Browsing by Subject "pain"
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Item Automated Detection And Quantification Of Pain Using Electroencephalography(2018-05) Vijayakumar, VishalEffective pain assessment and management strategies are needed to better manage pain. In addition to self-report, an objective pain assessment system to detect, quantify, and track the intensity of pain reduces the uncertainty of treatment outcome and provides a reliable benchmark for longitudinal evaluation of pain therapies. With electroencephalography (EEG) gaining traction as a reliable tool for characterizing brain regions active during pain, this work presents the development of robust and accurate machine learning algorithms on neuroimaging data using EEG to detect and quantify tonic thermal pain. To quantify pain, a random forest model was trained to using time-frequency wavelet representations of independent components obtained from EEG data. The mean classification accuracy for predicting pain on an independent test subject for a range of 1-10 is 89.45%, highest among existing state of the art quantification algorithms for EEG, demonstrating the potential of this tool to be used clinically to help improve chronic pain treatment. A temporally pain-specific biomarker using EEG was developed using EEG microstates to evaluate their specificity to pain compared to rest and two non-rest conditions evoking similar responses. Multifractal analyses on the microstate sequence showed that microstate interactions during pain were significantly more stable across time scales compared to non-painful conditions, but significantly more chaotic compared to resting state. A pain detection algorithm using deep learning techniques was constructed utilizing non-orthogonal temporal dependencies between microstates. Each branch of the deep learning network was trained to differentiate between pain and a non-painful condition to increase the specificity of the final algorithm to pain. The resulting algorithm improved on the state of the art by 14%, scoring 90.67% in terms of specificity to various levels of pain, compared to non-painful stimuli. Stacking this deep-learning pain detection algorithm on top of the pain quantification algorithm showed a 10% improvement in terms of F-score over the state of the art in pain quantification algorithms. This is an encouraging step forward in developing a clinically feasible tool that can detect, record, quantify and longitudinally compare the intensities of pain in patients to better aid the development of effective therapies to manage pain.Item Chronic Pain(2010-07-21) Aaron, Ashley EChronic, non-cancer pain is defined as pain of at least 3 months. Chronic pain is a common health issue that effects anywhere from 20-60% of Americans and accounts for $61 billion in lost productivity time in this country alone. It is often undertreated due to the complexity and controversy surrounding management with chronic opioid analgesics. Chronic pain is often accompanied by psychosocial co-morbidities, most notably depression, that further complicates its treatment. Chronic pain is often best addressed by a multi-disciplinary team that closely monitors each patient individually. While the use of opioid analgesics poses some risks, when managed properly, the extreme improvement in patient quality of life that can be obtained often far outweigh the risk.Item A Comparison of Dental Hygienists’ Reported Musculoskeletal Pain Levels Before and After a Health and Wellness Program(2021-08) Schoonbeck, HeidiObjectives: This study investigated dental hygienists’ self-reported musculoskeletal pain levels before and after participating in a health and wellness program. Methods: A descriptive validated pre-post-test survey compared dental hygienists’ self-reported pain levels. Paired t-tests examined changes from pre- to post-tests and Spearman’s correlation compared changes in pain scores to changes in demographic variables. Qualitative data was gathered via guided interviews of participants. Results: Average scores decreased from pre to post-test. A decrease in the Disabilities of the Arm, Shoulder and Hand (DASH) survey was correlated with a decrease in stress levels and more stretching. A decrease in the Oswestry Disability Index (ODI) was correlated with a decrease in perceptions of musculoskeletal health and stress levels. A decrease in DASH Work was correlated with a decrease in stress levels. Qualitative data supported survey results. Conclusion: Pain levels decreased after participating in a health and wellness program. Participants reported more knowledge about combining musculoskeletal therapies and recommended the program.Item Complement-3a receptor involvement in peripheral and central neuropathic pain(2019-09) Cook, JenniferVGF (non-acronymic), a neuropeptide precursor protein related to the chromogranin family, has been implicated in neuroplasticity associated with depression, learning and memory, and chronic pain. The Vulchanova lab has previously demonstrated that the VGF-derived peptide TLQP-21 contributes to both the development and maintenance of hypersensitivity after peripheral nerve injury and inflammation. The receptor for TLQP-21 is the complement-3a receptor C3aR1. Although the complement system has been implicated in mechanisms of neuropathic pain, the potential relevance of C3aR1 in these processes has not been addressed. This thesis examines the involvement of C3aR1 signaling following spared nerve injury (SNI) and spinal cord injury (SCI). I hypothesized that C3aR1 located on microglia are a key signaling mediator in neuropathic pain following peripheral and central injury. In this thesis, I show that C3aR1 is localized to microglia in both naïve mice, and mice following SNI and SCI. Following SNI, an antagonist to C3aR1 was able to transiently attenuate mechanical hypersensitivity. Additionally, I found that TLQP-21 specifically activates C3aR1 located on microglia. I identified that there was upregulation of C3aR1 in a time-dependent manner following SNI and SCI. The early increase of receptor expression indicates a potentially important role of C3aR1 signaling throughout the acute stages of peripheral and central nervous system injury. Prior to this thesis work, there were limited studies examining sensory changes occurring in male mice following SCI. I provide the most thorough characterization of behavior following SCI in male mice to date, and show for the first time that SCI mice exhibit a dramatic loss of light touch sensitivity. Utilizing an antisense oligonucleotide, I show a potentially protective effect of knocking down the C3aR1 receptor during the acute phase of spinal cord injury. I found that knockdown attenuated the loss of light touch sensitivity seen in spinal cord injury animals. Overall, this thesis highlights the potential relevance of C3aR1 as a therapeutic target following injury, and uncovers the complex role complement receptor-mediated immune signaling has in neuropathic pain.Item Frequency of Nonodontogenic Pain after Endodontic Therapy: A Systematic Review and Meta-Analysis(Elsevier, 2010-09) Nixdorf, DR; Moana-Filho, EJ; Law, AS; McGuire, LA; Hodges, JS; John, MTINTRODUCTION: Little is known about ill-defined pain that persists after endodontic procedures, including an estimate of the problem's magnitude. We conducted a systematic review of prospective studies that reported the frequency of nonodontogenic pain in patients who had undergone endodontic procedures. METHODS: Nonodontogenic pain was defined as dentoalveolar pain present for 6 months or more after endodontic treatment without evidence of dental pathology. Endodontic procedures reviewed were nonsurgical root canal treatment, retreatment, and surgical root canal treatment. Studies were searched in four databases electronically, complemented by hand searching. A summary estimate of nonodontogenic tooth pain frequency was derived using random-effects meta-analysis. RESULTS: Of 770 articles retrieved and reviewed, 10 met inclusion criteria, and nine had data on both odontogenic and nonodontogenic causes of pain. A total of 3,343 teeth were enrolled within the included studies and 1,125 had follow-up information regarding pain status. We identified 48 teeth with nonodontogenic pain and estimated a 3.4% (95% confidence interval, 1.4%-5.5%) frequency of occurrence. In nine articles containing data regarding both odontogenic and nonodontogenic causes of tooth pain, 56% (44/78) of all cases were thought to have a nonodontogenic cause. CONCLUSIONS: Nonodontogenic pain is not an uncommon outcome after root canal therapy and may represent half of all cases of persistent tooth pain. These findings have implications for the diagnosis and treatment of painful teeth that were previously root canal treated because therapy directed at the tooth in question would not be expected to resolve nonodontogenic pain.Item Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis(Elsevier, 2010-02) Nixdorf, DR; Moana-Filho, EJ; Law, AS; McGuire, LA; Hodges, JS; John, MTLittle is known about the frequency of persistent pain after endodontic procedures even though pain is a core patient-oriented outcome. We estimated the frequency of persistent pain, regardless of etiology, after endodontic treatment. METHODS: Persistent tooth pain was defined as pain present > or = 6 months after endodontic treatment. Endodontic procedures included in the review were pulpectomy, nonsurgical root canal treatment, surgical root canal treatment, and retreatment. Four databases were searched electronically complemented by hand searching. Two independent reviewers determined eligibility, abstracted data, and assessed study quality. A summary estimate of persistent all-cause tooth pain frequency was established by using a random-effects meta-analysis. Using subgroup analyses, we explored the influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate, follow-up duration, initial treatment versus retreatment, and quality of reporting (Strengthening the Reporting of Observational Studies in Epidemiology rankings) on the pain frequency estimate. RESULTS: Of 770 articles retrieved and reviewed, 26 met inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status. We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain. High and statistically significant heterogeneity among studies (I2 = 80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity. CONCLUSIONS: The frequency of all-cause persistent tooth pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%.Item Inducing Neural Plasticity and Modulation Using Multisensory Stimulation: Techniques for Sensory Disorder Treatment(2017-06) Gloeckner, Cory DaleIn this dissertation, we characterized the modulatory and plasticity effects of paired multisensory stimulation on neural firing in sensory systems across the brain. In the auditory system, we discovered that electrical somatosensory stimulation can either suppress or facilitate neural firing in the inferior colliculus (IC) and primary auditory cortex (A1) depending stimulation location. We also tested plasticity effects in A1 in response to paired somatosensory and acoustic stimulation with different inter-stimulus delays in anesthetized guinea pigs, and found that plasticity induced by paired acoustic and right mastoid stimulation was consistently suppressive regardless of delay, but paired acoustic and pinna stimulation was timing-dependent, where one inter-stimulus delay was consistently suppressive while other delays induced random changes. These experiments were repeated in awake animals with paired acoustic and pinna stimulation, and two animal groups of different stress levels were used to assess stress effects on plasticity. We found that in low-stress animals, the same inter-stimulus delay was consistently suppressive and a neighboring delay was consistently facilitative across all animals, which matches previous invasive spike-timing dependent plasticity studies (anesthesia may have affected these trends). Meanwhile, high-stress animal results were not consistent with expected time dependence and exhibited no trends across inter-stimulus delays, indicating that stress can have adverse effects on neuromodulation plasticity outcomes. In all other primary sensory cortices, we found that differential effects can be induced with paired sensory stimulation such that the location, amount, type, and timing of plasticity can be controlled by strategically choosing sensory stimulation parameters for modulation of each sensory cortex. We also investigated the ability to target subpopulations of neurons within a brain region and found that by stimulating at levels near activation thresholds, specific subpopulations of IC neurons can be targeted by varying somatosensory stimulation location. Furthermore, acoustic stimulation can excite or modulate specific areas of somatosensory cortex, and we mapped the guinea pig homunculus to characterize this. Overall, these findings illustrate the immense interconnectivity between sensory systems, and multisensory stimulation may provide a noninvasive neuromodulation approach for inducing controlled plasticity to disrupt pathogenic neural activity in neural sensory disorders, such as tinnitus and pain.Item Migraine As Predictor For Pain Intensity For Tmd Patients Undergoing Treatment(2015-08) Nascimento, ThiagoIntroduction: Temporomandibular disorders (TMD) occur in about 10% of the adult general population, which makes it a considerable public health problem. Some factors affect treatment outcome of TMD patients seeking care, and among the factors influencing the prognosis of TMD pain, are comorbid pain conditions. Headaches, particularly migraine, have long been reported to be more frequently associated in TMD patients. However, evidence is lacking whether migraine is a prognostic factor for TMD pain at follow-up for patients undergoing TMD treatment. Objective: To determine in TMD pain patients who undergo common non-surgical treatments whether the presence of migraine at time of diagnosis is associated with worse TMD pain intensity at follow-up over a time period of 18 months. Materials and Methods: In this prospective cohort study, a consecutive sample of 99 patients with a diagnosis of TMD pain consisting of MFP, arthralgia, and/or TMJ osteoarthritis according to RDC/TMD seeking care at the TMD and Orofacial Pain Clinic, University of Minnesota - School of Dentistry and undergoing common non- surgical treatments for TMD were recruited. Participants received a diagnosis of migraine according to International Classification of Headache Disorders 2nd edition (ICHD-II, 2004), the study exposure, at baseline. Characteristic pain intensity, the study outcome, was measured at 1, 6, 12 and 18 month follow-up and CPI differences at follow-up between patients with and without migraine were analyzed with several generalized equation estimation models and model selection was performed with QIC (Quasilikelihood under the Independence model Criterion). Baseline CPI status and sociodemographic variables were added to improve the model. Results: At time of diagnosis (baseline), patients with migraine had a CPI level of 53.9 (95% CI: 43.2-64.6) and patients without migraine had a CPI level of 55.8 (95% CI: 51- 60.5). At follow-up, CPI had decreased in both groups but patients with migraine had more pain. The statistically best fitting model predicted CPI values of 45.8, 38.4, 34.8 and 29.2 at 1, 6, 12, and 18 months, respectively for patients without migraine. Patients with migraine showed model-predicted differences, additional CPI compared to patients without migraine, of 10.6 (95% CI: -1.6 -22.9), 8.7 (95% CI: -8.0-25.4), 5.4 (95% CI: - 7.3-18.2) and 16.5 (95% CI: 5.2-27.8) at 1, 6, 12, and 18 months, respectively. According to guidelines to interpret effect sizes, the effect was "small."� A simple, more interpretable and still statistically well fitting model predicted that CPI decreases 0.96 per month during follow-up and patients with migraine have 11.6 (95% CI: 2.7-20.4) more CPI over the time period of 1.5 years than patients without migraine. Conclusion: For TMD patients who undergo common non-surgical treatments, migraine is a potential prognostic factor for TMD pain intensity at follow-up. Patients with migraine at the time of diagnosis have statistically significant more TMD pain intensity over a time period of 1.5 years than patients without. While the migraine effect is small, it suggests that treatment for migraine could possibly be incorporated in the overall treatment plan to improve patient outcomes.Item Modulation of Musculoskeletal Hyperalgesia by Brown Adipose Tissue Activity in Mice(2016-08) Goudie-DeAngelis, ElizabethBrown adipose tissue plays an important role in thermogenesis and metabolism in response to stress. Acutely, stress induces thermogenesis by increasing sympathetic tone to beta3 (β3) adrenergic receptors in brown adipose. Chronic stress leads to the hypertrophy of brown adipose, a phenomenon termed adaptive thermogenesis. Cold exposure and the associated sympathetic activity from a variety of stresses are also known to increase pain in patients suffering from painful disorders such as fibromyalgia syndrome. We theorized an association between brown adipose tissue activity and musculoskeletal hyperalgesia and tested this hypothesis in mice. Exposure to a cold swim stress enhanced musculoskeletal hyperalgesia, as indicated by morphine-sensitive decreases in grip force responses. Stimulation of β3 adrenergic receptors by injection of BRL37344, a β3 adrenergic agonist, also enhanced musculoskeletal hyperalgesia, consistent with the activation of the unique set of adrenergic receptors located in brown adipose. Chemical ablation of interscapular brown adipose, using Rose Bengal, attenuated the development of hyperalgesia in response to either swim stress or BRL37344. Similarly, elimination of the gene expressing uncoupling protein-1 (UCP1), the enzyme responsible for thermogenesis, prevented musculoskeletal hyperalgesia in response to a swim stress, as documented in UCP1-knock out (UCP1-KO) mice compared to wild type controls. Together these data provide a convergence of several lines of evidence suggesting that the acute activation of brown adipose contributes to muscloskeletal hyperalgesia. However, the baseline nociceptive sensitivity of UCP1-KO mice was greater than wild type controls, suggesting that a mechanism that promotes muscle pain is present that compensates for the absence of UCP1.Item A New Model for Acute Pain Management in Children: Examining Patient Characteristics and Potential Implications for Research and Practice(2021-05) Eull, DonnaAbstractCurrent literature suggests that acute pain management in hospitalized children remains substandard, resulting in adverse physical, cognitive, and emotional effects for many children. Improvements to pediatric acute pain management require an updated conceptual model and validation of current assumptions from the literature. The purpose of the three studies in this dissertation was to advance the state of the science on acute pain management in hospitalized children through an updated conceptual model, a critical review of literature, and analysis of pain management data from a children's hospital. The new acute pain management model transforms the role of the nurse from gatekeeper to facilitator in genuine partnership with children and families. The critical review of the literature suggested that differences in medication type and frequency for acute pain are associated with children’s sex and race/ethnicity, however study limitations make it difficult to draw meaningful conclusions about potential disparities in acute pain management for children. Findings from a retrospective chart review suggested no differences by sex, race/ethnicity, or limited English proficiency (LEP) in the average number of pain assessments, medication by weight, or outcomes. The results from this study may indicate progress in the management of acute pain in hospitalized children, as children in this study demonstrated average pain intensity scores which typically indicate mild, well-controlled pain. Replication of this study in other hospitals is needed to determine organizational effects on pain outcomes. Future research should also focus on identifying the components needed to establish genuine partnerships with patients and families and the potential influence of parents on effective pain management.Item Shingles a.k.a. Herpes Zoster(2008-02-05) Kelley, EleanorShingles is a painful rash characterized by red bumps that turn into blisters and resolves within 7-10 days. It is caused by a herpes virus that causes chicken pox and is more common in elderly or people with weak immune systems. It is treated with antiviral medication. The pain can last longer than the rash and can be severe. There a different types of treatment for the pain that you should talk to your doctor about.