Aspects of Pain, Its Assessment and Evaluation from An Acupuncture Perspective

2008

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Pain is a unique personal experience showing variability where gender and sex related effects might contribute. The mechanisms underlying the differences between women and men are currently unknown but are likely to be complex and involving interactions between biological, sociocultural and psychological aspects. In women, painful experimental stimuli are generally reported to produce a greater intensity of pain than in men. Clinical pain is often reported with higher severity and frequency, longer duration, and present in a greater number of body regions in women than in men. Women are also more likely to experience a number of painful conditions such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. With regard to biological factors, quantitative as well as qualitative differences in the endogenous pain inhibitory systems have been implicated, as well as an influence of gonadal hormones. Psychosocial factors like sex role beliefs, pain coping strategies, and pain related expectancies may also contribute to the differences. Being exposed to repeated painful visceral events (eg menses, labour) during life may contribute to an increased sensitivity to, and greater prevalence of, pain among women. When assessing the outcome of pharmacological and non-pharmacological therapies in pain treatment, the factors of gender and sex should be taken into account as the response to an intervention may differ. Preferably, treatment recommendations should be based on studies using both women and men as the norm. Due to variability in results, findings from animal studies and experiments in healthy subjects should be interpreted with care.

Section: Irritable Bowel Syndrome (Ibs)mentioning

confidence: 99%

Is it All about Sex? Acupuncture for the Treatment of Pain from a Biological and Gender Perspective

2008

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“…116 Descending pain inhibition is activated by acupuncture or moxibustion (heat stimulation) as well as by expectation. [117][118] Counter irritation and low threshold afferent inputs (vibratory stimulation, transcutaneous electrical nerve stimulation, TENS, or massage) may also activate inhibitory mechanisms at the spinal cord level. 119 In models of inflammation, inhibition of δ-opioid receptors prevents antihyperalgesia produced by high frequency stimulation, whereas inhibition of µ-opioid receptors prevents antihyperalgesia produced by low frequency stimulation, suggesting that both modalities may be tried in endometrialgia.…”

Section: Pain and Hormones In Endometriosismentioning

confidence: 99%

Is There a Role for Acupuncture in Endometriosis Pain, Or ‘endometrialgia’?

2008

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Endometriosis is a common cause of pelvic pain in women, many of whom suffer a progression of symptoms over their menstrual life. Symptoms may include combinations of abnormal visceral sensations and emotional distress. Endometriosis pain, or ‘endometrialgia’ often has a negative influence on the ability to work, on family relationships and sense of worth. Endometrialgia is often considered to be a homogeneous sensory entity, mediated by a specialised high threshold sensory system, which extends from the periphery through the spinal cord, brain stem and thalamus to the cerebral cortex. However, multiple mechanisms have been detected in the nervous system responsible for the pain including peripheral sensitisation, phenotypic switches, central sensitisation, ectopic excitability, structural reorganisation, decreased inhibition and increased facilitation, all of which may contribute to the pain. Although the causes of endometrialgia can differ (eg inflammatory, neuropathic and functional), they share some characteristics. Endometrialgia may be evoked by a low intensity, normally innocuous stimulus (allodynia), or it may be an exaggerated and prolonged response to a noxious stimulus (hyperalgesia). The pain may also be spontaneous in the absence of any apparent peripheral stimulus. Oestrogens and prostaglandins probably play key modulatory roles in endometriosis and endometrialgia. Consequently many of the current medical treatments for the condition include oral drugs, like non-steroid anti-inflammatory drugs, contraceptives, progestogens, androgenic agents, gonadotrophin releasing hormone analogues, as well as laparoscopic surgical excision of the endometriosis lesions. However, management of pain in women with endometriosis is currently inadequate for many. Possibly acupuncture and cognitive therapy may be used as an adjunct.

“…The evaluation of acupuncture-related effects, the trial design and the statistical analysis used constitute a challenge since the assessed variables commonly have subjective properties and are based on the person's own self-report. 1 Thus, the results that are seen are often varied, most probably due to interindividual variation in rating of the actual variable such that the treatment effects are expressed more (or less) in some individuals than in others. The basis for the individual variation is probably multi-modal and could be related to the individuals' expectation, aetiology of the condition, gender and genetic polymorphisms.…”

mentioning

confidence: 99%

“…In order to evaluate the treatment effects more properly and increase the possibility of detecting its effectiveness, it is, therefore, important to assess the level of perceived dysfunction or symptom, taking into account the individual variation as well as the systematic effects (the effects of the group). 1 Recommendations for treatment are commonly based on systematic effects (group responses) from randomised controlled trials without taking the patient's individual variation into account. [1][2][3] Another option to increase the possibility of detecting the effectiveness of treatment such as acupuncture is by using enriched enrolment randomised withdrawal trials designs.…”

mentioning

confidence: 99%

“…1 Recommendations for treatment are commonly based on systematic effects (group responses) from randomised controlled trials without taking the patient's individual variation into account. [1][2][3] Another option to increase the possibility of detecting the effectiveness of treatment such as acupuncture is by using enriched enrolment randomised withdrawal trials designs. 3 This design also allows for a naturalistic approach whereby the patient undergoes trial treatments before selecting the modality preferred, thereby optimising the effect.…”

mentioning

confidence: 99%

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Treatment Recommendations Should Take Account of Individual Patient Variation Not Just Group Responses

2009

Self Cite

Recommendations for treatment are commonly based on results evaluating variation in systematic effects (group responses) from randomised controlled trials without taking the individual patient's variation into account. In the evaluation of acupuncture-related treatment effects, the trial design and statistical analysis used are a challenge since the assessed variables commonly have subjective properties and are based on the person's own self-report. Thus, the results that are seen are often varied, most likely due to inter-individual variation in rating of the actual variable such that the treatment effects are expressed more (or less) in some individuals than in others. The basis for the individual variation is probably multi-modal and could be related to the individuals' expectation, gender, genetic polymorphisms and the aetiology of the condition. The assessment methods used should preferably have proven useful in controlled trials, and the methods for statistical analysis should consider the non-metric properties of the variable and the contribution of the individuals' variation in the results. In order to evaluate the treatment effects more properly and increase the possibility of detecting any effectiveness, it is therefore important to assess the level of perceived dysfunction or symptom, taking into account the individual variation as well as the systematic effects (the effects of the group). In the evaluation of acupuncture effects, both systematic and individual variation should be reported allowing for the detection of subgroup effects and thereby leading to treatment recommendations that are more likely to be based on each individual's specific needs.Acupuncture is a complex, multi-methodological treatment approach, with documented evidence in alleviation of pain and other types of subjective complaint. A complaint such as pain is a personal multidimensional experience that is defined by its different components, classified and evaluated according to aetiology, in order to provide a rational treatment approach. The evaluation of acupuncture-related effects, the trial design and the statistical analysis used constitute a challenge since the assessed variables commonly have subjective properties and are based on the person's own self-report.1 Thus, the results that are seen are often varied, most probably due to interindividual variation in rating of the actual variable such that the treatment effects are expressed more (or less) in some individuals than in others. The basis for the individual variation is probably multi-modal and could be related to the individuals' expectation, aetiology of the condition, gender and genetic polymorphisms.