Kent Stening

Influence of Estrogen Levels on Thermal Perception, Pain Thresholds, and Pain Tolerance : Studies on Women Undergoing in Vitro Fertilization.

UNLABELLED We examined the relationship between estrogen and pain in women undergoing in vitro fertilization (IVF). Quantitative sensory tests (QST) were performed twice during the IVF-regimen: once during hormonal down-regulation and once during hormonal up-regulation. A group of healthy men and a group of women using monophasic contraceptives were also examined, to control for session-to-session effects. Among the women undergoing IVF, serum 17β-estradiol levels differed strongly between treatments as expected, and increased from 65.7 (SD = 26) pmol/L during the down-regulation phase, to 5,188 (SD = 2,524) pmol/L during the up-regulation phase. Significant outcomes in the QST were only seen for temperature perception thresholds (1.7 °C versus 2.2 °C; P = .003) and cold pain threshold (11.5 °C versus 14.5 °C; P = .04). A similar change in cold pain threshold was also seen in the 2 control groups, however, and statistical analysis suggested that this change was due to a session-to-session effect rather than being the result of hormonal modulation. Heat pain thresholds, heat tolerance, pressure pain thresholds, and the cold pressor test showed no significant differences between sessions. These data demonstrate that pain perception and pain thresholds in healthy women show little, if any, changes even with major variations in serum estradiol levels. PERSPECTIVE This study shows that pain perception and tolerance in women undergoing in vitro fertilization do not vary, despite the dramatic changes in 17β-estradiol levels induced by the treatment regimen. The result thus suggests that in humans, contrary to experimental animals, changes in estrogen levels have little influence on pain sensitivity.

Hormonal replacement therapy does not affect self-estimated pain or experimental pain responses in post-menopausal women suffering from fibromyalgia: a double-blind, randomized, placebo-controlled trial

OBJECTIVES FM is a condition that preferentially affects women. Sex hormones, and in particular oestrogens, have been shown to affect pain processing and pain sensitivity, and oestrogen deficit has been considered a potentially promoting factor for FM. However, the effects of oestrogen treatment in patients suffering from FM have not been studied. Here, we examined the effect of transdermal oestrogen substitution treatment on experimental as well as self-estimated pain in women suffering from FM. METHODS Twenty-nine post-menopausal women were randomized to either 8 weeks of treatment with transdermal 17β-oestradiol (50 µg/day) or placebo according to a double-blind protocol. A self-estimation of pain, a set of quantitative sensory tests measuring thresholds to temperature, thermal pain, cold pain and pressure pain, and a cold pressor test were performed on three occasions: before treatment, after 8 weeks of treatment and 20 weeks after cessation of treatment. RESULTS Hormonal replacement treatment significantly increased serum oestradiol levels as expected (P < 0.01). However, no differences in self-estimated pain were seen between treatment and placebo groups, nor were there any differences between the two groups regarding the results of the quantitative sensory tests or the cold pressor test at any of the examined time points. CONCLUSION Eight weeks of transdermal oestradiol treatment does not influence perceived pain, pain thresholds or pain tolerance as compared with placebo treatment in post-menopausal women suffering from FM. TRIAL REGISTRATION ClinicalTrials.gov Registration; http://www.clinicaltrials.gov; NCT01087593.

Firefighters as First Incident Persons : breaking the chain of events and becoming a new link in the chain of survival

Purpose In order to shorten the response time, two part-time fire departments (FDs) in Sweden initialize a first incident person (FIP) assignment. This is done by alarming the crew manager as an FIP, responding in a separate emergency vehicle, and by arriving at the scene before rest of the crew. The purpose of this paper is to explore and describe experiences of the FIP assignment within an FD. Design/methodology/approach A multimethod design was used, influenced by Creswell and Plano Clark’s (2011) explanatory sequential mixed method design including emergency reports, a questionnaire and interviews. Findings The results show that the FIP assignment was a function that secured an early presence at the scene of an accident or emergency situations, which is beneficial for society in the form of a safety factor, for the firefighters in the form of early prior information on what to expect at the scene and for the patient in the form of early existential support and increased chances of survival. Originality/value In order to prevent full scenarios to happen and get the chance to save lives, an early response must be ensured. Hence, studies must be made in different settings, based on its unique conditions. This study indicates that by implementing FIP in FDs placed in a rural area, the FIP can break the chain of events and becoming a new link in the chain of survival.

Does physical pain impair abstract thinking

ABSTRACT The ability to think abstractly constitutes a fundamental dimension of human cognition. Although abstraction has been extensively studied, its emotional and affective antecedents have been largely overlooked. One experiment was conducted to examine whether physical pain affects abstraction. Drawing on Construal Level Theory [Trope, Y., & Liberman, N. (2010). Construal-level theory of psychological distance. Psychological Review, 117, 440–463] and Loewenstein’s [(1996). Out of control: Visceral influences on behavior. Organizational Behavior and Human Decision Processes, 65, 272–292] visceral factors theory, we hypothesised that pain impairs abstraction because pain constricts people’s mental horizons and lead to a concrete, inward-focus toward oneself in the here and now. Physical pain was manipulated between subjects (N = 150). The participants either kept their left hand immersed in cold (painful) water or neutral (painless) water while we measured abstract versus concrete behaviour identification, categorisation, and perceptual processing. Bayesian statistical analyses indicate substantial evidence against the hypothesis that pain impairs abstraction. In contrast to many other previously studied cognitive outcomes (e.g. attention), abstraction appears to be largely immune to acute, experimentally induced pain.

Meanings of Chronic Pain in Patient Interactions with Health Services

Chronic pain causes suffering for patients and managing chronic pain is one of the most common assignments in the health service. Health care professionals can profoundly influence the meaning patients and their families attribute to pain experience. Patients with chronic pain may feel discredited and called into question by skeptical medical professionals. Patients may have to fight to receive entitled care and to suggest suitable treatments. To contribute to medical decision-making and improved patient outcomes, health care professionals should integrate phenomenological narratives and stories about pain into health care in parallel with consulting the medical evidence. Professional care structures should not make health care professionals feel torn between meeting patient needs for existential support and the demand of meeting high clinical work-loads. Narratives and stories can provide shared structures that allow patients and medical professionals to make decisions that feel meaningful, accurate, and clear. Many patients use psychological strategies in their everyday lives in order to live meaningfully with persistent pain; but, this is not enough. Healthcare professionals need “dare to open up and accept personal and deep conversations with patients” about their pain experiences and the lived consequences of persistent pain.