Indiana University-Purdue University Indianapolis (IUPUI) / Compared to White individuals, Black individuals demonstrate a lower tolerance for experimental pain. Previous studies also suggest that prayer mediates the race difference in pain tolerance such that Black individuals pray more than White individuals with praying being associated with decreased pain tolerance. However, prayer as it has been studied in relation to pain is a passive coping strategy. Therefore, it is unclear whether prayer in and of itself is driving this relationship or whether it is due to the passive nature of the prayer. The purpose of the current study was to examine the interaction between prayer and race on experimental pain tolerance. Healthy undergraduates were randomly assigned to one of three prayer groups: active prayer, passive prayer, and no prayer. Participants were instructed to continually repeat a specified prayer while undergoing a cold pressor task measuring pain tolerance. Results of a 2 (Race: White vs. Black) X 3 (Prayer: active vs. passive vs. none) between-subjects ANOVA indicated there were no significant main effects of race [F(1,202) = 1.01; p = .32] or prayer [F(2,202) = 1.99; p = .14] on tolerance and no race X prayer interaction [F(2,202) = .37; p = .69]. However, a visual inspection of the means trended in the expected direction with those engaged in active prayer demonstrating longer tolerance (M = 53.77; SD = 49.96) than those engaged in passive prayer (M = 40.94; SD = 36.11) and no prayer (M = 41.63; SD = 40.84). These results suggest that the nature of prayer may influence its effect on pain outcomes. This is consistent with the literature which suggest that, compared to passive strategies, active coping strategies are associated with improved pain outcomes. These results may inform psychosocial pain treatments, especially for individuals who endorse the use of prayer as a coping strategy. Providers may consider encouraging patients to adopt a more active style of prayer in order to facilitate pain self-management.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in the field of Biokinetics Johannesburg, 2017 / Background: Patellofemoral pain (PFP) is a common knee complaint associated with pain around the patella. Research has identified altered electromyographic (EMG) activity of the knee muscles in individuals with PFP compared to a healthy population (Briani et al., 2016). Purpose: The purpose of this observational study was to identify the EMG activity of the quadriceps muscle during functional activities in participants experiencing PFP and participants with no PFP. Methods: The onset and sequence timing including the ranking and Q-angle in relation to the rectus femoris (RF), vastus medialis obliquus (VMO) and vastus lateralis (VL) activity was measured with surface EMG in 17 PFP participants and 17 controls during a sit to stand, squat, and step up and step down. Results: The RM-ANOVA discovered a significant difference in the onset of VMO compared to RF muscle between the activities in the PFP group (-0.11 to 0.07 sec; p = 0.03) and the healthy group (-0.18 to -0.03; p = <0.01), as well as the VL compared to the RF muscle in the PFP group (-0.07 to 0.13 sec; p = <0.01). Significant differences were shown comparing the ranking of EMG onset for the quadriceps muscle to each activity in the healthy group (p = <0.01 to 0.04), and in the PFP group for the sit to stand (p = 0.01). Onset of VMO activity was predominantly ranked first in the healthy group (56%) and the VL in the PFP group (44%). A Mann-Whitney U-test shown a significant relationship in the healthy group between the Q-angle and the VMO, VL and RF muscles during the step down activity (r = -0.53 to -0.55; p = 0.02 to 0.03). Conclusion: This study confirms that the quadriceps muscle responds differently to different functional activities in the PFP and healthy population respectively. The healthy group tend to utilize the VMO first, compared to the PFP group with altered onset of quadriceps activation. Furthermore, the greater the Q-angle is, the earlier the onset of quadriceps muscle will be in the healthy group. This relationship was not found in the PFP group. / MT2017

Breast cancer is one of the most common cancer diagnoses in women and is a significant cause of mortality and morbidity worldwide. Surgical treatment is indicated in most patients. Postmastectomy pain syndrome (PMPS) is a distinctive, persistent and debilitating neuropathic pain syndrome that develops after breast surgery. A review of the literature revealed no studies determining the prevalence of PMPS conducted in South Africa, specifically at the Chris Hani Baragwanath Academic Hospital (CHBAH). A detailed description of the prevalence of PMPS is needed to understand the problem in this patient group which may enable the development of a more effective pain management strategy.

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Tonsillectomy is one of the most commonly performed surgeries in North America. Guidelines exist for surgical candidacy for pediatric patients, but to date, there exists significant controversy and no clear guidelines advising physicians on treating pain post-tonsillectomy. Pain is the most frequent and potentially morbid complication of tonsillectomy, as it triggers return visits to physicians and hospitals following surgery, and can result in the need for hospital admission for hydration and pain control. In fact, a main point of controversy surrounds the use of a large class of analgesics known as non-steroidal anti-inflammatory drugs (NSAIDs), due to the potential for increased risk of bleeding as a result of their anti-platelet activity. However, NSAIDs have been shown to have a notable analgesic benefit in other surgical fields without conferring a significant bleeding risk. Moreover, they are known for their opioid-sparing effect, which is favored due to the many side-effects of opioids. Therefore, we undertook a systematic review of the literature to investigate the question of analgesic benefit for NSAIDs compared to other analgesics, and found that they were not different than opioids at treating post-tonsillectomy pain. However, the evidence available to answer this question was often flawed, warranting further investigation into this question. We were also especially interested in investigating commonly used analgesics such as ibuprofen and acetaminophen, so we devised a protocol that included these two medications. This protocol compares ibuprofen and acetaminophen to acetaminophen alone and seeks to show a significant opioid-sparing effect for ibuprofen. Ultimately, this topic is important because of the frequency with which tonsillectomies are performed and the importance of pain control following this procedure. / Thesis / Master of Science (MSc) / Tonsillectomy is the surgery that completely removes the tonsil from the throat, and many children and adults undergo this procedure for various reasons including infections, sleeping problems and other. This surgery has several side effects including pain, dehydration and bleeding. Pain is the most frequent of all these side effects, and can result in significant disturbances in the recovery experience, as well as cause the patient to require hospital visits and admission. Therefore pain control is important, and can be achieved incorporating medications such as non-steroidal anti-inflammatory drugs into the post-operative analgesic regimen. We investigated the role that these medications can play in relieving pain in this setting, and found that these are no different than opioids, such as morphine and codeine, the latter of which have many side-effects including breathing problems, constipation, itchiness, nausea, and others. However, there wasn't enough evidence to make definitive conclusions regarding the amount of opioids that can be avoided with the use of non-steroidal anti-inflammatory drug. Therefore, we designed a protocol for a randomized study to better understand this area that is so far little understood. The results of this study could help optimize pain control measures following tonsillectomy, and change the practice of surgeons favoring an evidence-based approach.

The first sensory synapse is the site where sensory afferent fibers make synaptic connections with second order neurons. Somatic and craniofacial afferents terminate in spinal cord dorsal horn (SDH) and caudal spinal trigeminal nucleus (CSTN). Neurotransmitter release from first order nerve terminals regulates ascending sensory transmission. Several lines of evidence indicate that plasticity in the spinal cord dorsal horn underlies secondary hyperalgesia. The sensory receptors, Transient Receptor Potential (TRP) channels, are expressed not only at peripheral terminals, but also at the central terminals of sensory neurons. While the role of these channels at the periphery is detecting environmental stimuli, their function at central terminals is not fully understood. Furthermore, TRP channel expression has been shown in CNS nuclei like hippocampus that are not tightly linked to somatosensation. In this study, I first determined the functionality of TRP channels at the first sensory synapse and hippocampus using pharmacological activators. I then determined if putatively endogenous TRP channel activators modulate synaptic transmission at the first sensory synapse. Lastly, I determined if recordings that respond to capsaicin demonstrate synaptic plasticity in either hippocampus or spinal cord, in an attempt to attribute synaptic plasticity mechanisms to TRPV1 activity at glutamatergic terminals. I have used slice patch-clamp technique to record miniature, spontaneous and evoked currents in lamina II neurons of spinal cord dorsal horn, CSTN and hippocampus. In lamina II neurons of SDH and CSTN, capsaicin, a TRPV1 agonist, robustly increased the frequency of mEPSCs and sEPSCs in a dose dependant manner. Although capsaicin increased m/sEPSC frequency, eEPSC amplitude, which reflects synchronous action potential propagation at glutamatergic terminals, was markedly depressed by capsaicin. Our studies indicate capsaicin inhibits action potential dependant transmission at central terminals. Resiniferatoxin (RTX) is a TRPV1 agonist that displays higher potency (>100 fold) compared to capsaicin, and deactivation with this agonist is minimal. RTX also depressed eEPSC amplitude in lamina II neurons of SDH and CSTN; unexpectedly, RTX increased m/sEPSC frequency to lesser extent compared to capsaicin. The TRPA1 agonist, N-methyl maleimide (NMM), increased s/mEPSC frequency in lamina II neurons; however, NMM did not depress eEPSC amplitude like capsaicin and RTX. It is possible that inhibition of nerve terminal firing is a unique property of TRPV1 agonists compared to other noxious chemicals. To justify a physiological relevance for nociceptive TRP channel expression at the first sensory synapse, I studied the effect of endogenous TRP channel agonists on synaptic transmission at the first sensory synapse. Anandamide (AEA) is an agonist of CB1/CB2 and TRPV1 receptors; it is less potent at TRPV1 receptors than capsaicin. AEA increased sEPSC frequency in 70% of neurons, whereas the remainder of neurons showed a decrease in sEPSC frequency. Unlike capsaicin and RTX, anandamide did not dramatically depress eEPSC amplitude. Methyl glyoxal (MG) is a putative TRPA1 agonist produced during conditions of hyperglycemia. MG increased the frequency of sEPSCs in SDH lamina II neurons. I next used high frequency synaptic stimulation (HFS-100 Hz, 1s) to model synaptic activity during pain transmission. HFS induced a modest increase in sEPSC frequency and minimally changed eEPSC amplitude; patches that showed HFS modulation also responded to capsaicin. In studying the role of TRP channels in modulating synaptic transmission at central synapses, I finally performed experiments in hippocampus with 2 objectives; 1) to determine extent of capsaicin responsiveness as an indicator of TRPV1 functionality, and 2) to evaluate synaptic plasticity in response to HFS. Capsaicin effect on sEPSC frequency in CA1 and CA3 neurons was minimal in comparison to its effect in dorsal horn neurons. HFS at schaffer collateral region caused LTP in CA1 neurons that was more pronounced than for spinal cord. In conclusion, TRP channels are expressed at central terminals of nociceptors where they modulate glutamatergic transmission. Studying their role at the first sensory synapse enhances our understanding of nociceptive transmission, and this study suggests this receptor for a target for intervening in pathological pain transmission at the level of spinal cord.