This document discusses various methods for measuring pain in humans and animals. It outlines 8 situations involving healthy and pathological states in humans and animals. For humans, it describes using psychophysics methods like pressure thresholds or pain behaviors like facial expressions to measure pain. For animals, including neonates, it discusses using withdrawal responses, vocalizations or escape behaviors with psychophysics and natural pain behaviors for assessment. It provides examples of measuring referred pain and developing animal models of clinical pain conditions like endometriosis to test treatments. Overall, the document outlines the key challenges and approaches to quantifying pain across different populations.
This document discusses various methods for measuring pain in humans and animals. It outlines 8 situations involving healthy and pathological states in humans and animals. For humans, it describes using psychophysics methods like pressure thresholds or pain behaviors like facial expressions to measure pain. For animals, including neonates, it discusses using withdrawal responses, vocalizations or escape behaviors with psychophysics and natural pain behaviors for assessment. It provides examples of measuring referred pain and developing animal models of clinical pain conditions like endometriosis to test treatments. Overall, the document outlines the key challenges and approaches to quantifying pain across different populations.
This document discusses various methods for measuring pain in humans and animals. It outlines 8 situations involving healthy and pathological states in humans and animals. For humans, it describes using psychophysics methods like pressure thresholds or pain behaviors like facial expressions to measure pain. For animals, including neonates, it discusses using withdrawal responses, vocalizations or escape behaviors with psychophysics and natural pain behaviors for assessment. It provides examples of measuring referred pain and developing animal models of clinical pain conditions like endometriosis to test treatments. Overall, the document outlines the key challenges and approaches to quantifying pain across different populations.
This document discusses various methods for measuring pain in humans and animals. It outlines 8 situations involving healthy and pathological states in humans and animals. For humans, it describes using psychophysics methods like pressure thresholds or pain behaviors like facial expressions to measure pain. For animals, including neonates, it discusses using withdrawal responses, vocalizations or escape behaviors with psychophysics and natural pain behaviors for assessment. It provides examples of measuring referred pain and developing animal models of clinical pain conditions like endometriosis to test treatments. Overall, the document outlines the key challenges and approaches to quantifying pain across different populations.
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Measuring Pain
Pain Seminar, Class # 2, MEASURES, p. 1
What we measure is a behavioral index of a presumed
pain state, which is therefore subject to all sorts of influences.
Nevertheless, if we want to understand mechanisms of
pain (i.e., what produces it) or how to treat it, we have to
be able to measure it quantifiably in health and disease, and we have to be able to model it in other animals (to help other animals as well as humans).
There are two basic assessment strategies:
Psychophysics: relates stimulus to behavior (i.e., a
stimulus has to be delivered and a response has to be
measured).
Pain Behaviors: the perception is ongoing; stimuli not
given.
SO, WE HAVE HUMANS
Subjects Conditon Type of measure Subjects Conditon Type of measure
HEALTHY -psychophysics
-pain behaviors
PATHOLOGY -psychophysics
-pain behaviors
OTHER ANIMALS (also: non-verbal, cognitively impaired humans)
HEALTHY -psychophysics
Pain Seminar, Class # 2, MEASURES, p. 2
-pain behaviors
PATHOLOGY -psychophysics
-pain behaviors
Situation #1: HEALTHY HUMAN
--psychophysics-nociception sensitivity to a stimulus Von Frey hairs: demonstration in class threshold magnitude estimation tolerance
VAS 0
10 worst pain imaginable
no pain
Ethics? Critiques?
Pain Seminar, Class # 2, MEASURES, p. 3
Situation #2: HEALTHY HUMAN
--pain behavior no obvious stimulus is given
From: Prkachin KM. The consistency of facial expressions of
pain: a comparison across modalities. Pain 1992;51:297-306.
This face [point to left-most face] shows no pain. The faces show more and more pain [point to each from left to right] up to this one [point to right-most face] - it shows very much pain. Point to the face that shows how much you hurt [right now].
Pain Seminar, Class # 2, MEASURES, p. 5
Situation #4: PATHOLOGY-HUMAN
--pain behaviors --rated by patient: VAS, MPQ Pain, Lotta
24 Oct 09
I have this pain
every Monday morning
Pain Seminar, Class # 2, MEASURES, p. 6
6:00am
Situation #4: PATHOLOGY-HUMAN
--other types of pain behaviors --rated by patient VAS (by observer); grimaces; # moans; heart rate; blood pressure; respiratory rate; etc.
BUT: consider
Pain Seminar, Class # 2, MEASURES, p. 7
Situation #5: HEALTHY ANIMAL
(also: non-verbal, cognitively-impaired humans)
--psychophysics--
Many tests, some examples:
Hot plate: withdrawal; vocalization Von Frey: withdrawal; vocalization Escape responses Facial expression
Grunau RV, Craig KD. Pain expression in neonates: facial action and cry. Pain. 1987;28:395-410.
HEAL LANCE
Taddio A, Stevens B, Craig K, Rastogi P, Ben-David S, Shennan A, Mulligan P,
Koren G. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision. N Engl J Med 1997;336:1197-1201.
CIRCUMCISION
Neonatal circumcision is a painful surgical procedure often performed without analgesia. We assessed the efficacy and safety of 5 percent lidocaine-prilocaine cream (Emla) in neonates undergoing circumcision. METHODS: We carried out a double-blind, randomized, controlled trial in 68 full-term male neonates: 38 were assigned to receive lidocaineprilocaine cream, and 30 to receive placebo. One gram of lidocaine-prilocaine or placebo cream was applied to the penis under an occlusive dressing for 60 to 80 minutes before circumcision. Behavioral (facial activity and time spent crying) and physiologic (heart rate and blood pressure) responses were recorded during the procedure. Blood samples were obtained at various times after drug application for measurements of methemoglobin and plasma lidocaine, prilocaine, and o-toluidine (a metabolite of prilocaine). RESULTS: A total of 68 and 59 neonates were included in the safety and efficacy analyses, respectively. Demographic characteristics such as gestational age and birth weight did not differ between the lidocaine-prilocaine and placebo groups. During circumcision, the neonates in the lidocaineprilocaine group had less facial activity (P= 0.01), spent less time crying (P<0.001), and had smaller increases in heart rate (P=0.007) than the neonates in the placebo group. Facial-activity scores were 12 to 49 percent lower during various steps of the procedure in the lidocaine-prilocaine group. As compared with neonates in the placebo group, infants in the lidocaine-prilocaine group cried less than half as much and had heart-rate increases of 10 beats per minute less. Blood methemoglobin concentrations (expressed as a percentage of the hemoglobin concentration) were similar (1.3 percent) in both groups. Lidocaine and prilocaine were detected in plasma in 23 (61 percent) and 21 (55 percent) of the infants treated with lidocaine-prilocaine cream, respectively. CONCLUSIONS: Lidocaine-prilocaine cream is efficacious and safe for the prevention of pain from circumcision in neonates.
Pain Seminar, Class # 2, MEASURES, p. 9
#5-HEALTHY ANIMAL: RAT-psychophysics
Assessment of vaginal nociception in the rat
Pain Seminar, Class # 2, MEASURES, p. 10
Situation #7: PATHOLOGY-ANIMAL-RAT
--psychophysics ANIMAL MODEL (for a clinical condition
ENDOMETRIOSIS IN WOMEN
Netter FN. Reproductive System, Ciba, West Caulfield NJ, 1965.
an estrogen-dependent condition, whose
Signs: growths of endometrial tissue in abnormal locations Symptoms: reduced fertility, severe dysmenorrhea, dyspareunia, dyschezia, chronic pelvic pain Other: can co-occur with interstitial cystitis, irritable bowel syndrome, ureteral and kidney stones, temporomandibular disorder, migraine, fibromyalgia, vulvodynia.
Pain Seminar, Class # 2, MEASURES, p. 11
Situation #7: PATHOLOGY-ANIMAL MODEL
--psychophysics--
ENDOMETRIOSIS IN RATS Autotransplants of pieces of uterine horn in the abdomen (For sham surgery, piece of fat are autotransplanted.)
This model was originally developed by Vernon and Wilson:
Vernon MW, Wilson EA. Studies on the surgical induction of endometriosis in the rat. Fertil Steril 44;1985:684-694.
The autotransplants become vascularized and develop
into fluid-filled cysts containing inflammatory cells. The cysts grow rapidly over a 1-month period, stabilizing by 2 months. They disappear after ovariectomy and reappear after estrogen replacement. Pain Seminar, Class # 2, MEASURES, p. 12
Situation #7: PATHOLOGY-ANIMAL-RAT
--psychophysics-The vaginal hyperalgesia is greatest in proestrus (estrogen levels high).
FROM: Cason A, Samuelson C, Berkley KJ. Horm Behav 2003;44:123-131
Pain Seminar, Class # 2, MEASURES, p. 13
Situation #6, #8: HEALTH/PATHOLOGY
ANIMALS --pain behaviors-Hard to study. How do you know if your dog or a newborn is in pain? Most work so far has been done in animals the context of a known pathophysiological condition. Little has been done in neonates or other non-verbal humans. [Example: Terstegen C, Koot HM, de Boer JB, Tibboel D. Measuring pain in children with cognitive impairment: pain response to surgical procedures. Pain. 2003 May;103(1-2):187-98.]
Pain behaviors evoked by
cutting the sciatic nerve. Attal N, Jazat F, Kayser V, Guilbaud G. Further evidence for 'pain-related' behaviours in a model of unilateral peripheral mononeuropathy. Pain 1990;41:235-51.
Pain behaviors evoked by an
artifical stone in the ureter Giamberardino MA, Valente R, De Bigontina P, Vecchiet L. Artifical ureteral calculosis in rats: behavioral characterization of visceral pain episodes and their relationship with referred lumbar muscle hyperalgesia. Pain (1995) 61:459-469.
Pain Seminar, Class # 2, MEASURES, p. 14
Class demonstration: BAT DETECTOR
Situation #6, #8: HEALTH/PATHOLOGY
ANIMALS --pain behaviors-Pain behaviors evoked by an artifical stone in the ureter Giamberardino MA, Valente R, De Bigontina P, Vecchiet L. Artifical ureteral calculosis in rats: behavioral characterization of visceral pain episodes and their relationship with referred lumbar muscle hyperalgesia. Pain (1995) 61:459-469.
ENDO surgery increases
pain behaviors associated with a ureteral stone.
..but shamENDO surgery decreases them!! SILENT STONES
Pain Seminar, Class # 2, MEASURES, p. 15
THE CONCEPT OF REFERRED PAIN
and REFERRED HYPERALGESIA
Diaphragm, Pericardium and Heart,
Heart, Digestive tract, Liver and Gall Bladder, Kidney and Ureter, Pelvic Organs FROM: http://anatomy.med.umich.edu/surface/abdomen/referred.html
Pain Seminar, Class # 2, MEASURES, p. 16
THE CONCEPT OF REFERRED PAIN
The same effect occurs for referred muscle nociception.
ENDO surgery decreases vocalization thresholds
to muscle stimulation to a greater extent in Change in stone-only vocalization ENDO+stone than rats. thresholds Vocalization threshold
