Background: Headache is common in the elderly. Cervical degenerative changes are universal with ageing and cervicogenic headache is proposed (albeit without evidence) as a frequent cause of headache in this age group. Previous research identified a pattern of cervical musculoskeletal impairment which differentiated cervicogenic headache from other frequent headaches but this study was undertaken on younger/middle aged individuals. The value of this diagnostic pattern could be questioned for an older population with concomitant age related changes in the musculoskeletal system. The first and foremost aim of this research was to determine if cervical musculoskeletal impairment was specific to headaches classifiable as cervicogenic or was more generic to headache in elders. Participants with headache were sub-grouped on the basis of the pattern of cervical musculoskeletal impairment and the relationship between this grouping and headache classification was investigated. The presence of sensory hypersensitivity and psychological distress are features of headache that can provide information on the underlying mechanisms and provide management directives for headache. There is little knowledge of whether or not these features are influenced by a factor of age. Thus the second and third aims of this research were to investigate sensory features and psychological and quality of life features in the elderly with headache. Methods: One hundred and eighteen subjects, aged 60 to 75 years with recurrent headache and 44 controls were studied. Ninety-three reported a single headache and 25, two or more headache types. All subjects completed the Neck Disability Index (NDI), Geriatric Depression Scale-short form (GDS-S) and SF-36 questionnaires. Subjects with headache also completed a headache questionnaire and the Survey of Pain Attitudes (SOPA-35). Neck function measures included range of motion, manual examination of cervical segments, cranio-cervical flexor muscle function, joint position sense, cervical muscle strength, cross-sectional area of selected cervical extensors and posture. Sensory measures included pressure pain thresholds (PPTs) and thermal pain thresholds (TPTs). PPTs were measured over the forehead, upper neck and at a remote site (tibialis anterior). TPTs were measured over the upper neck. Results: Cluster analysis, based on the three musculoskeletal variables aligned previously with cervicogenic headache, divided headache subjects into two groups; cluster 1 (n = 57), cluster 2 (n = 50). There was significantly reduced cervical extension, axial rotation, rotation in neck flexion and lateral flexion in the headache clusters than the control group, and in the frequency of symptomatic joint dysfunction (C0-1 – C7-T1) (all p < 0.05). Subjects in cluster 1 had significantly reduced range of cervical extension and axial rotation and frequency of symptomatic joint dysfunction (C1-2 and C7-T1) compared to those in cluster 2 and controls (all p < 0.05). More subjects in cluster 1 had headaches ≥ 15 days per month and histories of head/neck trauma (both p < 0.05). Most cervicogenic headaches were grouped in cluster 1, but musculoskeletal dysfunction was also found in headaches classifiable as migraine or tension-type headache. The analysis of subjects with single headaches revealed no significant differences between the headache groups (migraine, tension-type, cervicogenic and unclassifiable headaches) and controls in pressure and cold pain thresholds (all p > 0.05). Heat pain thresholds were significantly lower in the headache groups compared to controls (all p < 0.01) but there were no differences between headache types (all p > 0.05). There were no strong relationships between any headache variable and pain thresholds. Elders with headache scored lower on most SF-36 domains, higher on the GDS-S (p < 0.05) and comparably on the SOPA-35 (p > 0.05) compared to the control group. The GDS score was below the threshold value for depression. Differences in these measures were not dependent on the headache types but rather, headache frequency. Subjects with headaches ≥ 15 days/month scored lowest on SF-36 domains and highest on GDS-S questionnaire compared to those with headache < 15 days/month and controls (all p < 0.05). The mean NDI score in the subjects with headache indicated the presence of mild to moderate neck pain and disability. No strong relationships were found between well-being and headache frequency, intensity and length of headache history. The NDI score had the greatest influence on physical well-being and GDS-S score on mental well-being (p < 0.001). Conclusions: Several aspects of cervical musculoskeletal function, heat thresholds, general well being and quality of life were altered in elders with headache. Neck dysfunction was not uniquely confined to cervicogenic headache but was a generic feature of headache in the elderly. No generalized changes in pain sensitivity were present in elders with headache. Headache had a significant impact on elders’ quality of life but was not associated with depression. Neck pain was an important factor influencing function and well-being. Conservative management such as physiotherapy may be a safe and appropriate option for elders with headache, given its frequent association with cervical musculoskeletal impairment. Further research is required for a better understanding of the neck’s role in elders’ headache.

Background: Low back pain (LBP) is the leading cause of disability and is often accompanied with a back-related leg pain (around 60%), where those with radiating pain show worse overall clinical outcomes. Previous studies comparing these two groups have involved individuals with chronic LBP. It is not known if subjects who currently have LBP differ in pain sensitivity from those who have currently LBP accompanied with pain radiation to lower limbs. Aim: The aim of this study was to investigate whether there are differences in self-reported health and pain sensitivity between individuals currently having LBP with and without pain radiation to lower limbs. Method: Individuals with LBP (n=100) aged 40 to 70 years participated in this study. According the first question of STarT Back Pain Screening Tool about the pain radiation to leg(s), individuals were divided into two groups: radiation group (RG, n=36) and no radiation group (noRG, n=64). To gain the information about self-reported health, following questionnaires were used: Roland-Morris Disability Questionnaire, Fear-Avoidance Beliefs Questionnaire and Hospital Anxiety and Depression Scale. Pressure pain thresholds (PPTs) were measured with algometer (6 sites and 4 points of ’lower body’: gluteal and knee points). Mann-Whitney U-test was used to calculate differences on group and gender level. A logistic regression analyses was calculated (crude model), where belong to RG or not was the dependent variable and all self-reported data and PPTs were independent variables, all data were controlled for gender and age. Results: The RG reported worse disability (p=0.017), higher fear-avoidance beliefs (FAB) about physical activity (p=0.003), worse score in anxiety (p=0.002) and depression (p=0.001), and increased pain sensitivity (p=0.043) in 6 sites PPTs compared to the noRG. Higher score of disability, FAB (physical activity and work), anxiety and depression were associated with an increased risk of belonging to the RG (OR 1.05-1.50, 95% CI 1.01-1.94), controlled for gender and age. Conclusion: Individuals with LBP and pain radiation to lower limbs showed worse self-reported disability and fear-avoidance beliefs about physical activity than those with LBP only. Further, those with pain radiation were more sensitive to pain in general. Worse scores of all studied self-reported data were associated with an increased risk of belonging to the groups with pain radiation. To study gender differences larger sample sizes are needed. Individuals with LBP and pain radiation to lower limbs showed worse outcomes and therefore should receive a different treatment approach than those who have only LBP.

Background: Altered autonomic nervous system (ANS) function has been proposed as a mechanism in the development of central sensitisation (CS) and visceral pain hypersensitivity (VPH). The contribution of the parasympathetic nervous system (PNS) and the factors that mediate differences in sensitisation to acid are unclear and their study will clarify risk factors for oesophageal pain hypersensitivity (OPH) in gastrooesophageal reflux disease. Aims: To investigate psychophysiological and pharmacological manipulation of PNS tone in the development of OPH, and to determine factors which predict the development of OPH to acid infusion in healthy volunteers in a validated model of acid induced OPH. Methods: Pain thresholds to electrical stimulation in the proximal oesophagus were determined before and after a 30-minute distal oesophageal infusion of 0.15 mol/L hydrochloric acid in subjects. Sympathetic (SNS) and PNS parameters were measured at baseline and continuously thereafter. Subjects underwent psychological profiling for anxiety, depression, attachment vulnerability and personality type. Using this model, five studies were undertaken: Study 1 a pilot study to trail modulation suitability for further study used. In Study 2, subjects who demonstrated secondary hyperalgesia in the proximal non-acid-exposed oesophagus performed deep or sham breathing. Study 3 subjects, who did not sensitise to acid, underwent a validated stress test to induce OPH. With Study 4, deep breathing with IV saline (placebo) or atropine (PNS antagonist) was used to evaluate deep breathing’s induced PNS tone in OPH reduction. Study 5, a genetic pilot study, exploring the role of the GCH-1 haplotype in VPH. Results: ANS control’s key role in CS was clarified. Deep breathing increased PNS tone and prevented acid-induced OPH in comparison to sham breathing and confirmed increased PNS tone’s reversal of OPH. Psychological factors of anxiety, alexithymia and attachment status influence ANS modulation of CS. Individuals’ predisposition to VPH due to psychogenetic profiles were clarified and their biopsychosocial role illustrated. Conclusions and Inferences: A mechanistic explanation for the analgesic effect of deep breathing is provided with potential therapeutic implications in the treatment of VPH syndromes. Further clinical study is warranted to develop cost-effective treatments for chronic VPH syndromes.

Stress and monotonous work contribute substantially to the development of chronic musculoskeletal disorders. Yet, the pathophysiological mechanisms underlying the process, particularly the involvement of autonomic regulation, remain unclear. It has been suggested that altered motor control resulting from distorted sensory information from fatigued muscles may be an important component in the development of musculoskeletal disorders. Animal studies have shown that sympathetic nervous system activation exerts actions in skeletal muscles, such as vasoconstriction and modulation of afferent information from muscle spindles. However, few attempts have been made to address this issue in humans. Therefore, the first aim of the thesis was to investigate the impact of repetitive computer work with and without additional stressors on muscle oxygenation and position sense in the upper extremity. Assuming an important role of stress in the development of chronic musculoskeletal symptoms, one may expect open or latent manifestations of such symptoms in patients with non-specific stress-related illnesses. It is possible that sympathetic activation may influence pain perception, and that treatments aimed at reducing stress may also affect the pain experience. Thus, the second aim of the thesis was to evaluate the effects of a cognitive-behavioral training program and a physical activity program for patients with stress-related illnesses on autonomic reactivity, pain, and perceived health. First, a laboratory model of computer mouse use was characterized in terms of biomechanical exposure of the wrist, and wrist position sense was determined before and after 45 minutes of continuous mouse use. Then, the effects of performing the computer mouse work under time pressure and precision demands were determined. Autonomic activity and muscle oxygenation in the upper extremity were measured during the work, and wrist position sense was assessed before and after the work. When patients with stress-related illnesses were compared to healthy individuals in autonomic reactivity to functional tests, pressure-pain thresholds, and ratings of health, indications of a relation between autonomic reactivity and symptoms of pain was found. Hence, in a subsequent evaluation of a cognitive-behavioral training program and a physical activity program for patients with stress-related illnesses, post intervention effects on autonomic reactivity to functional tests, pressure-pain thresholds, ratings of health and return-to-work were studied during a period of 12 months after the intervention. The main findings were the following. 1) Wrist kinetics data obtained during the computer mouse work showed similarities to previously presented data for mouse-operated design tasks. 2) When time pressure and precision demands were added to the computer work, increased autonomic activity paralleled with decreased muscle oxygenation in the upper extremity was found. Wrist position sense accuracy, however, did not decrease after the work as it did when the work was performed without the additional demands. The result is intriguing, as it does not appear to be in concordance with previous animal studies. 3) Patients with stress-related illnesses showed higher autonomic reactivity to cognitive and physical laboratory tests than healthy control subjects. They also had substantially lower pressure-pain thresholds in the back, and rated poorer health and health-related behavior than the control subjects. 4) We found little difference in effect of cognitive-behavioral training and physical activity, compared to usual care, for patients with stress-related illnesses. Patients in the control group showed an improvement of about the same magnitude as in the treatment groups over the 12-month follow-up period. The present findings indicate a non-additive relation between autonomic activity during repetitive work and position sense inaccuracy. Furthermore, patients with stress-related illnesses often reported pain in the neck, shoulders, and lower back. This was associated with lower pressure-pain thresholds in the back and a modest increase in sympathetic reactivity to physical and mental tests, which might suggest a potential use of these methods in the clinical examination and rehabilitation of patients with stress-related illnesses.

INTRODUÇÃO: Tramadol é conhecido como um fármaco analgésico de ação central utilizado no tratamento de dores de intensidades moderada a forte. Efeito analgésico local já foi demonstrado. É, em parte, semelhante ao efeito anestésico local, mas outros mecanismos permanecem desconhecidos. O papel de receptores opioides periféricos na analgesia do tramadol na dor pós-operatória não é conhecido. Neste estudo, foi estudado o papel dos receptores opioides no efeito analgésico local do tramadol em modelo de dor por incisão plantar. MÉTODOS: Ratos machos jovens foram submetidos à incisão plantar e no primeiro dia pós-incisão foram divididos em quatro grupos: Grupo IP I-SF/SF - 50 uL de solução de NaCl 0,9% foram injetados na região plantar da pata posterior homolateral à incisão e, 15 minutos depois, novamente injetada a mesma quantidade de solução; Grupo IP II-SF/T_homo - 50 uL de NaCl 0,9% foram injetados na região plantar da pata homolateral e, 15 minutos depois, injetados 50 µL solução contendo 5 mg tramadol; Grupo IP III-SF/T_contra -50 uL de NaCl 0,9% foram injetados na região plantar da pata contralateral e, 15 minutos depois, 50 uL de solução contendo 5 mg de tramadol; Grupo IP IV-Nal/T_homo - 50 uL de solução contendo 200 ug de naloxona foram injetados na pata homolateral e, 15 minutos depois, 50 uL de solução contendo 5mg de tramadol foi injetada. Antes de receberem as injeções, os limiares de retirada da pata por estímulo mecânico produzido por analgesímetro eletrônico de von Frey foram medidos, e, depois da administração dos fármacos, os limiares de retirada foram avaliados nos tempos 15, 30, 45 e 60 minutos após a administração dos fármacos. O mesmo procedimento foi utilizado no segundo dia pós-incisão. As expressões proteicas dos receptores opioide ? (DOR) e µ (MOR) foram avaliadas usando técnica de immunoblotting de gânglios de raízes dorsais homolaterais (L3, L4, L5 e L6) de grupos de animais sem incisão e após 1, 2, 3 e 7 dias de animais submetidos à incisão plantar. RESULTADOS: A incisão plantar gerou marcada hiperalgesia mecânica que foi revertida por tramadol intraplantar nos dois dias. O tramadol intraplantar em pata contralateral não antagonizou a hiperalgesia mecânica, a naloxona antagonizou parcialmente o efeito analgésico do tramadol no primeiro dia pós-incisão, e antagonizou completamente no segundo dia pós-incisão. A expressão proteica de DOR aumentou no 2º, 3º e 7º dias pós-incisão, a expressão de MOR não se modificou. CONCLUSÕES: O tramadol apresentou efeito analgésico local após estímulo mecânico e esse efeito foi antagonizado por naloxona no segundo dia pós-incisão. A expressão de DOR aumentou após a incisão plantar / BACKGROUND: Tramadol is known as a central acting analgesic drugused for the treatment of moderate to severe pain. Local analgesic effect was already demonstrated. It is in part due to local anesthetic-like effect, but other mechanisms remain unclear. The role of peripheral opioid receptors in the local analgesic effect in postoperative pain is not known. In this study, we examined the role of peripheral opioid receptors in the local analgesic effect of tramadol in the plantar incision pain model. METHODS: Young male Wistar rats were submitted to plantar incision and in the first postoperative day (POD1) were divided into four groups:IP I-SF/SF,50 uL of 0.9% NaCl solution were injected in the plantar aspect of the homolateral hindpaw and again after 15 minutes; IP II-SF/T_homo, 50 uL of 0.9% NaCl solution were injected in the plantar aspect of the homolateral hindpaw and, 15 minutes later, 50 µL of solution containing 5 mg tramadol were injected in the same hindpaw; IP III-SF/T_contra, 50 uL of 0.9% NaCl were injected in the plantar aspect of the contralateral hindpaw and, 15 minutes later, 50 uL of solution containing 5 mg tramadol were injected in the same hindpaw; IP IVNal/T_homo, 50 uL of naloxone (200 ug) solution were injected in the homolateral hindpaw and 15 minutes later 50 µL of solution containing 5 mg tramadol were injected. Before receiving the assigned drugs, baseline withdrawal thresholds for mechanical hyperalgesia using electronic von Frey were measured, then, after receiving the assigned drugs, withdrawal thresholds were measured at 15, 30, 45 and 60 min after drug injection. The same procedure was repeated in POD2. u opioid receptor (MOR) and opioid receptor (DOR) protein expressions were evaluated using immunoblotting after removal of ipsilateral dorsal root ganglia (L3, L4, L5 and L6) in groups of rats non submitted to plantar incision and 1, 2, 3 and 7 days after incision. RESULTS: Plantar incision led to marked mechanical hyperalgesia that was reversed with intraplantar tramadol in both days. Contralateral tramadol did not affect mechanical hyperalgesia and naloxone antagonized partially intraplantar tramadol in POD1, and antagonized completely in POD2. DOR expression in DRGs increased in POD2, POD3 and POD7, MOR expression did not change. CONCLUSIONS: Tramadol presented local analgesic effect after mechanical stimuli and this effect was antagonized by naloxone in the second post incision day. DOR increased expression after plantar incision

Syfte: Syftet med denna studie var att undersöka hur statisk muskelkontraktion och cold pressor test påverkar kroppsegna smärtreglerande system (”Exercise induced analgesia” (EIA) och ”Conditioned pain modulation” (CPM)) hos patienter med kronisk ländryggssmärta kännetecknad av lumbal myalgi (LM) jämfört med friska kontroller. Försökspersoner och metod: Tjugosex friska köns- och åldersmatchade personer och tjugosex LM-patienter deltog. De utförde standardiserad statisk muskelkontraktion med m. Erector spinae (ME) i form av rygglyft och kontraktion av m. Quadriceps femoris (MQ) i form av knäledsextension. För att bedöma CPM användes sk cold pressor test. Smärttrösklar för tryck (PPTs) mättes över m. Deltoideus (MD), m. Erector spinae (ME) samt över m. Quadriceps (MQ) i vila och under resp. efter kontraktionen/cold pressor test. Under kontraktion mättes PPTs över den arbetande muskeln respektive över de två vilande musklerna. Dessutom undersöktes PPTs och känsligheten för övertrösklig trycksmärta (P7) i vila på 8 olika punkter på kroppen. Resultat: Kvinnliga LM-patienter hade ökad känslighet för trycksmärta (PPT) och övertrösklig trycksmärta (P7) jämfört med köns- och åldermatchade friska kontroller, medan manliga LM-patienter paradoxalt nog hade minskad känslighet för övertrösklig trycksmärta. Beträffande EIA fann vi att LM-patienter och kontroller kunde aktivera lokal EIA under kontraktion med ME. Vi fann dessutom en minskad förmåga hos LM-patienter att rekrytera generaliserad EIA under kontraktion med MQ. Slutligen hade LM-patienterna en normal funktion av CPM. Slutsats: LM-patienter kunde aktivera lokal EIA under kontraktion av ME, men hade mindre effektiv generaliserad EIA jämfört med kontrollerna, trots normal funktion av CPM. Våra resultat tyder på att muskelarbete med smärtande ryggmuskler skulle kunna användas för att minska smärtkänslighet i det drabbade området.

INTRODUÇÃO: Tramadol é conhecido como um fármaco analgésico de ação central utilizado no tratamento de dores de intensidades moderada a forte. Efeito analgésico local já foi demonstrado. É, em parte, semelhante ao efeito anestésico local, mas outros mecanismos permanecem desconhecidos. O papel de receptores opioides periféricos na analgesia do tramadol na dor pós-operatória não é conhecido. Neste estudo, foi estudado o papel dos receptores opioides no efeito analgésico local do tramadol em modelo de dor por incisão plantar. MÉTODOS: Ratos machos jovens foram submetidos à incisão plantar e no primeiro dia pós-incisão foram divididos em quatro grupos: Grupo IP I-SF/SF - 50 uL de solução de NaCl 0,9% foram injetados na região plantar da pata posterior homolateral à incisão e, 15 minutos depois, novamente injetada a mesma quantidade de solução; Grupo IP II-SF/T_homo - 50 uL de NaCl 0,9% foram injetados na região plantar da pata homolateral e, 15 minutos depois, injetados 50 µL solução contendo 5 mg tramadol; Grupo IP III-SF/T_contra -50 uL de NaCl 0,9% foram injetados na região plantar da pata contralateral e, 15 minutos depois, 50 uL de solução contendo 5 mg de tramadol; Grupo IP IV-Nal/T_homo - 50 uL de solução contendo 200 ug de naloxona foram injetados na pata homolateral e, 15 minutos depois, 50 uL de solução contendo 5mg de tramadol foi injetada. Antes de receberem as injeções, os limiares de retirada da pata por estímulo mecânico produzido por analgesímetro eletrônico de von Frey foram medidos, e, depois da administração dos fármacos, os limiares de retirada foram avaliados nos tempos 15, 30, 45 e 60 minutos após a administração dos fármacos. O mesmo procedimento foi utilizado no segundo dia pós-incisão. As expressões proteicas dos receptores opioide ? (DOR) e µ (MOR) foram avaliadas usando técnica de immunoblotting de gânglios de raízes dorsais homolaterais (L3, L4, L5 e L6) de grupos de animais sem incisão e após 1, 2, 3 e 7 dias de animais submetidos à incisão plantar. RESULTADOS: A incisão plantar gerou marcada hiperalgesia mecânica que foi revertida por tramadol intraplantar nos dois dias. O tramadol intraplantar em pata contralateral não antagonizou a hiperalgesia mecânica, a naloxona antagonizou parcialmente o efeito analgésico do tramadol no primeiro dia pós-incisão, e antagonizou completamente no segundo dia pós-incisão. A expressão proteica de DOR aumentou no 2º, 3º e 7º dias pós-incisão, a expressão de MOR não se modificou. CONCLUSÕES: O tramadol apresentou efeito analgésico local após estímulo mecânico e esse efeito foi antagonizado por naloxona no segundo dia pós-incisão. A expressão de DOR aumentou após a incisão plantar / BACKGROUND: Tramadol is known as a central acting analgesic drugused for the treatment of moderate to severe pain. Local analgesic effect was already demonstrated. It is in part due to local anesthetic-like effect, but other mechanisms remain unclear. The role of peripheral opioid receptors in the local analgesic effect in postoperative pain is not known. In this study, we examined the role of peripheral opioid receptors in the local analgesic effect of tramadol in the plantar incision pain model. METHODS: Young male Wistar rats were submitted to plantar incision and in the first postoperative day (POD1) were divided into four groups:IP I-SF/SF,50 uL of 0.9% NaCl solution were injected in the plantar aspect of the homolateral hindpaw and again after 15 minutes; IP II-SF/T_homo, 50 uL of 0.9% NaCl solution were injected in the plantar aspect of the homolateral hindpaw and, 15 minutes later, 50 µL of solution containing 5 mg tramadol were injected in the same hindpaw; IP III-SF/T_contra, 50 uL of 0.9% NaCl were injected in the plantar aspect of the contralateral hindpaw and, 15 minutes later, 50 uL of solution containing 5 mg tramadol were injected in the same hindpaw; IP IVNal/T_homo, 50 uL of naloxone (200 ug) solution were injected in the homolateral hindpaw and 15 minutes later 50 µL of solution containing 5 mg tramadol were injected. Before receiving the assigned drugs, baseline withdrawal thresholds for mechanical hyperalgesia using electronic von Frey were measured, then, after receiving the assigned drugs, withdrawal thresholds were measured at 15, 30, 45 and 60 min after drug injection. The same procedure was repeated in POD2. u opioid receptor (MOR) and opioid receptor (DOR) protein expressions were evaluated using immunoblotting after removal of ipsilateral dorsal root ganglia (L3, L4, L5 and L6) in groups of rats non submitted to plantar incision and 1, 2, 3 and 7 days after incision. RESULTS: Plantar incision led to marked mechanical hyperalgesia that was reversed with intraplantar tramadol in both days. Contralateral tramadol did not affect mechanical hyperalgesia and naloxone antagonized partially intraplantar tramadol in POD1, and antagonized completely in POD2. DOR expression in DRGs increased in POD2, POD3 and POD7, MOR expression did not change. CONCLUSIONS: Tramadol presented local analgesic effect after mechanical stimuli and this effect was antagonized by naloxone in the second post incision day. DOR increased expression after plantar incision

La douleur est une expérience humaine des plus universelles et d’une riche variabilité culturelle. Néanmoins, il y a peu d’études sur ce sujet en général et qui plus est, la recherche sur la douleur chez les Amérindiens est presque inexistante. L’expérience de douleur de quelques 28 millions d’Amérindiens en Amérique du Sud, dont les Quichuas (Inca), est encore méconnue. Cette recherche interdisciplinaire, psychophysiologique et anthropologique, vise deux buts : (1) Étudier les effets de type analgésique du défi verbal culturellement significatif chez les Quichuas ; et (2) Faire un survol de leur système de croyances concernant la douleur, leur façon de la percevoir, de la décrire, et de la contrôler. Pour le volet expérimental, on a recruté 40 hommes en bonne santé. Les volontaires étaient assignés de façon alternée soit au groupe expérimental (20) soit au groupe contrôle (20). On a enregistré chez eux les seuils de la douleur, et celui de la tolérance à la douleur. Chez le groupe expérimental, on a, de plus, mesuré le seuil de la tolérance à la douleur avec défi verbal. La douleur était provoquée par pression au temporal, et mesurée à l’aide d’un algésimètre. Après chaque seuil, on a administré une échelle visuelle analogique. Pour le deuxième volet de l’étude, un groupe de 40 participants (15 femmes et 25 hommes) a répondu verbalement à un questionnaire en quichua sur la nature de la douleur. Celui-ci touchait les notions de cause, de susceptibilité, les caractéristiques de la douleur, les syndromes douloureux, les méthodes de diagnostic et de traitement, ainsi que la prévention. Notre étude a révélé que les participants ayant reçu le défi verbal ont présenté une tolérance accrue à la douleur statistiquement significative. Les valeurs de l’échelle visuelle analogique ont aussi augmenté chez ce groupe, ce qui indique un état accru de conscience de la douleur. L’expérience de la douleur chez les Quichuas est complexe et les stratégies pour la combattre sont sophistiquées. Selon leur théorie, le vécu d’émotions intenses, dues à des évènements de la vie, à l’existence d’autres maladies qui affectent la personne de façon concomitante, et aux esprits présents dans la nature ou chez d’autres personnes joue un rôle dans l’origine, le diagnostic et le traitement de la douleur. Les Quichuas accordent une grande crédibilité à la biomédecine ainsi qu’à la médecine traditionnelle quichua. Ils perçoivent la famille et le voisinage comme étant des sources supplémentaires de soutien. Il ressort également que les Quichuas préfèrent un service de santé de type inclusif et pluraliste. En conclusion, cette étude a révélé que des mots culturellement significatifs ayant une connotation de défi semblent augmenter la tolérance à la douleur chez les Quichuas. Il s’agit de la première étude à documenter les effets analgésiques de la parole. D’autre part, cette étude souligne également la potentielle utilité clinique de connaître le système quichua de croyances entourant la douleur et le contrôle de cette dernière. Ceci s’avère particulièrement utile pour les cliniciens soucieux d’offrir des soins de santé de meilleure qualité, culturellement adaptés, dans les Andes. / Pain is among the most universal yet culturally diverse human experience. Nevertheless, there is a dearth of research on pain in general and particularly among the Indigenous Peoples in the Americas. Little is known about the pain experience and suffering of the 28 million Indigenous peoples of the Andes in South America, mainly Quichuas (Inca). The aim of this integrative cultural and psychobiological study is twofold: (1) To examine the analgesic effects of culturally meaningful daring words among the Quichuas; and (2) To explore how Quichua adults perceive, describe, and cope with pain. For the psychophysiological component, a controlled, experimental study was conducted with a total of 40 healthy adult men, distributed alternately in an experimental and control group with 20 participants on each group. They received a pressure pain stimulation using an algometer applied to the right temporal area. The pain threshold and pain tolerance threshold were measured in all participants. In addition, the experimental group received culturally meaningful daring Quichua words while their encouraged pain tolerance threshold was measured. After each threshold measurement, a visual analog scale was administered. The algometer and visual analog scale scores were analyzed using t-tests. For the anthropological component, an exploratory qualitative/descriptive survey was conducted with a convenience sample of 40 Quichua adults, including 15 women and 25 men, in the Northern Highlands of Ecuador. We administered verbally structured interviews using a Quichua questionnaire called “The Nature of Pain” [Nanay Jahua Tapuicuna]. The interviews covered the notions of causation of pain, vulnerability to pain, responses to pain, aggravating factors, frequent locations of pain, types of pain, duration, characteristics of pain, control of pain, pathways to care, and preventive measures. Participants receiving culturally meaningful daring words had statistically significant higher algometer values than those who did not receive them. Those who received daring words had higher VAS scores than those who did not receive them, reflecting their increased awareness of pain. The Quichuas’ pain experience is complex and their strategies to cope with it are sophisticated. According to the Quichuas, emotions, life events, co-morbid conditions, and supernatural forces play an important role in the cause, diagnosis and treatment of pain. They embrace biomedicine as well as Quichua traditional medicine. In their view family members and neighbors are valuable sources of health care and pain control. The pathway to pain care that the Quichua people favor is inclusive and pluralistic. Culturally meaningful daring words appear to increase tolerance to pain among the Quichua. This is a pioneering study that reveals the analgesic effects of daring words. It highlights the remarkable biological effects of language in humans. Knowledge of the “emic” details of the Quichuas’ belief system and coping strategies to control pain could be useful for the culturally competent health practitioner who is making efforts to provide high-quality medical care in the Andes.