Novel method for assessing age-related differences in the temporal summation of pain

Temporal summation (TS) of pain protocols typically involve the delivery of brief repetitive noxious stimuli held at a constant intensity and measuring the consequent increase in the perceived intensity of pain sensations. To date, no studies have examined the effect of a TS protocol on the perceived spatial dimensions of the pain experience and its interaction with age. This study used a new TS protocol that examined changes in the perceived size of the painful area in 22 younger adults and 20 older adults. Four trials of ten brief heat pulses delivered at a constant intensity were administered on the volar forearm. Interpulse intervals (IPIs) were 2.5 seconds or 3.5 seconds. Subjects rated the peak pain intensity (trials 1 and 3) or the size of the painful area (trials 2 and 4) after each pulse on a 0-100 scale. The magnitude of summation was calculated for each trial. Three seconds and 6 seconds after delivering the last heat pulse, the subjects rated the intensity or the size of any remaining pain (aftersensations). The results indicated that older adults compared to younger adults exhibited significantly greater summation of size ratings for the 2.5-second and 3.5-second IPI trials and size of pain aftersensations at 3 seconds following the 2.5-second IPI TS trial. These results suggest that aging is associated with enhanced endogenous facilitation of the perceived size of pain. The potential clinical and mechanistic implications of enhanced TS of size of pain remain unknown and warrant further investigation

Hypervigilance for innocuous tactile stimuli in patients with fibromyalgia: an experimental approach

Background: Hypervigilance, i.e., excessive attention, is often invoked as a potential explanation for the observation that many individuals with fibromyalgia show a heightened sensitivity to stimulation in various sensory modalities, such as touch and hearing. Compelling evidence for this assumption is, however, lacking. The aim of the present study was to investigate the presence of somatosensory hypervigilance in patients with fibromyalgia. Methods: Fibromyalgia patients (n=41) and a matched control group (n=40) performed a tactile change detection task in which they had to detect whether there was a change between two consecutively presented patterns of tactile stimuli presented to various body locations. The task was performed under two conditions: in the unpredictable condition, tactile changes occurred equally often at all possible body locations; in the predictable condition, the majority of tactile changes occurred at one specific body location. Results: It was hypothesized that the fibromyalgia group would show better tactile change detection in the unpredictable condition and when changes ocurred at unexpected locations in the predictable condition. The results did not support this hypothesis. In neither condition was the fibromyalgia group better than the control group in detecting tactile changes. Conclusions: No evidence was found to support the claim that patients with fibromyalgia display somatosensory hypervigilance. This finding challenges the idea of hypervigilance as a static feature of fibromyalgia and urges for a more dynamic view in which hypervigilance emerges in situations when bodily threat is experienced

Hate speech and the normative foundations of regulation

OA Monitor ExerciseOA Monitor ExerciseOA Monitor ExerciseRacist incidents on American university campuses in the 1980s triggered a storm of publications by scholars who coined the phrase ‘hate speech’ for the legal lexicon. Some of the offences had already been subject to legal or institutional penalties for harassment or vandalism. Several universities nevertheless adopted broad codes of conduct to penalise hateful expression. For two decades, however, the US Supreme Court had been marching in the opposite direction. It was interpreting the Constitution's First Amendment to prevent federal or state government from punishing speakers solely on grounds of the viewpoints they expres

Introduction to the Focus Section: 2013 Catholic Higher Education Collaborative (CHEC) Conference on Catholic School Financing

Introduction to the Focus Section

Panel Discussion: The State of Play for Parental Choice

Transcript of panel The State of Play for Parental Choice, presented at 2013 CHEC Conference, Notre Dame, IN

Chronic pain in Pachyonychia Congenita:evidence for neuropathic origin

Background: Pachyonychia congenita (PC) is a rare autosomal dominant skin disease with chronic pain being the most prominent complaint. Histological studies showing alterations in sensory innervation along with few reports on alterations in mechanical sensitivity suggest that PC may be a form of neuropathy.Objective: To systematically evaluate sensory function of PC patients vs. controls, here for the first time, in order to investigate PC pathophysiology.Methods: Patients (n=62) and controls (n=45) completed the McGill and Douleur Neuropathique-4 (DN4) questionnaires. Sensory testing included: detection and pain thresholds, pathological sensations, conditioned pain modulation (CPM) and temporal summation of pain (TSP).Results: A moderate-severe chronic pain in the feet, throbbing and stabbing in quality, was highly prevalent among PC patients (86%) and especially debilitating during weight bearing. In addition, the majority of patients had DN4 score ≥4 (62%), static allodynia (55%) and tingling (53%) in the feet. Compared to controls, PC patients exhibited thermal and mechanical hypoesthesia and mechanical hyperalgesia in the feet. CPM was reduced among the patients, and associated with more enhanced feet mechanical hyperalgesia. The specific gene and nature of the causative mutation did not affect any of these features.Conclusion: Although thermal and mechanical hypoesthesia may result from thicker skin, its presentation in painful regions along with mechanical hyperalgesia and allodynia point towards the possibility of neuropathic changes in PC. The clinical features and DN4 scores support this possibility and therefore neuropathic pain medications may be beneficial for PC patients. This article is protected by copyright. All rights reserved.</p

The effect of varying practitioner communication on patients' health status and treatment outcomes

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of interventions in which healthcare practitioner communication in face-to-face consultations with patients is experimentally varied in comparison to usual care or contrasted active control interventions, on patient health and treatment outcomes. A secondary aim is to investigate if the intervention effect is modified by intervention type, type of illness, length of follow-up, type of outcome and the way the subjects are exposed to communication in studies (real versus simulated)