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S W Harkins

Publications and source records attributed to S W Harkins.

At least 19 recordsLinked to original sources
PubMed2000

A clinical laboratory model for direct assessment of medication-induced antihyperalgesia and subjective effects: initial validation study.

Analgesic medications are often tested in clinical laboratory studies by observing their ability to reduce the pain produced by noxious stimuli presented to healthy skin. These medications may then be used clinically to reduce disease-related hyperalgesia. This article describes a clinical laboratory model useful for testing a medication's ability to reduce hyperalgesia in humans. Results demonstrate that ultraviolet (UV) light induces hyperalgesia, commonly prescribed analgesic medications reduce UV-induced hyperalgesia, and this UV-induced hyperalgesia model can be used to assess the time course of a medication's antihyperalgesia effects. Coupled with participant-rated measures of drug liking and mood, this model may prove useful for predicting the clinical efficacy and side-effect profile of novel analgesic medications in cost-efficient and statistically powerful laboratory studies.

Adult↗
PubMed2000

Psychophysiological and psychophysical responses to experimental pain induced by two types of cutaneous thermal stimuli.

Evoked potentials (EPs) to noxious thermal stimulation of skin may provide information about integrity of the nociceptive afferent system and thus small afferent fiber integrity. Here we describe subjective report, EPs and response times to noxious contact thermal and laser stimuli in the same subjects. Pain quality to both forms of stimulation was consistently reported as a brief pricking or stinging sensation (first pain), occasionally followed, after a silent period, by a diffuse burning sensation (second pain). EPs to laser generated heat pulses consisted of bi- or triphasic waveforms with a large positive wave at approximately 300 ms following arm stimulation and 360 ms following stimulation of the leg. EPs to contact heat pulses consisted of a single, scalp positive wave occurring approximately 830 ms following arm stimulation and 890 ms following leg stimulation. Both forms of noxious stimulation activated afferents with a conduction velocity consistent with that of A-delta fibers ( approximately 10 m/s) and with the psychophysical attributes of first pain.

Electroencephalography↗
PubMed1999

Otalgia and aversive symptoms in temporomandibular disorders.

The term Costen's syndrome has been used in the dentomedical literature to describe a constellation of craniofacial symptoms. Since some of the same complaints have been reported in patients with "generalized" psychological distress, symptoms associated with the syndrome may not be useful in differential diagnosis of temporomandibular disorders. The present study investigated whether some somatic complaints, particularly tinnitus and dizziness, were pathognomonic in patients with chronic temporomandibular pain. Illness behavior and personality factors were studied for possible interrelationships with these symptoms. Factor analysis revealed that tinnitus and dizziness loaded on separate factors. Tinnitus loaded with nasal stuffiness, tearing, and itching of the eyelids and nose, while dizziness loaded with complaints of altered taste and smell and blurred vision. Neither was consistently related to measures of pain or to indices of illness behavior or somatic focus.

Adult↗
PubMed1997

Quality of life following bladder training in older women with urinary incontinence.

This study investigated the changes in quality of life following a randomized controlled 6-week trial of bladder training in 123 older women with urinary incontinence. Both clinical (diary, pad test) and quality of life measures (Incontinence Impact Questionnaire (IIQ), Center for Epidemiological Studies-Depression Scale (CES-D)) and visual analog scales on symptom burden were obtained at baseline, 6 weeks and 6 months following treatment. All subscales and the composite scale of the IIQ and the visual analog scales were significantly improved following bladder training, with effects maintained 6 months later. No changes were observed in CES-D scores. Women with genuine stress incontinence and those with detrusor instability with or without concomitant stress incontinence had similar improvements. We conclude that bladder training is effective in improving the quality of life of incontinent women regardless of urodynamic diagnosis.

Aged↗
PubMed1996

Suppression of first pain and slow temporal summation of second pain in relation to age.

BACKGROUND: Thermal stimuli delivered to skin of the arms or legs can produce a sensation of two distinct pains. These pains have been associated with activity in A-delta (first pain) and C-fiber (second pain) nociceptive fibers, respectively. Under appropriate conditions first pain decreases in intensity (adaptation) while second pain increases in intensity (slow temporal summation). Change in first and second pain to repeated stimulation of skin has not been assessed in relation to age. METHODS: Ten younger (M = 25 years) and ten older (M = 65 years) subjects participated in a study of first and second pain intensity elicited by nociceptive range heat pulses (.7 second pulses; adapting temperature 39 degrees C to a stimulus temperature of 51 degrees C) delivered to skin of arms and legs. Response times to sensations of first and second pain were assessed to provide evidence that subjects were responding to first and second pain. RESULTS: Age groups did not differ on pain intensity ratings of initial stimuli to previously unstimulated skin for either first or second pain. Older subjects failed to evidence slow temporal summation of second pain at the leg. Response times to first, but not second pain from the leg were delayed in the elderly. Response times to first and second pain at the arm did not differ with age. Auditory response times were slower in the older group. CONCLUSIONS: Age did not influence pain intensity to unadapted and unsensitized skin. Slow temporal summation of second pain was not observed at the leg in the older group, suggesting that mechanisms subserving C-fiber mediated sensitization of second order nociceptive neurons may fail with age. Longer response times to first, but not second pain in older subjects may represent an age effect on myelinated (A-delta; first pain) and not unmyelinated (C-fiber; second pain) nociceptive afferents and may represent a type of small fiber peripheral neuropathy.

Acoustic Stimulation↗
PubMed1996

Response to tacrine in patients with dementia of the Alzheimer's type: cerebral perfusion change is related to change in mental status.

We evaluated change in cerebral hypoperfusion by single photon emission computed tomography (SPECT) in 12 patients with a clinical diagnosis of dementia Alzheimer's type (DAT) before and after treatment with Tacrine. Based on clinical evaluation of the SPECT scans before and after treatment, two groups of patients were identified. One (N = 5) experienced a relative decrease in cerebral perfusion and a decrease in mini-mental status examination (MMSE) scores across the treatment interval and was labeled "non-responders". A second group consisting of 7 patients was judged as showing an increase in cerebral perfusion at follow-up compared to baseline and an increase in MMSE scores. These were termed "responders". The group difference in MMSE score change was significant (Fisher's exact test: p < 0.008). Sensitivity (0.85) and specificity (1.0) and Receiver Operating Characteristic values (discriminability or d' = 3.12 and bias or beta = 4.6) indicated that direction of change in cerebral perfusion was a reasonable indicator of direction of change in MMSE scores. These results suggest that SPECT determined changes in cerebral perfusion may be useful in identification of DAT patients who are more likely to respond to centrally active agents such as tacrine.

Aged↗
PubMed1996

Geriatric pain. Pain perceptions in the old.

Pain is likely to be a different problem in the old-old and the frail elderly compared to the young-old. Little attention has been paid to date to the impact of pain on quality of life in dementia patients, in postfracture patients, or in nondemented nursing home residents. It is likely that pain is a major source of depression and suffering in these individuals. Although currently available pain assessment tools are appropriate for the young-old, their usefulness in the old-old has not yet been evaluated. Additional pain assessment tools are needed for uncommunicative patients. The effectiveness of pain relief treatments in such patients cannot be evaluated without appropriate assessment. Such assessment may depend upon well-developed behavioral and observational techniques, particularly in individuals with later-life dementias such as dementia of the Alzheimer's type-a condition responsible for in excess of 60% of nursing home residents.

Aged↗
PubMed1995

Pain-related limitation in activities of daily living in patients with chronic orofacial pain: psychometric properties of a disability index.

Pain-related limitations in activities of daily living are presented for 272 patients reporting orofacial pain of the temporomandibular region using the seven-item Pain Disability Index. Results showed that the factor structure for orofacial pain patients differed little from the factor structure for outpatients visiting chronic pain clinic settings. Analysis of pain diagnostic subgroups showed that patients suffering myogenous complaints had higher scores for four of seven daily-living activities that involved pain-related limitations than patients suffering discal disorders. The factor analytical findings indicated that these patients share common pain-related limitations in activities of daily living. These findings are also consistent with previous results indicating greater pain in orofacial pain patients diagnosed with pain complaints primarily myogenous in origin than in pain patients having discal disorders.

Activities of Daily Living↗
PubMed1992

Interexaminer comparison of bone scintigraphy and panoramic radiography of temporomandibular joints: correlation with signs and symptoms.

Panoramic radiographs of the temporomandibular joints of patients with orofacial pain were examined for evidence of pathology by three different groups of four dental specialists and by a group of four general dentists. Bone scans of the same joints were used as the "gold standard" for identification of disorder and indicated a low rate of correct readings by the four professional groups. When the symptomatic side of the complaint was used as the gold standard, there was no statistically significant association with the bone scan observations. Comparative analysis of other patient symptoms showed little agreement with panoramic radiographs and scintigraphs. Reliability estimates may be highly variable, even among clinical experts. These results show that neither radiologic technique would be definitive for diagnosis of TM disorders.

Adolescent↗
PubMed1991

Efficacy of bladder training in older women with urinary incontinence.

The efficacy of bladder training was evaluated in a randomized clinical trial involving 123 noninstitutionalized women 55 years and older with urinary incontinence. Subjects were urodynamically categorized as those with urethral sphincteric incompetence (N = 88) and those with detrusor instability with or without concomitant sphincteric incompetence (N = 35). Bladder training reduced the number of incontinent episodes by 57%; the effect was similar for both urodynamic diagnostic groups. The quantity of fluid loss was reduced by 54%. This was greater for patients with detrusor instability than for those without it. Diurnal and nocturnal voluntary micturitions were also reduced. The effect on nocturnal micturition, however, was not observed in subjects with unstable detrusor function. It is recommended that bladder training be considered as an initial step in treatment of women with urinary incontinence. Provided prior comprehensive clinical evaluation is done, it can be prescribed without the need for urodynamic characterization.

Aged↗
PubMed1991

Symptom report in orofacial pain patients: relation to chronic pain, experimental pain, illness behavior, and personality.

A study was conducted to determine symptom report patterns in a heterogenous population of orofacial pain patients and to evaluate how symptom patterns relate to various dimensions of the human pain experience. Results indicated that symptoms frequently associated with chronic orofacial pain disorders can be described by four indices related to the temporomandibular joint (TMJ) and its movement; discomfort of and parafunctional activities related to the masticatory muscles; interference of pain with activities of daily living; and presence of orofacial pain unrelated to myogeneous or arthrogenous TMJ disorders. Of these four symptom indices, only the pain interference (symptom) index was related to clinical pain and illness behavior. None was related to personality. Two of the indices were influenced by diagnosis. Biomechanical symptoms and parafunctional activities appear to be insignificantly related to perceived pain intensity, pain responsiveness, illness behavior, or personality, but are related to diagnosis. The results indicated that relatively simple symptom checklists have potential utility in screening orofacial pain patients and in evaluation of treatment outcome.

Adolescent↗
PubMed1990

An evaluation of sensory changes and pain relief in trigeminal neuralgia following intracranial microvascular decompression and/or trigeminal glycerol rhizotomy.

Nineteen patients with trigeminal neuralgia were treated with either trigeminal ganglion glycerolysis or glycerolysis and intracranial microvascular decompression. All had a good degree of pain relief. Of those receiving glycerol alone (group A), 50% subjectively reported a mild reduction of fine tactile sensation. A similar response was reported by those treated with both glycerol and decompression (group B). The degree of sensory loss was so mild that thermal testing was useless as a discriminatory tool. The degree of sensory loss was not greater when both surgical procedures were performed than when the less-invasive trigeminal ganglion glycerolysis alone was used.

Aged↗
PubMed1988

Rate of forgetting in mild Alzheimer's-type dementia.

Patients with mild dementia of the Alzheimer's type (DAT) and matched controls were examined for rate of forgetting line drawings of common objects. DAT patients demonstrated rapid forgetting in the first 10 min after learning to criterion. This finding is discussed with respect to memory consolidation and neuropathologic changes in dementia of the Alzheimer's type.

Aged↗
PubMed1988

The urinary diary in evaluation of incontinent women: a test-retest analysis.

This study investigated the use of a one-week urinary diary in the evaluation of incontinent women. The sample consisted of 50 community-dwelling women, ages 55 years and older, ambulatory, and mentally intact, who were volunteers in a clinical trial on behavioral management for urinary incontinence. All subjects kept a urinary diary for two consecutive weeks. An analysis of the immediate (one-week) test-retest variability and correlations on weekly diurnal micturition frequency, nocturnal micturition frequency, and urinary incontinent episodes were performed in subjects with sphincteric incompetence alone (N = 34) and in those with detrusor instability with or without concomitant sphincteric incompetence (N = 16). In addition, information obtained on history was compared with that obtained from the diary. Diurnal micturition frequency, nocturnal micturition frequency, and number of incontinent episodes were highly reproducible and did not differ by urodynamic diagnosis. Test-retest correlations were highest with diurnal micturition frequency and incontinent episodes. Lower correlations were observed with nocturnal micturition frequency, with a significant difference observed between diagnostic groups. Although modest, significant relationships between data collected by history and diary were observed in the overall sample, but there were significant differences between diagnostic groups. The results indicate that a one-week diary is a reliable method for assessing the frequency of voluntary micturitions and involuntary episodes of urine loss.

Aged↗