Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Self-mutilation occurs in 70-80% of patients who meet DSM-IV criteria for borderline personality disorder. Approximately 60% of these patients report that they do not feel pain during acts of self-mutilation such as cutting or burning. Findings of recent studies measuring pain perception in patients with BPD are difficult to interpret since variables such as distress, dissociation or relevant psychotropic medication have not been controlled. The Cold Pressor Test (CPT) and the Tourniquet Pain Test (TPT) were administered to 12 female patients with BPD who reported analgesia during self-mutilation and 19 age-matched healthy female control subjects. All subjects were free of psychotropic medication. The patients were studied on two occasions: during self-reported calmness and during intensive distress (strong urge to cut or burn themselves). Even during self-reported calmness, patients with BPD showed a significantly reduced perception of pain compared to healthy control subjects in both tests. During distress, pain perception in BPD patients was further significantly reduced as compared with self-reported calmness. The present findings show that self-mutilating patients with BPD who experience analgesia during self-injury show an increased threshold for pain perception even in the absence of distress. This may reflect a state-independent increased pain threshold which is further elevated during stress. Interpretation of these findings is limited by their reliance upon self-reports.
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PMID:Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior. 1097 64

Concerns about dependence on prescribed analgesia may compromise pain management, but there was previously little reliable evidence about substance dependence among patients with sickle cell disease (SCD). We conducted in-depth, semi-structured interviews with SCD patients in London, UK, to assess DSM-IV symptoms of substance dependence and abuse. Criteria were applied to differentiate between pain-related symptoms, which corresponded to the DSM-IV symptoms but involved analgesics used to control pain, and non-pain-related symptoms, which involved analgesic use beyond pain management. Pain-related symptoms are informative about how the pattern of recurrent acute pain in SCD may make patients vulnerable to perceptions of drug dependence. Non-pain-related symptoms are informative about more stringently defined dependence on analgesia in SCD. Inter-rater reliability was high, with mean Kappa coefficients of 0.67-0.88. The criteria could be used to assess analgesic dependence in other painful conditions. Pain-related symptoms were more frequent, accounting for 88% of all symptoms reported. When pain-related symptoms were included in the assessment, 31% of the sample met the DSM-IV criteria for substance dependence, compared with only 2% when the assessment was restricted to non-pain-related symptoms. Qualitative analysis of participants' descriptions of analgesic use showed that active coping attempts (attempts to anticipate pain and avoid hospital admissions) and awareness of dependence were themes in descriptions of both pain-related and non-pain-related symptoms. Seeking a more normal lifestyle and impaired activities were themes associated with pain-related symptoms. Psychological disturbance was a theme associated with non-pain-related symptoms. The implications are for more responsive treatment of pain in SCD and greater awareness of how patients' pain coping may be perceived as analgesic dependence. Further research could examine ways that pain-related and non-pain-related symptoms of dependence may be associated with other pain coping strategies and with the outcomes of treatment for painful episodes in hospital.
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PMID:Pain management and symptoms of substance dependence among patients with sickle cell disease. 1294 77

Approximately 70-80% of women meeting criteria for borderline personality disorder (BPD) report attenuated pain perception or analgesia during non-suicidal, intentional self-mutilation. The aim of this study was to use laser-evoked potentials (LEPs) and psychophysical methods to differentiate the factors that may underlie this analgesic state. Ten unmedicated female patients with BPD (according to DSM-IV) and 14 healthy female control subjects were investigated using brief radiant heat pulses generated by a thulium laser and five-channel LEP recording. Heat pulses were applied as part of a spatial discrimination task (two levels of difficulty) and during a mental arithmetic task. BPD patients had significantly higher heat pain thresholds (23%) and lower pain ratings (67%) than control subjects. Nevertheless, LEP amplitudes were either normal (N1, P2, P3) or moderately enhanced in BPD patients (N2). LEP latencies and task performance did not differ between patients and control subjects. The P3 amplitudes, the vertex potential (N2-P2), and the N1, which is generated near the secondary somatosensory cortex, were significantly reduced during distraction by mental arithmetic in both groups. In addition, P3 amplitudes reflected task difficulty. This study confirms previous findings of attenuated pain perception in BPD. Normal nociceptive discrimination task performance, normal LEPs, and normal P3 potentials indicate that this attenuation is neither related to a general impairment of the sensory-discriminative component of pain, nor to hyperactive descending inhibition, nor to attention deficits. These findings suggest that hypoalgesia in BPD may primarily be due to altered intracortical processing similar to certain meditative states.
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PMID:Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behavior: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings. 1527

Approximately two thirds of those with borderline personality disorder (BPD) who self-injure report diminished sensitivity to pain during acts of self-harm. Research on pain perception suggests that abnormalities of the motivational-affective domain likely contribute to the commonly reported hypo-analgesia evidenced in BPD. It is not that BPD individuals cannot detect or feel painful stimuli, rather their response to it seems to reflect differences in tolerance and willingness to report a stimulus as painful. Although specific processes involved with pain insensitivity have been debated in literature, the likelihood of generalized dysfunction in the somatosensory systems in BPD has not been considered. Prior BPD research has focused only on the pain submodality of somatosensation. This study assessed pain perception (nociception), basic touch (exteroception), and body sense (proprioception) somatosensory submodalities, in an effort to determine if generalized somatosensory deficits are present in BPD. Subjects diagnosed with DSM-IV BPD (n = 27) were compared with individuals who had a history of major depressive disorder with no current psychopathology (n = 20), and normal controls (n = 44), all drawn from a community setting. Individuals with BPD evidenced higher pain endurance and tolerance, but did not demonstrate generalized somatosensory deficits, as evidenced by appropriate functioning on tasks of exteroceptive and proprioceptive sensitivity. Findings are consistent with (but do not prove) a specific dysfunction in the pain-specific mechanism of sensitivity and perception in BPD, perhaps one that does not disturb the other somatosensory modalities. These data help to provide a firmer empirical basis for pain insensitivity as an endophenotype for BPD.
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PMID:Somatosensory processing and borderline personality disorder: pain perception and a signal detection analysis of proprioception and exteroceptive sensitivity. 2383 16

Background: Nitrous oxide (N2O) is used worldwide for analgesia and anesthesia. It is also used for recreational purposes by some people. N2O can have major side effects (myeloneuropathy, delusions, emphysema) when used to excess. In France, N2O is available as an equimolar mixture of oxygen and nitrous oxide (EMONO). Its substance use disorder potential is monitored by the French Monitoring Centre for Addiction (CEIP-A) network. Our objective is to provide an overview of the substance use disorder potential of N2O in general, and of EMONO in particular. Methods: This paper is based on a systematic review of the literature for case reports involving N2O use disorder and on CEIP-A network cases involving EMONO use disorder. We characterized use disorder in accordance with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) criteria. Furthermore, we considered data relating to medical history, age, gender, and N2O consumption habits. Results: We identified 59 cases of N2O use disorder in the literature and 17 cases of EMONO use disorder from the CEIP-A network. More than 90% of the cases used N2O in larger quantities and for longer than intended. Conversely, more negative as opposed to positive cases have been documented regarding tolerance and failed attempts to reduce usage. Conclusions: A specific profile of substance use disorder starts to emerge from all the cases studied here. Furthermore, we identified another way N2O use disorder can appear: through exposure for medical purposes.
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PMID:Nitrous oxide: What do we know about its use disorder potential? Results of the French Monitoring Centre for Addiction network survey and literature review. 3091 1

In 1880, Jules Cotard described a peculiar syndrome after observing the case of a 43-year-old woman, which was characterized by melancholic anxiety, delusions of damnation or possession, a higher propensity to suicide ideation and deliberate self-harm, analgesia, hypochondriac thoughts of non-existence or ruin of several organs, of the whole body, of the soul, of divinity, and the idea of immortality or inability to die. Several expansions and reinterpretations have been made of the so-called Cotard's syndrome, which is often encompassed in different neurological and psychiatric disorders, complicating and worsening their symptomatic frameworks and making more difficult their treatments. However, the nosographic characterization of Cotard's syndrome remains elusive and is not now classified as a separate disorder in both ICD and DSM-5. Here, we try to give an update, as well as a putative systematization, of current views and opinions about this nosological entity in the light of the recent progress in the clinic, psychopathology and psycho-neurobiology.
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PMID:The 'dead man walking' disorder: an update on Cotard's syndrome. 3250 Aug 1