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Perioperative hypothermia (PH) is body temperature < 36°C and may occur in total knee arthroplasty (TKA) surgery. Planned hypothermia is necessary in a select number of surgical procedures but inadvertent hypothermia has deleterious consequences. TKA is a painful procedure and PH may enhance or diminish the effect of opioids and TKA pain – its effect is unclear. A new treatment for PH is a forced-air warming gown. A randomized control trial of 30 TKA patients compared the standard treatment of warm cotton blankets to a forced-air warming gown. Patients treated with the warming gown had higher temperatures (p < 0.001), used less opioid (p = 0.05) and had more satisfaction (p = 0.004) than the standard blanket group. This study suggests that warming gowns may be an effective alternative to averting PH and advocates for more research to explore the relationship between PH and its effect on pain and opioids.

In the ideology of sentimentalism, physical sensation integrates the parts of the body into a whole, and the fragmented members of the body politic into a social community. However, intense pain is always an individual experience. It not only isolates us from other people, but is also isolates us from our own bodies: pain renders our bodies out of control. Moreover, pain attacks our very notion of self by threatening to render us unconscious, and unable to perceive that self. This complex of problems became especially acute for late eighteenth-century writers, as they tried to reconcile their sympathy for the French Revolution with the intense pain that the Revolution signified. What they articulated was a process by which the self initially identifies with the pained body of the other, but then appropriates that pain to make it one's own, thereby isolating the self from infectious Revolutionary sympathies.

Vulvar vestibulitis syndrome is a highly prevalent and under-investigated pain syndrome. It is believed to be the most common form of dyspareunia, or painful intercourse, in pre-menopausal women. Despite the fact that pain is its defining characteristic, its conceptualization as a sexual dysfunction remains the predominant view. The first chapter of this thesis reviews support for a re-conceptualization of vulvar vestibulitis as a pain disorder, and contends that the pain component must be measured as it is in chronic pain patients, both objectively and subjectively. This paper is followed by a study in which tactile and pain thresholds in genital and non-genital body areas of 13 women with vulvar vestibulitis syndrome and 13 non-affected women were measured, while data about the intensity and unpleasantness of these sensations were collected. Results indicated that women with vulvar vestibulitis have decreased tactile and pain thresholds in both genital and non-genital body areas, as well as higher unpleasantness ratings in response to painful stimuli than controls, replicating data from the chronic pain literature. The third paper presents a pain conceptualization of vulvar vestibulitis according to classification criteria used by the International Association for the Study of Pain, and introduces the development of a vulvalgesiometer, a standardized method of genital pain measurement. Data collected with the vulvalgesiometer are presented in the fourth paper, a study in which 14 women with vulvar vestibulitis and 14 control women participated. Women with vulvar vestibulitis had significantly lower pain thresholds, higher pain unpleasantness ratings, and used adjectives similar to those reported during intercourse in response to painful stimulation. The vulvalgesiometer was used to elicit genital tactile and pain sensation in the two groups while brain activation patterns were measured via functional magnetic rdsonance imaging, the focus of the fifth paper. Results demonstrated that women with vulvar vestibulitis have augmentations of brain activity in the processing of both painful and non-painful genital stimulation as compared with non-affected women. Overall, findings from these studies suggest that the pain of vulvar vestibulitis can be reliably measured and that the pain perspective has important implications for both research and treatment of urogenital pain problems.

Morphine is one of the most commonly prescribed medications for the relief of prolonged pain. Both basic science and clinical studies indicate that females require 2-3 times more morphine than males to achieve the same analgesic effect. To date, the mechanisms underlying sex differences in opiate responsiveness are unknown. Recent studies suggest that glial cells are potent modulators of morphine-based analgesia, and in particular, decrease the analgesic effect of opiates. Therefore, we tested the hypothesis that the sexually dimorphic effects of morphine were due to sex differences in glial cell activity. Our studies focused on the midbrain periaqueductal gray (PAG) as this region of the brain is critical for the analgesic effects of morphine. Adult male and female Sprague Dawley rats (250g- 400g) were procured from Charles River Laboratories, and were allowed 7 days to acclimate to the new facility. On the day of the experiment, animals received a subcutaneous injection of morphine (5mg/kg) or were handled in a similar manner. Thirty or 60 minutes after injections or handling, animals were perfused with a 4% paraformaldehyde and 2.5% acrolein tissue fixative solution. Brains were removed and stored in 20% sucrose until ready for sectioning. Brains were sectioned at 25mm using a freezing microtome, and immunohistochemical localization of markers for astrocyte glial cell activity was performed. Antibodies to glial fibrillary acidic protein (GFAP) were used to label activated astrocytes. If our hypothesis is correct, then females will have significantly greater density of the astrocyte cell activity marker GFAP as compared with males. Sex differences in PAG glial cell activity may provide the biological bases for the sexually dimorphic effect of morphine. This research may lead to better treatment for females experiencing prolonged chronic or neuropathic pain.

Johnston (1996) proposed that disability can be predicted by a model integrating biomedical and psychological variables; Johnston’s model has mainly been tested in chronic pain and most studies have found it to predict disability better than impairment alone. The first study replicated Dixon’s (2006) structural equation modelling study, which tested an updated variant of Johnston’s model with ICF constructs in orthopaedic patients on a waiting list for joint replacement surgery. The present study also extended these tests to post-surgery. Supportive results were found before surgery, as Dixon had also found, but also after surgery. However, few tests of the model at the within-person level had been conducted. Methodology of published experimental single-case studies targeting behaviour change was investigated in a large systematic review. Studies varied in quality and robustness of design, and few used statistical analyses. Johnston’s model was tested at the within-person level in a series of five correlational single-case studies; whether mood was predictive was also tested. Community participants with arthritis, chronic pain and activity limitations completed a daily dietary using a PDA of pain, activity level, mood and Johnston’s proposed variables, and wore an accelerometer to collect activity data. Differing from previous findings, pain (impairment) was not predictive, nor was self-efficiency, but motivational constructs (intention and goal-setting) did predict activity (limitations) in several cases. PBC predicted in the direction contrary to theory in two cases and was not predictive in the others. Mood was not predictive. Differences from previous findings suggest that the model may not predict the same way within individuals as between them, requiring further investigation.

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