Individual pain history and familial pain tolerance models: relationships to post-surgical pain.

OBJECTIVES: (a) To investigate the influence of previous pain experience and familial pain tolerance models on postsurgical pain; (b) to investigate the effect of personality traits on vicarious learning. DESIGN: Before surgery, the patients completed the Minnesota Multiphasic Personality Inventory (MMPI), Eysenck Personality Inventory (EPI), and State-Trait Anxiety Inventory (STAI) personality tests. They also underwent a semi-structured interview to collect information on familial pain tolerance models and their own pain history. Postthoracotomy pain was assessed by measuring its latency (h), intensity (VAS 0-10), and duration (days). SETTING: A unique protocol to minimize the use of pain killers and encourage the adoption of coping strategies to face postsurgical pain was in use in the Thoracic Department. PATIENTS: A total of 126 patients who were free from chronic pain and undergoing thoracic surgery entered the study. OUTCOME: Most patients recalled a history of surgical or medical pain and good pain tolerance models in their original family. An almost equal number denied pain or had good pain tolerance models in their present family. Only a few patients reported poor tolerance models. RESULTS: Patients who had previously been subjected to medical pain experienced a greater intensity of pain. In addition, those who had reported poor tolerance in the original family experienced both earlier and more severe pain. Some patients' personality traits were related to familial pain tolerance models. CONCLUSIONS: We conclude that knowledge of an individual's pain history and familial pain tolerance models can be useful in predicting and managing post-surgical pain.

Self-control expectancy and postsurgical pain: relationships to previous pain, behavior in past pain, familial pain tolerance models, and personality.

The importance of self-control expectancy on postsurgical pain was studied in 126 patients enrolled in a particular clinical setting. The contribution of previous pain experiences, past behaviors, vicarious experiences, and personality traits to self-control expectancy reported by patients was also investigated. To collect this information, a specific questionnaire and a semistructured interview were given before surgery. Minnesota Multiphasic Personality Inventory (MMPI), Eysenck Personality Inventory (EPI), and State-Trait Anxiety Inventory (STAI) personality tests were also administered. Postsurgical pain was assessed by measuring intensity (Visual Analogue Scale, VAS), latency (hr), and duration (days). Results show that expected emotional coping response is crucially related to the whole pain experience (intensity, latency, and duration). Self-control expectancy is associated with mastery behaviors in previous pains, vicarious experiences, and personality traits. These findings suggest that the knowledge of patients' beliefs about their ability to acquire and maintain control over impending pain is useful in predicting and managing postsurgical pain.

Diagnostic value of serum primary bile acids in detecting bile acid malabsorption.

Serum cholic and chenodeoxycholic acid conjugates were measured in fasting conditions and after meals in 14 patients with bile acid malabsorption due to ileal resection. Mean serum fasting levels of both primary bile acids did not differ from the controls. After meals, serum cholic acid peaks were lower in patients with ileal resection than in control subjects (p less than 0.001), while chenodeoxycholic acid peaks were reduced in colectomised patients (p less than 0.01). In the sera from patients with ileal resection, the glycine/glycine + taurine ratio for cholic and chenodeoxycholic acid increased (p less than 0.001) from morning to evening, and glycine/glycine + taurine ratio for chenodeoxycholic acid was significantly (p less than 0.01) different from the controls in the sera collected in the evening. The results are consistent with the concept of a better intestinal conservation of chenyl, mainly of the glycine conjugated from, than of cholylconjugates, in patients with ileal resection; this is probably because of passive absorption in the intestine. The postprandial peaks of serum cholic acid conjugates may therefore be regarded as a test of ileal dysfunction, while peaks of chenodeoxycholic acid conjugates suggest colonic impairment.

Bile acid malabsorption and bile acid diarrhea in intestinal resection.

Bile acid fecal excretion and dihydroxy bile acid concentration in the fecal water of patients with large (N = 6) and small (N = 8) ileal resection, colectomy (N = 5), and healthy controls (N = 10) have been studied in order to evaluate the degree of bile acid malabsorption and the occurrence of bile acid diarrhea in intestinal resections of different extent. Bile acid malabsorption was severe in large ileal resections, mild in small ones, and slight in colectomy. The fecal pH seems to be a limiting factor in the occurrence of a bile acid diarrhea, playing a critical role in determining the dihydroxy bile acid solubility in the fecal water. These results seem to suggest that the bile acids may induce water secretion in the colon not only in small but also in large ileal resections.

Serum primary bile acids in Gilbert's syndrome.

We studied some aspects of bile acid metabolism in 25 patients affected by Gilbert's syndrome, 5 patients with hemolytic anemia, and 25 control subjects in order to assess whether bile acids as well as bilirubin are affected in unconjugated hyperbilirubinemic conditions. We measured serum cholic and chenodeoxycholic acid conjugates fasting and postprandially, the plasma disappearance of intravenously injected cholyl[1-14C]glycine, 14CO2 in breath, and 14C in stools after oral administration of the same isotope. Mean serum fasting level of conjugated cholic acid was significantly reduced in hyperbilirubinemic patients (p less than 0.01) in comparison with the controls, while the postprandial elevation was similar. The cholyl[1-14C]glycine hepatic uptake was faster in the patients with Gilbert's syndrome, but no significant difference was found as far as 14CO2 in breath and 14C in stools were concerned. Additional in vitro studies showed that increasing bilirubin concentrations displace glycocholic acid and, to a lesser extent, glycochenodeoxycholic acid from their binding to albumin, the affinity constant of the latter bile acid being 30 times greater than that of the former one. This competition between bilirubin and bile acids explains the faster hepatic uptake of cholic acid conjugates and hence their lower serum levels in unconjugated hyperbilirubinemic conditions. In addition, low levels of cholic acid conjugates, together with normal serum chenodeoxycholic acid conjugate levels, discriminate Gilbert's syndrome from other causes of hyperbilirubinemia.

Effect of chenodiol on the small intestine. Unimpaired structure and function during therapy for gallstone dissolution.

To test whether long-term oral dosage with chenodiol (chenodeoxycholic acid) used for dissolution of cholesterol gallstones would cause impairment of small-intestinal structuree or function, ten patients were studied before and after three months of oral chenodiol administration, 15 mg/kg of body weight per day. Small-intestinal structure was assessed by roentgenogram and intestinal biopsy, using both light and electron microscopy. Small-intestinal function was assessed by xylose, fat and vitamin B12, lactose, and bile-acid absorption. Bile acid metabolism was also characterized by the breath test for deconjugation using carbon dioxide labeled with radioactive carbon 14. No significant abnormalities were found. The results suggest that oral chenodiol administration does not impair intestinal structur or function in doses used for gallstone dissolution.

Results with six "kit" radioimmunoassays for primary bile acids in human serum intercompared.

We examined six radioimmunoassay procedures for measuring primary bile acids in human serum (two 3H-labeled and four 125I-labeled). A significant (p < 0.01) correlation was observed between measurements in the assay both for cholic acid and chenodeoxycholic acid, at low and high concentrations of serum bile acids. All kits were acceptable with respect to accuracy, precision, stability, and analytical recovery. All six procedures gave similar results for chenodeoxycholic and cholic acid in sera of 80 healthy subjects; the agreement was also close when the two primary bile acids were compared with their sum in serum. Normal values ranged from 0.4 to 2.5 mumol/L for conjugated chenodeoxycholic acid and from 0.3 to 1.5 mumol/L for conjugated cholic acid. The 125I assays do not require liquid-scintillation equipment but 125I induces a decrease in the affinity constant of antibody. The sensitivity of the assays was still adequate for measuring bile acids in the serum of healthy fasting persons and liver-disease patients.

Serum bile acids in newborns and children.

A specific and sensitive radioimmunoassay for cholic, chenodeoxycholic, and lithocholic acid conjugates and for sulfolithocholylglycine was used to measure serum bile acids (BA) in infants and children. Elevated cholic and chenodeoxycholic acid values were observed in the first year of life in fasting infants. Newborn babies presented high levels of primary BA not correlated with those of the mothers. In premature newborn babies who had not yet been fed, meal induced a considerable reduction in the primary BA levels in serum. In normally fed babies, meal induced a significant increase in the primary BA levels in serum. These data suggest a progressive maturity throughout the first year of life of the serum BA determinants, i.e., gallbladder emptying, intestinal motility and absorption, and hepatic uptake.

[Kinetics of 14C-cholic acid in the baboon under normal conditions and in cholestasis. Description and validity of a multicompartmental model]. / Cinetica dell'acido colico-14C nel barbuino in condizioni fisioloigiche e di colestasi. Descrizione e validita' di un modello multicompartimentale.

A multicompartmental model was applied to the study of the plasmatic and biliary kinetics of the 14C-Cholic acid intravenously injected into a baboon in normal and cholestatic condition. For the evaluation of transfer rates FORTAN IV procedures were used, utilizing Powell method. The degree of fitting was: in normal condition in serum 7% for free and 35% for conjugated Cholic acid, while in bile 5% and 4% respectively; in serum in cholestatic condition 7% for free and 12% for conjugates. The high degree of fitting and reliable estimation of transfer rates suggest that the multicompartmental model applied represents most likely the physio-pathological conditions studied.