Verbal Reports Of Pain Research Articles

When shared pain is not half the pain: enhanced central nervous system processing and verbal reports of pain in the presence of a solicitous spouse.

The experience of pain and pain behaviors is not only determined by physiological but also psychosocial factors. In this context, the learning history of the individual and specifically operant reinforcement related to spouse responses might play an important role. We investigated the effect of a solicitous and habitually pain-reinforcing spouse for the processing of pain in patients with chronic pain. Using multichannel electroencephalography, pain behaviors, and self-reports of pain, we examined 20 patients with chronic back pain (10 with solicitous and 10 with nonsolicitous spouses) and 10 matched healthy controls. The participants received a series of painful and nonpainful electrical stimuli applied to the site of pain (back) and a control area (finger) in the presence vs absence of the spouse. The global field power of the electroencephalogram with a focus in the frontal region was enhanced in patients with chronic back pain who had a solicitous spouse compared to those with a nonsolicitous spouse and the healthy controls. This was specific for the painful stimulation at the back and occurred only in the presence but not the absence of the spouse. Pain ratings of intensity and unpleasantness were also higher in the patients with solicitous spouses when the spouse was present during painful stimulation. These data suggest that significant other responses indicative of operant reinforcement may have a direct effect on the cerebral processing of pain and related pain perception.

Neural measures of the role of affective prosody in empathy for pain

Emotional communication often needs the integration of affective prosodic and semantic components from speech and the speaker’s facial expression. Affective prosody may have a special role by virtue of its dual-nature; pre-verbal on one side and accompanying semantic content on the other. This consideration led us to hypothesize that it could act transversely, encompassing a wide temporal window involving the processing of facial expressions and semantic content expressed by the speaker. This would allow powerful communication in contexts of potential urgency such as witnessing the speaker’s physical pain. Seventeen participants were shown with faces preceded by verbal reports of pain. Facial expressions, intelligibility of the semantic content of the report (i.e., participants’ mother tongue vs. fictional language) and the affective prosody of the report (neutral vs. painful) were manipulated. We monitored event-related potentials (ERPs) time-locked to the onset of the faces as a function of semantic content intelligibility and affective prosody of the verbal reports. We found that affective prosody may interact with facial expressions and semantic content in two successive temporal windows, supporting its role as a transverse communication cue.

A supplemental report to a randomized cluster trial of a 20-week Sun-style Tai Chi for osteoarthritic knee pain in elders with cognitive impairment

ObjectiveThis was a secondary data analysis of a cluster-randomized clinical trial that tested the efficacy of a 20-week Sun-style Tai Chi (TC) program in reducing pain in community-dwelling elders with cognitive impairment and knee osteoarthritis (OA). The study also examined whether elders’ level of cognitive function was related to the outcomes of the TC program. MethodElders (N=55) were recruited from 8 study sites. Each site was randomly assigned to participate in either a 20-week TC or an education program. Verbal report of pain was measured by a Verbal Descriptor Scale (VDS) at weeks 1, 5, 9, 13, 17 and 21 (designated as times 1–6). Pain behaviors and analgesic intake were also recorded at times 1–6. ResultsAt post-test, scores on the VDS and observed pain behaviors were significantly better in the TC group than in the control group (p=0.008–0.048). The beneficial effects of TC were not associated with cognitive ability. ConclusionThese results suggest that TC can be used as an adjunct to pharmacological intervention to relieve OA pain in elders with cognitive impairment.Trial registration: Clinical Trial.gov NCT01528566.

Analysis of Nursing Diagnoses Applied to Emergency Room Patients - Using the NANDA Nursing Diagnosis Classification -*

Purpose: This study was done to identify essential nursing diagnoses using NANDA and their related factors and defining characteristics of patients who were cared in an emergency room. Methods: The research checklist developed by the researcher consisted of 44 nursing diagnoses with defining characteristics and related factors and was applied to 235 patients who were admitted to an emergency room from November 1 to December 31, 2012. Results: Forty-one of forty-four nursing diagnoses were identified. The most frequent nursing diagnoses were acute pain, risk for falls, and activity intolerance. The most frequent defining characteristic for the nursing diagnosis of ‘acute pain’ was verbal report of pain. The agreement rate with NANDA (2009)'s defining characteristics was 66.7%. Conclusion: Results indicate that identification of essential nursing diagnoses and their defining characteristics and related/risk factors is important for emergency patient nursing care to facilitate use of NANDA taxonomy in the emergency nursing practice and documentation systems. 주요어: 간호진단, 응급실 Key words: Nursing diagnosis, Emergency room

Content Validation of the Nursing Diagnosis Acute Pain in the Czech Republic and Slovakia

The main purpose of the study was to validate the defining characteristics of the nursing diagnosis acute pain in the Czech Republic and Slovakia. This is a descriptive study. The validation process involved was based on Fehring's diagnostic content validity model. Four defining characteristics were classified as major by Slovak nurses and eight defining characteristics were classified as major by Czech nurses. Validation of the nursing diagnosis acute pain in the Czech and Slovak sociocultural context has shown that nurses prioritize characteristics that are behavioral in nature as well as patients' verbal reports of pain. Verbal reports of pain and behavioral indicators are important for arriving at the nursing diagnosis acute pain.

Feeling More Pain, Yet Showing Less: The Influence of Social Threat on Pain

The present study investigated the effects of social threat to physical integrity on reported pain and facial pain expression. Predictions of a cognitive appraisal model and a communicative perspective on pain expression were compared. Participants (N = 67) received 5 electric pain stimuli administered by a confederate. They were led to believe that 5 pain stimuli were the minimum, a fixed amount, or the maximum number of pain stimuli allowed, thereby varying the social threat posed by the confederate. Reported pain and facial pain expression were recorded during the delivery of pain stimuli. Increased perceived social threat led to an increase of reported pain, specifically for high pain catastrophizing participants, while it led to a reduction of facial pain expression. This is the first study to demonstrate that a social threat manipulation has opposite effects on reported pain and facial expression, suggesting differences in adaptive function for both forms of pain expression. Perspective This is the first demonstration showing an increase in verbal pain report and a decrease in nonverbal pain expression at the same time during social threat. This knowledge may contribute to improving pain assessment in different contexts.

Clinical Validation of Nursing Diagnoses of Acute Pain in Hospitalized Children

Clinically validate (Fehring's model) the characteristics of the nursing diagnosis acute pain in 65 hospitalized children. Cross-sectional study. This study resulted in 13 major characteristics (expressive behavior, change of mental state, verbal report of pain, observed evidence of pain, narrowed focus, position to avoid pain, guarding behavior, sleep disturbance, protective gestures, changes in heart rate, changes in muscle tone, changes in respiratory rate, and facial mask) and in 5 minor characteristics (changes in blood pressure, coded report, changes in breathing pattern, distraction behavior, and changes in appetite). Characteristics with R > 0.50 and ≤ 1 were valid in the diagnosis acute pain. Clinical validation studies must be reproduced in different populations.

Non-verbal cues to identify osteoarthritic knee or hip pain in elders

Knee and hip pain from osteoarthritis (OA) are the leading causes of disability in elders, but little attention has been paid to OA knee or hip pain in the elderly population, and even less attention to elders who are unable to verbally express their pain. An alternative to verbal report is needed to identify OA knee or hip pain in this population. The study was designed to determine whether motor and gait patterns predicted knee or hip pain in elders. Research questions were: 1) what are the sensitivity and specificity of a pain assessment model combining motor patterns and gait patterns in predicting self-report of pain by elders who can verbally express their pain, controlling for age, gender, race, obesity, and physical function? 2) what is the best model to predict verbal report of pain if elders cannot verbally express their pain and thus only non--verbal cues are available? Pain report, gait patterns, and motor patterns were assessed in 192 elders.

Threat of pain influences social context effects on verbal pain report and facial expression

Current theoretical models of pain catastrophizing have diverging predictions regarding the role of social context and perceived threat on pain expression. The communal coping model of catastrophizing predicts that high pain catastrophizers display more pain expression in the presence of another, regardless of the threat value of the pain, while a cognitive appraisal model predicts high pain catastrophizers to express more pain when pain has increased threat value, regardless of social context. A 2 × 2 factorial design was used to test the validity of both predictions. Healthy participants with varying levels of pain catastrophizing were exposed to a cold pressor task, consisting of a 60 s immersion and 60 s recovery period. Interestingly, the immersion results revealed that beyond and independent from the effects of pain catastrophizing, the effect of threat on verbal pain report and facial expression was dependent on social context and vice versa. In a threatening context, perceived threat of pain mediated the inhibitory effect of social presence on pain expression, suggesting that the observer acted as a safety signal. In the recovery period, social presence enhanced facial expression, but only when no threat was induced. The results are discussed in terms of the dynamic interaction between social context and threat appraisals.

Interaction of intensity and order regarding painful events

While stimulus intensity obviously affects degree of pain responding, presentation order effects of stimuli of different intensities on acute pain responses are under-researched. The present study examined the effects of manipulating presentation order of lower and higher pain stimulus intensity. Using 96 undergraduates, this investigation employed a 2 x 2 mixed research design, with pain stimulus sequence as a between-subjects variable and pain stimulus trial as a repeated measure. When the greater pain stimulus intensity was presented last, verbal report of pain was higher. Also, performance of a cognitive task was interrupted the least when the lower stimulus intensity was presented last. Heart rate, however, was highest when the greater stimulus intensity was presented first, and pain tolerance was greatest when the lower stimulus intensity was presented first. Results are discussed in relation to adaptation-level effects, and implications for pain experienced in clinical settings are suggested.

Operant conditioning of enhanced pain sensitivity by heat–pain titration

Operant conditioning mechanisms have been demonstrated to be important in the development of chronic pain. Most experimental studies have investigated the operant modulation of verbal pain reports with extrinsic reinforcement, such as verbal reinforcement. Whether this reflects actual changes in the subjective experience of the nociceptive stimulus remained unclear. This study replicates and extends our previous demonstration that enhanced pain sensitivity to prolonged heat–pain stimulation could be learned in healthy participants through intrinsic reinforcement (contingent changes in nociceptive input) independent of verbal pain reports. In addition, we examine whether different magnitudes of reinforcement differentially enhance pain sensitivity using an operant heat–pain titration paradigm. It is based on the previously developed non-verbal behavioral discrimination task for the assessment of sensitization, which uses discriminative down- or up-regulation of stimulus temperatures in response to changes in subjective intensity. In operant heat–pain titration, this discriminative behavior and not verbal pain report was contingently reinforced or punished by acute decreases or increases in heat–pain intensity. The magnitude of reinforcement was varied between three groups: low ( N 1 = 13), medium ( N 2 = 11) and high reinforcement ( N 3 = 12). Continuous reinforcement was applied to acquire and train the operant behavior, followed by partial reinforcement to analyze the underlying learning mechanisms. Results demonstrated that sensitization to prolonged heat–pain stimulation was enhanced by operant learning within 1 h. The extent of sensitization was directly dependent on the received magnitude of reinforcement. Thus, operant learning mechanisms based on intrinsic reinforcement may provide an explanation for the gradual development of sustained hypersensitivity during pain that is becoming chronic.

Modulation of electrically induced pain by paired pulse transcranial magnetic stimulation of the medial frontal cortex

Objective Aim of this study was to investigate whether paired pulse transcranial magnetic stimulation (ppTMS) applied over the medial frontal cortex (MFC) affects acute Aδ fiber-mediated electrically induced pain. In addition, we investigated whether this effect depends on the time course of the stimulation, on the noxious stimulus intensity or on the ppTMS intensity. Methods For painful stimulation, the electrical stimulus for the nociceptive flexion reflex (NFR) was used. PpTMS (ISI: 50 ms) was applied over the medial frontal cortex at different intervals ranging from 0 to 1000 ms following the previous elicited NFR in 10 healthy volunteers. Three sequences at 3 different NFR stimulus intensities (at NFR threshold, 1.3× and 1.6×NFR threshold) with a ppTMS stimulus intensity at 1.2×resting motor threshold (RMT) and one sequence with elevated ppTMS at 1.6×RMT stimulus intensity were performed. Pain intensity and pain unpleasantness were assessed by visual analogue scales. Results Pain ratings differed in dependence of the interstimulus interval between NFR and ppTMS. Post-hoc t-tests revealed an increased verbal pain report within interstimulus intervals from 25 to 75 ms at NFR threshold as well as for 25 ms at 1.3×NFR threshold when ppTMS was applied at 1.2×RMT and from 0 to 75 ms at 1.6×NFR threshold when ppTMS was applied at 1.6×RMT. Conclusions The present data suggest that ppTMS over MFC—applied in a certain time window—can enhance pain perception of acute Aδ fiber-mediated electrically induced pain. We hypothesize that the increase of pain is due to interference between ppTMS and the incoming nociceptive input. Further pain processing might be modulated by direct effects on MFC or indirect effects on anterior cingulate cortex (ACC) or spinal nociception. Significance Brain areas involved in cognitive and emotional adaptation to pain can be used, in place of primary motor areas, as cortical targets in TMS trials of experimental or ongoing pain.

Ways of talking about experiences of pain among older patients following orthopaedic surgery

The aim of this study was to examine how older patients who had undergone hip surgery described their experience of pain. A verbal report of pain is considered to be the single most reliable indicator of a person's pain experience. When assessing pain, healthcare professionals must be able to interpret the content of pain reports in order to understand older patient's pain experiences. The study was carried out in two orthopaedic and two elder care wards in a large university hospital in Sweden in 2000. Altogether, 38 patients with hip replacement (mean age = 75) and 22 patients with hip fracture (mean age = 81) took part. A face-to-face interview was conducted with each patient on the second day after operation. Data were transcribed and analysed using descriptive qualitative content analysis. Participants expressed their pain in a nuanced and detailed way in everyday language. Four main themes with sub-themes emerged: (a) objectification (localizing; quantifying; characterizing; temporalizing); (b) compensating (substitution; picturing); (c) explaining (functionalizing pain and its relief; externalizing pain and its relief); (d) existentializing (present pain orientation; future pain orientation). Exploring the ways older patients talk about pain is expected to result in a better understanding of the older patient's need of empathic individualized care and in the optimization of pain management.

Pain Report and Pain-Related Evoked Potentials Operantly Conditioned

The purpose of the present study was to answer the question whether pain report can be increased and decreased by operant conditioning. We predicted that the conditioned pain effects would remain significant after correction for social desirability and fantasy proneness. Furthermore, we tried to show that the neurophysiologic basis of verbal pain report, defined by pain (event)-related potentials, was affected by the conditioning procedure. Specifically, it was expected that the central recording site N150-P260 pain (event)-related potentials peak-to-peak amplitude would show the largest effect. There were 4 groups: an up-conditioning group, a down-conditioning group, an at-random conditioning, and no-feedback control group. Healthy patients received 45 calibrated pain stimuli of equal physical intensity and were asked to rate the pain intensity they experienced. Up-conditioning was established by rewarding the subject if pain report increased compared with the previous trial. Down-conditioning of pain report was achieved by rewarding a decrease in the pain score. Results of the subjective pain reports clearly indicated that both forms of conditioning succeeded. Up-conditioning resulted in the highest pain scores and down-conditioning in the lowest scores with the two control groups in between them. Controlling for level of social desirability and fantasy proneness did not negatively influence these results. The N150-P260 pain (event)-related potentials peak-to-peak central recording site component also showed the predicted effect and reached statistical significance. We concluded that the subjective report of pain as well as a specific pain-related potentials component can be operantly conditioned.

Sex differences in nociceptive withdrawal reflex and pain perception

Experimentally induced pain often reveals sex differences, with higher pain sensitivity in females. The degree of differences has been shown to depend on the stimulation and assessment methods. Since sex differences in pain develop anywhere along the physiological and psychological components of the nociceptive system, we intended to compare the nociceptive flexion reflex (NFR) as a more physiological (spinal) aspect of pain procession to the verbal pain report of intensity and unpleasantness as the more psychological (cortical) aspect. Twenty female and twenty male healthy university students were investigated by use of nociceptive flexion reflex threshold (staircase method) after electrical stimulation of the N. suralis. Furthermore, we assessed supra-threshold reflex responses (latency, amplitude and area) by applying 10 stimuli 5 mA above reflex threshold. Following each stimulation, the subjects provided pain ratings of intensity and unpleasantness on a visual analogue scale. Females exhibited marked lower nociceptive flexion reflex thresholds than males, while the supra-threshold reflex response tailored to the individual reflex threshold did not show any significant differences. The verbal pain ratings, corrected for NFR threshold, were not found to differ significantly. The large sex differences in nociception that were present in NFR threshold but not in the pain ratings corroborate the hypothesis that spinal processes contribute substantially to sex differences in pain procession.

Vital signs and nurses' choices of titrated dosages of intravenous morphine for relieving pain following cardiac surgery.

Postoperative pain, if unrelieved, will impede patients' recovery. A theoretical model of factors which influence nurses' choices of titrated dosages of intravenous (IV) morphine was constructed for this study. This study aimed to examine whether or not a patient's vital signs would influence nurses' choices of titrated dosages of IV morphine for relieving pain following cardiac surgery. A survey design with a vignette and questionnaire method was used to collect data. The vignette developed by McCaffery & Ferrell was modified and adapted for this study. It described the pain reports and vital signs of two patients on postoperative day 1 following cardiac surgery. Convenience sampling was used to seek voluntary participation from 29 registered nurses working in the cardio-thoracic intensive care unit of a private hospital in Sydney, Australia. A protocol of the unit allowed nurses to titrate IV morphine against the pain of patients following cardiac surgery. The results showed that the pain assessment of the two patients in the vignette documented by the nurses were not consistent. The titrated dosages (a bolus dosage and a maintenance dosage) chosen by the nurses for the patient with slightly elevated vital signs differed significantly from the titrated dosages chosen by the same group of nurses for another patient with vital signs at the lower end of the stable range (t=3. 33, d.f.=25, P < 0.01 for a bolus dosage and t=3.73, d.f.=25, P < 0. 01 for a maintenance dosage). Different risk factors were stated by the nurses in titrating the bolus and maintenance dosages of IV morphine. The importance of accepting patients' verbal reports of pain as well as the provision of optimal dosages of IV morphine for pain relief is highlighted. A disadvantage of using a vignette and questions method is that the patients' clinical status is somewhat unreal. Further studies, however, were also recommended.

Reduction of propofol injection pain with a double lumen IV set

Study Objective: To investigate if the use of a new double lumen IV set (DLIS) decreases the incidence of propofol injection pain compared with single lumen IV set (SLIS) administration. Design: Prospective, randomized, double-blinded study. Setting: Operating rooms in a university hospital. Patients: 50 adult ASA physical status I and II patients of both genders undergoing general anesthesia for elective surgery. Interventions: Patients were injected with propofol either through a DLIS or a SLIS. Measurements and Main Results: Three different pain indices were recorded to be present or absent: (1) verbal report of pain during propofol injection, (2) grimacing during propofol injection, and (3) recall of injection pain in the recovery room. When the DLIS was used, the incidence of verbal pain, grimacing during propofol injection, and recall of pain during recovery were lowered significantly by 53%, 46%, and 52 %, respectively (chi square analysis of contingency table with Yates correction, p < 0.05). Conclusions: The DLIS significantly reduced the incidence of propofol injection pain compared with SLIS. Further studies are indicated to evaluate the cost-effectiveness of this device.

Occupational Therapists' Experiences and Knowledge of Pain in Children

The purpose of this study was to describe the extent to which occupational therapists observed and treated pain in children and adolescents and their current awareness, understanding of, and satisfaction with assessment and treatment of pain. Data from 129 of 200 ( 64.5%) pediatric occupational therapist who responded to a 22-item questionnaire were analyzed. Results indicated that respondents ( a) seldom to sometimes suspected the present of pain with specific age groups they have treated, ( b) sometimes to often reported suspecting pain when asked about a specific disability, ( c) primarily used covey (verbal reports of pain) measures to detect pain, ( d) were unfamiliar with pediatric pain assessment tools, ( e) seldom addressed pain during treatment, ( f) demonstrated a moderate level of awareness of issues related to pain in children, ( g) perceived that their entry-level education on pediatric pain was not adequate, and ( h) were not satisfied with their current knowledge of pediatric pain. These results suggest a need and desire for education of occupational therapist about pain in children.

Occupational Therapists' Experiences and Knowledge of Pain in Children

The purpose of this study was to describe the extent to which occupational therapists observed and treated pain in children and adolescents and their current awareness, understanding of, and satisfaction with assessment and treatment of pain. Data from 129 of 200 ( 64.5%) pediatric occupational therapist who responded to a 22-item questionnaire were analyzed. Results indicated that respondents ( a) seldom to sometimes suspected the present of pain with specific age groups they have treated, ( b) sometimes to often reported suspecting pain when asked about a specific disability, ( c) primarily used covey (verbal reports of pain) measures to detect pain, ( d) were unfamiliar with pediatric pain assessment tools, ( e) seldom addressed pain during treatment, ( f) demonstrated a moderate level of awareness of issues related to pain in children, ( g) perceived that their entry-level education on pediatric pain was not adequate, and ( h) were not satisfied with their current knowledge of pediatric pain. These re...

Hypnotic hypo- and hyperalgesia: divergent effects on pain ratings and pain-related cerebral potentials

Pain ratings and pain-related cerebral potentials in response to noxious stimuli were investigated under hypnotic hypo- or hyperalgesia. Out of a sample of 50 subjects the 10 most highly hypnotizable were selected using the Stanford Hypnotic Susceptibility Scale. Phasic pain was induced by brief electrical stimuli intracutaneously applied to the subject's left middle finger. The subjects took part in three experimental sessions. The first session was without hypnosis for familiarization with the experimental surroundings. In the two other sessions, the subjects were hypnotized and given a suggestion of analgesia or hyperalgesia with respect to pain sensation in the left hand. The sequence of hypnosis was matched within and between sessions. Pain ratings and late cerebral somatosensory evoked potentials (SEP) were used to quantify pain reactions. In addition, auditory evoked potentials (AEP) and spontaneous EEG were evaluated to differentiate between pain-specific and unspecific effects of hypnosis. Only the subjects' verbal reports of pain were drastically influenced by hypnosis: suggestion of analgesia diminished the mean pain ratings, suggestion of hyperalgesia enhanced them ( P < 0.001). In contrast, the amplitudes of the late somatosensory potentials evoked by the pain-inducing stimuli were not modified in either of the suggestive states. Furthermore, no effects of hypnosis were found on AEPs and on the power spectra of the spontaneous EEG. The results are discussed on the basis of a dissociation of sensory and affective components of pain under hypnosis.