The Preventive Value of Acupoint Sensitization for Patients with Stable Angina Pectoris: A Randomized, Double-Blind, Positive-Controlled, Multicentre Trial

Background. Acupoint sensitization is considered an important factor in the efficacy of acupoint therapy. This study aimed to evaluate the efficacy of acupressure in the prevention of stable angina pectoris using acupoints with different pressure-pain sensitivities. Methods. A total of 202 patients were enrolled and randomly assigned to a high-sensitivity group (HSG) (n = 109) in which patients received acupressure at the five acupoints with the highest sensitivity to pain and a low-sensitivity group (LSG) (n = 93) in which patients received acupressure at the five acupoints with the lowest sensitivity to pain. The duration of acupressure treatment was 4 weeks, and the patients were evaluated at baseline, week 4, and week 8. The primary outcome was a change in the frequency of angina attacks from baseline. The secondary outcomes included nitroglycerin consumption, the Canadian Cardiovascular Society classification, and the Seattle Angina Questionnaire score. Adverse events such as bleeding and subcutaneous haemorrhage were recorded in both groups. Results. The effect of acupressure compared with baseline on the prevention of angina pectoris in HSG was better than that in LSG at week 4 (incidence rate ratio (IRR): 0.691 and 95% confidence interval (CI): [0.569, 0.839]) and week 8 (IRR: 0.692 and 95% CI: [0.569, 0.839]). No significant difference between groups was found in the frequency of nitroglycerin consumption at week 4 (odds ratio (OR) = 0.863 and 95% CI: [0.147, 5.077]) or week 8 (OR = 1.426 and 95% CI: [0.211, 9.661]). Two themes in the questionnaire showed significantly different changes from baseline between the two groups. Scores on the angina frequency (AF) subscale had changed more from the baseline in the HSG at week 8 than in the LSG (mean difference (MD) = 3.807 and 95% CI: [0.673, 6.942]). Scores on the treatment satisfaction (TS) subscale had also changed more in the HSG than in the LSG at week 4 (MD = 3.651 and 95% CI: [0.327, 7.327]) and week 8 (MD = 4.220 and 95% CI: [0.347, 7.346]). One patient in the LSG reported bruising at the acupoint. No unexpected safety problems arose. Conclusions. This study showed that acupressure at acupoints with high sensitivity to pain may effectively reduce the frequency of stable angina pectoris episodes. This trial is registered with NCT03975140.

The Parent Version of the Sensitivity to Pain Traumatization Scale (SPTS-P): A Preliminary Validation

Sensitivity to pain traumatization (SPT) is defined as the propensity to develop responses to pain that resemble a traumatic stress reaction. To date, SPT has been assessed in adults with a self-report measure (Sensitivity to Pain Traumatization Scale (SPTS-12)). SPT may also be relevant in the context of parenting a child with chronic pain, as many of these parents report clinically elevated posttraumatic stress symptoms (PTSS). This study aimed to develop and validate a measure of parent SPT by adapting the SPTS-12 and evaluating its psychometric properties in a sample of parents whose children have chronic pain. In total, 170 parents (90.6% female) and children (aged 10–18 years, 71.2% female) were recruited from a tertiary chronic pain program. Parents completed the parent version of the SPTS-12 (SPTS-P) and measures of PTSS, depression, and parenting behaviors. Youth completed measures of pain. Consistent with the SPTS-12, the SPTS-P demonstrated a one-factor structure that accounted for 45% of the variance, adequate to good reliability and moderate construct validity. Parent SPT was positively related to their protective and monitoring behaviors but was unrelated to youth pain intensity, unpleasantness, and interference. These results provide preliminary evidence for the psychometric properties of the SPTS-P and highlight the interaction between parent distress about child pain and parent responses to child pain.

Effective management of children’s pain and anxiety in the Emergency Department

Effective management of children’s pain and anxiety during Emergency Department (ED) visits facilitates medically necessary care and procedures, and increases patient, family, and healthcare provider satisfaction. This chapter will review and update the chapter from the first edition that described evidence-based techniques for achieving this goal. A significant focus is on nonpharmacological strategies to relieve children’s anxiety, because high levels of anxiety exacerbate sensitivity to pain and disrupt the coping mechanisms of the child and parent. In addition, advances in techniques for pain relief for specific procedures will be detailed. Aspects of procedural sedation and analgesia that are especially pertinent to the ED will also be reviewed, along with two recommended regimens for moderate and deep sedation.

Medical education and distrust modulate the response of insular-cingulate network and ventral striatum in pain diagnosis

Healthcare providers often underestimate patients' pain, sometimes even when aware of their reports. This could be the effect of experience reducing sensitivity to others pain, or distrust towards patients' self-evaluations. Across multiple experiments (375 participants), we tested whether senior medical students differed from younger colleagues and lay controls in the way they assess people's pain and take into consideration their feedback. We found that medical training affected the sensitivity to pain faces, an effect shown by the lower ratings and highlighted by a decrease in neural response of the insula and cingulate cortex. Instead, distrust towards the expressions' authenticity affected the processing of feedbacks, by decreasing activity in the ventral striatum whenever patients' self-reports matched participants' evaluations, and by promoting strong reliance on the opinion of other doctors. Overall, our study underscores the multiple processes which might influence the evaluation of others' pain at the early stages of medical career.

How Can Someone Do This to Themselves?

It is not uncommon to encounter patients who appear to exaggerate their pain complaints for one reason or another. However, these are to be differentiated form those diagnosed with malingering or factitious disorders (FD). Both can be difficult to identify. Malingerers engage in a willfully and deliberately attempt to misrepresent their situation for some type of gain. FD represents a group of patients with significant psychiatric problems. Their behavior often includes self-inflicted wounds, which need to be differentiated from actions that may reflect a suicide attempt, depression, or the self-injurious behavior related to dissociative disorder. The FD patient may well have an altered sensitivity to pain. Their treatment is complex and requires an experienced professional.

The Relationship between Pain Sensitivity, Pain Catastrophizing and Hangover Severity

Recent research found a significant and positive correlation between hangover severity and pain catastrophizing. The current study aimed to verify these findings. Data from N = 673 subjects with a mean (SD) age of 42.2 (19.1) years old (range: 18 to 87 years old) was evaluated. An online survey collected data on alcohol consumption and hangovers related to their heaviest drinking occasion between 15 January and 14 March 2020. When correcting for the amount of alcohol consumed, significant correlations were found between hangover severity and both sensitivity to pain (r = 0.085, p = 0.029) and pain catastrophizing (r = 0.095, p = 0.015). In addition, subjective intoxication correlated significantly with sensitivity to pain (r = 0.080, p = 0.041) and pain catastrophizing (r = 0.099, p = 0.011). Overall, the results were more pronounced in men than women, and the associations with pain catastrophizing were strongest for the subscale assessing rumination. In conclusion, although statistically significant, the observed correlations were of small magnitude. Nevertheless, the observations confirm previous findings that suggest a link between pain perception, alcohol consumption, and hangover severity, which warrants further investigation.

Evidence that pain sensitivity is rhythmic in humans, mainly driven by the endogenous circadian system and little by sleep

Pain intensity has been reported to fluctuate during the day in some experimental and clinical conditions, but the mechanisms underlying these fluctuations are unknown. Although the circadian timing system is known to regulate a wide range of physiological functions, its implication in pain regulation is unknown. We show here, using highly controlled laboratory constant routine conditions, that pain sensitivity is rhythmic over the 24-hours and strongly controlled by the endogenous circadian timing system. We find that pain sensitivity follows a sinusoidal circadian rhythmicity, with a maximum in the middle of the night and a minimum in the afternoon. We also find a weak homeostatic control of pain sensitivity, with a linear increase over the 34 hours of prolonged wakefulness, which parallels that of sleep pressure. Using mathematical modelling, we describe that the circadian system accounts for 80% of the full magnitude of pain sensitivity over the 24 hours, and that sleep-related processes account for only 20%. This result reveals that nocturnal analgesia is predominantly induced by the circadian system and has been wrongly attributed only to sleep. Our findings highlight the need to consider the time of day in pain assessment, and suggest that personalized circadian medicine may be a promising approach to pain management.Significance statementWe discovered that sensitivity to pain is rhythmic in healthy humans, that sensitivity is maximal at night and minimal in the afternoon. Contrarily to the current thinking that sleep is the best painkiller, we find that the 24-h rhythmicity of sensitivity to pain is mainly controlled by a biological circadian clock in our body, and very little by our sleep. Our article reveals the neurobiological mechanisms involved in driving the rhythmicity of pain perception in humans, with the main time-piece located in the brain (the suprachiasmatic nuclei in the hypothalamus). Our findings challenge the current vision of pain physiology, and reveal the need to consider time-of-day and internal biological time for pain evaluation and pain management.