Background: The majority of women described hysterosalpingography (HSG) as a painful procedure. There is little information on the features of HSG-associated pain and factors that predispose to increased pain experience. Objectives: This study investigated preprocedure psychological state and related demographic factors as predictors of pain perception in women undergoing HSG. Methods: The sample included 99 women selected through consecutive sampling at the Radiology Department, University of Benin Teaching Hospital, Benin City, Nigeria. The study utilized a cross-sectional survey design to collect data using Spielberger's State-Trait Anxiety Inventory, Zung Self-rating Depression Scale, and Visual Analog Scale for the perception of pain and state anxiety. Results: The women with lower state anxiety reported significantly lower pain perception (X̅ = 6.69) than the women with high anxiety (X̅ = 7.93). Trait anxiety, state anxiety, and depression jointly predicted pain perception among the women undergoing HSG, with R2 = 0.117, F (3,95) = 6.797; P < 0.001. They collectively accounted for about 17.7% variance in pain perception. Conclusion Patients being prepared for the HSG procedure can be educated on concerns related to anxiety and coping strategies and be provided with anxiolytics or other medication as clinically indicated.
Demography ; Pain Perception ; Women

The periaqueductal gray (PAG) is a complex mesencephalic structure involved in the integration and execution of active and passive self-protective behaviors against imminent threats, such as immobility or flight from a predator. PAG activity is also associated with the integration of responses against physical discomfort (e.g., anxiety, fear, pain, and disgust) which occurs prior an imminent attack, but also during withdrawal from drugs such as morphine and cocaine. The PAG sends and receives projections to and from other well-documented nuclei linked to the phenomenon of drug addiction including: (i) the ventral tegmental area; (ii) extended amygdala; (iii) medial prefrontal cortex; (iv) pontine nucleus; (v) bed nucleus of the stria terminalis; and (vi) hypothalamus. Preclinical models have suggested that the PAG contributes to the modulation of anxiety, fear, and nociception (all of which may produce physical discomfort) linked with chronic exposure to drugs of abuse. Withdrawal produced by the major pharmacological classes of drugs of abuse is mediated through actions that include participation of the PAG. In support of this, there is evidence of functional, pharmacological, molecular. And/or genetic alterations in the PAG during the impulsive/compulsive intake or withdrawal from a drug. Due to its small size, it is difficult to assess the anatomical participation of the PAG when using classical neuroimaging techniques, so its physiopathology in drug addiction has been underestimated and poorly documented. In this theoretical review, we discuss the involvement of the PAG in drug addiction mainly via its role as an integrator of responses to the physical discomfort associated with drug withdrawal.
Amygdala ; Humans ; Morphine ; Nociception ; Periaqueductal Gray ; Substance-Related Disorders

BACKGROUND: Painful procedures intensify hospital-related stress and anxiety leading to unpleasant experience that can adversely affect procedure outcomes and health seeking behaviors.

OBJECTIVE: To determine the effect of a cold vibrator device on pain perception of children aged 6-12 years old during Mantoux Test at the Out-Patient Department of the Philippine Children's Medical Center.

METHODOLOGY: This is a single blinded, randomized control trial where one-hundred four (104) subjects were randomly assigned to experimental (54 subjects) and control group (50 subjects) through fishbowl method. The experimental group received the cold vibrator prior to Mantoux test while the control group received the Mantoux test alone. Pre and post procedural heart rate, respiratory rate and oxygen saturation were obtained. The responses were evaluated using the Wong-Baker Faces Pain Scale.

RESULTS: Pain score was higher in the control group. Wilcoxon Rank-Sum Test showed mean rank of 67.5 with aggregated pain rank of 3645.00 compared to experimental group (with cold vibrator) of 36.3 with aggregated pain rank of 1815.00 with a p value 0.0000000046. There was no significant difference between the physiologic parameters (heart rate, respiratory rate, and oxygen saturation) before and after procedure between the two groups.

CONCLUSION AND RECOMMENDATION: The use of the cold vibrator was effective in reducing pain perception. It can be used as an adjunct to mitigate pain for needle-related procedures. Demographic data could also be correlated to the pain scores of the subjects. 

pain perception, patient satisfaction, and cost. Analyses were performed in accordance with the intention-to-treat principle.RESULTS: The composite wound complication rate in the entire cohort was 16.6% (n=50); the complication rate was significantly higher in group A than in the other groups. Infection was the most common wound complication observed in the entire study group (86%) and was significantly higher in group A than in groups B and C (P≤0.001).CONCLUSION: The use of staples for cesarean section skin closure is associated with an increased risk of wound complications and prolonged hospital stay postoperative visits.]]>
Cesarean Section ; Cohort Studies ; Emergencies ; Female ; Humans ; Length of Stay ; Nylons ; Obstetric Surgical Procedures ; Pain Perception ; Patient Satisfaction ; Pregnancy ; Seroma ; Skin ; Sutures ; Wounds and Injuries

BACKGROUND: Brennan’s rodent paw incision model has been extensively used for understanding mechanisms underlying postoperative pain in humans. However, alterations of physiological parameters like blood pressure and heart rate, or even feeding and drinking patterns after the incision have not been documented as yet. Moreover, though eicosanoids like prostaglandins and leukotrienes contribute to inflammation, tissue levels of these inflammatory mediators have never been studied. This work further investigates the antinociceptive effect of protein C after intra-wound administration. METHODS: Separate groups of Sprague–Dawley rats were used for quantitation of cyclooxygenase (COX) activity and leukotriene B4 level by enzyme-linked immunosorbent assay, as well as estimation of cardiovascular parameters and feeding and drinking behavior after paw incision. In the next part, rats were subjected to incision and 10 μg of protein C was locally administered by a micropipette. Both evoked and non-evoked pain parameters were then estimated. RESULTS: COX, particularly COX-2 activity and leukotriene B4 levels increased after incision. Hemodynamic parameters were normal. Feeding and drinking were affected on days 1 and 3, and on day 1, respectively. Protein C attenuated non-evoked pain behavior alone up to day 2. CONCLUSIONS: Based upon current observations, Brennan’s rodent paw incision model appears to exhibit a prolonged period of nociception similar to that after surgery, with minimal interference of physiological parameters. Protein C, which is likely converted to activated protein C in the wound, attenuated the guarding score, which probably represents pain at rest after surgery in humans.
Animals ; Blood Pressure ; Drinking ; Drinking Behavior ; Eicosanoids ; Enzyme-Linked Immunosorbent Assay ; Heart Rate ; Hemodynamics ; Humans ; Inflammation ; Leukotriene B4 ; Leukotrienes ; Nociception ; Pain, Postoperative ; Prostaglandin-Endoperoxide Synthases ; Prostaglandins ; Protein C ; Rats ; Rodentia ; Wounds and Injuries

The lamina II, also called the substantia gelatinosa (SG), of the trigeminal subnucleus caudalis (Vc), is thought to play an essential role in the control of orofacial nociception. Glycine and serotonin (5-hydroxytryptamine, 5-HT) are the important neurotransmitters that have the individual parts on the modulation of nociceptive transmission. However, the electrophysiological effects of 5-HT on the glycine receptors on SG neurons of the Vc have not been well studied yet. For this reason, we applied the whole-cell patch clamp technique to explore the interaction of intracellular signal transduction between 5-HT and the glycine receptors on SG neurons of the Vc in mice. In nine of 13 neurons tested (69.2%), pretreatment with 5-HT potentiated glycine-induced current (I(Gly)). Firstly, we examined with a 5-HT₁ receptor agonist (8-OH-DPAT, 5-HT(1/7) agonist, co-applied with SB-269970, 5-HT₇ antagonist) and antagonist (WAY-100635), but 5-HT₁ receptor agonist did not increase IGly and in the presence of 5-HT₁ antagonist, the potentiation of 5-HT on I(Gly) still happened. However, an agonist (α-methyl-5-HT) and antagonist (ketanserin) of the 5-HT₂ receptor mimicked and inhibited the enhancing effect of 5-HT on I(Gly) in the SG neurons, respectively. We also verified the role of the 5-HT₇ receptor by using a 5-HT₇ antagonist (SB-269970) but it also did not block the enhancement of 5-HT on I(Gly). Our study demonstrated that 5-HT facilitated I(Gly) in the SG neurons of the Vc through the 5-HT₂ receptor. The interaction between 5-HT and glycine appears to have a significant role in modulating the transmission of the nociceptive pathway.
Animals ; Glycine ; Mice ; Neurons ; Neurotransmitter Agents ; Nociception ; Patch-Clamp Techniques ; Receptors, Glycine ; Serotonin ; Signal Transduction ; Substantia Gelatinosa

The capsaicin receptor TRPV1 (transient receptor potential vanilloid 1) has been an object of intense interest for pharmacological development on account of its critical role in nociception. In the course of structure activity analysis, it has become apparent that TRPV1 ligands may vary dramatically in the rates at which they interact with TRPV1, presumably reflecting differences in their abilities to penetrate into the cell. Using a fast penetrating agonist together with an excess of a slower penetrating antagonist, we find that we can induce an agonist response of limited duration and, moreover, the duration of the agonist response remains largely independent of the absolute dose of agonist, as long as the ratio of antagonist to agonist is held constant. This general approach for limiting agonist duration under conditions in which absolute agonist dose is variable should have more general applicability.
Capsaicin ; Ligands ; Nociception

BACKGROUND: This study evaluated the efficacy of virtual reality (VR) distraction and counter-stimulation (CS) on dental anxiety and pain perception to local anesthesia in children. METHODS: A prospective, randomized, single-blinded interventional clinical trial with a parallel design was used. Seventy children 7–11 years old who required local anesthesia (LA) for pulp therapy or tooth extraction were recruited and allocated to two groups with equal distribution based on the intervention. Group CS (n = 35) received CS and Group VR (n = 35) received VR distraction with ANTVR glasses. Anxiety levels (using pulse rate) were evaluated before, during, and after administration of local anesthesia, while pain perception was assessed immediately after the injection. Wong-Baker faces pain-rating scale (WBFPS), visual analog scale (VAS), and Venham's clinical anxiety rating scale (VCARS) were used for pain evaluation. Student's t-test was used to test the mean difference between groups, and repeated measures ANOVA was used to test the mean difference of pulse rates. RESULTS: Significant differences in mean pulse rates were observed in both groups, while children in the VR group had a higher reduction (P < 0.05), and the mean VCARS scores were significant in the VR group (P < 0.05). Mean WBFPS scores showed less pain perception to LA needle prick in the CS group while the same change was observed in the VR group with VAS scores. CONCLUSIONS: VR distraction is better than CS for reducing anxiety to injection in children undergoing extraction and pulpectomy.
Anesthesia, Local ; Anxiety ; Child ; Dental Anxiety ; Eyeglasses ; Glass ; Heart Rate ; Humans ; Needles ; Pain Perception ; Prospective Studies ; Pulpectomy ; Tooth Extraction ; Visual Analog Scale

Nociception monitoring devices using changes in autonomic nervous system activity have been developed in numerous ways. Although there have been few studies conducted on children, compared to the relatively higher number of studies on adults, most of the nociception monitors in children, as in adults, appear to be more useful than the standard clinical practice that uses hemodynamic parameters in the evaluation and treatment of intraoperative nociception (pain) during general anesthesia. Particularly, when monitoring the surgical pleth index (SPI) in anesthetized children, the application of a new target range of SPI values (≤ 40) to the SPI monitoring criteria seems to be necessary for providing a more proper intraoperative analgesia. The analgesia nociception index (ANI) shows promising results in anesthetized adults, and recently, positive results along with cardiorespiratory coherence have been reported in pediatric patients. Newborn infant parasympathetic evaluation (NIPE) could be useful for providing adequate analgesia in newborns, infants, and children under 2 years of age in anesthetized or awake states. In cases of skin conductance and pupillometry, further studies are needed. Understanding the pros, cons, and limitations of these nociception monitoring tools will provide more effective and safe intraoperative analgesia to pediatric patients undergoing general anesthesia, and it may also help to plan and conduct promising research on the use of perioperative nociception monitoring in pediatric patients in the future.
Adult ; Analgesia ; Anesthesia, General ; Autonomic Nervous System ; Child ; Hemodynamics ; Humans ; Infant ; Infant, Newborn ; Monitoring, Intraoperative ; Nociception ; Pain Measurement ; Skin

Dysregulation of excitatory neurotransmission has been implicated in the pathogenesis of neuropsychiatric disorders. Pharmacological inhibition of N-methyl-D-aspartate (NMDA) receptors is widely used to model neurobehavioral pathologies and underlying mechanisms. There is ample evidence that overstimulation of NMDA-dependent neurotransmission may induce neurobehavioral abnormalities, such as repetitive behaviors and hypersensitization to nociception and cognitive disruption, pharmacological modeling using NMDA has been limited due to the induction of neurotoxicity and blood brain barrier breakdown, especially in young animals. In this study, we examined the effects of intraperitoneal NMDA-administration on nociceptive and repetitive behaviors in ICR mice. Intraperitoneal injection of NMDA induced repetitive grooming and tail biting/licking behaviors in a dose- and age-dependent manner. Nociceptive and repetitive behaviors were more prominent in juvenile mice than adult mice. We did not observe extensive blood brain barrier breakdown or neuronal cell death after peritoneal injection of NMDA, indicating limited neurotoxic effects despite a significant increase in NMDA concentration in the cerebrospinal fluid. These findings suggest that the observed behavioral changes were not mediated by general NMDA toxicity. In the hot plate test, we found that the latency of paw licking and jumping decreased in the NMDA-exposed mice especially in the 75 mg/kg group, suggesting increased nociceptive sensitivity in NMDA-treated animals. Repetitive behaviors and increased pain sensitivity are often comorbid in psychiatric disorders (e.g., autism spectrum disorder). Therefore, the behavioral characteristics of intraperitoneal NMDA-administered mice described herein may be valuable for studying the mechanisms underlying relevant disorders and screening candidate therapeutic molecules.
Adult ; Animals ; Autistic Disorder ; Blood-Brain Barrier ; Cell Death ; Cerebrospinal Fluid ; Grooming ; Humans ; Injections, Intraperitoneal ; Mass Screening ; Mice ; Mice, Inbred ICR ; N-Methylaspartate ; Neurons ; Nociception ; Pathology ; Synaptic Transmission ; Tail