• Anesthesia related pain management strategies and 24 hour postoperative outcomes in traumatic tibia fracture patients

      Virts, Elena Victorovna; Storr, Carla L. (2015)
      Background: Pain management Pain management research is uncommon in trauma patients with tibia fracture who undergo surgery within 24 hours of admission. Acute intoxication is a risk factor for orthopedic trauma; however, whether pain management outcome differs between sober and intoxicated patients at admission is unknown. Purpose: Three commonly used anesthesia-related pain management (ARPM) strategies (Benzo, administration of preoperative benzodiazepines within 90 minutes of anesthesia start; Opioid, intraoperative administration opioids by the end of surgery; and Combo, a combination of both strategies) were examined for postoperative outcomes (pain intensity, time to achieve postanesthesia care unit [PACU] discharge criteria, total postoperative opioid consumption, and frequency of postoperative nausea and vomiting [PONV]). The outcomes associated with these ARPM strategies were evaluated according to whether a patient was sober or intoxicated at admission. Methods: A chart review of 206 adult trauma patients admitted for tibia fractures in 2007 though 2009 provided information on personal characteristics and physical status, perioperative pain intensity, administration of analgesics and pharmacological adjuvants, frequencies of PONV, time required to achieve PACU discharge criteria, surgical and injury attributes, and alcohol intoxication on admission. A mixed effects model and linear and logistic regressions were used to examine the relationships between the ARPM strategies and outcomes. Results: Most patients (84%) received an ARPM strategy (Benzo, 30%; Opioid, 21%; Combo, 33%). A majority (83.5%) reported severe pain; one third experienced PONV. Postoperative opioid consumption (range, 3.75 to 336.88 mg of morphine) and time required to achieve PACU discharge criteria (range, 10 to 358 minutes) varied widely. All ARPM strategies were associated with higher pain ratings compared with control patients, without altering the time required to achieve PACU discharge criteria. All ARPM strategies decreased total opioid consumption up to 50%, but this effect was limited to the first four postoperative hours. Combo strategy reduced the occurrence of PONV, but higher pain ratings were reported. Intoxicated patients received the most benefit from Benzo strategy, whereas Opioid strategy was detrimental to them. Conclusion: Benzodiazepines are recommended for orthopedic trauma patients who are intoxicated on admission, whereas a combination strategy is more appropriate for patients prone to PONV.
    • Influence of Social Observational Learning on Pain Perception

      Raghuraman, Nandini; Colloca, Luana (2018)
      Background: Placebo hypoalgesia is the reduction of pain purely by treatment context. Humans are social beings and learn about their environment by observing others. Research shows observational learning induces placebo hypoalgesia, but its neural underpinnings are not explored. Methods: During EEG acquisitions, twenty-six healthy participants observed a demonstrator experiencing pain on two inert creams on the forearm. He showed painful and neutral expression for each. They then received same creams and recorded their pain ratings. Results: We got 11 responders reporting lower pain (Placebo x = 12.8 ± 3.7, (F (1, 10) = 11.812, p = 0.006)) and 10 non-responders who showed opposite trend (Placebo x = -6.9±3.5, (F (1, 9) = 3.85, p = 0.081)). The peak alpha frequencies during eyes closed resting state did not correlate with placebo response. Conclusion: Social learning does induce placebo in certain people, and further EEG task analysis can help generate an electrophysiological marker for placebo.
    • Pain, coping, and depression following burn injury

      Ulmer, Janice Fitzgerald; Gift, Audrey G. (1991)
      Pain, coping, and depression were examined in a convenience sample of 32 burn injured men and women. Subjects were interviewed 3 times at approximately weekly intervals. The first and third interviews focused on coping, the second interview focused on how burn pain is described and rated by burn injured subjects and their care providers. Three criterion variables, pain intensity, pain distress, and depression were used to measure coping outcome. Five variables, severity of injury, surgical intensity, baseline depression, duration of pain, and level of analgesic drug were predicted to influence coping. Although the burn wound was identified as the source of worst pain, when subjects were asked to rate wound, donor, and skin graft pain using the short form McGill Pain Questionnaire (MPQ-SF), no significant differences were found. Average pain intensity, average pain distress, and level of depression decreased significantly over time. Pain with routine activity and pain worst continued to be rated moderate to severe by most patients at the third interview. No changes were noted in coping strategy use when coping was measured using the Coping Strategies Questionnaire. Subjects' perceptions of their ability to control pain increased significantly over the three measurement sessions. Subjects' perceptions of their ability to decrease their pain increased but did not achieve significance. Significant correlations between predictor and criterion variables were found for severity of injury, duration of pain, level of analgesic drug, baseline depression, and perceptions of ability to control and decrease pain. Significant correlations were also found between the criterion variables and beliefs related to personal control and the tendency to catastrophize. A significant positive correlation was found between care provider estimates of pain distress today and the average self-reported pain distress score. Care provider estimates of pain intensity today did not correlate with the average self-reported pain intensity score. When t-test comparisons were made between care provider and patient ratings no significant differences were found.
    • Racial/ethnic differences in experimental pain sensitivity and associated factors - Cardiovascular responsiveness and psychological status

      Kim, Hee Jun; Dorsey, Susan Grace (2016)
      Background Racial/ethnic disparities related to pain in the US have been reported that racial/ethnic minorities have greater levels of chronic pain and receive lower quality of care. Underlying mechanisms to explain the racial/ethnic differences in pain is unclear. Enhanced experimental pain sensitivity is suggested to be associated with ethnic differences in clinical pain. Purpose To examine racial/ethnic differences in experimental pain sensitivity, and evaluate contribution of cardiovascular responsiveness and psychological status to racial/ethnic differences in experimental pain sensitivity. Methods The baseline data of TMD-free 3,159 individuals - non-Hispanic white (NHW): 1,637, African-American (AA): 1,012, Asian: 299, and Hispanic: 211 - from the OPPERA prospective cohort study were used. Quantitative sensory testing measures for pressure, mechanical cutaneous, and heat pain were used. Cardiovascular responsiveness measures (e.g., BP, HR, HR/MAP ratio, and heart rate variability) and psychological status (depression, anxiety, stress, coping, and catastrophizing) were included in the analyses. Structural equation modeling with maximum likelihood estimation method was used for mediation analyses. Putative mediators that showed significant racial/ethnic differences were entered into the final models simultaneously with age, gender, BMI, study site, education and income level as covariates. Results Racial/ethnic minorities showed higher pain sensitivity, including heat pain tolerance, heat pain rating (HPR), heat pain aftersensation (HPA), mechanical cutaneous pain ratings and aftersensation (MCPRAS), and mechanical cutaneous pain temporal summation (MCPTS), compared to NHWs. Catastrophizing significantly mediated the associations between ethnicity and pain sensitivity (heat pain tolerance, HPR, HPA, MCPRAS, and MCPTS) for both AAs and Asians, compared to NHWs. Coping negatively mediated the association between race/ethnicity and heat pain tolerance, HPR, and MCPTS in both AAs and Asians, compared to NHWs. HR/MAP ratio showed a significant negative mediating effect on the association between race/ethnicity (AAs vs. NHWs) and heat pain tolerance. Negative emotion mediated the associations between race/ethnicity (Asians vs. NHWs) and mechanical cutaneous pain threshold, HPR, and MCPRAS. Conclusion The identified mediators should be considered in pain management programs to implement better strategies to reduce clinical pain, especially for AAs and Asians in the US. Further clinical research is required to increase our understanding of the suggested mechanisms.
    • The relationship of pain characteristics, type of cancer, and opioid consumption to quality of life, psychological distress, and pain outcomes

      Polomano, Rosemary Carol; Belcher, Anne E. (1995)
      The relationship of pain to quality of life (QOL) outcomes has been studied; yet, for the most part, the presence and magnitude of pain have been the major variables of interest. Little is known about the impact of pain types (somatic, visceral and neuropathic) on QOL. The primary purpose of this study was to evaluate the extent to which physiological source(s) of pain, pain duration, intensity, location(s), number of sites, relief, sensory and affective components, and opioid consumption affect perceptions of QOL and psychological distress. In addition, the association and validity of pain language in predicting physiologic pain were evaluated. A convenience sample (N = 100) of subjects with chronic pain from advanced cancer was recruited for study from three outpatient medical oncology practices. Information was collected on age, sex, tumor type, treatment information, average daily opioid requirement, physiologic source(s) of pain, pain location(s), number of painful sites, and duration of pain. Each subject completed the following measures: (a) a Numeric Pain Rating (NRS) Scale for present pain intensity (PPI) and average worst pain intensity (WPI); (b) pain relief scale (VASPR); (c) the sensory and affective Short Form-McGill Pain Questionnaire (SF-MPQ); (d) The Brief Symptom Inventory (BSI) (psychological distress); and, (e) The Quality of Life Survey (QOLS). Data analyses were conducted using The SSPS-PC Program and the SAS Software System. Multiple regression analysis determined that SF-MPQ affective component, VASPR and age accounted for a significant portion (25.3%) of the variance in the QOLS scores, while WPI, VASPR and age explained 21.3% of the model for psychological distress. Discriminant Analysis, Chi-Square analyses and linear logistic regression evaluated significant associations of pain language to physiological pain categories. No significant differences in the QOLS, BSI and average pain intensity were found for pain location and cancer diagnosis using MANOVA's. ANOVA and Student's t-tests assessed differences among pain types. Subjects with a component of neuropathic pain experienced significantly more psychological distress, (p<.05), average pain (p<.01), greater sensory and affective pain (SF-MPQ) (p<.001), and present pain (p<.01).