scholarly journals Rethinking pain threshold as a zone of uncertainty

2019 ◽  
Author(s):  
Victoria J Madden ◽  
Peter R Kamerman ◽  
Mark J Catley ◽  
Valeria Bellan ◽  
Leslie N Russek ◽  
...  
Keyword(s):  
Stimulus Intensity ◽  
Pain Threshold ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Individual Variability ◽  
Stimulus Response ◽  
Stable Relationship ◽  
Painful Events ◽  
The Individual ◽  
Actual Response

AbstractBackgroundThe pain threshold is traditionally conceptualised as a boundary that lies between painful and non-painful events, suggesting a reasonably stable relationship between stimulus and response. In two previous experiments, participants received laser stimuli of various intensities and rated each stimulus on the Sensation and Pain Rating Scale (SPARS), which includes ranges for rating painful and non-painful events and clearly defines the presumed boundary between them. In the second experiment, participants also provided ratings on the conventional 0-100 Numerical Rating Scale for pain (NRS) and a new rating scale for non-painful events. Those data showed the SPARS to have a curvilinear stimulus-response relationship, reflecting that several different intensities may be rated as painful and non-painful in different trials. This suggests that participants were uncertain about painfulness over a range of intensities and calls into question the idea of a boundary between non-painful and painful events. The current study aimed to determine the number of different stimulus intensities across which each participant provided ‘painful’ and ‘non-painful’ reports in different trials.MethodsWe undertook novel exploratory analyses on data from the aforementioned two experiments (n = 19, 11 female, 18-31 years old; n = 7, 5 female, 21-30 years old). We used the binomial test to formally determine the width of this ‘zone of uncertainty’ about painfulness, using ratings on the SPARS and the comparator scales, and data visualisation to assess whether trial-to-trial change in stimulus intensity influences ratings.ResultsWe found that the width of the zone of uncertainty varied notably between individuals and that the zone was non-continuous for most participants. Plots of group-level data concealed the inter-individual variability apparent in the individual plots, but still showed a wide zone of uncertainty on both the SPARS and the NRS, but a narrow zone on the scale for non-painful events. There was no evidence that trial-to-trial change in stimulus intensity influenced ratings.ConclusionsThe variability revealed by this study has important design implications for experiments that include initial calibration of repeatedly delivered stimuli. The variability also stands to inflate the size of sample that is required for adequate statistical powering of experiments, and provides rationale for the use of statistical approaches that account for individual variability in studies of pain. Finally, the high variability implies that, if experimental stimuli are to be used in clinical phenotyping, many trials may be required to obtain results that represent a single patient’s actual response profile.

scholarly journals MDR1 Genotypes and Haplotypes Are Closely Associated with Postoperative Fentanyl Consumption in Patients Undergoing Radical Gastrectomy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Fan Zhang ◽  
Jianbin Tong ◽  
Wenxiang Qing ◽  
Zhonghua Hu ◽  
Jie Hu ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Opioid Analgesic ◽  
Individual Variability ◽  
Radical Gastrectomy ◽  
Nucleotide Polymorphisms ◽  
Multidrug Resistance Gene ◽  
Numerical Rating ◽  
Fentanyl Consumption ◽  
The Individual

Fentanyl is a powerful opioid analgesic, and its analgesic effect is greatly different among individuals. This study was aimed at exploring the effects of multidrug resistance gene-1 (MDR1) genetic variation on postoperative fentanyl consumption. A total of 135 patients, who planned to undergo radical gastrectomy with general anesthesia, were studied. The subjects received patient-controlled analgesia (PCA) by intravenous fentanyl within 48 hours after operation and maintained a numerical rating scale (NRS) score ≤ 3 . The consumption and side effects of fentanyl were recorded within 24 hours and 48 hours after the operation. Single nucleotide polymorphisms (SNPs) of all patients with MDR1 1236C>T, 2677G>T/A, and 3435C>T were screened by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) or DNA sequence analysis after PCR. There was no difference in postoperative fentanyl consumption among patients having 2677G>T/A and 3435C>T polymorphisms (all P > 0.05 ). MDR1 1236C>T polymorphisms and haplotypes combined by three SNPs, however, significantly affected postoperative fentanyl consumption (all P < 0.05 ). Moreover, 1236TT genotype carriers consumed more fentanyl during 24 hours ( P = 0.038 ) and 48 hours ( P = 0.003 ) postoperatively. The MDR1 TTT haplotype carriers needed more fentanyl compared with the CGC haplotype carriers during the first 48 hours after surgery ( P = 0.017 ). Nausea, vomiting, and dizziness were not found to have significant differences among the above three SNPs and their haplotypes ( P > 0.05 ). MDR1 1236C>T polymorphism and haplotypes were factors contributing to the individual variability in postoperative fentanyl consumption.

scholarly journals Effectiveness of chiropractic modality on chronic low back pain patients, A quasi-experimental study

2020 ◽  
Author(s):  
Behdokht Aleali ◽  
Mohammad Hossein Sharifi ◽  
Malihe Sousani ◽  
Alireza Salehi
Keyword(s):  
Experimental Study ◽  
Back Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Therapeutic Modality ◽  
Global Rating ◽  
Significant Difference ◽  
Quasi Experimental ◽  
The Mean ◽  
The Individual

Abstract BackgroundLow back pain (LBP) is one of the most prevalent diseases in the developed and developing countries, which imposes high socioeconomic burden on both the individual and the community. There are limited studies that explain the clinically meaningful impact of chiropractic modality in chronic LBP.MethodThis is a quasi-experimental study. Participants were patients who had referred to Shiraz private chiropractic clinics with more than three month chronic LBP and had no pathologic abnormalities. Data were collected in two stages, baseline visit and 8 weeks after treatment. The effect of intervention measured throughout three questionnaire including Roland Morris Disability Questionnaire (RMDQ), Numerical Rating Scale (NRS) and self-assessment Global Rating of Change (GRC) questionnaires.Result141 patients analyzed, the mean age of participants was 40.18 ± 10.42 years of old and 40 (28.4%) were male. The mean duration of LBP was 56.73 ± 45.11 months. Before and after intervention, based on RMDQ and NRS data, indicated that the mean difference ± Standard Deviation was 5.54 ± 4.95 and 2.44 ± 1.64 the statistically significant difference (P < 0.001) and (P < 0.001) among all demographic and clinical characteristic variables, except job status. The mean ± SD of GRC was 56.13 ± 33.03%. Based on the RMDQ cut-off point, 88 participants (62%; 95% CI: 50–70) have been affected by chiropractic with a clinically meaningful effect. In addition, the chiropractic may be an effective therapeutic modality in treating patients with mild, moderate, or even severe MRI findings.ConclusionComplementary chiropractic treatment amongst chronic LBP patients may be an appropriate adjuvant to conventional treatments to improve disability and pain intensity reduction in both genders.

scholarly journals Variability of Multiple Sclerosis Spasticity Symptoms in Response to THC:CBD Oromucosal Spray: Tracking Cases through Clinical Scales and Video Recordings

2018 ◽  
Vol 10 (2) ◽  
pp. 169-176
Author(s):  
Peter Flachenecker ◽  
Francesco Saccà ◽  
Carlos Vila
Keyword(s):  
Multiple Sclerosis ◽  
Rating Scale ◽  
Demyelinating Disease ◽  
Numerical Rating Scale ◽  
Individual Variability ◽  
Additional Treatment ◽  
Response To Treatment ◽  
Walk Test ◽  
Modest Improvement ◽  
Clinical Scales

Multiple sclerosis (MS) is an inflammatory and neurodegenerative autoimmune demyelinating disease of the central nervous system. Patients exhibit heterogeneous patterns of disabling symptoms, including spasticity. In the majority of patients with MS spasticity, it and its associated symptoms contribute to disability, interfere with performance of everyday activities, and impair quality of life. Even under treatment with oral antispasticity drugs, about a third of patients continue to experience spasticity of moderate to severe intensity, underscoring the need for additional treatment options. The efficacy of tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray as add-on therapy in patients with refractory MS spasticity has been demonstrated in clinical trials and observational studies. To gain insight into patients’ response to treatment at the individual level, in-depth changes from baseline in various clinical scales and video-assessed parameters were evaluated in patients with resistant MS spasticity before and after 1 month of treatment with THC:CBD oromucosal spray. All 6 patients showed ≥20% improvement in the spasticity Numerical Rating Scale (i.e., were initial responders to treatment), but displayed individual variability in other spasticity-related parameters. Improved Modified Ashworth Scale scores were observed in 5 cases, with a reduction of –2/–3 points in lower limb scores for 1 patient who also showed benefit in terms of a more stable gait but modest improvement in the timed 10-meter walk test (10MWT). Improvement in the 10MWT (or 25-foot walk test) was noted in 4 of the 6 cases. THC:CBD oromucosal spray also improved upper limb function as indicated by faster 9-Hole Peg Test results.

Pediatrics

2019 ◽  
pp. 312-322
Author(s):  
Michale Sofer ◽  
Francis Wickham Kraemer
Keyword(s):  
Abdominal Surgery ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Scale ◽  
Older Children ◽  
Interventional Techniques ◽  
Neonatal Pain ◽  
Open Abdominal Surgery ◽  
Numerical Rating ◽  
The Individual

Following surgery, pediatric patients suffering from pain warrant consistent and frequent pain assessments. This chapter describes a variety of scales that can be used and that must be tailored to the developmental stage of the child. Examples of commonly used pediatric scales include the Neonatal Pain, Agitation and Sedation Scale (N-PASS); Face, Legs, Activity, Cry, Consolability (FLACC); Numerical Rating Scale (NRS); and the Wong Baker FACES Pain Scale. In the setting of open abdominal surgery, certain interventional techniques (continuous epidural, peripheral truncal blockade) can be used to significantly decrease pain and must be tailored to the individual patient and specific surgical subtype. Separate from interventional techniques, older children may also use patient-controlled analgesia (PCA) devices to deliver systemic opioids. For patients who are too young or are unable to press a PCA device, a variety of nurse-controlled analgesic protocols exist to deliver such systemic analgesic therapies.

scholarly journals Relative and absolute test-retest reliabilities of pressure pain threshold in patients with knee osteoarthritis

2018 ◽  
Vol 18 (2) ◽  
pp. 229-236 ◽  
Author(s):  
Neeraja Srimurugan Pratheep ◽  
Pascal Madeleine ◽  
Lars Arendt-Nielsen
Keyword(s):  
Knee Osteoarthritis ◽  
Pain Sensitivity ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Individual Variability ◽  
Minimal Detectable Change ◽  
Systematic Bias ◽  
Pressure Pain ◽  
Significant Difference ◽  
The Individual

Abstract Background and aims: Pressure pain threshold (PPT) and PPT maps are commonly used to quantify and visualize mechanical pain sensitivity. Although PPT’s have frequently been reported from patients with knee osteoarthritis (KOA), the absolute and relative reliability of PPT assessments remain to be determined. Thus, the purpose of this study was to evaluate the test-retest relative and absolute reliability of PPT in KOA. For that purpose, intra- and interclass correlation coefficient (ICC) as well as the standard error of measurement (SEM) and the minimal detectable change (MDC) values within eight anatomical locations covering the most painful knee of KOA patients was measured. Methods: Twenty KOA patients participated in two sessions with a period of 2 weeks±3 days apart. PPT’s were assessed over eight anatomical locations covering the knee and two remote locations over tibialis anterior and brachioradialis. The patients rated their maximum pain intensity during the past 24 h and prior to the recordings on a visual analog scale (VAS), and completed The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and PainDetect surveys. The ICC, SEM and MDC between the sessions were assessed. The ICC for the individual variability was expressed with coefficient of variance (CV). Bland-Altman plots were used to assess potential bias in the dataset. Results: The ICC ranged from 0.85 to 0.96 for all the anatomical locations which is considered “almost perfect”. CV was lowest in session 1 and ranged from 44.2 to 57.6%. SEM for comparison ranged between 34 and 71 kPa and MDC ranged between 93 and 197 kPa with a mean PPT ranged from 273.5 to 367.7 kPa in session 1 and 268.1–331.3 kPa in session 2. The analysis of Bland-Altman plot showed no systematic bias. PPT maps showed that the patients had lower thresholds in session 2, but no significant difference was observed for the comparison between the sessions for PPT or VAS. No correlations were seen between PainDetect and PPT and PainDetect and WOMAC. Conclusions: Almost perfect relative and absolute reliabilities were found for the assessment of PPT’s for KOA patients. Implications: The present investigation implicates that PPT’s is reliable for assessing pain sensitivity and sensitization in KOA patients.

THE STUDY OF THE INDIVIDUAL VARIABILITY OF THE LINEAR DIMENSIONS OF THE SPHENOID SINUS

2019 ◽  
Vol 21 (1) ◽  
pp. 64-70
Author(s):  
O.V. Mareev ◽  
◽  
G.O. Mareev ◽  
M.E. Gutynina ◽  
D.A. Maksimova ◽  
...  
Keyword(s):  
Sphenoid Sinus ◽  
Individual Variability ◽  
Linear Dimensions ◽  
The Individual

Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

2020 ◽  
Vol 8 (1) ◽  
pp. 21-21
Author(s):  
Mani Mofidi ◽  
Ali Dashti ◽  
Mahdi Rezai ◽  
Niloufar Ghodrati ◽  
Hoorolnesa Ameli ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Musculoskeletal Pain ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Vital Signs ◽  
Categorical Variables ◽  
Intravenous Morphine ◽  
Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

Comparison of Analgesic Effect of Levobupivacaine with Dexmedetomidine and Levobupivacaine for Scalp Block before Supratentorial Craniotomy: A Randomized Controlled Trial

2020 ◽  
Vol 103 (10) ◽  
pp. 1028-1035
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Control Group ◽  
Study Group ◽  
Analgesic Requirement ◽  
Supratentorial Craniotomy ◽  
Numerical Rating ◽  
Fentanyl Consumption ◽  
Scalp Block

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

scholarly journals Ultrasound-guided superficial cervical plexus block for analgesia in patients undergoing craniotomy via suboccipital retrosigmoid approach: study protocol of a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e034003
Author(s):  
Kun Peng ◽  
Min Zeng ◽  
Jia Dong ◽  
Xiang Yan ◽  
Dexiang Wang ◽  
...  
Keyword(s):  
Nerve Block ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Control Group ◽  
Cervical Plexus ◽  
Ethics Review ◽  
Superficial Cervical Plexus Block ◽  
Cervical Plexus Block ◽  
Plexus Block

IntroductionScalp nerve block has been proven to be an alternative choice to opioids in multimodal analgesia. However, for the infratentorial space-occupying craniotomy, especially the suboccipital retrosigmoid craniotomy, scalp nerve block is insufficient.Methods and analysisThe study is a prospective, single-centre, randomised, paralleled-group controlled trial. Patients scheduled to receive elective suboccipital retrosigmoid craniotomy will be randomly assigned to the superficial cervical plexus block group or the control group. After anaesthesia induction, superficial cervical plexus nerve block will be performed under the guidance of ultrasound. The primary outcome is the cumulative consumption of sufentanil by the patient-controlled intravenous analgesia pump within 24 hours after surgery. Secondary outcomes include the cumulative consumption of sufentanil at other four time points and numerical rating scale pain severity score.Ethics and disseminationThe protocol (version number: 2.0, 10 April 2019) has been approved by the Ethics Review Committee of China Registered Clinical Trials (Ethics Review No. ChiECRCT-20190047). The findings of this study will be disseminated in peer-reviewed journals and at scientific conferences.Trial registration numberNCT04036812

scholarly journals Application of 3D printing and framework internal fixation technology for high complex rib fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xuetao Zhou ◽  
Dongsheng Zhang ◽  
Zexin Xie ◽  
Yang Yang ◽  
Menghui Chen ◽  
...  
Keyword(s):  
3D Printing ◽  
Internal Fixation ◽  
Locking Plate ◽  
Rating Scale ◽  
Preoperative Planning ◽  
Numerical Rating Scale ◽  
Chest Ct ◽  
Rib Fractures ◽  
X Rays ◽  
With Screws

Abstract Objective To explore the clinical effect of 3D printing combined with framework internal fixation technology on the minimally invasive internal fixation of high complex rib fractures. Methods Total 16 patients with high complex rib fractures were included in the study. Before the procedure, the 3D rib model was reconstructed based on the thin-layer chest CT scan. According to the 3D model, the rib locking plate was pre-shaped, and the preoperative planning were made including the direction of the locking plate, the location of each nail hole and the length of the screw. During the operation, the locking plate was inserted from the sternum to the outermost fracture lines of ribs with screws at both ends. In addition, the locking plate was used as the frame to sequentially reduce the middle fracture segment and fix with screws or steel wires. Chest x-rays or chest CT scans after surgery were used to assess the ribs recovery. All patients were routinely given non-steroidal anti-inflammatory drugs (NSAIDS) for analgesia, and the pain level was evaluated using numerical rating scale (NRS). Results The preoperative planning according to the 3D printed rib model was accurate. The reduction and fixation of each fracture segment were successfully completed through the framework internal fixation technology. No cases of surgical death, and postoperative chest pain was significantly alleviated. Five to 10 months follow up demonstrated neither loosening of screws, nor displacement of fixtures among patients. The lungs of each patients were clear and in good shape. Conclusion The application of 3D printing combined with framework internal fixation technology to the high complex rib fractures is beneficial for restoring the inherent shape of the thoracic cage, which can realize the accurate and individualized treatment as well as reduces the operation difficulty.

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