Pain Of Presence And Pain Of Absence Pdf
File Name: pain of presence and pain of absence .zip
- Menstruation - pain (dysmenorrhoea)
- Congenital Absence of Pain
- Is absence of evidence of pain ever evidence of absence?
Patient information : See related handout on dysuria , written by the authors of this article. The most common cause of acute dysuria is infection, especially cystitis. Other infectious causes include urethritis, sexually transmitted infections, and vaginitis.
The studies on the mechanisms of ketamine antinociception have led to conflicting results. In this study, the authors investigated the contribution of supraspinal monoaminergic descending inhibitory system to ketamine analgesia for acute nociception and inflammation-induced hyperalgesia. Male Sprague-Dawley rats were used. The paw withdrawal latencies to radiant heat stimuli were measured to assess the thermal nociceptive threshold. The analgesic effects of intrathecal or intraperitoneal ketamine were examined in the rats that received unilateral intraplantar carrageenan and in those that were untreated.
Menstruation - pain (dysmenorrhoea)
The weak correlation between pain and structural changes in knee osteoarthritis is widely reported. In a previous within-person, knee-matched case-control study among Caucasians, the severity of radiographic osteoarthritis ROA was strongly associated with both the presence of frequent knee pain and pain severity.
Among subjects with knees discordant for either frequent knee pain or pain severity, we examined the relationship between ROA and the presence of frequent knee pain using conditional logistic regression, and between ROA and pain severity using a stratified proportional odds model with an amalgamating conditional likelihood.
In total, urban Chinese, rural Chinese, Japanese, Korean, 1, Caucasian, and African-American patients were included. Even mild ROA was significantly associated with frequent knee pain. In addition, ROA was also strongly associated with the severity of knee pain. These results show that structural pathology is associated with knee pain in different ethnic populations.
Osteoarthritis OA is the most common joint disorder and the leading cause of disability among the elderly 1 , 2. The number of individuals with clinical OA in the United States increased from 21 million in to nearly 27 million by 3. Pain from knee OA is a key symptom informing the decision to seek medical care, and an important antecedent to disability 4. Furthermore, symptomatic knee OA is the most common reason for total knee replacement, and the use of this surgical procedure has increased rapidly over the past few decades.
In South Korea, the number of total knee replacements increased almost two-fold between and 6. Such a rapid increase in the prevalence of this already common disease suggests that OA will have a growing impact on healthcare and public health systems in the future 3. To date, the majority of studies have reported that radiographic OA ROA is poorly correlated with knee symptoms, and most risk factors for ROA are not strong predictors of knee pain 1 , 7.
Considering the traditional concept that nociceptive sensory input from tissue damage is the main mechanism leading to pain, the weak correlation between pain and knee structural changes is somewhat counter-intuitive. Pain perception is complex, however, and knee pain is frequently associated with non-OA variables, such as psychosocial factors, education, economic statusas well as local pathology 8. Previously, a within-person, knee-matched case-control study included patients with knees discordant for the presence of pain or pain severity; in that study, Neogi and colleagues demonstrated that the severity of radiographic knee OA was strongly associated with both the presence of frequent knee pain and pain severity 9.
These findings indicate that the pathological changes revealed by radiographs are indeed correlated with pain. Neogi et al. To date, there remains a paucity of information as to whether the relationship between radiographic knee OA and knee pain is consistent across racial groups or geographic regions.
In multiple studies, the tolerance to, perception of, and response to experimental and acute pain have been reported to vary according to ethnicity and culture 10 , Thus, the question of whether findings obtained in Caucasians can be generalised to other racial or ethnic populations remains uncertain. This study included 3, individuals who had unilateral frequent knee pain or knees that were discordant for pain severity. Participants from the three Asian countries were lighter, shorter, and had a lower mean body mass index than their counterparts in the United States.
Such an association was found even in knees with mild disease. A recent meta-analysis showed that ROA of the knee at baseline was inconsistently associated with worsening knee pain and did not predict physical functioning Unlike structural lesions in OA, pain is a subjective experience unique to each individual, with natural variability among individuals in terms of sensitivity to, and perception and tolerance of, pain stimuli.
A number of factors e. In addition, central sensitisation, as measured by temporal summation or neuroimaging, was shown to be significantly associated with knee OA symptom severity, while there was no association between sensitisation and radiographic severity Unless all of these risk factors are measured and controlled, studies comparing groups of individuals with respect to the effect of pathological lesions on the risk or severity of knee pain are susceptible to residual confounding bias A within-person, knee-matched case-control study design 9 ensures that all person-level factors that are associated with knee pain are distributed evenly between both knees, eliminating their confounding effects between comparison groups.
Several aspects of this study are notable. The participants in these studies had different socio-cultural and educational backgrounds and anthropometrical characteristics, engaged in different recreational and occupational activities, and showed differences in the prevalence of knee OA. Compared with other countries, especially large difference in economic and cultural lifestyle exists in China, considering the dimension of its area and historic perspectives.
For example, in a population-based cohort study conducted among residents living in rural areas in Wuchuan, China, while the overall prevalence of radiographic knee OA among rural residents was similar to that among urban residents in Beijing, the symptomatic OA was twice as prevalent in Wuchuan 25 as that in Beijing However, in all of the studies, the results demonstrated that radiographic knee OA, even mild OA, is associated with knee pain and pain severity; which increases the validity of the current findings.
Second, although the sample size varied markedly in the five studies, resulting in wider confidence intervals for some effect estimates e.
Finally, while the questions used to assess knee pain and pain severity varied among the five included studies, the findings themselves did not appear to be influenced by this potential limitation.
This again indicates that structural lesions do indeed contribute to knee pain, regardless of how they are assessed. Our study had several limitations. First, due to the study design, the analyses used to assess the association between radiographic features and the presence of frequent knee pain were restricted mostly to individuals with unilateral knee pain. As a result, the conclusions of our study may not generalise to individuals with bilateral knee pain.
Nevertheless, it is difficult to imagine that the association between structural lesions revealed by radiographs and knee pain observed among individuals with unilateral knee pain would not apply to those with bilateral knee pain. Second, our study looked at the tibiofemoral joint only, but it is possible that some of the knee pain could have arisen from pathology in the patellofemoral joint. The within-person, knee-matched approach may have an inherent limitation due to selectively favouring knee OA with a traumatic aetiology.
Differences in musculoskeletal pain perception have been reported according to race and ethnicity; however, difference regarding the structure-symptom relationship in knee OA has not previously been reported. These results show that structural pathology captured by radiographic imaging, such as osteophytes and joint space narrowing, are associated with knee pain in different ethnic populations.
All methods were performed in accordance with the relevant guidelines and regulations in each participating centers. The details of each study have been published previously, and we briefly describe each of the studies in the following paragraphs. Participants completed a home interview that included questions regarding knee pain and its severity. Bilateral, anteroposterior AP fully extended weight-bearing knee radiographs were taken for all participants in the hospital according to the Framingham OA Study protocol.
One bone and joint radiologist read knee films according to the reading protocols of the Framingham OA Study. The small number of disagreements did not occur in any particular direction, suggesting that there was no likelihood of bias in estimates. Data on both knee pain and knee ROA were available from 2, participants Bilateral, AP fully extended weight-bearing knee radiographs were taken for all participants in the hospital according to the Framingham OA Study protocol.
The weighted kappa on KL grade for the intra-rater reliability was 0. Data on both knee pain and knee ROA were available from 1, participants Study participants were randomly recruited from Itabashi, Hidakagawa, and Taiji, Japan to determine the environmental and genetic background of bone and joint diseases Knee radiographs were read without knowledge of participant clinical status by a single well-experienced orthopaedist.
One hundred other radiographs were also scored by two experienced orthopeadic surgeons using the same atlas for inter-rater variability. The intra- and inter- reader variabilities evaluated for KL grade 0—4 were confirmed by the kappa analysis to be sufficient for assessment 0. Data on both the presence of frequent knee pain and knee ROA were available from 2, subjects. A random sample of residents was recruited from Chuncheon, Korea to investigate quality of life and health.
Radiographs were read twice by one reader, an academically based rheumatologist. Films allocated different K-L grades at the two readings were adjudicated by consensus between the original reader and a second reader, another academically based rheumatologist. Data on both knee pain and knee ROA were available from individuals At baseline and yearly follow-up clinic visits, data on clinical parameters e. Radiographs were read independently by two study readers, a musculoskeletal radiologist and a rheumatologist at Boston University.
In the case of discrepancy, readings were adjudicated by consensus with a third reader. Of the 4, subjects included in the OAI, 3, Caucasians and African-Americans had both knee pain and knee radiograph data.
All subjects were asked about the presence of frequent pain in each of their knees. However, in the BOA and WOA studies, the question regarding knee pain severity was only presented to subjects who responded positively to the frequent knee pain question, and the question on pain severity was not knee-specific.
In the ROAD study, data on knee pain severity were only collected at the person, rather than the knee, level. Thus, for the BOA, WOA, and ROAD studies, we limited our analysis to subjects who had reported unilateral frequent knee pain and assumed that pain severity referred to the knee that experienced frequent knee pain.
Knee symptoms were rated by assessors blinded to the radiographic findings. Radiographs from all studies were scored by assessors blinded to symptom status.
We conducted a within-person, knee-matched case-control study to examine the relationships between the severity of ROA and the presence of frequent knee pain and pain severity. To examine the relationship between knee ROA and the prevalence of frequent knee pain, we identified individuals who indicated that they experienced unilateral frequent knee pain. The knee with frequent knee pain served as the case knee, and the contralateral knee without frequent pain served as the control; thus, the two knees of each individual formed a matched pair.
We assessed the association between ROA and the presence of frequent knee pain using conditional logistic regression. We identified subjects in whom knees were discordant for knee pain severity. As noted above, for the BOA, WOA, and ROAD studies, knee pain severity was assessed on a person level rather than on a knee level; thus, we limited our analysis to subjects who had reported unilateral frequent knee pain.
We performed amalgamating conditional logistic regression analysis to examine the association between ROA and knee pain severity 30 , which is an ordinal outcome variable. As an extension to conditional logistic regression, amalgamating conditional logistic regression analyzes matched ordinal data. All statistical analyses were performed using SAS software ver.
Felson, D. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Guccione, A. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Lawrence, R. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Hadler, N.
Knee pain is the malady—not osteoarthritis. Merrill, C.
Congenital Absence of Pain
Routine electrophysiologic investigation showed no abnormalities. The threshold and latency of electrically elicited corneal reflex and cortical potentials evoked by tooth pulp stimulation were normal, but suprathreshold electric stimulation of corneal mucosa and dental pulp, as well as electric stimulation of dorsal roots, did not elicit pain. The total CSF opioid activity was raised. However, naloxone hydrochloride administration failed to reverse the analgesia. The axon reflex to intradermal injection of histamine dihydrochloride was absent. Cutaneous nerve branches showed unspecific changes affecting part of unmyelinated axons. Most of the unmyelinated as well as the myelinated axons were normal.
Is absence of evidence of pain ever evidence of absence?
Dysmenorrhoea is the term used to describe painful periods. Period pain from your first period or shortly after, and without a known cause, is known as primary dysmenorrhoea.
Pathophysiology and Differential Diagnosis
Pain is a distressing feeling often caused by intense or damaging stimuli.