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PubMed2005

Elevated pain threshold in eating disorders: physiological and psychological factors.

Several studies have found decreased pain sensitivity in patients with eating disorders but it is unclear what physiological and psychological factors are associated with this abnormality. In the present investigation, thermal pain threshold latency, somatoform dissociation, body image disturbance and physiological indices of autonomic neural system activity were measured in 39 female patients with eating disorders (21 with anorexia nervosa and 18 with bulimia nervosa) and 17 healthy women. Pain threshold was elevated in patients with eating disorders, especially those with binge-purging symptomatology. A regression analysis indicated that increased pain threshold is moderately associated with decreased peripheral skin temperature and weakly associated with lack of familiarity with one's own body. However, the between group differences in pain perception remained significant after controlling for peripheral skin temperature. Hence, elevation of pain threshold in eating disorders is a replicable finding, which is not explicable by peripheral indices of autonomic system activity or by somatoform dissociation. In future research it may be evaluated as a potential marker of broader phenotype of decreased interoceptive awareness, which may be associated with vulnerability to the development of eating disorders.

Adult↗
PubMed2005

Pain thresholds in daily transformed migraine versus episodic migraine headache patients.

OBJECTIVE: The objective of this study was to test whether pain thresholds of patients with episodic migraine (EM) are significantly different from transformed migraine (TM) patients as measured by Quantitative Sensory Testing (QST) and Semmes-Weinstein Monofilaments (SW). BACKGROUND: Although there are many theories, none have undeniably proven why many TM patients are refractory to triptans and other gold standard medications. The hypothesis was that baseline pain thresholds of TM patients are lower than EM patients. METHODS: Episodic (n = 40) and Transformed (n = 41) migraineurs with and without aura were examined with QST and SW over eight locations (bilateral ophthalmic, maxillary, C4/posterior neck, and forearm). All patients completed two visits, baseline and severe migraine. RESULTS: TM patients have lower pain thresholds, than EM patients, as measured on QST and SW testing. A total of 81 out of 129 patients completed both parts of the study at baseline and severe migraine. There were significant differences (P < .05) between EM and TM groups at baseline on maxillary, neck (EM = 45.91 degrees C and TM = 42.94 degrees C), and arm. CONCLUSIONS: TM patients, clinically known to report skin hypersensitivity during migraine, were found to have lower pain thresholds than EM patients, both with severe migraine, and at baseline, measured by QST and SW mechanical testing. As with Burstein's work in EM patients with lowered pain thresholds during their acute migraine, central sensitization may be the explanation for non-responsiveness to triptans in a high proportion of TM patients. The difference in pain threshold at the neck location was such a strikingly frequent difference between EM and TM patients, that this indicates the need for future research to clarify the directional relationship and the relative importance of muscular versus peripheral versus central hypersensitivity in the determination of allodynia.

Adult↗
PubMed1998

Change in pain threshold by meperidine, naproxen sodium, and acetaminophen as determined by electric pulp testing.

The purpose of this study was to compare changes in pain threshold caused by meperidine, naproxen sodium, acetaminophen, and placebo. The change in pain threshold was measured by electric pulp testing. Acetaminophen elevated the pain threshold statistically significantly. Clinically, however, the superiority of acetaminophen is questionable. No elevation of the pain threshold occurred with narcotic drugs or with nonsteroidal anti-inflammatory drugs: our research shows that the electric pulp tests of patients who have taken these drugs preoperatively will have results similar to those of patients who have taken no drugs. We question the philosophy of administering these drugs for change in pain threshold at the levels used here preoperatively.

Acetaminophen↗
PubMedDate not supplied

Measuring the pain threshold and tolerance using electrical stimulation in patients with Type II diabetes mellitus.

OBJECTIVE: The aim of the study was to assess pain threshold and tolerance in diabetics with/without neuropathy and to compare that in with healthy controls. METHODS: In this cross-sectional and comparative study, 79 diabetics (57 without neuropathy and 22 with neuropathy) and 32 healthy controls (63 women and 48 men) with a mean age of 48.11+/-7.52 years were studied. Seventy-nine diabetics, aged 33 to 74, who met inclusion criteria were evaluated using electrical stimulation (faradic current) to assess pain threshold and tolerance on upper and lower extremities and were compared with healthy controls. They also were evaluated using Michigan Neuropathy Screening Index (MNSI), 5.07 mmg Semmes Weinstein Monofilament, and visual analog scale (VAS). Pain threshold and tolerance were measured experimentally. RESULTS: Of all participants, 32.4% had pain complain. Eighteen diabetics without neuropathy (31.6%) and 9 diabetics with neuropathy (40.9%) reported pain. The result of upper and lower extremities' pain threshold and tolerance showed that there was a significant difference between diabetics and healthy participants (P<.05). Diabetics with neuropathy had the highest pain threshold and tolerance. The impairments in light touch sense were highest in diabetics with neuropathy (P<.05). CONCLUSION: Measuring pain threshold and tolerance of diabetic patients using electrical stimulation is an easy, noninvasive, cheap and repeatable method and can be used for defining the onset of diabetic neuropathy and controlling prognosis at early stage.

Adult↗
PubMed1991

Pain threshold changes by skin vibratory stimulation in healthy subjects.

The purpose of this research is to evaluate the changes of cutaneous pain threshold induced by vibratory stimuli applied to the skin. The pain threshold was tested by means of electrical stimuli using the method of limits. Both vibratory stimuli (conditioning stimuli) and electrical stimuli (test stimuli) were driven by a computer. The experiments were carried out on the dorsal surface of the second phalanx of the index finger in the dominant hand of 34 healthy subjects (18 males and 16 females). The conditioning stimuli were sinusoidal waves (250 microm peak to peak) at a rate of 30 and 300 Hz. During the experiment (6 min of vibration and 9 min after) the cutaneous temperature of the stimulated area was recorded. Both vibratory rates induced significant increases of the pain threshold but the 30 Hz vibrations were the more effective. After stimulation the pain threshold lowered to a steady value which was higher than before the start of vibrations. Such threshold changes showed no correlation throughout the experiment with changes in skin temperature. We therefore advance the hypothesis that the main factors which modulate the pain threshold are neuronal connections between tactile and pain pathways.

Adult↗
PubMed1988

Effects of diflunisal on cutaneous sensory and pain thresholds.

The analgesic activity of diflunisal was evaluated through the measurement of cutaneous sensory and pain thresholds after electrical stimulation. Twelve healthy volunteers were examined at baseline and five hourly intervals after oral administration of 500 mg and 1 gm of diflunisal. The results showed that the sensory threshold was not modified by diflunisal, but that the pain threshold was significantly increased two and three hours after 500 mg of diflunisal and one, two, and three hours after 1 gm of diflunisal. At two hours the pain threshold was significantly higher after 1 gm than after 500 mg of diflunisal. It is concluded that diflunisal produces an actual increase of the pain threshold in healthy human subjects and that the amplitude, latency, and duration of its effect are dose related.

Administration, Oral↗
PubMed1997

Chronobiology of nasal chemosensitivity: do odor or trigeminal pain thresholds follow a circadian rhythm?

Odor and trigeminal pain thresholds were studied four times each at 24:00, 04:00, 08:00, 12:00, 16:00 and 20:00 h in randomized order on different days in five healthy male volunteers. No circadian rhythm of olfactory or trigeminal thresholds were observed. However, the variability of odor, but not pain thresholds, increased from 04:00 h (thresholds between 0.4 and 1.2 p.p.m.) to 16:00 h (thresholds between 0.1 and 2 p.p.m.). It is hypothesized that environmental influences contribute to this increase in variance.

Adult↗
PubMed1992

Pain threshold in diabetic rats: effects of good versus poor diabetic control.

Pain threshold was assessed via tail flick latency in streptozotocin diabetic rats following a 1-month period of either good or poor diabetic control. Additionally, tail flick latencies were determined under test conditions of euglycemia (60-120 mg/dl) and hyperglycemia (greater than 250 mg/dl) for both groups of diabetic rats. Conditions of hyperglycemia resulted in a significant decrease in tail flick latency in diabetic animals maintained in good as well as poor diabetic control. However, tail flick latencies for animals in the good but not in the poor diabetic control group increased when animals were euglycemic at the time of testing. Animals in the poor diabetic control group continued to have reduced tail flick latencies even after acute normalization of blood glucose levels. These results suggest that chronic states of hyperglycemia that attend prolonged periods of poor diabetic management may lead to persistent alterations in pain threshold. In contrast, the reduced pain threshold of rats maintained in good diabetic control was reversed by a normalization of blood glucose levels. These findings provide evidence for two patterns of hyperalgesia in diabetic rats: (1) a readily reversible form in well-maintained diabetic rats that is altered by reducing circulating blood glucose levels to control values and (2) a more persistent form found in poorly controlled diabetic rats that does not respond to acute normalization of blood glucose.

Animals↗
PubMed2004

Pain thresholds during and after treatment of severe depression with electroconvulsive therapy.

Pain and depression are often associated suggesting that both conditions share a common neurobiological mechanism, which modulate emotional function and processing of noxious information. Pain thresholds are hypothesized to be altered in depressed patients and normalized with the amelioration of depression. The purpose of this study was therefore to determine pain thresholds in patients during and after treatment with electroconvulsive therapy (ECT) of severe depression and in healthy controls. Seventeen depressed patients (Hamilton depression score > 18) and an age and gender matched control group of same size participated in the study. Pain detection and tolerance thresholds to pressure and pain tolerance thresholds to the Cold Pressor Test by exposure to ice-water was measured twice in depressed patients during and after ECT and twice in controls with a similar time interval. While ECT significantly improved Hamilton depression score (from mean 23.9 (SD:5) to mean 12.5 (SD:5.7)) there was no significant change in pain thresholds during and after ECT in the patient group. However, depressed patients had significantly lower pain tolerance in the Cold Pressor Test on both examinations and on pressure pain tolerance on the second examination day than their corresponding control subjects. The differential effect of ECT on depression score and pain processing indicate that mood and noxious processing are not medicated directly by the same systems but that a complex relationship between pain and depression exists.

Adolescent↗
PubMed2005

Effect of long-term neck muscle training on pressure pain threshold: a randomized controlled trial.

Muscle tenderness has been measured in several studies to evaluate effectiveness of treatment methods, but only short-term results have been reported so far. The aim of the present study was to evaluate the long-term effects of two different muscle training methods on the pressure pain threshold of neck muscles in women with neck pain. Altogether 180 woman with chronic, non-specific neck pain were randomized into three groups: neck muscle endurance training, neck muscle strength training and control groups. The main outcome measures included pressure pain threshold measurement at six muscle sites and on the sternum. Neck pain was assessed by a visual analogue scale (VAS). At the 12-month follow-up statistically significantly higher pressure pain threshold values were obtained in both training groups at all muscle sites compared to the baseline, while no significant change occurred in the controls. Significantly higher changes in pressure pain threshold were detected at all six sites in the strength training group and at four out of six sites in the endurance training group compared to the control group. This is the first study to show an increase in pressure pain thresholds as a result of long-term muscle training. A decrease in neck pain was associated with reduced pressure pain sensitivity in neck muscles, showing that the pressure pain threshold may be a useful outcome measure of the effectiveness of neck muscle rehabilitation.

Adult↗
PubMed1993

Pain thresholds during standardized psychological stress in relation to perceived psychosocial work situation. Stockholm Music I Study Group.

The hypothesis that perceived psychosocial work situation is associated with pain threshold was tested on a sample of 103 men and women aged 19-65 yr in Stockholm. Half of the studied sample was a random sample of men (N = 26) and women (N = 31), while the remaining subjects were medical secretaries (women, N = 28) and furniture movers (N = 31). Pain thresholds were measured by means of an algometer before, during and after a standardized colour word test. The measurements were made on six different points in the neck and shoulder region. Before psychological stress in the laboratory, perceived psychological demands were significantly associated with pain threshold--the higher the demands the higher the pain threshold. During stress those who reported low decision latitude and high degree of sleep disturbance were shown to have a low pain threshold. The findings are consistent with the hypothesis that subjects with high demand levels have an elevated pain threshold when they are not under excessive psychological stress. During psychological stress, on the other hand, those with low decision latitude are more pain sensitive than others, and this is aggravated in those who also report a high degree of sleep disturbance.

Adaptation, Psychological↗
PubMed2004

Denture wearing and strong bite force reduce pressure pain threshold of edentulous oral mucosa.

Pain in denture supporting tissue is one of the most common and critical problems affecting function and treatment outcomes in complete denture prosthetics. The objective of this study was to investigate the effects of denture wearing and bite force on the pressure pain threshold (PPT) of edentulous oral mucosa. PPT was measured in denture and non-denture-wearing patients by using an electronic-controlled pressure algometer. Bite force was measured in denture-wearing patients by using a pressure-detecting sheet. The mid palate showed 200-300% higher PPT than the buccal alveolar mucosa (two-way anova, P < 0.0001). Denture-wearing patients exhibited 40% lower palatal PPT than non-denture-wearing patients. In denture-wearing patients, PPT in the selected areas of the oral mucosa was negatively correlated with bite force. Denture wearing may reduce PPT in selected areas of the edentulous oral mucosa, and the PPT reduction may be associated with mechanical stress on the mucosa generated by bite force.

Adult↗
PubMed1988

Effects of heterotopic ischemic pain on muscular pain threshold and blink reflex in humans.

Ischemic pain was induced in the left arm of 6 healthy volunteers using a modification of the submaximal effort tourniquet test. Its effects on both muscular pain threshold (determined in the vastus medialis muscle by means of electrical stimulation) and on the 2nd component of the blink reflex (R2) were investigated in the contralateral body side. Muscular pain threshold increased (peak value during ischemic pain) and maintained significantly higher values for 60 min. R2 response decreased while its latency increased; these variations appeared during ischemic pain and reached a maximum soon after the end of ischemia, still remaining significant for 15 min. The results support the suggestion that the analgesic effects of heterotopic noxious stimulation in humans are subserved by supraspinal inhibitory mechanisms.

Adult↗
PubMed1996

Mechanisms of spontaneous tension-type headaches: an analysis of tenderness, pain thresholds and EMG.

Pericranial muscle tenderness, EMG levels and thermal and mechanical pain thresholds were studied in 28 patients with tension-type headache and in 30 healthy controls. Each patient was studied during as well as outside a spontaneous episode of tension-type headache. Outside of headache, muscle tenderness and EMG levels were significantly increased compared to values in controls subjects, while mechanical and thermal pain thresholds were largely normal. During headache, muscle tenderness evaluated by blinded manual palpation increased significantly, while pressure pain thresholds remained normal and pressure pain tolerances decreased. Thermal pain detection and tolerance threshold decreased significantly in the temporal region, but remained normal in the hand. EMG levels were unchanged during headache. It is concluded that one of the primary sources of pain in tension-type headache may be a local and reversible sensitization of nociceptors in the pericranial muscles. In addition, a segmental central sensitization may contribute to the pain in frequent sufferers of tension-type headache.

Adult↗
PubMed1975

Increase of pain threshold as a function of conditionsing electrical stimulation. An experimental study with application to electro-acupuncture for pain suppression.

Previous studies have shown that 2 Hz electrical conditioning stimulation of hands and cheeks increased the tooth pain threshold. In the present study the relation between strength of conditioning stimulation and amplitude of pain threshold increase is elucidated. Intense conditioning stimulation, giving subjective beating sensations and extensive muscles twitches, is required to obtain a substantial pain threshold increase. The results are discussed in relation to intensities used in electro-acupuncture and to interindividual variation of the effect. It is suggested that pain relief is obtained due to an inhibitory feed-back mechanism activated, not via low threshold afferents but via high threshold afferents.

Acupuncture Therapy↗
PubMed2004

[Quantification of gender specific thermal sensory and pain threshold before and after laser needle stimulation].

Quantitative thermal sensory and pain threshold testing (QST) was performed in 29 adult healthy volunteers (mean age 24.2 +/- 2.7 years; range: 18-29 years; 20 females, 9 males) using the Thermal Sensory Analyser TSA-II (Medoc Advanced Medical Systems, Ramat Yishai, Israel, and Minneapolis, Minnesota, USA) before and after laser needle acupuncture and placebo stimulation, respectively. Significant (p < or = 0,001; t-test) gender-specific differences were seen on cold pain threshold analysis. No significant changes in parameters of thermal sensory and pain thresholds were found before and after laser needle or placebo stimulation at acupuncture points for acute pain. However, a trend towards change in the median value of cold pain sensation after laser needle stimulation (p = 0.479; paired t-test; n.s.) was seen within the group of healthy females. The influence of stimulation of acupuncture points for chronic pain on the various parameters needs to be clarified in future studies.

Acupuncture↗
PubMedDate not supplied

The measurement of pain threshold in man by means of electrical stimuli. A critical appraisal.

The problem of pain threshold measurement in man is critically considered. The advantages of electrical stimuli in determining the cutaneous pain threshold are discussed. The conducting properties of the skin to electric current are carefully examined: in fact, such properties must be taken into account when electrical stimuli are applied to the skin. A series of investigations on pain threshold measurement by means of electrical stimuli are reported. The different sensations induced by stimulating the skin with different kinds of electrodes and different types of stimuli were analysed: trains of 5 square waves of 0.5-2 msec at the frequency of 250 Hz, applied to the skin by means of unpolarizable electrodes, were selected as the best suited stimuli for practical application. This kind of stimulation was applied in physiological and clinical investigations. The measurement of pain threshold by electrical stimuli was especially useful for the clinical examination and for the study of pathogenetic mechanisms of painful diseases.

Electric Conductivity↗
PubMed1998

Sensory, motor, and pain thresholds for stimulation with medium frequency alternating current.

OBJECTIVES: To investigate the effect of frequency of alternating current on the sensory, motor, and pain thresholds in normal subjects, and to establish the optimal frequency for motor stimulation with minimal subject discomfort. DESIGN: A repeated measures design using two groups of 11 subjects. SETTING: A laboratory setting was used. PARTICIPANTS: Participants were volunteers who met the inclusion criteria. INTERVENTIONS: Alternating current with 20 different carrier frequencies between 1 and 35 kHz, all modulated at 50 Hz, was applied to each subject on two separate occasions. For half the subjects, the frequency was increased or decreased sequentially (reversed on second occasion), and for the other half, it was applied in a different random order on each occasion. MAIN OUTCOME MEASURES: The voltage at the sensory threshold was recorded for each applied frequency. This was subsequently repeated for motor and pain thresholds. RESULTS: Sensory, motor, and pain thresholds decreased with increasing frequency between 1 kHz and approximately 10 kHz. Above 10 kHz, the thresholds increased. The ratio pain threshold/sensory threshold increased systematically with increasing frequency over the range examined. By contrast, the ratio pain threshold/motor threshold showed a distinct maximum at a frequency of 10 kHz. Marked accommodation to motor and pain fiber stimulation was observed. CONCLUSIONS: For comfortable sensory stimulation, a high frequency of alternating current is preferable. Discrimination between pain and motor stimulation is maximal at a frequency of approximately 10 kHz. This suggests that the optimal frequency for comfortable motor stimulation, one that is least likely to elicit pain fiber stimulation, is close to 10 kHz.

Adult↗