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PubMed2003

Induction of non-painful and painful intestinal sensations by hypertonic saline: a new human experimental model.

BACKGROUND AND AIMS: To develop a pain model for chemical stimulation of the human gut. METHODS: In a double-blind experimental study 10 subjects with a previously performed sigmoidostomy were randomised to receive injections with either isotonic or hypertonic saline in the colonic mucosa. In the hypertonic experimental arm, 0.1 ml of 0.9%, 2%, 4%, and 6% and 0.2 ml of 2% and 4% saline were given. In the placebo arm, six 0.9% saline injections of the same quantities were given. In a separate experiment 0.8 ml 4% saline was infused into the mucosa by a pump over a period of 2min. The pain intensity was rated on a 0-10 visual analogue scale with 5 as the pain threshold. RESULTS: The hypertonic saline injections resulted in local as well as referred non-painful and painful sensations in 9 out of the 10 subjects. The evoked sensations were mostly described as a smarting sensation with an intensity of median 1 (range 0-5.6) for 0.1 ml 2% saline to median 2.9 (range 0-6.2) for 0.2 ml 4% saline. Seven subjects reported referred sensations to the abdominal skin. Continuous infusion of 4% saline resulted in a consistent sensory response in all subjects, with a median intensity of 4.1 (range 2.1-8.1). This sensory intensity was reproducible in 70% in a retest experiment after median 7 weeks. In the placebo arm a total of 70 isotonic saline injections only resulted in inconsistent, short-lasting non-painful sensations in three subjects. CONCLUSION: The model represents a safe method for direct chemical activation of the sensory endings in the human gut. The model may be used for pharmacological screening of analgesics and for basic investigations in patients suffering from gastrointestinal diseases.

Adult↗
PubMed2003

Music reduces sensation and distress of labor pain.

Labor pain is often severe, and analgesic medication may not be indicated. In this randomized controlled trial we examined the effects of music on sensation and distress of pain in Thai primiparous women during the active phase of labor. The gate control theory of pain was the theoretical framework for this study. Randomization with a computerized minimization program was used to assign women to a music group (n = 55) or a control group (n = 55). Women in the intervention group listened to soft music without lyrics for 3 hours starting early in the active phase of labor. Dual visual analog scales were used to measure sensation and distress of pain before starting the study and at three hourly posttests. While controlling for pretest scores, one-way repeated measures analysis of covariance indicated that those in the music group had significantly less sensation and distress of pain than did the control group (F (1, 107) = 18.69, p <.001, effect size =.15, and F (1, 107) = 14.87, p <.001, effect size =.12), respectively. Sensation and distress significantly increased across the 3 hours in both groups (p <.001), except for distress in the music group during the first hour. Distress was significantly lower than sensation in both groups (p <.05). In this controlled study, music--a mild to moderate strength intervention--consistently provided significant relief of severe pain across 3 hours of labor and delayed the increase of affective pain for 1 hour. Nurses can provide soft music to laboring women for greater pain relief during the active phase when contractions are strong and women suffer.

Adult↗
PubMed2001

Differential fear of cardiopulmonary sensations in emergency room noncardiac chest pain patients.

Fear of bodily sensations has received extensive attention in relation to panic disorder, and more recently, other types of anxiety pathology and chronic pain problems. Extending this work, the present study examined fear of bodily sensations and its underlying dimensions in emergency room patients with Noncardiac Chest Pain (NCCP; n = 63). We posited a "differential specificity" hypothesis, expecting that specific cardiopulmonary fears would be more strongly associated with NCCP symptoms relative to other bodily fears. As hypothesized, participants reported cardiopulmonary sensations as significantly more fear-provoking than numbness, dissociation, and gastrointestinal sensations. Additionally, regression analysis indicated that after accounting for theoretically relevant demographic variables and health status, cardiopulmonary fear was the best predictor of a composite index of cardiac complaints intensity, even after removing variance related to the absolute number of cardiac complaints. We discuss these findings in relation to the specific role for the fear of cardiopulmonary sensations in chest pain complaints, with implications for better understanding the underlying psychological processes involved in NCCP.

Chest Pain↗
PubMed2001

Fat digestion modulates gastrointestinal sensations induced by gastric distention and duodenal lipid in humans.

BACKGROUND AND AIMS: It is unclear whether fat digestion is required for the induction of gastrointestinal sensations and whether different fats have different effects. We investigated the effect of fat digestion and of medium-chain triglycerides (MCTs; C < 12) and long-chain triglycerides (LCTs; C > 16) on gastrointestinal sensations. METHODS: In a double-blind study, 15 healthy subjects were studied on 5 occasions during which LCT or MCT emulsions (2 kcal/min), with or without 120 mg tetrahydrolipstatin (THL, lipase inhibitor), or sucrose polyester (SPE, nondigestible fat) were infused intraduodenally in randomized order. After 30 minutes, the proximal stomach was distended in 1 mm Hg steps/min. Intensity of gastrointestinal sensations (on a 0-10 visual analog scale), plasma cholecystokinin (CCK) levels, and gastric volumes were assessed throughout. RESULTS: LCT and MCT increased gastric volume at baseline pressure compared with SPE, and LCT more than MCT. THL entirely abolished this effect (volumes [mL]: LCT, 213 +/- 19; LCT-THL, 39 +/- 3; MCT, 155 +/- 12; MCT-THL, 43 +/- 5; SPE, 44 +/- 5). Only LCT increased plasma CCK levels (pmol/L per 30 minutes: LCT, 21 +/- 2; LCT-THL, 9 +/- 1; MCT, 9 +/- 1; MCT-THL, 11 +/- 1; SPE, 9 +/- 1). During distentions, intragastric volumes were greater during infusion of LCT and MCT than during the respective THL conditions or SPE, but plasma CCK levels did not change. The intensity of sensations increased (hunger decreased) more with LCT than with MCT. During infusion of THL or SPE, the effects were smaller than during LCT or MCT. CONCLUSIONS: Fat digestion is required for the modulation of gastrointestinal sensations during gastric distention. The effects of fat depend on the fatty acid chain length and are not entirely explained by release of CCK.

Adult↗
PubMed2000

Comparison of nipple and areolar sensation after breast reduction by free nipple graft and inferior pedicle techniques.

Breast reduction with free nipple-areolar transplantation has traditionally been used for patients with gigantomastia. It is a widely held belief that there is little or no recovery of sensation in the nipple-areolar complex after this procedure. We set up a retrospective study to compare nipple-areolar sensation after free nipple grafting with that after breast reduction by the more commonly performed inferior pedicle technique. We reviewed 38 patients (17 free nipple grafts and 21 inferior pedicles) at least 1 year after breast reduction and measured the nipple and areolar pressure sensibility in each breast with Semmes-Weinstein monofilaments. We found some degree of recovery of sensation in all patients, with areolar sensation being similar in the two groups but nipple sensation being superior in the inferior pedicle group. In addition, we assessed the erectile function of the nipples in each group.

Adult↗
PubMed2002

Cortical representation of first and second pain sensation in humans.

Single painful stimuli evoke two successive and qualitatively distinct sensations referred to as first and second pain sensation. Peripherally, the neural basis of this phenomenon is a dual pathway for pain with Adelta and C fibers mediating first and second pain, respectively. Yet, the differential cortical correlates of both sensations are largely unknown. We therefore used magnetoencephalography to record and directly compare first and second pain-related cortical responses to cutaneous laser stimuli in humans. Our results show that brief painful stimuli evoke sustained cortical activity corresponding to sustained pain perception comprising early first pain-related and late second pain-related components. Cortical activity was located in primary (S1) and secondary (S2) somatosensory cortices and anterior cingulate cortex. Time courses of activations disclosed that first pain was particularly related to activation of S1 whereas second pain was closely related to anterior cingulate cortex activation. Both sensations were associated with S2 activation. These results correspond to the different perceptual characteristics of both sensations and probably reflect different biological functions of first and second pain. First pain signals threat and provides precise sensory information for an immediate withdrawal, whereas second pain attracts longer-lasting attention and motivates behavioral responses to limit further injury and optimize recovery.

Adult↗
PubMed2005

Paradoxical sensation of nasal airflow in patients with common cold. Are we measuring the correct modality?

CONCLUSIONS: A paradoxical relationship between objective and subjective measures of nasal obstruction exists in participants not exposed to any treatment. The sensation of nasal obstruction may be due to the amalgamation of many different nasal sensations. Improved methods for measuring nasal sensations are required to further investigate the relationship between objective and subjective measures of nasal obstruction. OBJECTIVES: In a recent study it was shown that the subjective sensation of nasal patency increased as the nasal passages became objectively more obstructed in patients who received a placebo compared to those who received an oral decongestant. This paradoxical response may be explained as a placebo effect, i.e. patients who received a placebo may have expected to feel less obstructed. The aim of the present study was to investigate this interesting paradox by determining objective and subjective measures of nasal obstruction over time in participants not exposed to any treatment. MATERIAL AND METHODS: A total of 60 healthy participants with common cold were recruited. Objective and subjective measures of nasal obstruction were recorded at baseline and at 1 and 2 h using posterior rhinomanometry and a visual analogue scale. RESULTS: Objective measures demonstrated an increase in nasal obstruction over time for both nasal passages considered together and for individual nasal passages. Subjective measures demonstrated a sensation of decreased nasal obstruction over time for both nasal passages considered together and for individual nasal passages.

Adult↗
PubMedDate not supplied

Sensation seeking and alcohol use by college students: examining multiple pathways of effects.

This study tests the proposition that peer influence mediates the effect of sensation seeking, a personality trait, on alcohol use among college students. Cross-sectional data to test this proposition were collected from a representative sample of college students at a large public northeastern university (N = 427). Results of hierarchical regression analyses showed that, as hypothesized, sensation seeking influenced personal alcohol use both directly and indirectly, through its impact on students' frequency of association with alcohol-using peers and the size of their drinking norm misperception. The findings suggest that interventions that seek to limit the frequency in which high sensation seekers associate with peers whose alcohol use is extreme or, alternatively, seek to facilitate social interactions of high sensation seekers with normative peers, may supplement efforts to influence sensation seekers' alcohol and other drug use through tailored mass media advertisements.

Adolescent↗
PubMed2001

Drug use prevention for the high sensation seeker: the role of alternative activities.

Research demonstrating links between sensation-seeking and drug use, and sensation-seeking and participation in leisure activities suggests designing substance misuse prevention projects that encourage substituting alternative activities for drug use. The current study uses factor analysis and discriminant analysis to provide comprehensive information on the kinds of activities high-sensation seekers participate in. Factor analysis of activity participation indicates an eight factor solution. Discriminant analysis of factor scores indicates that high-sensation seekers can be discriminated from low-sensation seekers on the basis of two factors, active-adventure and conflict-combat. Implications for prevention program design are discussed.

Adolescent↗
PubMed1997

Oral irritant effects of nicotine: psychophysical evidence for decreased sensation following repeated application and lack of cross-desensitization to capsaicin.

Psychophysical methods were used to assess changes in the intensity of irritant sensations elicited by repeated application of capsaicin and nicotine delivered unilaterally to the tongue of human subjects. Whereas capsaicin (0.5 or 3 p.p.m.; repeated at 1 min intervals over 10 min) evoked progressively stronger ratings of irritation (sensitization), there was a significant decrement in irritation ratings (desensitization) to repeated application of nicotine (0.1%). A two-alternative forced-choice (2-AFC) procedure was additionally used to test for self- and cross-desensitization. After the subjects had received either repeated capsaicin or nicotine, a rest period ensued followed by the 2-AFC procedure. Either capsaicin or nicotine was delivered bilaterally to the tongue and subjects were asked to choose which side yielded a stronger sensation. Following capsaicin pretreatment, subjects reported that capsaicin evoked a stronger sensation on the previously untreated side (capsaicin self-desensitization). Similar self-desensitization was observed with nicotine. Furthermore, nicotine evoked a significantly weaker sensation on the side of the tongue pretreated with capsaicin (cross-desensitization). In contrast, capsaicin did not consistently evoke a weaker sensation on the nicotine-pretreated side, indicating an absence of cross-desensitization. These results are discussed in terms of physiological mechanisms that might underlie the contrasting sensory effects of nicotine versus capsaicin.

Adolescent↗
PubMed2005

Clean intermittent catheterization in genitally sensate children: patient experience and health related quality of life.

PURPOSE: Clean intermittent catheterization (CIC) has proven successful for bladder emptying in children without genital sensation with success rates of 94% to 100% in select groups. A subset of the pediatric population requires CIC for bladder dysfunction, yet has normal genital sensation. This study was designed to assess our experience with CIC in genitally sensate children and the health related (HR) quality of life (QOL) for them and their families. MATERIALS AND METHODS: A multimodality questionnaire on the usage, learning curve and degree of difficulty of CIC was developed. The PedsQLtrade mark 4.0 Generic Core Scales, a reliable, validated HRQOL survey developed for pediatric patients with chronic disease, was used to assess patient and parental QOL. Children in our practice with normal genital sensation and bladder dysfunction requiring CIC were contacted to complete these questionnaires. When possible, QOL data were collected from the patient (self-report) and one or both of the parents (parent-proxy report). RESULTS: Data for 12 males and 8 females were collected, including 30 QOL questionnaires (12 self, 18 proxy). Of the patients 80% were able to learn CIC technique in 1 clinic visit with the help of a nurse. On a 10-point scale (1-not difficult, 10-very difficult) the mean degree of difficulty for learning the CIC technique was 3.25 for males and 4.00 for females (3.55 overall). On a 10-point scale (1-uncomfortable, 10-very comfortable) mean comfort level with the CIC technique was 9.12 for females and 9.46 for males (9.33 overall). On the PedsQL 100-point scale mean QOL was 83.24 for the self-report compared to 81.78 for the parent proxy report. The QOL for normal children has previously been shown as 83 (self) to 87.61 (proxy). CONCLUSIONS: CIC was an easy technique for most sensate children to learn in 1 visit and master in a short time. Overall comfort with the technique was excellent and few problems were encountered. Their HRQOL was comparable to that of normal children.

Adolescent↗
PubMedDate not supplied

Intravenous injection of high and medium concentrations of computed tomography contrast media and related heat sensation, local pain, and adverse reactions.

OBJECTIVES: To evaluate the incidence of acute adverse reactions and degrees of heat sensation and local pain after intravenous injection of high and medium concentrations of iodinated contrast medium for computed tomography (CT). METHODS: A prospective study was performed involving 729 patients who underwent contrast CT scans. High-concentration (370 mgI/mL) and medium-concentration (300 mgI/mL) iodinated contrast medium was assigned to 342 patients (group H, aged 20-90 years, mean = 59.8 years) and to 387 patients (group M, aged 20-95 years, mean = 61.7 years), respectively. An injection rate of contrast medium (1, 2, or 4 mL/s) at a base volume of 2 mL/kg of body weight was selected according to the protocols for the evaluated diseases and regions. Each patient was assessed for heat sensation and local pain at the injection site using a visual analog scale (ranging from none for 0 to severe for 10). Acute adverse reactions were recorded when they occurred. RESULTS: There were no significant differences in patient background factors, including age, sex, history of prior adverse reactions, and allergies, between the 2 groups. The score for heat sensation was significantly higher in group H than in group M (4.46 +/- 2.44 vs. 3.44 +/- 2.45; P < 0.0001 for heat sensation). The data did not show a higher incidence of adverse reactions in group H than in group M (5 [1.46%] of 342 patients vs. 2 [0.52%] of 387 patients; P = 0.26) or a higher score for local pain in group H than in group M (0.98 +/- 1.70 vs. 0.88 +/- 1.49; P = 0.66), respectively. CONCLUSIONS: High and medium concentrations of iodinated contrast medium can be used for CT study with comparable safety profiles even though heat sensation produced by the high-concentration CM is greater than that produced by the medium-concentration CM.

Adult↗
PubMed1988

Developing a sensation information message for femoral arteriography.

Sensation information is proposed as a way of decreasing the patient's distress during a threatening health care event. A first step in developing a sensation information message is to determine the content of the message. This study, using a systematic theory-based methodology, was conducted to describe and validate the common physical sensations experienced by patients undergoing the diagnostic procedure of femoral arteriography. (A conceptual framework based on how an individual perceives or senses a situation was used.) A three-stage survey design was used including: (1) tool development following observation of the procedure and pilot-testing of the interview schedule, (2) interview of patients who had undergone femoral arteriography about the sensations experienced during the procedure, and (3) validation of the responses. Twenty-one steps in the femoral arteriography procedure of which patients were aware were identified. Nine 'feeling' sensations commonly experienced during the procedure and the sights and sounds associated with the procedure were determined. The sequencing and duration of procedure steps were observed and the environment in which the procedure was performed was described.

Adult↗
PubMed2005

Effect of acute acoustic stress on anorectal function sensation in healthy human.

Little is known about the effects of acute acoustic stress on anorectal function. To determine the effects of acute acoustic stress on anorectal function and sensation in healthy volunteers. Ten healthy volunteers (7 M, 3 F, mean age 34 +/- 3 years) underwent anorectal manometry, testing of rectal compliance and sensation using a barostat with and without acute noise stress on separate days. Rectal perception was assessed using an ascending method of limits protocol and a 5-point Likert scale. Arousal and anxiety status were evaluated using a visual analogue scale. Acoustic stress significantly increased anxiety score (P < 0.05). Rectal compliance was significantly decreased with acoustic stress compared with control P (P < 0.000001). In addition, less intraballoon volume was needed to induce the sensation of severe urgency with acoustic stress (P < 0.05). Acoustic stress had no effect on hemodynamic parameters, anal sphincter pressure, threshold for first sensation, sensation of stool, or pain. Acute acoustic stimulation increased anxiety scores, decreased rectal compliance, and enhanced perception of severe urgency to balloon distention but did not affect anal sphincter pressure in healthy volunteers. These results may offer insight into the pathogenesis of stress-in-induced diarrhoea and faecal urgency.

Acoustic Stimulation↗
PubMed2004

Oesophageal wall stretch: the stimulus for distension induced oesophageal sensation.

Recently, we reported a novel ultrasound technique to assess the biomechanical properties of the oesophagus in humans. To investigate whether the oesophageal sensation induced by oesophageal distension correlates with wall tension, wall stress or wall strain, we studied 20 healthy subjects using a manometry catheter equipped with a high-compliance bag and a high-frequency intraluminal ultrasound probe. Oesophageal distensions were performed by injecting 1-20 mL water into the bag for 20-30 s. Subjects scored the nature (heartburn or chest pain) and severity of sensation in response to distension, before and after atropine (15 microg kg(-1), i.v.). Ultrasound images of oesophagus were digitized and measurements were made to calculate oesophageal wall tension, stress and strain during distensions. Subjects experienced mostly heartburn, not chest pain, in response to oesophageal distension. Oesophageal wall strain and bag pressures correlated best with the oesophageal sensation. Atropine reduced bag pressure but did not affect the distension induced heartburn and chest pain. We conclude that heartburn is a common sensation in response to oesophageal distension in normal subjects. A strong correlation between wall strain and oesophageal sensation suggests that the wall stretch is the stimulus for nociceptive mechanoreceptors of the oesophagus.

Adult↗
PubMed2006

Sensation and distribution of stress and deformation in the human oesophagus.

Evaluation of the distribution of stresses and strains in relation to distension-induced sensation in the human oesophagus is valuable for understanding oesophageal biomechanics and mechano-sensation. In 12 healthy volunteers a specially designed oesophageal bag containing an endoscopic ultrasound probe was inflated to the moderate pain level. Ultrasound images, bag pressure and perceived sensation were recorded before and after pharmacological relaxation of the smooth muscle with butylscopolamine. The oesophagus was assumed to be circular and thick-walled. Distension induced a tensile circumferential stretch, radial compression and longitudinal shortening. Both circumferential strain and stress were highest at the mucosal surface and decreased throughout the wall. The stiffness increased throughout the wall and was highest at the outer surface (P < 0.001). The decrease in stiffness in response to butylscopolamine was non-significant. The infused volume (P = 0.012) and circumferential stress (P < 0.001) were most closely associated with the distension-induced sensation (adjusted R2 = 0.88). The perceived sensation was highly individual but was unaffected by butylscopolamine (P > 0.08). The present study provides a method for computation of the stress-strain distribution throughout the wall and the mechano-sensory interaction in the human oesophagus. In the future, this may be useful for understanding of mechanoreceptor responses and generation of symptoms in visceral organs in health and in disease.

Adult↗
PubMed1991

Cold and warm cutaneous sensation in diabetic patients.

The assessment of cutaneous thresholds for thermal sensation is now recognized as a valuable method to detect small nerve fibre function in diabetes. Methods commonly used do not allow separate measurements of warm and cold perception. However, there is evidence that the fibre subtypes which signal cold and warm sensation are different (A-delta-fibres and C-fibres, respectively). To investigate if diabetes affects cold and warm sensation equally, thresholds were assessed separately in 30 diabetic patients (age 47.9 +/- 15.1 (+/- SD) years; duration of diabetes, 19.1 +/- 13.3 years). Comparisons were made with 71 non-diabetic control subjects (age 59.7 +/- 22.1 years). Thermal discrimination thresholds for cold and warm sensation were determined for the left foot with a two-alternative forced choice method. In both diabetic patients and in the control group cooling thresholds were smaller than warming thresholds. In diabetic patients log thermal discrimination thresholds for warmth increased 0.1 per decade (p less than 0.001), a relationship comparable to that seen in non-diabetic patients. There was no relationship between cooling thresholds and age in diabetic patients despite a significant (p less than 0.001) deterioration with age in control subjects. This difference in the influence of age on cold sensitivity was significant (p less than 0.03). Both warm and cold sensation were not related to the duration of diabetes. We conclude that assessment of warm threshold is preferred for the detection of minor disturbances of small nerve fibre function in diabetes.

Adult↗
PubMed2001

Effects of an alpha(2)-adrenergic agonist on gastrointestinal transit, colonic motility, and sensation in humans.

To characterize alpha(2)-adrenergic control of motor and sensory functions of gastrointestinal tract and colon, we studied dose-related effects of clonidine (placebo or up to 0.3 mg po) by random assignment in 55 healthy humans. Gastrointestinal transit was measured in all subjects; in 35, we assessed colonic compliance, tone, and sensations of gas and pain during phasic distensions. Clonidine did not significantly alter gastrointestinal or colonic transit, but it increased colonic compliance and reduced fasting tone without altering colonic response to a meal. Clonidine significantly reduced aggregate sensation to distensions overall and had significant linear dose-related sensory effects at 8- and 24-mmHg distensions. Effect on pain (including dose-response relationship) was due to 0.3-mg dose for distensions at 24 mmHg. We confirmed that clonidine relaxes fasting colonic tone and reduces sensation of pain. In this study, gut transit was not altered by clonidine, and novel dose-response characteristics and clonidine's effect on gas sensation are provided. Doses as low as 0.05 mg may be effective and potentially useful in reducing colonic tone and gas sensation.

Adrenergic alpha-Agonists↗