 95%CI: 1.0–5.0). Although at different percentages, both students and patients experienced dental fear. Current patient with previous experience of dental pain had more dental fear.

Chinese-Australian Women’s Knowledge, Facilitators and Barriers Related to Cervical Cancer Screening: A Qualitative Study

Understanding the different facilitators and barriers to screening within cultural and ethnic groups is important for developing appropriate education and outreach programs to underserved groups. Qualitative methods were employed to gain a rich understanding of participant views. In-depth interviews were conducted with 18 Chinese Australian women in their native languages and analysed using content analysis. Knowledge of cervical cancer was low, and few participants understood the benefits and purpose of screening. Having a doctor's recommendation was a strong motivator, and returning for screening was encouraged by having a female Chinese doctor perform the exam, receiving a reminder letter and the absence of cost for screening participation. However, participation was inhibited by logistical barriers, cultural beliefs and previous painful screening experiences. A range of multifaceted facilitators and barriers must be considered when developing interventions to increase the rates of cervical screening in this population.

Factors associated with self-reported pain scores among ED patients

IntroductionPain is a common presenting complaint among emergency department (ED) patients. The verbal numeric pain scale is commonly used in the ED to assess self-reported pain. This study was undertaken to describe and compare pain scores in a variety of painful conditions and identify factors associated with self-reported pain scores. MethodsThe study was a prospective, observational, descriptive survey study conducted at an urban university hospital ED. Eligible participants included consenting adults 18 years and older, with an acute painful condition, who spoke English, and were not in severe distress. Through a structured interview, collected data included pain score; diagnosis; medical history; previous painful experiences; and demographic information including age, insurance status, and highest level of education completed. ResultsAmong 268 eligible participants, 263 (98%) consented and completed the study protocol. Seventy-one percent of participants were 50 years old or younger; 55%, women; and 68%, white. Fifty-four percent had private insurance, and 81%, high school education or higher. The most common chief complaints were soft tissue injury (33%), abdominal pain (18%), and chest pain (13%). The median self-reported pain score was 7/10 (mean, 6.7; interquartile range, 6-9; range, 0-10). The most common previous painful experiences were childbirth (21%), major trauma (18%), and surgery (14%). Participants cited reasons for self-reported pain scores, including current feeling of pain (62%), comparison to previous pain (31%), and comparison to hypothetical pain (12%). The number of previous ED visits was positively correlated with current pain score (Spearman correlation R = 0.28; P < .001). The chief complaints associated with the highest pain scores included dental pain (mean pain score, 8.5) and back pain (mean pain score, 7.6). Chief complaints associated with the lowest pain scores included chest pain (mean pain score, 5.2) and other medical conditions (mean pain score, 5.3). Factors associated with higher pain scores included younger age (P < .001, Kruskal-Wallis), Medicaid insurance (P = .02), and lower educational status (P = .01). There was not a statistically significant association between current pain score and sex, race, previous painful experiences, or number of hospital admissions. ConclusionEmergency department patients with acute painful conditions report a wide range of self-reported pain scores. Participants rated pain based on current feeling of pain or comparison to previous or hypothetical pain. Chief complaints with highest pain scores included dental pain and back pain. Factors associated with higher pain scores included younger age, Medicaid insurance, lower educational status, and higher number of previous ED visits.

Nonpharmacologic Techniques for Distress Reduction During Emergency Medical Care: A Review

When pain is effectively managed, distress in children undergoing Emergency Department procedures is often due to anxiety and fear. This distress can be caused by many factors including being in an unfamiliar environment, exposed to strangers, not knowing what to expect or anticipation based upon previous painful experiences. This article reviews some of the many non-pharmacological developmentally-based strategies that can be implemented in the emergency department to reduce a child’s distress. These techniques can help improve treatment and procedural success, and ultimately create a more satisfying experience for the patient, family and medical team.

Activation of Central Pain Pathways in Rheumatic Diseases: What We have Learned from Functional Neuroimaging Studies

Pain is a major symptom in rheumatic diseases. Understanding the nature of patients pain symptoms in a rheumatology setting is integral to their assessment and optimising care. In recent years we have increasingly come to appreciate that not only is pain dependent on the underlying pathological process, but is also influenced by a number of additional factors that include genetics, the environment of the individual, previous pain experience and psychological status. Although local inflammation in the joint leads to the release of pro-inflammatory mediators including prostaglandins and cytokines that activate nociceptive signals in the joint, recent work has suggested that central activation of the brain is also important in mediating chronic pain in a number of rheumatic conditions including rheumatoid arthritis, fibromyalgia, osteoarthritis and back pain. A number of imaging modalities have been utilized in recent years to gain a deeper understanding of the pathways involved in the perception of pain in the rheumatic diseases. Functional Magnetic Resonance Imaging (fMRI), has been used to assess how the brain responds to and also mediates pain in the presence of arthritic disease. Positron emission tomography (PET) and Single photon emission computed tomography (SPECT) can produce blood flow images of the brain, or with the appropriate choice of radiopharmaceutical can also be used to image metabolic activity or specific neuroreceptors. Magnetoencephalography (MEG) can map cortical brain activity with high temporal resolution. These techniques have shown altered regional cerebral blood flow in areas of the brain in rheumatoid arthritis and fibromyalgia and have been used to determine pathways implicated in the perception of pain in specific conditions including complex regional pain syndrome and fibromyalgia. The information gained from functional imaging studies has improved our understanding of pain perception in rheumatic diseases and so may aid a more effective treatment for pain as will be discussed further in this review.