What causes pins and needles? Why do we get this strange sensation? Discover the science behind this common experience and learn effective tips to reduce finger prick pain for diabetes management.

Alleviating the Pain of Finger Pricks for Diabetes Management

Managing diabetes can be a literal pain, with the frequent finger pricks required for blood sugar testing being a major source of discomfort. However, there are several strategies people with diabetes can employ to reduce the pain and discomfort associated with this necessary task.

Test on the Sides of Your Fingers

When performing blood sugar testing, it’s important to avoid the sensitive pad of the fingertip and instead focus on the sides of the fingers where there is better blood flow. This can significantly reduce the pain experienced during the finger prick.

Warm Up Your Hands Before Testing

Testing blood sugar levels when your hands are cold can be more painful than when they’re warmer. To improve blood flow and make the finger prick less unpleasant, try rubbing your hands together, sitting on them briefly, or washing them with warm water and soap before testing.

Adjust the Lancet Depth

The depth and force of the lancet used for blood testing can greatly impact the level of pain experienced. Work with a diabetes educator or your healthcare provider to determine the optimal lancet setting for your needs, and consider using a pediatric lancet if you are particularly sensitive.

Avoid Alcohol Wipes Before Testing

Wiping the skin with alcohol before lancing can tighten the skin and make obtaining a blood sample more difficult, leading to increased pain. Instead, wash the area with just soap and water to prepare for testing.

Rotate Finger Testing Sites

Consistently using the same finger and spot for blood sugar testing can lead to calluses and scarring, which may reduce pain in the short term but can cause issues in the long run. Regularly switching to a different finger or even using your thumb can help prevent these complications.

Use a Fresh Lancet Each Time

Lancets become duller with repeated use, which can contribute to increased finger prick pain. Try changing the lancet with every blood sugar test to ensure you’re always using a sharp, clean needle.

Choose the Right Blood Glucose Monitor

Different blood glucose monitoring systems require varying lancet depths and may offer the option to test on alternative body sites. Selecting a monitor that provides a comfortable and convenient testing experience can make a significant difference in reducing finger prick pain.

Experiment with Alternate Site Testing

For times when you’re not concerned about the risk of low blood sugar, consider investigating alternate site testing options, such as the palm of your hand, thigh, or arm. Working with a diabetes educator can help determine the best alternative testing sites for your individual needs, providing your fingers a much-needed break.

Understanding the Science Behind Pins and Needles

The strange sensation of pins and needles, also known as paresthesia, is a common experience that occurs when a nerve is compressed or irritated. This causes the nerve signals to become disrupted, leading to the tingling, prickling, or numbness that many people describe.

The pressure or irritation on the nerve can stem from a variety of causes, including sitting or sleeping in an awkward position, wearing tight clothing or accessories, or even certain medical conditions. When the pressure is relieved, the nerve function typically returns to normal, and the pins and needles sensation subsides.

While the experience of pins and needles can be uncomfortable, it is generally harmless and temporary. However, if the sensation persists or is accompanied by other concerning symptoms, it’s important to consult a healthcare professional to rule out any underlying medical issues.

Strategies for Managing Finger Prick Pain

By employing the tips outlined above, individuals with diabetes can take proactive steps to reduce the pain and discomfort associated with finger prick blood sugar testing. From adjusting the testing technique to exploring alternate testing sites, these strategies can help make this necessary task more bearable and contribute to better overall diabetes management.

Remember, finding the right approach may require some trial and error, but the effort is well worth it to minimize the pain and make the blood sugar testing process as comfortable as possible. With the right tools and techniques, managing diabetes can become a little less of a “pain” in the literal sense.

8 Tips to Reduce Finger Prick Pain | Diabetes Center

Managing diabetes can be a pain — literally. And the more blood sugar testing you do, the more of a pain it is, confirms Sacha Uelmen, RDN, CDE, director of nutrition for the American Diabetes Association. Still, monitoring blood sugar levels is a critical component of good diabetes management — research involving more than 5,000 people with diabetes has shown that those who test blood sugar regularly have better blood sugar control than those who rely solely on diabetes medication. Fortunately, there are a number of ways to lessen the pain that comes along with that testing. So if finger pricks make you feel like a voodoo doll, here are eight strategies to try:

1. Test on the Side of Your Finger

When doing diabetes blood sugar testing, resist aiming straight for all that real estate on the tip of your finger — that’s definitely painful. “When testing on your finger, use only the sides of your finger, where there’s better blood flow, and not the pad of the finger,” says Hector Verastigui, RN, CDE, clinical research coordinator at the Texas Diabetes Institute in San Antonio. “Testing on the pad of the finger is more painful.”

2. Warm Up Your Hands

Testing when your hands are cold can be more painful than when they’re warmer. To heat up your fingers, just sit on them briefly, rub them together, or give them a good scrub using warm water and soap. “This will get the blood flow going,” says Verastigui. When getting that all-important drop of blood is less painful, managing diabetes is easier.

3. Adjust the Lancet Depth

If blood sugar testing is always painful for you, it’s possible that your lancet is set to hit too hard or too deep. Part of managing diabetes includes adjusting the depth and force of the lancet properly. If you’re having trouble figuring out how to do this, or determining which depth will get you the least painful blood testing experience with the most accurate blood sugar monitoring result, work with a diabetes educator or the nurse in your doctor’s office. If you’re particularly sensitive, using a pediatric lancet could result in a less painful diabetes blood sugar test.

4. Skip the Alcohol Wipe

If you’re in the habit of using an alcohol wipe or an alcohol-based sanitizer to clean your finger before lancing, try washing with just soap and water instead. “We don’t recommend wiping the skin with alcohol because alcohol is an astringent, which tightens the skin and makes obtaining a blood sample more difficult,” says Verastigui. And that makes diabetes blood sugar testing more painful.

5. Switch Fingers Regularly

When you’re managing diabetes, it’s easy to get in a habit of using the same finger — and the same spot on that finger — for blood sugar testing. This leads to calluses and scarring, even if you find there’s slightly less pain from the thicker skin. Instead, build on the advice to test on the sides of fingers by using a different finger every time. Testing on your thumb is an option as well, although Verastigui points out that since the thumb is used so often in day-to-day activities, the pain from testing there could last longer. Whether you’ll want to give your thumb a try is an individual choice.

6. Use a Fresh Lancet

Each lancet starts out nice and sharp. But if you use the same one repeatedly for your diabetes blood sugar testing, as many people try to do, it can become dull. This doesn’t bother everyone, but it could be contributing to your finger-pricking pain. Try changing the lancet with every blood sugar testing to see whether that reduces this diabetes pain.

7. Get the Best Monitor for You

Different blood glucose monitor systems require different depths, and some let you do blood sugar testing in different locations on your body. Consider making a switch if your current one is just too uncomfortable for regular diabetes management. Also make sure you know how to use your system properly. Verastigui suggests sticking with brand names and avoiding too-good-to-be-true sales pitches.

8. Experiment

Finding your blood sugar testing “sweet spots” may take some trial and error. For the most successful management of your diabetes, you might want to investigate alternate site testing. This means testing your diabetes blood sugar levels on other parts of your body at times when you aren’t worried about the possibility of low blood sugar. Work with a diabetes educator to learn whether the palm of your hand, a thigh, an arm, or another body part would be a good option, to give your fingers a rest. Your palm can be a particularly good alternative, says Uelmen.

Why do we get pins and needles?

Why do we get pins and needles?

(Image credit: Tom Wachtel/Flickr/CC BY 2.0)

It feels like a thousand tiny pinpricks – though a few shakes and it’s usually all over. What causes the strange sensation? BBC Future investigates.

E

Everyone has experienced that tingling sensation in the hands or feet. We call it “pins and needles” because it feels like someone is gently raking your skin over and over again with hundreds of tiny little pointy objects.

Your skin might feel a bit numb, as if you can’t feel any sensations besides those pins and needles. When your foot “falls asleep,” it can actually become a little uncomfortable to place the full weight of your body on it. Not quite painful, but not altogether pleasant either. But if you wait a few minutes and shake out your sleepy limb, the sharp piercing nature of the sensation eventually fades away.

The sensation itself is properly referred to as “paresthesia,” and the fairly harmless variety described above is quite reasonably known as “temporary paresthesia.” But what is actually going on underneath your tingling skin? The biology behind those pins and needles is actually quite straightforward.

Putting pressure on limbs constricts blood flow, causing the tingling feeling (Credit: Getty Images)

There are nerves throughout your body, biological superhighways whose job is to relay information between the brain and the rest of the body. If you place too much pressure on one of your arms or legs – something that’s quite easy to do because ape limbs are long and gangly – you could temporarily pinch the nerves that run through them. Meanwhile, you’re also putting a little too much pressure on the blood vessels that supply those nerves, like crimping a garden hose to prevent the flow of water.

This causes your brain to be deprived of the information it expects from those nerve bundles, and the nerves themselves aren’t receiving the oxygenated blood they need from your heart. Then, when that pressure is relieved, blood floods back into your limb and the nerves begin firing information to and from the brain.

A handful of experiments in the 1930s and 1940s helped researchers to understand the progression of the sensation. Luckily, it’s pretty easy to put a limb to sleep: all you need is a blood pressure cuff that’s set to squeeze a participant’s arm or leg to a higher pressure than his or her systolic blood pressure. That’s exactly what a pair of Oxford University researchers did in 1946.

Starting a minute or two after the pressure was applied, and reliably lasting for three to four minutes, was a sensation that they called “compression tingling”. Their participants described it as “a faint comfortable soda-water sensation”, or as “buzzing,” or “a fine light tingle.” Some felt as if they had “ants running up and down inside the skin.”

(Credit: Science Photo Library)

The second stage, which usually begins 10 minutes later, was described as a “velvety numbness”. That feeling lasts as long as the pressure on the limb’s nerve and blood supply remains.

Finally, after the pressure is released, comes the third stage: this is known as “release pricking”. That’s the part usually referred to as “pins and needles.” As Oxford physiologist George Gordon noted in Nature in 1948, “the intensity and number of the pricks depend on the length of nerve which is recovering from any fixed period of depressed blood supply…no [particular] part of a nerve is particularly concerned in generating the impulses which give rise to this form of ‘pins and needles’.”

Release pricking is typically more painful than the first two stages, but the emotional aspect of the experience is more often described as curiosity or interest. It hurts, but only physically. The sensation eventually subsides, but people are usually unable to pinpoint exactly at what point their skin sensations return to normal.

But not all pins and needles are of the temporary variety. Chronic paresthesia can occur as part of a variety of neurological disorders or following particularly traumatic nerve damage, like a bad burn.

In one study, researchers from Montreal’s Hotel-Dieu Hospital and McGill University worked with 104 burn patients to understand the long-term pain that followed their injuries. Many continued to feel pain even a year after their treatment was completed. After all, intense burns can often involve the destruction of nerves and their receptors, and surgical treatments for those injuries often involve skin grafts, which can also involve damage to and scarring of nerve cells.

Some people report long-lasting pins and needles after receiving local anaesthetic (Credit: Science Photo Library)

Nearly two-thirds of patients in the study reported continued tingling on their burn sites, and a quarter of them reported the more intense pins and needles. “Pain and paresthesias can persist for many years after the injury,” wrote the researchers in the Journal of Pain and Symptom Management. “[They] may be present every day, and can interfere with the patient’s activities such as work, sleep, and social life.” That’s much more than the minor trifle that pins and needles represent for most of us.

Paresthesia can also occur following the administration of local anaesthetic medications during dental work. While it’s a rare event, and it isn’t yet clear just why this occurs, there are a few possibilities. It could be that the needle used to deliver the drug accidentally touches and then damages a nerve, or it could be that blood haemorrhages into the sheath surrounding the nerve fibre, which increases pressure. Alternatively, the injection itself may deliver enough fluids to increase pressure on the nerve, or perhaps the anaesthetic chemical is just toxic enough to damage nearby neurons.

A 2010 University of Toronto study published in the Journal of the American Dental Association rounded up data from more than 11,000 “adverse effects” reported over a decade to the US Food and Drug Administration (USFDA) following the use of one of five kinds of local anaesthetics. Of those who experienced some form of paresthesia, 89% of it occurred in their tongues. Imagine not being able to speak or eat without feeling an awkward numb, tingling sensation in your tongue. The rest felt it in their lips instead. In one case, the paresthesia lasted for a whopping 736 days after the initial dental treatment – that’s more than two years.

And it’s not just pharmaceutical anaesthetics that can deliver paresthesias to the mouth, ranging from mild tingling to painful pricking. Peppers can do it too, thanks to the capsaicin locked away in chillies and peppers that deliver a pleasingly painful punch when delivered in small doses. Szechuan peppers, though, also contain compounds called alkylamides, which deliver a “tingling pungency,” similar to the compression tingling that precedes pins and needles.

The capsaicin in chillis can also cause a feeling similar to pins and needles (Credit: Science Photo Library)

It’s such a predictable effect that in folk medicine, the extracts of Xanthoxylum have been used for anaesthesia. The plants have even become known in some communities as the “toothache tree.”

Pins and needles may be an annoying reality for us, but it’s good to remember that it could be much, much worse. Most of us only have to get a little blood flowing and the irritation simply goes away.

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Assessment of Neonatal Pain During Heel Prick: Lancet vs Needle—A Randomized Controlled Study | Journal of Tropical Pediatrics

Abstract

Background

Heel prick is a frequent painful procedure in newborns. A lancet or a 26-gauge needle is used for a heel prick in India.

Objective

To compare the pain caused by heel prick with a lancet or a 26-gauge needle in newborns admitted in the neonatal intensive care unit (NICU) using the preterm infant pain profile (PIPP).

Methods

This randomized controlled trial was conducted over 2 months in a Level III NICU with a sample size of 40 subjects (20 in each group), which was required for the study to have a power of 80% with an alpha error of 0.05. Hemodynamically stable newborns on at least those on partial oral feeds undergoing heel prick for routine glucose monitoring were randomized into two groups within 48 h of NICU admission after informed parental consent: heel prick with a lancet or with a 26-gauge needle using computer-generated random numbers. Two milliliters of expressed breast milk was given 2 min before the heel prick. Pain before, during and after (1 and 5 min) was assessed using the PIPP score. The primary outcome measure was the PIPP score. The secondary outcome measures were the duration of audible cry and the number of pricks needed for an adequate sample. Statistical analysis was done using the Mann Whitney U test and Friedman’s test on SPSS v.21. A p value of < 0. 05 was significant.

Results

There were 40 neonates, 24 males and 16 females included in the study with a median age of 7 days. The mean birth weight was 2441 g (SD: 699) at a mean gestation of 34.4 weeks (SD: 3.2). The median PIPP scores at 0–30 s after heel prick were 7.05 ± 3.57 with a lancet vs. 9.35 ± 3.68 a needle (p = 0.052). There was a significantly lower duration of audible cry with use of lancet (10.5 ± 18.5 s vs. 75.2 ± 12.0 s with needle; p = 0.03). All heel pricks resulted in adequate sampling.

Conclusion

Heel prick with a lancet causes less crying than a 26-gauge needle, though the PIPP scores are not significantly different.

INTRODUCTION

There is an increasing awareness regarding pain management in neonates. Literature suggests that health care personnel are aware of pain caused by procedures and their specific analgesic management [1–5]. This, however, does not seem to be reflected in practice [1, 2]. Admission to the neonatal intensive care unit (NICU) increases the newborn’s exposure to inevitable procedures causing pain. The pain caused during these procedures may be managed by pharmacologic measures such as opioids and sedatives or non-pharmacological measures such as kangaroo mother care, administration of breast milk, warmth and sucrose solution [5–7]. The non-pharmacologic measures merit further exploration, as most of these exploit physiologic mechanisms of pain relief, thus alleviating the possible adverse risks of pharmacological pain relief. This does not mean that pharmacological measures should never be used; instead, there should be a high threshold in turning to analgesics only after non-pharmacological measures are exhausted.

Heel prick is one of the most common procedures carried out in newborns in both sick and well newborns [1, 3, 4, 8, 9]. In a study done in our institute to assess the burden of painful procedures in the NICU³, it was observed that each baby was subjected to 8. 09 ± 5.53 painful procedures every day. Though it is considered to be moderately painful [3], the cumulative pain due to a heel prick could be tremendous, making pain reduction during this procedure an urgent priority, using non-pharmacological procedures as much as possible.

World over, various devices such as needles and lancet and needles are used for heel prick. Nurses perceive that lancet may be more painful although there is no evidence to support this claim owing to the paucity of published data on whether lancet or needle is less painful for heel prick. In an attempt to answer this question, we undertook this randomized controlled study among newborns undergoing heel prick in our NICU in an attempt to ascertain whether there was a difference in pain perceived during this procedure depending on whether a lancet or 26-gauge needle was used. Pain perceived by the newborns was our outcome measure, which was assessed by the preterm infant pain profile (PIPP). A difference observed between the two devices could result is a major reduction in cumulative burden of pain to the newborn by a simple policy change involving the use of the lesser pain-causing device for heel prick in future.

MATERIALS AND METHODS

This randomized controlled trial was done in a level III NICU of South India over a period of 2 months. Hemodynamically stable newborns with <48 h of NICU admission, on at least those given partial oral feeds undergoing heel prick for routine glucose monitoring were included in the study. Newborns on ventilatory support, or neurologically abnormal or with congenital anomalies or exposed to sedatives/analgesics/anticonvulsants within 5 days before the study were excluded.

The study included data collection from 40 newborns admitted in NICU who underwent the heel prick for glucose monitoring. All demographic details were also collected. After a written informed parental consent, the eligible newborns were randomized into two groups: heel prick with a lancet and heel prick with a 26-gauge needle using computer-generated random numbers. Allocation concealment was achieved by using sequentially numbered opaque sealed envelope containing the codes for heel prick.

The gestational age and the behavioral state were recorded before the heel prick. The pulse oximeter was connected to the upper extremity of the newborn. The lancet used was Medipoint blood lancet 0473 and the needle was 26 G needle BD precision Glide needle. Two milliliters of expressed breast milk (EBM) was given 2 min before the heel prick as per unit pain management protocol [9]. All heel pricks were done by one of the selected group of staff nurses who had adequate experience in neonatal care to minimize variation in pain during heel prick. The heel prick was done using all sterile precautions. The principal investigator video recorded the newborns face and pulse oximeter readings with two separate cameras for PIPP scoring for a period of 5 min after the heel prick. PIPP scoring was determined at 0–30 s, 1–1½ min, 3–3½ min and 5–5½ min by replays of the video records. A backup soft copy of the video records was also created. All video analyses for PIPP score were done independently by the principal investigator and the co-investigator. The duration of audible cry was documented during review of the video. The number of pricks taken to get the adequate amount of blood for glucose testing by glucometer was documented. In a bid to decrease bias, we performed a repeat analysis on the videos in two ways: first, the same investigator carried out PIPP scoring after a 3-month period, and second, another assessor carried out PIPP scoring. These analyses were represented as Bland-Altman plots of the cumulative PIPP scores across all the time points (Supplementary Figs S1 and S2).

Outcome measures

The primary outcome measure was the PIPP scores. The secondary outcome measures were duration of audible cry and the number of pricks needed for an adequate sample.

Statistical Tests Statistical analysis was done using SPSS 21. The PIPP pain scores after heel prick by the two methods were then compared by the Mann Whitney U test and the change of PIPP scores over time were compared using Friedman’s test. A p value of <0.05 was taken as significant. Sample size: The sample size was calculated to be 40 (20 in each arm) based on Barker’s study [8] for the study to have a power of 80% with an alpha error of 0.05.

Ethics: The study was carried out after ethical approval from the institutional ethical review board. (IERB no.: 1/94/2013)

OBSERVATIONS AND RESULTS

There were 40 neonates, 24 males and 16 females included in the study, with a median age of 7 days. The trial flow is shown in Fig. 1. The lancet group and 26 G needle group had comparable birth weights and gestation (2338.65 g ± 736.5 vs. 2439.95 g ± 665; 35.15 weeks ± 3.1 vs. 35.95 weeks ± 2.5). The median PIPP scores and the individual facial components at 0–30 s, 1–1½ min, 3–3½ min and 5–5½ min after the heel prick are shown in Table 1. Non-parametric tests were used, as the data were not normally distributed. The results of the Friedman’s test for both groups are represented as a bar-plot in Table 2, the p value from Friedman’s test for change over time separately in each group suggested a significant change over time in both groups, but the change was not different between the groups. There was no significant difference in time required to complete the procedure or number of attempts required to draw the required quantity of blood. In both instances, the difference in bias as evaluated by the Bland–Altman plots was not more than one PIPP point, which suggests that the inter-observer and intra-observer bias were small.

Table 1.

PIPP Score and audible cry—lancet vs. needle

Time period .	Parameter .	Lancet .	Needle .	.
		Median (IQR) .	Median (IQR) .	.
0–30 seconds	PIPP score	6 (4, 9)	9.5 (8, 13)
	Brow bulge	1 (0, 1.25)	2 (1, 3)
	Eye squeeze	1 (0, 1.25)	2 (1, 3)
	Nasolabial fold	1 (0, 1. 25)	2 (1, 3)
	Heart rate (beats/min)	149.5 (135, 154)	145.5 (129, 151)
	Oxygen saturation (%)	96 (91, 97)	94.5 (92, 98)
1-1 ½ min	PIPP score	4 (3, 6)	5 (2, 12)
	Brow bulge	0 (0, 0)	0 (0, 2)
	Eye squeeze	0 (0, 0)	0 (0, 2)
	Nasolabial fold	0 (0, 0)	0 (0, 2)
	Heart rate (beats/min)	139.5 (128, 154)	134 (129, 151)
	Oxygen saturation (%)	96 (91–98)	95.5 (91, 97)
3–3 ½ min	PIPP score	3 (3, 5)	4 (2, 9)
	Brow bulge	0 (0, 0)	0 (0, 1.25)
	Eye squeeze	0 (0, 0)	0 (0, 1. 25)
	Nasolabial fold	0 (0, 0)	0 (0, 1.25)
	Heart rate (beats/min)	138.5 (132–150)	134.5 (122, 142)
	Oxygen saturation (%)	95.5 (93–97)	96.5 (89, 98)
5–5 ½ min	PIPP score	3 (2, 4)	4 (2, 7)
	Brow bulge	0 (0, 0)	0 (0, 0.5)
	Eye squeeze	0 (0, 0)	0 (0, 0.5)
	Nasolabial fold	0 (0, 0)	0 (0, 0.5)
	Heart rate (beats/min)	136.5 (130, 146)	131.5 (125, 143)
	Oxygen saturation (%)	94.5 (93, 97)	96.5 (96, 98)
		Mean (SD)	Mean (SD)	p value
0–330 seconds	AUDIBLE CRY (seconds)	10.50 (18.5)	75.20 (124)	0.024

Table 1.

PIPP Score and audible cry—lancet vs. needle

Table 2.

PIPP median (quartile 1, quartile 3) values in the two groups at different time points

Table 2.

PIPP median (quartile 1, quartile 3) values in the two groups at different time points

Fig. 1

Fig. 1

DISCUSSION

The results of this study point toward a reduction in newborn pain when a lancet was used to procure blood during the heel-prick procedure as opposed to a 26-gauge needle. A difference of 2 in the PIPP scores, though not statistically significant, could be clinically significant, considering the potential cumulative decrease in pain during hospital stay, as heel prick is a common procedure. In our previous study, heel lance accounted for 30% of 6832 painful procedures that 101 infants experienced during NICU stay [3].

The trend to reduction in pain with use of lancet could be possibly explained by the controlled depth of invasion by the lancet and a more superficial plane, which is breached. Though the reduction in PIPP score was not statistically significant, it must be noted that three of the five components of the PIPP score during the first 30 s of the procedure differed significantly between the two groups, with the lancet causing less pain. The components that did not differ significantly included rise in heart rate and decreased oxygen saturation.

Cry is a distress signal by the newborn, which is easily perceived by the health care providers. It is considered as an objective measure of pain. It is well accepted that a baby’s cry is a source of stress for the mother [2]. The duration of audible cry was significantly lower with the use of a lancet. However, newborns crying might also be indicative of discomfort or a sense of vulnerability, which may also be evoked during a painful procedure. Contemporary techniques of identifying newborn pain such as using functional MRI (fMRI) imaging may help untwine the factors contributing to an audible cry during a painful procedure [10]. fMRI might be a more reliant method to assess neonatal pain but is currently not feasible in lower-middle-income research setting. Reduction in audible cry could still indicate that use of lancet was less painful as well as reduced the stress of NICU mothers. Reduction in the behavioral aspects of the PIPP score also could further alleviate the anxiety of mothers who frequently witness their babies’ painful procedures. However, the effect on stress of the mothers was not evaluated in our study.

This study was conducted after use of EBM in both groups. We have previously demonstrated the analgesic effect of EBM for moderately painful procedures [9]. It is our unit protocol to use EBM as a tool to reduce procedural pain. The difference in PIPP scores, therefore, assumes greater importance, as this reduction is seen from a lower baseline PIPP score because of EBM. It also suggests that pain management must be multipronged, as no single intervention can totally alleviate pain.

Our study did not find any difference in the success of either the lancet or the needle in adequacy of sampling. Multiple pricks were not required for infants in this study. This could be owing to the fact that the study was conducted by one from a selected group of experienced nurses to minimize the variation in pain, as pain during heel prick is not only caused by the prick but also by the squeeze of the heel and the handling of the foot.

Various studies have evaluated the efficacy of a lancet. Shephered et al. compared two different lancet devices, namely, tenderfoot and genie lancet. They found that tenderfoot was superior in terms of quality of the blood sample, time taken to collect the sample, number of heel pricks required to take the sample, whether squeezing of heel was required, pain expressed by the baby and presence of bruising. Experienced midwives were more efficient in sample collection [11]. Cologna et al. also compared two lancet devices, namely, tenderfoot and traditional lancetta. Tenderfoot again proved superior in the previously mentioned parameters; however, its cost ($3.75) and post-procedure bleeding made its use debatable [12]. Harpin demonstrated the efficacy of automatic lancet over the manual lancet [13]. We used a basic lancet costing Rs 2. The 26 G needle cost Rs 5. This study took into consideration the economic challenges of neonatal care and used a low-cost lancet (USD = $0.032).

One of the limitations of our study is that it is not blinded. All aspects of analyses were done by the principal investigator who also videographed the baby. However, the co-investigator who verified the PIPP scores independently was unaware of the randomization. We tried eliminating sources of bias by having a single nurse carry out all heel-prick procedures, administering 5 ml of EBM to each neonate and randomizing, but sources of bias, particularly in analyzing results could still exist, as the study was not blinded. Though the PIPP score adjusts for gestational age, the newborn study population could have possibly been more homogenous in terms of gestational age and reasons for NICU admission.

CONCLUSION

A sick neonate on an average undergoes >60 procedures per day [3]. Of these procedures, 30%–66% are heel prick [1, 3, 4, 8, 9]. Heel prick with a lancet is associated with a trend toward lower PIPP scores and significantly lower duration of audible cry in newborns even after use of an analgesic (EBM). The results of this study, therefore, indicate a potential area for intervention that is economical in both terms of money and time.

Supplementary data

Supplementary data are available at Journalof Tropical Pediatrics online.

ACKNOWLEDGMENTS

We wish to thank the parents of the subjects for participating in the study and Dr Tinku Thomas for assisting with the statistics.

FUNDING

This study was funded as part of the Indian Council of Medical Research STS project 2013-02326.

References

1

Simons

SHP

,

Van Dijk

M

,

Anand

KS

, et al. 

Do we still hurt newborn babies?

Arch Pediatr Adolesc Med

2003

;

157

:

1058

–

64

.2

Latimer

MA

,

Johnston

CC

,

Ritchie

JA

,

Gilin

D.

Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates

.

J Obs Gynecol Neonatal Nurs

2009

;

38

:

182

–

94

.3

Britto

CD

,

Rao Pn

S

,

Nesargi

S

, et al. 

PAIN–perception and assessment of painful procedures in the NICU

.

J Trop Pediatr

2014

;

60

:

422

–

7

.4

Johnston

C

,

Stevens

B.

Experience in a neonatal intensive care unit affects pain response

.

Pediatrics

1996

;

98

:

925

–

30

.5

Lago

P

,

Garetti

E

,

Merazzi

D

, et al. 

Guidelines for procedural pain in the newborn

.

Acta Paediatr Int J Paediatr

2009

;

98

:

932

–

9

.6

Gray

L

,

Garza

E

,

Zageris

D

, et al. 

Sucrose and warmth for analgesia in healthy newborns: an RCT

.

Pediatrics

2015

;

135

:

e607

–

14

.7

Harrison

D

,

Beggs

S

,

Stevens

B.

Sucrose for procedural pain management in infants

.

Pediatrics

2012

;

130

:

918

–

25

.8

Barker

DP

,

Rutter

N.

Exposure to invasive procedures in neonatal intensive care unit admissions

.

Arch Dis Child Fetal Neonatal Ed

1995

;

72

:

F47

–

8

.9

Sahoo

JP

,

Rao

S

,

Nesargi

S

, et al. 

Expressed breast milk vs 25% dextrose in procedural pain in neonates, a double blind randomized controlled trial

.

Indian Pediatr

2013

;

50

:

203

–

7

.10

Goksan

S

,

Hartley

C

,

Emery

F

, et al. 

fMRI reveals neural activity overlap between adult and infant pain

.

Elife

2015

;

2015

:

1

–

13

.11

Shepherd

AJ

,

Glenesk

A

,

Niven

CA

, et al. 

A Scottish study of heel-prick blood sampling in newborn babies

.

Midwifery

2006

;

22

:

158

–

68

.12

Cologna

M

,

Sperandio

L.

The effect of two different methods of heel lancing on pain reaction in preterm neonates [in Italian]

.

Assist Inferm Ric

1999

;

18

:

185

–

92

.13

Harpin

VA

,

Rutter

N.

Making heel pricks less painful

.

Arch Dis Child

1983

;

58

:

226

–

8

.

© The Author [2017]. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected]

Pain Principles (Section 2, Chapter 6) Neuroscience Online: An Electronic Textbook for the Neurosciences | Department of Neurobiology and Anatomy

Most of the sensory and somatosensory modalities are primarily informative, whereas pain is a protective modality. Pain differs from the classical senses (hearing, smell, taste, touch, and vision) because it is both a discriminative sensation and a graded emotional experience associated with actual or potential tissue damage.

Pain is a submodality of somatic sensation. The word “pain” is used to describe a wide range of unpleasant sensory and emotional experiences associated with actual or potential tissue damage. Nature has made sure that pain is a signal we cannot ignore. Pain information is transmitted to the CNS via three major pathways (Figure 6.1).

Most ailments of the body cause pain. The ability to diagnose different diseases depends to a great extent on the knowledge of the different qualities and causes of pain. Sensitivity and reactivity to noxious stimuli are essential to the well-being and survival of an organism. Pain travels through redundant pathways, ensuring to inform the subject: “Get out of this situation immediately.” Without these attributes, the organism has no means to prevent or minimize tissue injury. Individuals congenitally insensitive to pain are easily injured and most of them die at an early age.

For thousands of years, physicians have tried to treat pain without knowing the details of the ways in which pain is signaled from the injured part of the body to the brain, or the ways in which any of their remedies worked. Recent discoveries about how the body detects, transmits and reacts to painful stimuli, have allowed physicians to relieve both acute and chronic pain.

6.1 Pain Receptors

Pain is termed nociceptive (nocer – to injure or to hurt in Latin), and nociceptive means sensitive to noxious stimuli. Noxious stimuli are stimuli that elicit tissue damage and activate nociceptors.

Nociceptors are sensory receptors that detect signals from damaged tissue or the threat of damage and indirectly also respond to chemicals released from the damaged tissue. Nociceptors are free (bare) nerve endings found in the skin (Figure 6.2), muscle, joints, bone and viscera. Recently, it was found that nerve endings contain transient receptor potential (TRP) channels that sense and detect damage. The TRP channels are similar to voltage-gated potassium channels or nucleotide-gated channels, having 6 transmembrane domains with a pore between domains 5 and 6. They transduce a variety of noxious stimuli into receptor potentials, which in turn initiate action potential in the pain nerve fibers. This action potential is transmitted to the spinal cord and makes a synaptic connection in lamina I and/or II. The cell bodies of nociceptors are mainly in the dorsal root and trigeminal ganglia. No nociceptors are found inside the CNS.

Nociceptors are not uniformly sensitive. They fall into several categories, depending on their responses to mechanical, thermal, and/or chemical stimulation liberated by the damage, tumor, and/or inflammation.

Skin Nociceptors. Skin nociceptors may be divided into four categories based on function. The first type is termed high threshold mechanonociceptors or specific nociceptors. These nociceptors respond only to intense mechanical stimulation such as pinching, cutting or stretching. The second type is the thermal nociceptors, which respond to the above stimuli as well as to thermal stimuli. The third type is chemical nociceptors, which respond only to chemical substances (Figure 6.2). A fourth type is known as polymodal nociceptors, which respond to high intensity stimuli such as mechanical, thermal and to chemical substances like the previous three types. A characteristic feature of nociceptors is their tendency to be sensitized by prolonged stimulation, making them respond to other sensations as well.

Joint Nociceptors. The joint capsules and ligaments contain high-threshold mechanoreceptors, polymodal nociceptors, and “silent” nociceptors. Many of the fibers innervating these endings in the joint capsule contain neuropeptides, such as substance P (SP) and calcitonin gene-related peptide (CGRP). Liberation of such peptides is believed to play a role in the development of inflammatory arthritis.

Visceral Nociceptors. Visceral organs contain mechanical pressure, temperature, chemical and silent nociceptors. The visceral nociceptors are scattered, with several millimeters between them, and in some organs, there are several centimeters between each nociceptor (Figure 6.3). Many of the visceral nociceptors are silent. The noxious information from visceral organs and skin are carried to the CNS in different pathways (Figures 6.3 and 6.4).

Silent Nociceptors. In the skin and deep tissues there are additional nociceptors called “silent” or “sleep” nociceptors. These receptors are normally unresponsive to noxious mechanical stimulation, but become “awakened” (responsive) to mechanical stimulation during inflammation and after tissue injury. One possible explanation of the “awakening” phenomenon is that continuous stimulation from the damaged tissue reduces the threshold of these nociceptors and causes them to begin to respond. This activation of silent nociceptors may contribute to the induction of hyperalgesia, central sensitization, and allodynia (see below). Many visceral nociceptors are silent nociceptors.

Activation of the nociceptor initiates the process by which pain is experienced, (e.g., we touch a hot stove or sustain a cut). These receptors relay information to the CNS about the intensity and location of the painful stimulus.

6.2 Factors that Activate Nociceptors

Nociceptors respond when a stimulus causes tissue damage, such as that resulting from cut strong mechanical pressure, extreme heat, etc. The damage of tissue results in a release of a variety of substances from lysed cells as well as from new substances synthesized at the site of the injury (Figure 6.5). Some of these substances activate the TRP channels which in turn initiate action potentials. These substances include:

1. Globulin and protein kinases. It has been suggested that damaged tissue releases globulin and protein kinases, which are believed to be amongst the most active pain-producing substances. Minute subcutaneous injections of globulin induce severe pain.
2. Arachidonic acid. Arachidonic acid is one of the chemicals released during tissue damage. It is then metabolized into prostaglandin (and cytokines). The action of the prostaglandins is mediated through a G protein, protein kinase A cascade. The prostaglandins block the potassium efflux released from nociceptors following damage, which results in additional depolarization. This makes the nociceptors more sensitive. Aspirin is an effective pain killer because it blocks the conversion of arachidonic acid to prostaglandin.
3. Histamine. Tissue damage stimulates the mast cells to release histamine to the surrounding area. Histamine excites the nociceptors. Minute subcutaneous injections of histamine elicit pain.
4. Nerve growth factor (NGF). Inflammation or tissue damage triggers the release of NGF. NGF then binds to TrkA receptors on the surfaces of nociceptors leading to their activation. Minute subcutaneous injections of NGF elicit pain.
5. Substance P (SP) and calcitonin gene-related peptide (CGRP) are released by injury. Inflammation of tissue damage also results in SP and CGRP release, which excites nociceptors. Minute subcutaneous injection of substance P and CGRP elicits pain. Both peptides produce vasodilation, which results in the spread of edema around the initial damage.
6. Potassium – K⁺. Most tissue damage results in an increase in extracellular K⁺. There is a good correlation between pain intensity and local K⁺ concentration.
7. Serotonin (5-HT), acetylcholine (ACh), low pH (acidic) solution, and ATP. These substances are released with tissue damage. Subcutaneous injections of minute qualities of these products excite nociceptors.
8. Muscle spasm and lactic acid. Not only can some headaches result from muscle spasms of smooth muscle, stretching of a ligament can also elicit pain. When muscles are hyperactive or when blood flow to a muscle is blocked, lactic acid concentration increases and pain is induced. The greater the rate of tissue metabolism, the more rapidly the pain appears. Minute subcutaneous injections of lactic acid excite nociceptors.

The release of these substances sensitizes the nociceptors (C fibers) and reduces their threshold. This effect is referred to as peripheral sensitization (in contrast to central sensitization that occurs in the dorsal horn).

Within 15-30 seconds after injury, an area of several cm around the injured site shows reddening (caused by vasodilation) called a flare. This response (inflammation) becomes maximal after 5-10 minutes (Figure 6.6), and this region shows a lowered pain threshold (i.e., hyperalgesia).

Hyperalgesia. Hyperalgesia is an increased painful sensation in response to additional noxious stimuli. One explanation for hyperalgesia is that the threshold for pain in the area surrounding an inflamed or injured site is lowered. An additional explanation is that the inflammation activates silent nociceptors and/or the damage elicits ongoing nerve signals (prolong stimulation), which led to long-term changes and sensitized nociceptors. These changes contribute to an amplification of pain or hyperalgesia, as well as an increased persistence of the pain. If one pricks normal skin with a sharp probe, it will elicit sharp pain followed by reddened skin. The reddened skin is an area of hyperalgesia.

Allodynia. Allodynia is pain resulting from a stimulus that does not normally produce pain. For example, light touch to sunburned skin produces pain because nociceptors in the skin have been sensitized as a result of reducing the threshold of the silent nociceptors. Another explanation of allodynia is that when peripheral neurons are damaged, structural changes occur and the damaged neurons reroute and make connection also to sensory receptors (i.e., touch-sensitive fibers reroute and make synaptic connection into areas of the spinal cord that receive input from nociceptors).

In conclusion, the several kinds of endogenous chemicals are produced with tissue damage and inflammation. These products have excitatory effects on nociceptors. However, it is not known whether nociceptors respond directly to the noxious stimulus or indirectly by means of one or more chemical intermediaries released from the traumatized tissue.

6.3 Pain Thresholds and Just Noticeable Differences

Exposing the skin to controlled heat (produced by heating element or laser) makes it possible to measure the threshold for pain. When the temperature of the skin reaches 45 ± 1°C, subjects report pain. Non-noxious thermal (< 45°C) receptors are innervated by different types of nerve fibers than those responding to the pain. A temperature of approximately 45ºC denaturates tissue protein and elicits damage in all subjects (Figure 6.7). That is, the pain threshold in all subjects is about the same. However, the response to pain is different among people.

Pain is measured by the degree of pain intensity. Different degrees of pain intensity are defined as Just Noticeable Differences (JND). There are 22 JND for pain elicited by heat to the skin (Figure 6.8A). This discrimination is possible because the discharge frequency of the nociceptors increases with increasing skin temperature (Figure 6.8B). Thus, nociceptors also supply information on the stimulus intensity (intensity coding) in addition to the injury location.

6.4 Pain Fibers

The cell bodies of the primary afferent pain neurons from the body, face, and head are located in the dorsal root ganglia (DRG) and in the trigeminal ganglia respectively. Some of these cell bodies give rise to myelinated axons (A delta fibers), and others give rise to unmyelinated axons (C fibers). The free nerve endings arise from both A delta fibers and the unmyelinated C fibers, which are scattered together (Figure 6.9).

A delta fibers (group III fibers) are 2-5 mm in diameter, myelinated, have a fast conduction velocity (5-40 meters/sec), and carry information mainly from the nociceptive-mechanical or mechanothermal-specific nociceptors. Their receptive fields are small. Therefore, they provide precise localization of pain.

C fibers (group IV fibers) are 0.4-1.2 mm in diameter, unmyelinated, have a slow conduction velocity (0.5-2.0 meters/sec), and are activated by a variety of high-intensity mechanical, chemical and thermal stimulation and carry information from polymodal nociceptors. C-fibers comprise about 70% of all the fibers carrying noxious input. Two classes of C-fibers have been identified. The receptive field of these neurons is large and, therefore, less precise for pain localization.

Upon entering the spinal cord, the pain fibers bifurcate and ascend and descend to several segments, forming part of the tract of Lissauer before synapsing on neurons on Rexed layers I to II. In general, nociceptors responding to noxious stimuli transmit the information to the CNS via A delta fibers, which make synaptic connections to neurons in Rexed layer I (nucleus posterior marginalis). The nociceptors responding to chemical or thermal stimuli (i.e., the polymodal nociceptors) carry their activity mainly by C unmyelinated fibers. One class of C fibers terminates in Rexed layer I, and the second class terminates in Rexed layer II (substantia gelatinosa). These fibers release substance P, glutamate, aspartate calcitonin gene related peptide (CGRP), vasoactive intestinal polypeptide (VIP), and nitric oxide.

6.5 Double Pain Sensations

Two sequential pain sensations in short time intervals is the result of sudden painful stimulation. The first one is immediately after the damage. It is followed several seconds later with additional pain sensation. These two separate sensations are several seconds apart because a fast transmitting information sensation is carried via A delta fibers and is followed several seconds later with slow transmitting pain information carried via C fibers. This phenomenon is known as “double pain sensation” (Figure 6.9).

Two experimental procedures were used to verify which information is carried by which fibers.

1. Externally applied pressure, such as compression of the skin above a nerve, first blocks the myelinated A delta fibers, while C fibers continue to conduct action potentials and allow the slow conducting pain to be carried.
2. A low dose of local anesthesia applied to peripheral nerves blocks the unmyelinated C fibers before the myelinated A delta fibers. Under this condition, the slow conducting pain information is blocked, and only the fast conducting pain information by A delta fibers is carried to the CNS. This experiment provides additional evidence that two different types of nerve fibers carry noxious information.

6.6 Nociceptive Neurons in the Spinal Cord (Nocineurons)

The synaptic terminals of the axons of the dorsal root ganglion, which carry noxious information arriving to Rexed layers I and II (Figure 6.10), release neurochemical agents such as substance P (SP), glutamate, aspartate, vasoactive intestinal peptide (VIP), cholecystokinin (CCK), somatostatin, calcitonin gene-related peptide (CGRP), galanin, and other agents. These agents activate the nocineurons. It was shown that when SP and CGRP are applied locally within the spinal cord dorsal horn, glutamate is released. The release of glutamate excites the nocineurons. Furthermore, SP receptors (neurokinin receptors) and NMDA receptors (glutamate) interact which result that the NMDA receptors will become more sensitive to glutamate, which results in central sensitization. The functions of these peptides are largely unknown but they presumably mediate slow, modulatory synaptic actions in the dorsal horn neurons. The neuropeptides are always co-localized with other “classical” neurotransmitters.

There are four general types of nocineurons in the spinal cord (Figure 6.10):

1. High threshold mechanoreceptor neurons or nociceptive specific neurons. These neurons are excited only by noxious cutaneous and/or visceral stimuli. The nociceptive afferent fibers release glutamate and different neuropeptides to activate the dorsal horn neurons.
2. Chemical nociceptor neurons are excited by chemical or thermal noxious stimulus in the skin or in visceral organs.
3. Thermal nociceptor neurons are excited by chemical or thermal noxious stimulus in the skin or in visceral organs.
4. Polymodal-nociceptive neurons or multi, or wide dynamic range nociceptive neurons. These neurons are excited by both noxious and non-noxious cutaneous and/or visceral stimuli (polymodal nociceptive neurons). These neurons are activated by a variety of noxious stimuli (mechanical, thermal, chemical, etc.) and respond incrementally to increasing intensity of the stimuli.

Rexed lamina I contains a higher proportion of nociceptive specific neurons, whereas Rexed lamina II contains predominantly multi-receptive wide dynamic range neurons. The nociceptive-specific neurons alert the subject when a stimulus is noxious, and the multi-receptive neurons provide the subject with information about the parameters of the noxious stimulus. In general, C fibers release neuropeptides such as substance P whereas the A delta fibers release glutamate.

6.7 Classification of Pain

Pain has been classified into three major types:

1. Pricking pain. Pain caused by a needle, pin prick, skin cut, etc. – elicits a sharp, pricking quality, stinging pain sensation carried fast by the A delta fibers. The pain is precisely localized and of short duration. Pricking pain is also called fast pain, first pain or sensory pain. Pricking pain is present in all individuals and is a useful and necessary component of our sensory repertoire. Without this type of protective pain sensation, everyday life would be difficult. Pricking pain arises mainly from the skin, and carried mainly by A delta fibers which permits discrimination (i.e., permits the subject to localize the pain).
2. Burning pain or soreness pain. Pain caused by inflammation, burned skin, etc., is carried by the C fibers (slowly conducted pain nerve fibers). This type of pain is a more diffuse, slower to onset, and longer in duration. It is an annoying pain and intolerable pain, which is not distinctly localized. Like pricking pain, burning pain arises mainly from the skin. It is carried by the paleospinothalamic tract. (The old primitive transmission system for diffuse pain which does not permit exact localization.)
3. Aching pain is a sore pain. This pain arises mainly from the viscera and somatic deep structures. Aching pain is not distinctly localized and is an annoying and intolerable pain. Aching pain is carried by the C fibers from the deep structures to the spinal cord.

Test Your Knowledge

All of the following are released in response to noxious stimulation at the damaged site(s) EXCEPT:

A. Globulin

B. Dopamine

C. Arachnoid Acid

D. Acetylcholine

E. Histamine

All of the following are released in response to noxious stimulation at the damaged site(s) EXCEPT:

A. Globulin This answer is INCORRECT.

B. Dopamine

C. Arachnoid Acid

D. Acetylcholine

E. Histamine

All of the following are released in response to noxious stimulation at the damaged site(s) EXCEPT:

A. Globulin

B. Dopamine This answer is CORRECT!

Dopamine is not released in response to noxious stimulation.

C. Arachnoid Acid

D. Acetylcholine

E. Histamine

All of the following are released in response to noxious stimulation at the damaged site(s) EXCEPT:

A. Globulin

B. Dopamine

C. Arachnoid Acid This answer is INCORRECT.

D. Acetylcholine

E. Histamine

All of the following are released in response to noxious stimulation at the damaged site(s) EXCEPT:

A. Globulin

B. Dopamine

C. Arachnoid Acid

D. Acetylcholine This answer is INCORRECT.

E. Histamine

All of the following are released in response to noxious stimulation at the damaged site(s) EXCEPT:

A. Globulin

B. Dopamine

C. Arachnoid Acid

D. Acetylcholine

E. Histamine This answer is INCORRECT.

C fibers transmit which type of pain?

A. Pricking pain

B. Stimulation produced analgesia

C. Referred pain

D. Burning pain

E. Sharp pain

C fibers transmit which type of pain?

A. Pricking pain This answer is INCORRECT.

B. Stimulation produced analgesia

C. Referred pain

D. Burning pain

E. Sharp pain

C fibers transmit which type of pain?

A. Pricking pain

B. Stimulation produced analgesia This answer is INCORRECT.

C. Referred pain

D. Burning pain

E. Sharp pain

C fibers transmit which type of pain?

A. Pricking pain

B. Stimulation produced analgesia

C. Referred pain This answer is INCORRECT.

D. Burning pain

E. Sharp pain

C fibers transmit which type of pain?

A. Pricking pain

B. Stimulation produced analgesia

C. Referred pain

D. Burning pain This answer is CORRECT!

C fibers carry the burning pain sensation.

E. Sharp pain

C fibers transmit which type of pain?

A. Pricking pain

B. Stimulation produced analgesia

C. Referred pain

D. Burning pain

E. Sharp pain This answer is INCORRECT.

C fibers are

A. small myelinated fibers which carry sharp pain

B. large unmyelinated fibers which carry burning pain

C. small unmyelinated fibers which carry burning pain

D. large myelinated fibers which carry sharp pain

E. large myelinated fibers which carry temperature sensation

C fibers are

A. small myelinated fibers which carry sharp pain This answer is INCORRECT.

B. large unmyelinated fibers which carry burning pain

C. small unmyelinated fibers which carry burning pain

D. large myelinated fibers which carry sharp pain

E. large myelinated fibers which carry temperature sensation

C fibers are

A. small myelinated fibers which carry sharp pain

B. large unmyelinated fibers which carry burning pain This answer is INCORRECT.

C. small unmyelinated fibers which carry burning pain

D. large myelinated fibers which carry sharp pain

E. large myelinated fibers which carry temperature sensation

C fibers are

A. small myelinated fibers which carry sharp pain

B. large unmyelinated fibers which carry burning pain

C. small unmyelinated fibers which carry burning pain This answer is CORRECT!

The C fibers are unmyelinated fibers that carry burning pain.

D. large myelinated fibers which carry sharp pain

E. large myelinated fibers which carry temperature sensation

C fibers are

A. small myelinated fibers which carry sharp pain

B. large unmyelinated fibers which carry burning pain

C. small unmyelinated fibers which carry burning pain

D. large myelinated fibers which carry sharp pain This answer is INCORRECT.

E. large myelinated fibers which carry temperature sensation

C fibers are

A. small myelinated fibers which carry sharp pain

B. large unmyelinated fibers which carry burning pain

C. small unmyelinated fibers which carry burning pain

D. large myelinated fibers which carry sharp pain

E. large myelinated fibers which carry temperature sensation This answer is INCORRECT.

Aspirin acts to block the formation of

A. Bradykinins

B. Prostaglandins

C. Histamine

D. Dopamine

E. Serotonin

Aspirin acts to block the formation of

A. Bradykinins This answer is INCORRECT.

B. Prostaglandins

C. Histamine

D. Dopamine

E. Serotonin

Aspirin acts to block the formation of

A. Bradykinins

B. Prostaglandins This answer is CORRECT!

Prostaglandins is the answer because aspirin blocks the prostaglandins release from the damaged tissue. Prostaglandins activate the nociceptors. Aspirin has no effect on other chemicals released at the damage site.

C. Histamine

D. Dopamine

E. Serotonin

Aspirin acts to block the formation of

A. Bradykinins

B. Prostaglandins

C. Histamine This answer is INCORRECT.

D. Dopamine

E. Serotonin

Aspirin acts to block the formation of

A. Bradykinins

B. Prostaglandins

C. Histamine

D. Dopamine This answer is INCORRECT.

E. Serotonin

Aspirin acts to block the formation of

A. Bradykinins

B. Prostaglandins

C. Histamine

D. Dopamine

E. Serotonin This answer is INCORRECT.

A delta fibers transmit primarily

A. burning diffuse pain information

B. pricking localized pain information

C. aching diffuse pain information

D. visceral pain information

E. phantom pain information

A delta fibers transmit primarily

A. burning diffuse pain information This answer is INCORRECT.

B. pricking localized pain information

C. aching diffuse pain information

D. visceral pain information

E. phantom pain information

A delta fibers transmit primarily

A. burning diffuse pain information

B. pricking localized pain information This answer is CORRECT!

A delta fibers carry sharp/pricking pain, all the others are carried by C fibers.

C. aching diffuse pain information

D. visceral pain information

E. phantom pain information

A delta fibers transmit primarily

A. burning diffuse pain information

B. pricking localized pain information

C. aching diffuse pain information This answer is INCORRECT.

D. visceral pain information

E. phantom pain information

A delta fibers transmit primarily

A. burning diffuse pain information

B. pricking localized pain information

C. aching diffuse pain information

D. visceral pain information This answer is INCORRECT.

E. phantom pain information

A delta fibers transmit primarily

A. burning diffuse pain information

B. pricking localized pain information

C. aching diffuse pain information

D. visceral pain information

E. phantom pain information This answer is INCORRECT.

Pain receptors/nociceptors are

A. bipolar cells

B. free nerve endings

C. epithelial receptors

D. Pacinian corpuscles

E. Meissner corpuscles

Pain receptors/nociceptors are

A. bipolar cells This answer is INCORRECT.

B. free nerve endings

C. epithelial receptors

D. Pacinian corpuscles

E. Meissner corpuscles

Pain receptors/nociceptors are

A. bipolar cells

B. free nerve endings This answer is CORRECT!

Only the free nerve endings are the receptors (nociceptors) that sense pain.

C. epithelial receptors

D. Pacinian corpuscles

E. Meissner corpuscles

Pain receptors/nociceptors are

A. bipolar cells

B. free nerve endings

C. epithelial receptors This answer is INCORRECT.

D. Pacinian corpuscles

E. Meissner corpuscles

Pain receptors/nociceptors are

A. bipolar cells

B. free nerve endings

C. epithelial receptors

D. Pacinian corpuscles This answer is INCORRECT.

E. Meissner corpuscles

Pain receptors/nociceptors are

A. bipolar cells

B. free nerve endings

C. epithelial receptors

D. Pacinian corpuscles

E. Meissner corpuscles This answer is INCORRECT.

Double pain sensation results from

A. two different pain receptors

B. two different pathways, differing in the number of the synapses

C. two different fibers which conduct the impulses at different velocities

D. two different neurotransmitters

E. two different neuropeptides

Double pain sensation results from

A. two different pain receptors This answer is INCORRECT.

B. two different pathways, differing in the number of the synapses

C. two different fibers which conduct the impulses at different velocities

D. two different neurotransmitters

E. two different neuropeptides

Double pain sensation results from

A. two different pain receptors

B. two different pathways, differing in the number of the synapses This answer is INCORRECT.

C. two different fibers which conduct the impulses at different velocities

D. two different neurotransmitters

E. two different neuropeptides

Double pain sensation results from

A. two different pain receptors

B. two different pathways, differing in the number of the synapses

C. two different fibers which conduct the impulses at different velocities This answer is CORRECT!

The reason for double pain sensation is that two different fibers (A delta and C fibers) carries pain sensation at different speed.

D. two different neurotransmitters

E. two different neuropeptides

Double pain sensation results from

A. two different pain receptors

B. two different pathways, differing in the number of the synapses

C. two different fibers which conduct the impulses at different velocities

D. two different neurotransmitters This answer is INCORRECT.

E. two different neuropeptides

Double pain sensation results from

A. two different pain receptors

B. two different pathways, differing in the number of the synapses

C. two different fibers which conduct the impulses at different velocities

D. two different neurotransmitters

E. two different neuropeptides This answer is INCORRECT.

A delta fibers transmit which type of pain to VPL?

A. Pricking pain

B. Deep pain

C. Visceral pain

D. Burning pain

E. Aching pain

A delta fibers transmit which type of pain to VPL?

A. Pricking pain This answer is CORRECT!

A delta fibers carry pricking/sharp pain. Al the other pains (deep, visceral, burning, aching) are carried via C fibers.

B. Deep pain

C. Visceral pain

D. Burning pain

E. Aching pain

A delta fibers transmit which type of pain to VPL?

A. Pricking pain

B. Deep pain This answer is INCORRECT.

C. Visceral pain

D. Burning pain

E. Aching pain

A delta fibers transmit which type of pain to VPL?

A. Pricking pain

B. Deep pain

C. Visceral pain This answer is INCORRECT.

D. Burning pain

E. Aching pain

A delta fibers transmit which type of pain to VPL?

A. Pricking pain

B. Deep pain

C. Visceral pain

D. Burning pain This answer is INCORRECT.

E. Aching pain

A delta fibers transmit which type of pain to VPL?

A. Pricking pain

B. Deep pain

C. Visceral pain

D. Burning pain

E. Aching pain This answer is INCORRECT.

Sharp pain, induced by a skin cut for example, is classified by

A. Burning pain

B. Aching pain

C. Somatic pain

D. Pricking pain

E. Visceral pain

Sharp pain, induced by a skin cut for example, is classified by

A. Burning pain This answer is INCORRECT.

B. Aching pain

C. Somatic pain

D. Pricking pain

E. Visceral pain

Sharp pain, induced by a skin cut for example, is classified by

A. Burning pain

B. Aching pain This answer is INCORRECT.

C. Somatic pain

D. Pricking pain

E. Visceral pain

Sharp pain, induced by a skin cut for example, is classified by

A. Burning pain

B. Aching pain

C. Somatic pain This answer is INCORRECT.

D. Pricking pain

E. Visceral pain

Sharp pain, induced by a skin cut for example, is classified by

A. Burning pain

B. Aching pain

C. Somatic pain

D. Pricking pain This answer is CORRECT!

A delta fibers carry information induced by a skin cut, which is classified as a pricking pain.

E. Visceral pain

Sharp pain, induced by a skin cut for example, is classified by

A. Burning pain

B. Aching pain

C. Somatic pain

D. Pricking pain

E. Visceral pain This answer is INCORRECT.

Frontiers | Is Prick of Conscience Associated With the Sensation of Physical Prick?

Introduction

Prick of Conscience is regarded as one of the most popular English poems of the Middle Ages (Lewis and McIntosh, 1982). The poem characterized by humility and fear describes divine-human relationships (Morey, 2012), and addresses a concern for confession of sins in the late medieval England (Galloway, 2009). The English word “prick” metaphorically illustrates disturbed feelings after engaging in guilty acts, as noticed in the metaphor, “prick of conscience,” which expresses feelings of guilt (e.g., Longman Dictionary of Contemporary English, Merriam-Wester Dictionary). People may express their remorse and penitence by saying, “I feel a prick of conscience,” or “It pricks my conscience.” Yet, the definition of “prick” is to physically pierce or puncture the object with a tiny sharp material (e.g., “A finger is pricked with a needle.”). This paper investigates a possible relationship between physical prick and emotional prick (i.e., guilt).

Notably, a similar expression exists in Korean. When a native speaker of Korean feels guilty about moral issues such as lying, he or she would say, “It pricks my conscience (or heart).” This metaphorical expression can be used both colloquially and formally in Korean. The usage of this Korean phrase can be found in the National Korean Dictionary in the entry for “prick”: “It pricks my conscience.” In this example, the verb “prick” refers to not only being physically punctured by sharp objects but also being emotionally disturbed by someone or at an event. In this sense, Kim (2005) stated that the feeling of guilt was “to be pricked” in Korean, which posits the possibility that this term can describe emotions and sensations. Earlier studies on Korean idioms also suggested that the phrase, “one’s heart is pricked,” describes an emotional experience of guilt (Chang and Chang, 1994; Park, 2002). Given that people commonly relate immoral conscience with acute pain from pricking, it raises an interesting question if feelings of guilt can be experienced in the physical setting (i.e., a needle prick) as reflected in the embodied cognition framework.

Research on embodied cognition assumes that bodily states are the consequences of social cognition as well as the causes of cognition (Barsalou, 2008). Furthermore, the extant literature in embodied cognition suggests that cognitive representations are grounded in the brain’s sensorimotor systems (i.e., sensation and action of the body; Niedenthal et al., 2005; Barsalou, 2010). Notably, given the nature of metaphorical expressions that delivers beyond the literal meaning (Landau et al., 2010; Lakoff, 2012), many scholars support the argument that there is a significant association between bodily experience and emotional experience in, for example, “coldness” (Zhong and Leonardelli, 2008), “comfort food” (Troisi and Gabriel, 2011), “fishiness” (Lee et al., 2015), “heavy-heartedness” (Min and Choi, 2016), “highness” (Schubert, 2005), “warmth” (Williams and Bargh, 2008), and “weight” (Jostmann et al., 2009). Taken together, these findings propose an intriguing possibility that the metaphorical sense of pricking as in the expression “prick of conscience” may be associated with physical prick (e.g., a needle prick).

Many research studies on guilty conscience have adopted the embodied cognition perspective. For instance, Zhong and Liljenquist (2006) demonstrated links between physical cleansing and moral cleanliness. They tested a metaphorical expression, “washing away one’s sins” and found that threatening one’s moral purity increases a desire to engage in physical cleansing behaviors. Moreover, results also indicated that the act of washing hands restores the sense of moral purity in participants. Similarly, researchers have demonstrated that physical cleansing alleviates guilt and reduces compensatory helping behaviors (Zhong and Liljenquist, 2006; Xu et al., 2014), enhances optimism (Kaspar, 2013), and moderates the impairing effect of threatened morality on the executive control system (Kalanthroff et al., 2017). Furthermore, priming feelings of guilt by manipulating participants’ body postures elevated negative backlash and increased pro-social behaviors (Rotella and Richeson, 2013). To sum up, previous studies on embodied cognition concerning conscience and guilt have primarily focused on the relationship between guilt and moral compensatory behaviors that attenuate feelings of guilt (e.g., physical cleansing, pro-social behaviors). However, less literature addresses the physical experiences accompanied by feelings of guilt.

Some major studies compare the bodily experience of guilt to a subjective feeling of weight. For example, Day and Bobocel (2013) asserted that the emotional experience of guilt could be embodied as a sensation of weight, as reflected in the metaphorical expression, “weight on one’s conscience.” Kouchaki et al. (2014) also found a significant association between subjective body weight and feelings of guilt. The results of this study indicated that individuals who wore a heavy backpack reported increased feelings of guilt as compared to those who wore a light backpack. Considering the association between guilt and subjective body weight based on the “weight of guilt” metaphor, we predict a similar relationship between the experiences of guilt and the bodily experience of the physical prick, inspired by the metaphorical expression of “prick of conscience.”

On a similar note, it is worth noting Bastian et al. (2011)’s study of guilt and pain. In their study, participants were asked to recall either personal unethical acts or casual interactions with people on the day before the experiment. They were then asked to put their hands in a bucket full of ice. Results indicated that participants who recalled guilty experiences in the past rated the experience as more painful than the control group. Accordingly, given that threatened moral self-image tends to heighten the sensitivity to physical pain, it is safe to assume that depending on feelings of guilt, individuals may report different degrees of sensitivity against finger prick.

As mentioned above, Zhong and Liljenquist (2006) found that threatening one’s moral purity increased a desire to engage in physical cleansing behaviors and the act of washing hands washed away one’s sins (i.e., reduced moral emotions such as disgust, regret, and guilt). Based on the results, Schnall et al. (2008) notably predicted that cleanliness would wash away other people’s sins. As predicted, they found that a cognitively activated concept of cleanliness and physical cleansing behaviors reduced the perceived severity of moral transgressions of others. Just as engaging in physical cleansing associated with moral cleanliness can result in less severe moral judgments, the bodily experience of finger prick that might be associated with moral guilt is expected to increase the severity of moral judgments of other people’s transgressions.

As noted above, we predicted that the sense of guilt might increase the sensitivity to physical prick and that physical prick would affect the moral judgments on others. In this article, we examined three studies that reveal a significant association between emotional- and physical prick. Participants were native Korean speakers who were familiar with the expression “It pricks my conscience” in the contexts of guilt. In Study 1, we investigated whether the manipulated sense of guilt would make participants less likely to engage in a traditional Korean remedy that involves finger prick (i.e., getting acupunctured) when they were assumed to be suffering from an upset stomach. In Study 2, we developed a situation where participants had to make a choice whether or not to tell the truth and observed their decision-making process. We then pricked their hands with an acupuncture device to examine whether the pain from the finger prick was stronger and if the prick felt deeper when participants had lied. In Study 3, we investigated whether the pricking sensation induced by the needle increased the severity of moral judgments as a downstream consequence of experiencing the embodied guilt.

Study 1

In Study 1, we conducted a preliminary experiment to examine the association between prick of conscience and a temporary willingness to experience finger prick. If feelings of guilt are associated with the increased sensitivity to physical prick, participants who feel guilty may be less likely to experience the pain caused by the needle than the other types of pain. To test this hypothesis, we employed a traditional Korean treatment, which involves finger prick for an upset stomach (Stone et al., 2016). When Korean people have an upset stomach, they choose either to prick their fingers with the needle or take over-the-counter medication as a remedy.

Half of the participants were asked to recall past unethical acts, and the other half were asked to recall their ethical acts (i.e., between-subject design). We then asked all the participants to assume that they suffer from indigestion. Subsequently, they rated their willingness toward two different treatment methods: finger prick and medication (i.e., within-subject design). We predicted an interaction effect such that participants with increased feelings of guilt would be less likely to choose a method that involves finger prick, whereas those in the control group would not show any difference in their preferences over the two treatment methods.

Method

Participants

Power analysis using G^∗Power (Faul et al., 2007) suggested a minimum of 74 participants would be needed to detect an effect of moderate size (f = 0.25) of interaction effect at a power of 0.99 when conducting a two-way mixed ANOVA with two independent groups and two dependent variables. 90 undergraduate students (53 males, 37 females; mean age = 22.11 years, SD = 0.99 years) participated in this study, and they received a stationery product worth 3,000 Korean won (equivalent to the US $3) in return for their participation. This study was approved by the Research Ethics Committee of the Korea Military Academy. We obtained written informed consent from all participants prior to the study.

Procedure

Participants were informed that this study was to investigate the relationship between recalling ethical/unethical acts and the emotional state aroused by the memories. Participants were randomly assigned to two conditions (Recall: unethical vs. ethical), similar to other previous studies (e.g., Zhong and Liljenquist, 2006; Day and Bobocel, 2013). In the unethical condition, participants (n = 45) were asked to recall a situation where they had committed unethical acts. They were then instructed to describe past situations and note their feelings attached to the memories. To maintain confidentiality, participants were informed that they might jot down a few keywords that they had recalled if they wanted and were informed that those keywords would not be revealed. In the ethical condition, participants (n = 45) were asked to recall and describe their ethical acts in the past.

Immediately after priming, participants were asked to rate their guilty feelings on an Adapted Shame and Guilt Scale (ASGS; Hoblitzelle, 1987). We adopted a Korean version of ASGS (Nam, 2007). Among 30 items in total, we used 15 items that measured guilt for this study (i.e., “condemned,” “liable,” “wrong,” “unethical,” “guilty,” “chided,” “reproached,” “immoral,” “delinquent,” “unconscionable,” “wicked,” “criminal,” “indecent,” “unscrupulous,” “imprudent”; α = 0.96). The items were rated on a scale of 1 (not at all) to 5 (very much).

Participants were then asked to assume that they were suffering from indigestion at that moment. They were given two treatment options for alleviating the upset stomach; option one was to take a strong dose of medication, and option two was finger prick as part of the traditional Korean treatment (Stone et al., 2016). Participants rated how willing they were to choose each option to treat their imaginary stomachache on a scale of 1 (never willing) to 9 (very willing). These two treatment options were presented in random order and were expected to produce the same level of pain and anxiety. These options were tested in a pilot test with an independent sample of 18 undergraduate students, and we found that the two options were equally preferred to relieve indigestion without priming (pricking a fingertip: M = 6.28, SD = 1.57, taking a dose of medication: M = 6.39, SD = 1.75), t(17) = −0.36, p = 0.73, on a scale of 1 (not favor at all) to 9 (favor strongly). Finally, we obtained their demographics, and debriefing followed.

Results and Discussion

Participants who recalled personal unethical acts (M = 3.82, SD = 0.84) reported heightened feelings of guilt than those who recalled ethical acts (M = 2.20, SD = 0.95), t(88) = 8.51, p < 0.001, d = 1.79. This result suggests that the priming was successful. Next, we conducted a 2 (condition: recalling unethical act vs. ethical act) × 2 (option: pricking a finger with a needle vs. taking a strong dose of medication) two-way mixed ANOVA. Results indicated that a non-significant main effect for recall, F(1,88) = 0.34, p = 0.56, r = 0.06. The main effect of option was also not significant, F(1,88) = 2.76, p = 0.10, r = 0.17. Findings, however, were qualified by a significant interaction effect, F(1,88) = 10.62, p = 0.002, r = 0.33 (Figure 1). Specifically, the simple effect analysis showed that participants in the unethical condition were less likely to prick their fingers with the needle (M = 4.87, SD = 2.79) while it did not affect their choice of taking medication (M = 6.64, SD = 2.25), F(1,88) = 12.10, p = 0.001, r = 0.35. However, those in the ethical condition did not show any difference in their preferences over the two options (finger prick: M = 5.82, SD = 2.53, medication: M = 5.24, SD = 2.37), F(1,88) = 1.28, p = 0.26, r = 0.12.

Figure 1. Willingness to prick a finger with a needle and to take a strong dose of medicine to treat indigestion across two conditions in Study 1. Error bars represent 95% CI.

As predicted, participants who recalled past unethical acts reported decreased interests in the treatment option with the finger prick as compared to taking a strong dose of medication as a treatment, whereas this pattern was not found among participants who recalled their ethical acts. The result of Study 1 substantiates the first hypothesis that the emotional prick of conscience is associated with the bodily sensation of physical prick.

It is notable that there was no significant difference in participants’ willingness to treat their imaginary symptom (i.e., the mean composite of pricking one’s finger and taking a strong dose of medication) between the unethical group (M = 5.76, SE = 0.27) and the ethical group (M = 5.53, SE = 0.27), F(1,88) = 0.34, p = 0.56. If guilty feelings make people more sensitive to pain in general, there should be the main effect of condition (i.e., unethical vs. ethical conditions) indicating lower mean scores in the unethical condition compared to those in the ethical condition. Accordingly, Study 1 rules out an alternative explanation that guilt makes people more reluctant to pain in general. Overall, this result suggests that prick of conscience decreases the likelihood of people experiencing the finger prick.

Study 2

If Study 1 addressed the association between guilt-inducing memories and unwillingness to engage in the physical pain induced by the prick, Study 2 focused on exploring the links between feelings of guilt in the status quo and the finger prick. Specifically, we examined whether participants who told a lie would become more sensitive to the pricking stimulus than those who told the truth. Participants in the test condition were given a situation where they had to determine between telling a lie (i.e., the lie condition) and telling the truth (i.e., the truth condition), whereas participants in the control condition were not presented this situation. They were then pricked their hands with the needle three times. They rated how deep they sensed the needle and how painful it was. We expected that the guilty conscience induced by the act of lying would lead to a more sensitive reaction. To be specific, when pricked by the needle, we predicted that participants in the lie condition would sense the prick deeper and with more pain as compared to those in the truth- and the control condition. However, we did not have any specific prediction for the difference between the truth- and the control groups.

Method

Participants

154 undergraduate students (72 males, 82 females; mean age = 20.58 years, SD = 1.14 years) participated in this study, and they received partial course credits and 3,000 Korean won (the US $3) in return for their participation. Power analysis using G^∗Power (Faul et al., 2007) suggested a minimum of 137 participants would be needed to detect a large effect size (f = 0.40) at a power of 0.99 when conducting ANOVA with three independent groups.

Procedure

Study 2 was a correlational research design and consisted of two sessions. Instead of manipulating participants to feel guilty, we let participants decide whether or not to tell a lie so that they would be divided naturally into self-selected sub-groups (i.e., the lie group or truth group). To control potential variables that might affect the physical sensation of the needle prick, we asked a total of 144 participants to complete two assessments in the first session. First, we measured participants’ sensitivity to a sensory stimulus. Previous research indicated that somatosensory amplification was associated with pain perception (Lee et al., 2010; Ferentzi et al., 2017). Thus, we adopted the Somatosensory Amplification Scale (SSAS; Barsky et al., 1990) to evaluate the base level of participants’ sensitivity to sensory experiences prior to the experiment. The SSAS included 10 items on a five-point Likert scale (1 = not at all to 5 = very much; α = 0.72) and we used the Korean version of SSAS (Won and Shin, 1998).

In addition, Cohen et al. (2011) argued that people who were prone to feeling guilty were less likely to deceive others. Accordingly, we measured participants’ dispositional guilt with ASGS (Hoblitzelle, 1987) to explore the link between dispositional guilt and tendencies to lie as well as its impacts on the degree of sensitivity to the pricking stimulus. Similar to Study 1, 15 items were selected among 30 items in ASGS (Hoblitzelle, 1987). Participants were asked to rate to what extent they usually experienced feelings of guilt (1 = not at all to 5 = very much).

The second session was conducted a month after the first session. Participants were randomly assigned to a test group (n = 106) and a control group (n = 48). Participants in the test group had to contemplate over whether or not to tell the truth, whereas those in the control group did not have to. There were three laboratory rooms; in the first room, participants were greeted, in the second room they were primed depending on each condition, and finally in the third room they had the needle prick for three times.

Upon arrival, participants checked in the first room and each participant was escorted to the second room. In the second room, the participant was informed about the purpose of the study, where the research staff member deliberately mentioned the compensation. The prompt is followed.

“The experiment will be conducted in the next room (the third room) and will take about 10 min. We will give you 3,000 Korean won in return for your participation. By the way, you are very lucky because our research budget has been cut down recently that you are the last participant to receive 3,000 Korean won. From the person that comes right after you, he or she will be given only 1,000 Korean won. We are telling you this because we want you to take this study seriously. Please read the consent form and sign it for us.

When the staff member tried to leave the room to prepare for the next experiment, the guide suddenly entered into the room (on purpose) with an actor who pretended to be another participant. The guide then told the staff member that the actor came in earlier than expected. The staff member welcomed the actor, told the actor to wait for a minute, and left the room. Eventually, the participant and the actor were left together in the second room for about 3 min. The actor would look at the consent form for a while and asked the participant as below.

“Hello. I am participating in the study as well. Did you hear anything about the experiment from the staff? (Pointing the part in the consent form where it states remuneration) We may receive some money for participation. Have you heard about how much we would get paid?”

We wanted to pay special attention to how participants answered to the actor’s last question. After 3 min, the staff returned to the second room and took the participant to the next room (third room). The actor wrote down the participant’s responses on the note. Participants assigned to the control condition did not see the actor. They were escorted to the third room straight away after signing the consent form in the second room.

In the third room, participants were finger-pricked three times with an acupuncture device. The acupuncture device was designed to be clicked like a ball-point pen so that the experimenter could prick the participants with consistent strength and depth. We set the needle to cut the skin 2 mm deep. The experimenter then pricked the participants’ non-dominant hands three times. In the first trial, participants were asked to put their hands on the desk, with their palms facing downwards, and the experimenter pricked the center of the back of participants’ hands with the acupuncture device. For the second attempt, they were asked to put their hands with their palms facing upwards, and the experimenter pricked the center of the participants’ palms. Lastly, for the third trial, they were asked to do the same as the second attempt, and the experimenter pricked the middle of the participants’ wrists. After participants were pricked by the experimenter in each trial, they rated the perceived depth of the prick from the device on a continuous slider that ranged from 0 (not being pricked at all) to 10 (being pricked very deeply). Participants also scored how painful the prick was, using the same slider scale from 0 (not painful at all) to10 (very painful). These two questions were randomly presented to the participants. As for how deep participants sensed the needle prick on the back of their hands, palms, and wrists, the ratings were averaged (i.e., mean composite of prick; α = 0.75). Likewise, the ratings for perceived pains from each trial were also averaged (i.e., mean composite of pain; α = 0.75).

Participants in the test group were then asked to answer five more questions: “Did you remember the participant who was waiting for the experiment with you in the previous room?,” “Did you remember the question that the participant asked you?,” “How did you respond to the question?,” “Do you think that you lied to the participant?” Finally, they were asked to rate how much they felt guilty about their response on a scale of 1 (not guilty at all) to 9 (very guilty). Lastly, participants were thoroughly debriefed and provided the compensation (3,000 Korean won). Participants in the control condition were also given 3,000 Korean won.

Results and Discussion

We first divided the participants in the test group into two subgroups; in one subgroup, participants told a lie and in another, they told the truth. It was based on three criteria – the experimenter’s judgment based on the participant’s answers recorded by the actor, the actor’s judgments, and the participants’ reports. Most of the participants were easily sorted to one of two groups (i.e., the lie group and truth group) as all three judgments coincided with each other. Responses that were considered to be truth included “I was told that I would receive 3,000 Korean won, but it will be 1,000 won for you because they said they had to cut down the budget and could not afford to pay 3,000 Korean won anymore.” or “3,000 Korean won.” On the other hand, participants who said, “I haven’t heard about the reward.,” “I don’t know about the compensation.,” or “1,000 Korean won.” were categorized as the lie group. However, some participants were difficult to be categorized as three judgments did not correspond to each other or even participants themselves could not identify if they lied or not. For example, their answers were, “The staff will directly inform you about the reward.” or “I think it’s not appropriate for me to tell you about the reward.” Thus, those in these cases (i.e., 11 participants) were excluded from the analysis. In addition, it was revealed in the debriefing that three participants had doubted the actor’s questioning. Thus, these three participants were also excluded from the analysis.

In consequence, 54 participants were classified into the lie group, 38 participants to the truth group, and 48 participants to the control group. Participants in the lie group (M = 4.24, SD = 2.94) reported that they felt more guilty at the moment of answering to the actor’s question about the pay than those in the truth group (M = 1.71, SD = 2.29), t(90) = 4.44, p < 0.001, d = 0.95. We then tested whether the dispositional guilt predicted the likelihood of lying, using logistic regression. Participants with higher levels of dispositional guilt were significantly more inclined to lie (B = 0.96, SE = 0.46, Wald χ² = 4.40, p = 0.036, odds ratio = 2.61, 95% CI for odds ratio [1.07, 6.38]. This result rebutted Cohen et al. (2011)’s results that individuals with higher scores on guilt would become less deceptive.

Next, a one-way ANOVA analysis was conducted to determine if dispositional sensitivity to sensory experiences were varied among groups. Results indicated a non-significant effect between the lie group (M = 2.95, SD = 0.47), the truth group (M = 3.07, SD = 0.46), and control group (M = 2.96, SD = 0.70), F(2,137) = 0.83, p = 0.54, ω² = −0.01.

To test whether participants in the lie group felt the prick deeper than those in the truth or control groups, we conducted a one-way ANOVA analysis. As predicted, there was a significant difference between groups, F(2,137) = 11.34, p < 0.001, indicating a large effect size, ω² = 0.13. Scheffé post hoc test showed that participants in the lie group (M = 4.95, SD = 1.28) sensed the needle prick deeper than those in the truth group (M = 3.86, SD = 1.38), p = 0.001 and the control group (M = 3.80, SD = 1.44), p < 0.001. There was no significant difference between the truth group and the control group, p = 0.98. When tested for each condition (i.e., back of one’s hand, palm, and wrist), the same pattern was found in the results (see Table 1).

Table 1. Descriptive statistics and significance tests in Study 2.

In a similar vein, we examined whether the level of pain (i.e., mean composite of pain) appeared different among groups. There was a significant group difference, F(2,137) = 5.71, p = 0.004, ω² = 0.25, and the Scheffé test indicated that the lie group (M = 4.08, SD = 1.49) felt more pain when pricked by the device than the truth group (M = 3.26, SD = 1.11), p = 0.02, and the control group (M = 3.27, SD = 1.49), p = 0.02. The truth group and the control group did not differ from each other, p = 0.99. The one-way ANOVA test for each trial yielded slightly different results and yet, we found a tendency regardless. The lie group felt most painful while the truth group and the control group felt relatively less painful (see Table 1).

In sum, Study 2 substantiates our hypothesis that prick of conscience would be related to increased sensitivity in the experience of physical prick. To be specific, participants whose conscience pricked them due to telling lies right before the experiment (i.e., lie group) sensed the prick deeper and felt more pain than the other participants in the truth group and the control group.

Study 2 reaffirms and expands the results from Study 1 in that the significant association between prick of conscience and physical prick was found in the real setting. Considering that participants in the truth group and the control group had the same base level of sensation for the needle prick, Study 2 suggests that perceived feelings of guilt (i.e., lying) does have an influence on the physical sensation caused by pricking.

Study 3

Studies 1 and 2 showed that prick of conscience induced by recalling and engaging in unethical acts could be embodied in the physical prick. As discussed earlier, Schnall et al. (2008) stated that physical cleansing reduces the severity of moral judgments. They predicted that people would perceive moral transgression less negatively after physically cleansing themselves. As a result, they found that physical cleanliness was cognitively activated by a scrambled-sentences task (Study 1) and the act of physical cleansing (i.e., hand washing, Study 2) made moral judgments on other’s misdeeds less severe.

Given that physical cleansing reduces perceived wrongness of moral transgression, the physical prick associated with a sense of moral guilt may increase the severity of moral judgments on other’s transgressions. Thus, we conducted Study 3 to expand the findings from Studies 1 and 2 by examining the downstream impacts of the embodied guilt on moral judgments. We constructed a hypothesis that participants who were pricked by the needle would make more severe moral judgments than those who were not.

Method

Participants

Power analysis using G^∗Power (Faul et al., 2007) suggested a minimum of 137 participants would be needed to detect an effect of large size (f = 0.40) at a power of 0.99 when conducting the one-way ANOVA test with three independent groups. In this study, 137 undergraduate students (68 males, 69 females; mean age = 21.31, SD = 1.64 years) participated and received stationery products worth 3,000 Korean won in return for their participation.

Procedure

Participants were informed about the purpose of the study that examined the relationship between physical stimulus and pain. They were randomly assigned to one of the three conditions – the strong prick, the weak prick, and no prick (control group). In two conditions that involved the needle prick, participants’ hands were pricked three times and were asked to rate their sensation as to how deep they were pricked and how painful it was. Participants in the strong prick condition (n = 47) were pricked 3 mm deep and those in the weak prick condition (n = 46) were pricked 1 mm deep. Participants in the control group (n = 44) were not pricked.

After pricking, participants were informed that they would participate in a separate experiment on moral judgments. They were instructed to judge several moral dilemmas. Moore et al. (2008) created 24 critical dilemmas and 14 filler dilemmas based on existing studies (i.e., Greene et al., 2001, 2004). Critical dilemmas made participants contemplate over a scenario where they would have to kill one person to save many others. Filler scenarios included similar moral dilemmas, however, they did not involve killing people. Focusing on minor moral issues in the present study, we utilized eight moral dilemma situations related to stealing, lying, and being dishonest with the fillers: “Been Caught Stealing,” “Taxes,” “Stock Tip,” “Plasma Screen,” “Resume,” “Illegal Lunch,” “Employee Morale,” and “Insurance Fraud.” Participants were asked to rate whether the protagonist’s behaviors were appropriate in each scenario on a scale of 1 (perfectly okay) to 9 (extremely wrong). To rule out the influence of emotional reactions from the priming, we asked participants to take another assessment called, “Positive and Negative Affect Schedule (PANAS; Watson et al., 1988).” We used the Korean version of PANAS (Park and Lee, 2016). Finally, they reported their age and sex, and were debriefed.

Results and Discussion

Participants in the strong (3 mm) prick condition (M = 5.34, SD = 1.65) reported that they sensed the needle prick deeper than those in the weak (1 mm) prick condition (M = 3.55, SD = 1.83), t(91) = 4.94, p < 0.001, d = 1.03. They (M = 4.19, SD = 1.57) also reported more pain to the needle prick compared to participants in the weak prick condition (M = 2.61, SD = 1.72), t(91) = 4.62, p < 0.001, d = 0.96. Next, we tested whether the priming affected the emotion ratings at the end of the experiment by conducting the one-way ANOVA analysis. The results showed that there was no statistically significant difference in the scores for both positive affect, F(2,134) = 1.57, p = 0.21, ω² = 0.01, and negative affect, F(2,134) = 0.17, p = 0.85, ω² = −0.01, which leads to a conclusion that the priming did not appear to induce any positive or negative emotional reactions to the participants.

We then computed the mean composite of all eight moral dilemmas and examined whether the needle prick increased the severity of moral judgments. The one-way ANOVA analysis on the composites showed the effect of condition, F(2,134) = 23.44, p < 0.001, ω² = 0.14. There was no significant difference in moral judgments between the strong- and the weak conditions, p = 0.90. However, participants in the strong prick condition appeared to have more negative moral judgments than the control group (M = 5.75, SD = 1.61), p < 0.001 and so did the weak prick condition, p = 0.001. The pattern of results was consistent across the scenarios (see Table 2).

Table 2. Means ratings for moral vignettes in Study 3.

Study 3 demonstrated that needle prick increased the severity of moral judgments. Particularly, it is important to note that the depth of the needle (i.e., 3 and 1 mm) did not have a major effect on participants’ moral judgments but the pain induced by the needle prick did. Taken together, the data from Study 3 are consistent with our hypotheses that prick of conscience is associated with the sensation of the physical prick.

General Discussion

This study was conducted to investigate whether prick of conscience would be grounded in bodily experiences of physical prick (e.g., a needle prick), using a sample of Korean participants who were familiar with the metaphorical expression “It pricks my conscience.” The results of the study lent support to our hypothesis that prick of conscience is associated with the physical sensation of pricking. Participants who recalled unethical acts (Study 1) and who lied (Study 2) appeared to become more sensitive to the needle prick than those who did not. In addition, participants who had the needle prick made more severe moral judgments than participants in the control condition (Study 3).

This study also provides several implications. First, the findings of the present study propose that metaphors do not only convey linguistic connotations but also plays a significant role in social cognition (Zhong and Leonardelli, 2008; Landau et al., 2010). Although a rich body of literature has identified embodied metaphors in words, very few studies have measured embodied metaphors in idioms. We suggest that “prick of conscience” would be regarded as another embodied metaphor, which broadens the understanding of the relationship between language and social cognition.

Second, the present study is noteworthy in that it is the first study to highlight the connection between embodied guilt and a sense of prick in South Korea. “It pricks my conscience” is a widely used expression among Koreans in the context of guilt or remorse. As Santana and de Vega (2011) illustrate how metaphors allow people to understand abstract concepts represented in the sensory-motor experiences, our studies of “prick of conscience” demonstrate that this metaphor can be experienced physically. Anderson (2003) also stresses the importance of a dynamic interaction between the human brain and cultural contexts when it comes to an individual’s embodied social cognition. This is also congruent with Leung et al. (2011)’s proposal of “embodied cultural cognition,” which indicates that body-mind linkages are not randomly formed but derived from the meanings informed by the socio-cultural contexts, such as cultural imperatives, values, and habits. Guilt is a universal emotion that people feel when they commit unethical acts or violate moral standards. However, the way that guilty feelings are expressed can vary. In Western culture, it is common to say, “I feel guilty,” whereas in Asian culture, especially in South Korea, people use the metaphor, “It pricks my conscience.” to articulate their guilty feelings. Accordingly, this metaphor can be deemed as culturally driven, although the current study cannot provide explanations for the role of cultural aspect in the associative link between emotional and physical prick.

Third, it is worth highlighting how our findings differ from those in earlier studies on the effect of experiencing physical pain after recalling or engaging in unethical acts. Previous research has been focused on self-punishment as a sign of remorse (Bastian et al., 2011; Nelissen, 2012; Inbar et al., 2013). When people feel guilty but have no opportunity to recompense, they tend to punish themselves to get rid of themselves of guilt. This tendency is called the “Dobby Effect” by Nelissen and Zeelenberg (2009). Nelissen (2012) contends that people are more willing to punish themselves with electrical shocks if the person they feel guilty for is presented in the same room. By contrast, they were inclined to punish themselves less intensively when they were alone. It also aligns with Bastian et al. (2011) conclusion that people who recalled personal unethical acts would hold their hands in the ice bucket longer and would rate the experience more painful than participants without the priming. These findings suggest that guilt-induced self-punishment serves as an atonement for sins, and thus, guilty people are more motivated to inflict physical pain to themselves. On the contrary, this paper focuses on punishment by others in that we made participants be pricked by others rather than pricking themselves with the needle. In addition, although participants in Study 1 rated the willingness to prick their fingers with the needle, finger prick in Study 1 was a therapeutic way to treat indigestion rather than self-punishment. Thus, the present study makes a positive contribution to understanding the source of physical pain in managing guilt. In other words, guilt can be eliminated to some extent by experiencing physical pain through self-punishment, however, the physical pain inflicted by others is not related to atonement, but only worsens the sense of moral purity.

Fourth, the current research contributes to the impacts of the absence of guilt on the bodily sensation. The results of Study 2 revealed that there was no significant effect of telling the truth on the sensation of being pricked. When participants told a lie (the lie condition), they reported higher sensitivity to the needle prick compared to participants who told the truth (the truth condition) or said nothing (the control condition). However, there were no differences in the sensation of the needle prick between the truth and the control conditions. Consistent with the results, feelings of guilt that participants felt when they replied to the actor’s question was not correlated with how deep they sensed the prick, r = 0.14, p = 0.20, and how painful they felt, r = 0.12, p = 0.27. These findings were consistent with the result of Day and Bobocel (2013) study that examined the relationship between guilt and subjective body weight. They found that unethical acts made participants feel heavier than they usually do, whereas ethical acts did not make participants feel any lighter. That is, there was no difference in perceived weights between participants who recalled personal ethical acts and those who did not recall any memories at all. Thus, these findings suggest that a lack of guilt does not affect the bodily sensation in relation to the guilt.

Fifth, participants’ moral judgments were influenced by whether or not they had the needle prick (i.e., 3 and 1 mm) rather than the depth of the prick in Study 3. This finding is in line with the previous research on how hand washing reduces moral taint such as physical disgust, regret, or guilt (Zhong and Liljenquist, 2006) and makes moral judgments about others more severe (Schnall et al., 2008). They also found that a mere act of washing was attributed to moral purity, not how many times people wash their hands to get rid of moral transgressions. Likewise, the current findings suggest that the prick itself influences participants’ moral judgments on others regardless of the depth of the needle prick.

Sixth, we should note previous studies that examined the relationship between physical cleanliness and moral judgments. In Study 3, we found that the bodily experience of physical prick led to more severe moral judgments as a consequence of embodied guilt. This is congruent with Schnall et al. (2008) study that physical cleansing after feeling disgusted from a movie reduces the severity of moral judgments. However, one notable work reveals a contradictory finding that physical cleanliness leads to harsher moral judgments (Zhong et al., 2010). Researchers point out that the effect of cleanliness or dirtiness is context-sensitive, which means that physical cleansing after a disgusting experience is different from the cleansing behavior without any pre-experience of disgust (Zhong et al., 2010; Lee and Schwarz, 2011). To be specific, they argue that removing dirty residues (i.e., physical cleansing) from one’s mind after watching a disturbing film presumably attenuates disgust and hence makes the perception of transgression on others less aversive. Similarly, feeling cleaner after engaging in physical cleansing without experiencing disgust leads to moral superiority and therefore, renders harsher judgments on others’ immoral acts. In this respect, it is possible that physical prick leads to moral inferiority in Study 3, as we made participants pricked by the needle without any pre-inducement of feelings. In contrast to the explanations by the previous authors, however, the results of Study 3 indicated that physical prick resulted in harsher judgments. We argue that this inconsistency is derived from the different nature of the moral vignettes used in the studies. In Zhong et al. (2010) study, participants judged contested social issues chosen by the authors including alcoholic, casual sex, homosexuality and many others. However, as Zhong et al. (2010) mentioned, participants were asked to make moral judgments on social issues with ambiguous moral implications. Similarly, Schnall et al. (2008) used six moral vignettes of which was called the “Trolley” problem that made participants decide whether to switch the track of a trolley to kill one worker in order to save five others. However, these scenarios did not represent obvious moral transgressions. Indeed, the effect of physical cleanliness on the ratings of each dilemma showed inconsistent results between Studies 1 and 2 in their research. In contrast to their studies, our research used moral scenarios where the protagonist commits obvious moral transgressions such as lying or stealing. We believe this is the strength of our study in that the findings highlight the importance of using clear moral scenarios for priming. Future studies might consider investigating the nuance of the relationship between embodied guilt and moral judgments with more relevant moral scenarios.

Seventh, although it was not our main interests of the present study, it is important to note the comparison between Study 2 of our research and Study 2 of Cohen et al. (2011)’s experiment. Both studies followed similar procedures where participants had to decide whether or not to lie. Interestingly, our results contradict the results of Cohen et al. (2011). 54 participants (59%) lied and 38 (41%) told the truth in our study, whereas 23 (32%) lied and 49 (68%) told the truth in Cohen et al. (2011)’s experiment. Furthermore, participants who lied had a stronger dispositional trait to feel guilty compared to those who told the truth in the current study, and participants with a stronger inclination to feel guilty are less likely to lie in Cohen et al. (2011)’s study. Two studies provided different motivational contexts where in Cohen et al. (2011)’s study, deceiving other participants was directly related to the compensation while it did not affect the reward in our study. We believe that such conflicting results were attributed to the participants’ different cultures. Guilt is differently conceptualized across cultures (Bedford and Hwang, 2003; Bedford, 2004; Anolli and Pascucci, 2005; Wong and Tsai, 2007). In western culture, individuals feel guilty when they fail to embrace their authentic selves (Spicer, 2011). On the other hand, the sense of duty and obligations to significant others matter hugely in eastern culture (i.e., Chinese culture; Bedford, 2004). Therefore, the seemingly disparate results imply that guilt may be manifested differently across cultures (Tangney et al., 1989). Further research will be needed to fully disentangle the relationship between dispositional guilt and lie.

Finally, it is worth noting that some recent attempts to replicate the existing findings in the embodied cognition have failed (e.g., Johnson et al., 2014; Lynott et al., 2014). Researchers criticized that underpowered studies contribute to low success rates of replication studies (Perugini et al., 2014; Anderson et al., 2017). In Study 1 (n = 90), we found a significant interaction effect, F(1,88) = 10.62, p = 0.002, yielding a medium effect size, r = 0.33 with power of 90%. In Study 2 (n = 140), the results showed a significant difference in the perception of vividness of being pricked among groups, F(2,137) = 11.34, p < 0.001, indicating a large effect size, ω² = 0.13 with 99% power. We also found that the perception of pain varied among groups, F(2,137) = 5.71, p = 0.004, yielding a large effect size, ω² = 0.25, and 86% power. In Study 3 (n = 137), the results indicated a significant difference in moral judgments (i.e., mean composite of all eight dilemmas) among groups, F(2,134) = 23.44, p < 0.001, with a large effect size, ω² = 0.14, and 99% power. Taken together, the effect size and statistical power observed in our research indicate that our study is not underpowered and therefore, stand statistically strong despite the replication crisis in the field.

Limitations

Although the findings and the implications of our studies are compelling, there are some limitations. First, in Study 1, we found that when we asked participants who recalled past transgressions to rate how willing they were to prick their fingers with the needle or to take a strong dose of medication, the rating for the needle prick was higher than the score for taking medication, whereas the ratings for both options were not significantly different to the participants who recalled ethical acts. Although the results were consistent with our hypothesis, an additional simple effect analysis based on each option indicated that willingness for finger prick was not different between participants in the unethical condition (M = 4.87, SD = 2.79) and those in the ethical condition (M = 5.82, SD = 2.53), F(1,88) = 2.90, p = 0.09, r = 0.42. On the other hand, the willingness to take a strong dose of medication was different between conditions (unethical condition: M = 6.64, SD = 2.25, ethical condition: M = 5.24, SD = 2.37), F(1,88) = 8.28, p = 0.005, r = 0.29). Thus, the results may suggest that feelings of guilt may increase the willingness to take medication in lieu of pricking the finger. However, we note that the difference in willingness for finger prick between the two groups is marginally significant, p = 0.09, yielding a larger effect size, r = 0.42 than willingness for taking strong medication, r = 0.29. Although the pilot test with 18 undergraduate students confirmed that the two treatments were favored almost equally, we did not measure nor control participants’ pre-existing preferences for the main study. Thus, another avenue for future research is to consider measuring individuals’ preferences for each treatment methods prior to the priming.

Second, the design of Study 2 was not experimental but correlational. We did not manipulate participants’ decisions to tell a lie or not. Rather, they made their own choices. Accordingly, the results could not draw causal relationships between the act of lying (independent variable) and the physical sensation of the needle prick (dependent variable). Thus, given the descriptive nature of non-experimental research, Study 2 could not address third-variable problems, leaving other interpretations for the results. Although we measured dispositional sensitivity to sensory experiences and found that there was no significant difference across conditions, we did not manipulate participants’ decisions to engage in guilt-induced behaviors because we were aware of the possibility that participants might attribute the act of lying to others, in this case the experimenter, and accordingly, might not feel guilty in a genuine sense. Therefore, we welcome future research that extends our work in investigating the links between the guilty conscience and physical sensation of the needle prick with relevant experimental designs.

Third, previous research suggests a two-way relationship between mind and body such that feelings of guilt increase a desire to engage in physical cleansing behaviors while physical cleansing reduces guilty emotions (Zhong and Liljenquist, 2006). In the current research, Studies 1 and 2 focused on the effects of guilt in the sensation of physical prick, whereas Study 3 examined the effects of the physical prick on moral judgments of others’ misbehaviors. However, Study 3 did not represent the reversed effect of Studies 1 and 2 because we assessed how participants perceived moral transgressions on others rather than their moral self-images. Thus, the results of Study 3 indicate subsequent effects of experiencing the embodied metaphor, “prick of conscience.” Future research can inquire the effects of physical prick on moral self-judgments with relevant experimental designs.

Finally, our sample is limited to Korean populations who are accustomed to the metaphor “It pricks my conscience,” and thus, our studies might not be applicable to other populations with different cultural backgrounds. To our knowledge, there is no other countries except for South Korea that articulate feelings of guilt through sensations such as pricking or piercing. Although Japanese and Chinese populations share similar cultural values and norms with Koreans, they do not have the expression “prick of conscience” in their languages to reflect feelings of guilt. Due to within and between cultural variations, it is most likely that other researchers, even though they share similar Asian culture, will yield results that might be different from what we have found. Several avenues for future studies include to what extent this linguistic expression of “prick of conscience” would be valid in cross-cultural studies since this term is considered to be culturally- and linguistically bounded to Koreans.

Conclusion

Overall, this research provides evidence that prick of conscience is not just a linguistic metaphor but it evokes both emotional and physical responses. If The Prick of Conscience is the most popular poem in Middle English reflecting religious aspects of washing away the sins, “prick of conscience” in the Korean metaphor can be interpreted as a manifestation of cultural language and social context.

Data Availability Statement

The datasets generated for this study are available on request to the corresponding author.

Ethics Statement

This study was carried out in accordance with the recommendations of the American Psychological Association, with written informed consent from all participants. All participants gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the Research Ethics Committee of the Korea Military Academy.

Author Contributions

XK and JL conceived, designed, and conducted the study. XK wrote the first draft of the manuscript. JL performed the statistical analysis. HL contributed to the interpretation of the results. All authors revised the manuscript, and read and approved the final manuscript.

Funding

This research was funded by Hwarangdae Research Institute at the Korea Military Academy.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Footnotes

References

Anderson, S. F., Kelley, K., and Maxwell, S. E. (2017). Sample-size planning for more accurate statistical power: a method adjusting sample effect sizes for publication bias and uncertainty. Psychol. Sci. 28, 1547–1562. doi: 10.1177/0956797617723724

PubMed Abstract | CrossRef Full Text | Google Scholar

Anolli, L., and Pascucci, P. (2005). Guilt and guilt-proneness, shame and shame-proneness in Indian and Italian young adults. Pers. Individ. Dif. 39, 763–773. doi: 10.1016/j.paid.2005.03.004

CrossRef Full Text | Google Scholar

Barsky, A. J., Wyshak, G., and Klerman, G. L. (1990). The somatosensory amplification scale and its relationship to hypochondriasis. J. Psychiatr. Res. 24, 323–334. doi: 10.1016/0022-3956(90)90004-a

PubMed Abstract | CrossRef Full Text | Google Scholar

Bastian, B., Jetten, J., and Fasoli, F. (2011). Cleansing the soul by hurting the flesh: the guilt-reducing effect of pain. Psychol. Sci. 22, 334–335. doi: 10.1177/0956797610397058

PubMed Abstract | CrossRef Full Text | Google Scholar

Bedford, O., and Hwang, K. K. (2003). Guilt and shame in Chinese culture: a cross−cultural framework from the perspective of morality and identity. J. Theory Soc. Behav. 33, 127–144. doi: 10.1111/1468-5914.00210

CrossRef Full Text | Google Scholar

Bedford, O. A. (2004). The individual experience of guilt and shame in Chinese culture. Cult. Psychol. 10, 29–52. doi: 10.1177/1354067×04040929

CrossRef Full Text | Google Scholar

Chang, S., and Chang, K. (1994). A study of Korean idioms: focusing for emotional expression. J. East Asian Cult. 25, 295–318.

Google Scholar

Cohen, T. R., Wolf, S. T., Panter, A. T., and Insko, C. A. (2011). Introducing the GASP scale: a new measure of guilt and shame proneness. J. Pers. Soc. Psychol. 100, 947–966. doi: 10.1037/a0022641

PubMed Abstract | CrossRef Full Text | Google Scholar

Faul, F., Erdfelder, E., Lang, A. G., and Buchner, A. (2007). G Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods 39, 175–191. doi: 10.3758/bf03193146

PubMed Abstract | CrossRef Full Text | Google Scholar

Ferentzi, E., Köteles, F., Csala, B., Drew, R., Tihanyi, B. T., Pulay-Kottlár, G., et al. (2017). What makes sense in our body? Personality and sensory correlates of body awareness and somatosensory amplification. Pers. Individ. Dif. 104, 75–81. doi: 10.1016/j.paid.2016.07.034

CrossRef Full Text | Google Scholar

Galloway, A. (2009). “Gower’s confessio amantis, the prick of conscience, and the history of the latin gloss in early english literature,” in John Gower: Manuscripts, Readers, Contexts, ed. M. Urban, (Turnhout: Brepols), 39–70. doi: 10.1484/m.disput-eb.3.1632

CrossRef Full Text | Google Scholar

Greene, J. D., Nystrom, L. E., Engell, A. D., Darley, J. M., and Cohen, J. D. (2004). The neural bases of cognitive conflict and control in moral judgment. Neuron 44, 389–400. doi: 10.1016/j.neuron.2004.09.027

PubMed Abstract | CrossRef Full Text | Google Scholar

Greene, J. D., Sommerville, R. B., Nystrom, L. E., Darley, J. M., and Cohen, J. D. (2001). An fMRI investigation of emotional engagement in moral judgment. Science 293, 2105–2108. doi: 10.1126/science.1062872

PubMed Abstract | CrossRef Full Text | Google Scholar

Hoblitzelle, W. (1987). “Differentiating and measuring shame and guilt: the relation between shame and depression,” in The Role of Shame in Symptom Formation, ed. H. B. Lewis, (Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.), 207–235.

Google Scholar

Johnson, D. J., Cheung, F., and Donnellan, M. B. (2014). Does cleanliness influence moral judgments? Soc. Psychol. 45, 209–215. doi: 10.1027/1864-9335/a000186

CrossRef Full Text | Google Scholar

Kalanthroff, E., Aslan, C., and Dar, R. (2017). Washing away your sins will set your mind free: physical cleansing modulates the effect of threatened morality on executive control. Cogn. Emot. 31, 185–192. doi: 10.1080/02699931.2015.1086313

PubMed Abstract | CrossRef Full Text | Google Scholar

Kaspar, K. (2013). Washing one’s hands after failure enhances optimism but hampers future performance. Soc. Psychol. Personal. Sci. 4, 69–73. doi: 10.1177/1948550612443267

CrossRef Full Text | Google Scholar

Kim, H. (2005). Sense words as an expression of emotion. Korean Lang. Lit. 140, 163–195.

Google Scholar

Lee, D. S., Kim, E., and Schwarz, N. (2015). Something smells fishy: olfactory suspicion cues improve performance on the Moses illusion and Wason rule discovery task. J. Exp. Soc. Psychol. 59, 47–50. doi: 10.1016/j.jesp.2015.03.006

CrossRef Full Text | Google Scholar

Lee, J. E., Watson, D., and Law, L. A. F. (2010). Lower-order pain-related constructs are more predictive of cold pressor pain ratings than higher-order personality traits. J. Pain 11, 681–691. doi: 10.1016/j.jpain.2009.10.013

PubMed Abstract | CrossRef Full Text | Google Scholar

Lee, S. W., and Schwarz, N. (2011). Wiping the slate clean: psychological consequences of physical cleansing. Curr. Dir. Psychol. Sci. 20, 307–311. doi: 10.1177/0963721411422694

CrossRef Full Text | Google Scholar

Leung, A. K. Y., Qiu, L., Ong, L., and Tam, K. P. (2011). Embodied cultural cognition: situating the study of embodied cognition in socio−cultural contexts. Soc. Personal. Psychol. Compass 5, 591–608. doi: 10.1111/j.1751-9004.2011.00373.x

CrossRef Full Text | Google Scholar

Lewis, R. E., and McIntosh, A. (1982). A Descriptive Guide to the Manuscripts of the Prick of Conscience. Oxford: Society for Medieval Languages and Literature.

Google Scholar

Lynott, D., Corker, K. S., Wortman, J., Connell, L., Donnellan, M. B., Lucas, R. E., et al. (2014). Replication of “Experiencing physical warmth promotes interpersonal warmth” by Williams and Bargh (2008). Soc. Psychol. 45, 216–222. doi: 10.1126/science.1162548

PubMed Abstract | CrossRef Full Text | Google Scholar

Moore, A. B., Clark, B. A., and Kane, M. J. (2008). Who shalt not kill? Individual differences in working memory capacity, executive control, and moral judgment. Psychol. Sci. 19, 549–557. doi: 10.1111/j.1467-9280.2008.02122.x

PubMed Abstract | CrossRef Full Text | Google Scholar

Morey, J. H. (2012). Prick of Conscience. Kalamzoo, MI: Medieval Institute Publications.

Google Scholar

Nam, K. (2007). Coping Strategy Effects on Psychological Symptoms Associated with Shame- and Guilt-Inducing Experiences. Doctoral dissertation, Seoul National University, Seoul.

Google Scholar

Nelissen, R. M. (2012). Guilt-induced self-punishment as a sign of remorse. Soc. Psychol. Personal. Sci. 3, 139–144. doi: 10.1177/1948550611411520

CrossRef Full Text | Google Scholar

Niedenthal, P. M., Barsalou, L. W., Winkielman, P., Krauth-Gruber, S., and Ric, F. (2005). Embodiment in attitudes, social perception, and emotion. Pers. Soc. Psychol. Rev. 9, 184–211. doi: 10.1207/s15327957pspr0903_1

PubMed Abstract | CrossRef Full Text | Google Scholar

Park, H. S., and Lee, J. M. (2016). A validation study of Korean version on PANAS-revised. Korean J. Psychol. Gen. 35, 617–641.

Google Scholar

Park, S. (2002). A comparative study of idioms in English and Korean: centered around idioms with human body parts. J. Engl. Lang. Lit. 44, 191–216.

Google Scholar

Perugini, M., Gallucci, M., and Costantini, G. (2014). Safeguard power as a protection against imprecise power estimates. Perspect. Psychol. Sci. 9, 319–332. doi: 10.1177/1745691614528519

PubMed Abstract | CrossRef Full Text | Google Scholar

Rotella, K. N., and Richeson, J. A. (2013). Body of guilt: using embodied cognition to mitigate backlash to reminders of personal & ingroup wrongdoing. J. Exp. Soc. Psychol. 49, 643–650. doi: 10.1016/j.jesp.2013.02.013

CrossRef Full Text | Google Scholar

Schnall, S., Benton, J., and Harvey, S. (2008). With a clean conscience: cleanliness reduces the severity of moral judgments. Psychol. Sci. 19, 1219–1222. doi: 10.1111/j.1467-9280.2008.02227.x

PubMed Abstract | CrossRef Full Text | Google Scholar

Spicer, A. (2011). Guilty lives: the authenticity trap at work. Ephemera Theory Polit. Org. 11, 46–62.

Google Scholar

Stone, T. E., Kang, S. J., Cha, C., Turale, S., Murakami, K., and Shimizu, A. (2016). Health beliefs and their sources in Korean and Japanese nurses: a Q-methodology pilot study. Nurse Educ. Today 36, 214–220. doi: 10.1016/j.nedt.2015.10.017

PubMed Abstract | CrossRef Full Text | Google Scholar

Tangney, J. P., Wagner, P., and Gramzow, R. (1989). The Test of Self-Conscious Affect. Fairfax, VA: George Mason University.

Google Scholar

Troisi, J. D., and Gabriel, S. (2011). Chicken soup really is good for the soul: “Comfort Food”. Fulfills the need to belong. Psychol. Sci. 22, 747–753. doi: 10.1177/0956797611407931

PubMed Abstract | CrossRef Full Text | Google Scholar

Watson, D., Clark, L. A., and Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. J. Pers. Soc. Psychol. 54, 1063–1070. doi: 10.1037/0022-3514.54.6.1063

PubMed Abstract | CrossRef Full Text | Google Scholar

Williams, L. E., and Bargh, J. A. (2008). Experiencing physical warmth promotes interpersonal warmth. Science 322, 606–607.

PubMed Abstract | Google Scholar

Won, H., and Shin, H. K. (1998). A study on the cognitive characteristics of somatization (1): the reliability and validity of the Korean versions of somatosensory amplification scale and symptom interpretation questionnaire. Korean J. Clin. Psychol. 17, 33–39.

Google Scholar

Wong, Y., and Tsai, J. (2007). “Cultural models of shame and guilt,” in The Self-Conscious Emotions: Theory and Research, eds J. L. Tracy, R. W. Robins, and J. P. Tangney, (New York, NY: Guilford Press), 209–223.

Google Scholar

Xu, H., Bègue, L., and Bushman, B. (2014). Washing the guilt away: effects of personal versus vicarious cleansing on guilty feelings and prosocial behavior. Front. Hum. Neurosci. 8:97. doi: 10.3389/fnhum.2014.00097

PubMed Abstract | CrossRef Full Text | Google Scholar

Zhong, C. B., Strejcek, B., and Sivanathan, N. (2010). A clean self can render harsh moral judgment. J. Exp. Soc. Psychol. 46, 859–862. doi: 10.1016/j.jesp.2010.04.003

CrossRef Full Text | Google Scholar

Pinprick Test – an overview

Neurologic Examination

For all suspected spinal injuries, an accurate baseline neurologic examination should be carefully documented in patients who are conscious and cooperative. The sensory examination should include evaluation of light touch, pain, and proprioceptive function. Pain and temperature sensation are mediated by the spinothalamic tract that traverses the anterolateral column of the spinal cord. This can be assessed with the use of a clean needle to test pinprick sensation and an alcohol pad for temperature discrimination. Light touch and proprioceptive (position) sensation are functions of the posterior spinal columns. One can test light touch by stroking the extremity with a piece of paper, and one can test proprioception by asking the patient to determine directional change in the position of a finger or toe.

Dermatomal patterns of sensation correlate with the spinal nerve roots exiting specific anatomic levels of the spinal cord (Fig. 12-4). C1 and C2 innervate the occipital region, C3 and C4 innervate the nape of the neck, C5 innervates the deltoid region, C6 innervates the radial aspect of the forearm, C7 innervates the long finger, C8 innervates the ulnar border of the hand, and T1 innervates the medial border of the arm. The chest and abdomen are innervated by the T2–T12 nerve roots. Specifically, T4 provides sensation at the nipple line, T10 provides sensation at the umbilicus, and T12 provides sensation at the inguinal ligament. In the lower extremities, the pattern of sensory innervation mirrors the embryonic rotational maturation of the limbs. L1 and L2 contribute innervation below the inguinal ligament to the medial thigh, L3 provides sensation to the anterior midthigh, L4 provides sensation to the knee region and medial calf, L5 provides sensation to the lateral calf and first web space, and S1 provides sensation to the lateral aspect and sole of the foot. The perineal region is innervated by the S3–S5 roots. Preservation of function at this level, referred to as sacral sparing, is important because it indicates that some of the spinal tracts are still intact and that the injury to the spinal cord is incomplete; therefore it is associated with a better prognosis for neurologic recovery.

Motor function should be graded on a scale of 0 to 5 with grade 0 indicating complete paralysis, grade 1 indicating trace function, grade 2 indicating full range of joint motion with gravity eliminated, grade 3 indicating antigravity function, grade 4 indicating function against slight resistance, and grade 5 indicating normal strength against resistance. The level of SCI can be assessed by the presence or absence of function in key muscle groups. In the upper extremities, C5 innervates the muscles responsible for elbow flexion; C6, wrist extension; C7, wrist flexion; C8, finger flexion; and T1, finger abduction. In the lower extremities, L2 innervates hip flexion, L3, knee extension; L4, ankle dorsiflexion; L5, great toe extension; and S1, ankle plantar flexion.

Deep tendon reflexes should be graded as absent (0), hypoactive (1), normal (2), or hyperreflexic (3). In the upper extremities, the biceps tendon reflex is mediated by the C5 nerve root, the brachioradialis is mediated by C6, and the triceps is mediated by C7. In the lower extremity, the patellar tendon reflex is mediated by L4, and the Achilles tendon is mediated by S1.

The abdominal, Babinski, and bulbocavernosus reflexes should also be assessed. The abdominal reflex is performed by division of the belly into four quadrants, with the umbilicus at the center. When the skin in each of the quadrants is stroked, the umbilicus should deviate in that direction. Absence of a response may signify an upper motor neuron lesion, whereas asymmetric loss of the reflex may indicate a localized lower motor neuron lesion. The Babinski test is performed by stroking the lateral plantar aspect of the foot. A pathologic response is indicated by an upgoing great toe and is indicative of an upper motor neuron lesion.

The bulbocavernosus reflex is an important test for determination of the status of an injury to the SCI. The test involves a digital rectal examination with simultaneous application of traction on an in-dwelling Foley catheter (or with squeezing of the glans penis or clitoris). The presence of the reflex is indicated by concurrent contraction of the anal sphincter and heralds the end of spinal shock. Spinal shock is a transient phenomenon that occurs within the first 24 hours of SCI and is thought to be due to swelling about the neural structures within the spinal column. Once spinal shock has passed, as indicated by return of the bulbocavernosus reflex, the status of the SCI can be predictably characterized. This reflex is less reliable with injuries around the conus medullaris (T12–L2) because the afferent nerve fibers that mediate the reflex lie within the zone of injury and may be directly affected. As a consequence, return of the reflex may take much longer in this group of patients.³⁴⁰ Additionally, all patients with a significant spinal injury should have an evaluation of bladder function with the use of postvoiding straight catheterization.

When an accurate neurologic examination cannot be obtained because of the child’s age or altered mental status, findings that may suggest an SCI in the initial evaluation period include flaccidity, diaphragmatic breathing without the assistance of accessory muscles, priapism, and the presence of clonus.²⁹⁷ Evaluation of a patient in this setting should include inspection and palpation of the spine from the occiput to the sacrum, assessment of motor and sensory function as determined by the ability to withdraw from painful stimuli, and testing of deep tendon, abdominal, Babinski, and bulbocavernosus reflexes.

Thigh Pain Overview

People describe the sensations of meralgia paresthetica in various ways—tingling, pins and needles pricking, the sensation of a cell-phone vibration, or a badly sunburned feeling.

Meralgia paresthetica, which affects 32 out of every 100,000 people, is one cause of thigh pain. The symptoms include anything from a searing burning pain to numbness in the front and side of the thigh. The pain feels very superficial, and the skin on the affected leg feels different to the touch compared to the other side. The sensations can vary from week-to-week, and the symptoms rarely extend below the knee.

The Lateral Femoral Cutaneous Nerve

The culprit inside your body zapping you with thigh pain has a long name—the lateral femoral cutaneous nerve. As a sensory nerve, its job is not to move your leg, but instead to tell you if a soccer ball is hitting your thigh, an insect is crawling over your thigh, or to sense if your thigh is otherwise being touched or burned. Originating in the spine, the nerve traverses over bones, then through muscle, ligaments, and fat to reach your thigh skin, where it performs its mission of converting tactile cues into electrical messages that it sends back to the spine and up to your brain.

The nerve encounters challenging bodily geography along its path from your spine to your leg, however, as it must summit the mountainous iliac crest of your pelvis, tunnel through the sinewy psoas muscle, leap over the bony ski-jump-like protrusion of the anterior superior iliac spine, weave through the inguinal ligament in your groin, and finally emerge out through fat layers to your skin. Interestingly, not everyone’s lateral femoral cutaneous nerve takes the same path from their lumbar spine to their thigh skin. Nor does it branch in the same areas. Scientists dissecting cadavers noted the peculiar differences in the branching pattern and locale of this nerve even in the 1800s.

The high blood sugar levels of those with undiagnosed or untreated diabetes can make nerves more vulnerable to injury, as well as those with hypothyroidism.

What Causes Meralgia Paresthetica?

No matter how your nerve travels or branches, anywhere along its route that the nerve gets pinched, it can cause a burning, tingling, or numbness in the thigh. Around 150 years ago, it was tight corsets that pinched the nerve against the hip bone. Today, a utility belt, military pack equipment or tight jeans might cause the same symptoms of pain or numbness. Or, if the nerve is getting pinched farther down by the inguinal ligament in your groin, it might be because a cellular phone in your pocket is compressing it. Cyclists have reported the pain, as well as those who are obese and have a layer of abdomen hanging against the pelvis and compressing the nerve. Seat belt injuries during a car accident can irritate the nerve as well.

A 2018 study showed that almost one-fourth of patients placed face-down in an operating room on a certain frame for posterior spine surgeries lasting longer than 3.5 hours had meralgia paresthetica as the nerve got pinched between the frame and a ligament or bone.

Besides the nerve getting pinched by forces from the outside, internal forces can also add pressure to a nerve, like that of a growing baby during pregnancy, a tumor, or scar tissue. Certain surgeries, like those that involve harvesting bone for grafting from the iliac crest of your pelvic bone, may lead to inadvertent damage to the lateral femoral cutaneous nerve, resulting in the telltale thigh pain. Other surgeries where the lateral femoral cutaneous nerve is at risk for damage include spine procedures, hip replacements, pelvic osteotomies, bariatric surgery, aortobifemoral bypass, and significantly, laparoscopic hernia repairs. One study reports that cases of meralgia paresthetica are up 5% after laparoscopic hernia repair cases using the theoretically minimally invasive instruments in comparison with open incision hernia repairs.

In addition to mechanical injury, there are a few other internal abnormalities that might make a person more susceptible to meralgia paresthetica. The high blood sugar levels of those with undiagnosed or untreated diabetes can make nerves more vulnerable to injury, as well as those with hypothyroidism, or whose bodies are prone to inflammation thanks to lead poisoning or alcoholism.

Updated on: 03/13/19

Thigh Pain (Meralgia Paresthetica) Diagnosis

90,000 What Pains in the Heart Are Saying | Causes of pain in the heart area

Not all pains in the left side of the chest are caused by cardiac pathologies. The causes of such symptoms can be diseases of the respiratory system, digestion, muscles, nervous and endocrine systems. How to understand the nature of pain in the region of the heart and start the correct treatment?

What is the cause of the pain?

It is important to determine what kind of problem in your body is causing discomfort.

• If pain appears during physical exertion, changes with movement, change of position, deep breath, then most likely it is thoracic sciatica, or otherwise intercostal neuralgia;
• Short-term or intermittent aching pain in the region of the heart is a common complaint with neuroses;
• Pressing or stitching pains accompanied by shortness of breath are associated with disturbances in the functioning of the intestines;
• And if painful sensations directly depend on periods of fasting and taking any food, then the reason lies in gastrointestinal diseases.

How to find the source of pain?

When pain in the heart area occurs, it is important to correctly determine its true cause, excluding, if possible, cardiac diseases. This requires a thorough examination by a cardiologist, surgeon and neurologist. Mandatory diagnostic methods are:

• ECG,
• Holter examination,
• echocardiography,
• X-ray,
• computed tomography and MRI of the spine.

According to the results of examinations, specialists will be able to say how painful sensations in the heart region are associated with the most important organ of the human body. If the cardiologist and neurologist do not find any serious violations in the work of the heart muscle and the condition of the spine, then you will have to look for the cause of the pain in an endocrinologist or gastroenterologist. Often, pressing chest pains are caused by stomach cramps.

What to do at the moment of an attack?

Acute pressing pain in the left side of the body may occur suddenly.The main thing is not to panic. What to do during an attack:

• take the most comfortable position, sitting or reclining,
• provide air flow and loosen clothing,
• take nitroglycerin tablet,
• call an ambulance.

Only professional doctors are able to help you get rid of pain with minimal losses for the general physical condition of the body.

90,000 Pain in the area of ​​the heart symptoms in women, men

Annual statistics clearly show that heart diseases are consistently holding leading positions in the lists of the most common in Russia. Out of 1000 people, such diagnoses are made to 26 patients.

The prevalence of these pathologies, according to experts, is caused by premature “aging” of the tissues of the heart muscle. Untimely diagnosis also plays a role. Cardiologists warn: ignoring heart pain is dangerous! If you are concerned about pain in the heart area, do not wait for the situation to worsen, urgently consult a doctor: +7 (495) 640-57-56.

Acute pain in the heart is a symptom of a serious illness that can manifest itself completely unexpectedly and lead to irreparable consequences for the body. That is why it is very important to have a timely and regular examination. Now you have a unique opportunity to undergo a free specialist consultation and a set of preparatory examinations when registering for a course of enhanced external counterpulsation or shock wave therapy of the heart:

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Just before the end of autumn, undergo a free consultation and a set of preparatory examinations * when registering for a course of enhanced external counterpulsation or shock wave therapy of the heart.**

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How to recognize heart pain?

Sharp pains in the region of the heart or pronounced discomfort in the retrosternal region are manifestations of angina pectoris. However, not only heart pains manifest themselves in this way, there may be neurological disorders, disruptions in the work of the respiratory and digestive systems. To a layman, any chest pains seem to be a heart pathology, but they can be manifestations of osteochondrosis, neuralgia and even pulmonary diseases, for example, pleurisy.

How to recognize that it is the heart that hurts? Unfortunately, it is impossible to independently diagnose cardiac pathology; only specialists can do this using modern diagnostic equipment. However, it is important to know the main symptoms of heart disease. If you find any of them in yourself – urgently consult a cardiologist:

• pain does not stop for an hour or more;
• painful sensations occur even during a night’s rest with complete physical rest;
• the intensity of pain decreases after taking nitroglycerin;
• painful spasms are accompanied by a feeling of suffocation, dizziness, lightheadedness;
• in the chest begins to hurt after intense physical or psychological stress;
• palpitations noticeably increase, heart irregularities are felt;
• the skin acquires an unhealthy pale shade;
• physical weakness and malaise are felt, sweating is manifested.

Heart pain in women: symptoms

Gender characteristics of the manifestation of cardiac pathologies are associated, first of all, with the peculiarities of physiology. For manifestations of pain in the region of the heart in women are characterized by:

• respiratory failure;
• abdominal pain, acute abdomen, nausea, vomiting;
• severe swelling of the lower extremities;
• frequent urination.

Stitching heart pains

Suddenly appearing sharp stabbing pain in the heart is one of the most striking signs of a heart attack, which often leads to a heart attack. It is worth urgently calling an ambulance if the pain radiates to the left arm, neck, lower jaw and back. However, pain has the same character when:

• pericarditis or inflammation of the heart membrane;
• cardiomyopathy;
• neurosis, the localization of which is near the heart;
• coronary spasm, characterized by impaired blood circulation of the heart vessels.

Manifestations of aching pain in the heart

Heart pain can radiate to joints and areas that are difficult to relate to the heart muscle. The most common is the aching pain in the region of the heart, it is accompanied by difficulty in movement, numbness of the left arm, manifestations of angina pectoris. But do not confuse such a manifestation of pain syndrome with signs of neuralgia and diseases of the spine.To exclude these reasons, you need to undergo a thorough examination.

Pressing heart pains

Basically, sensations of this nature indicate the presence of angina pectoris. Such pain can be given to the chin, and to the lower jaw, and to the shoulder. In this case, numbness of the left hand is observed from the shoulder joint to the fingers. The duration of an attack can vary from one hour to several days. Pain occurs both as a result of exertion and in a calm state.Often, patients complain that their heart hurts at night, noting just the oppressive nature of the pain.

However, it is possible to accurately diagnose a heart attack only as a result of an examination, since myocarditis and mitral valve prolapse, as well as intercostal neuralgia, also manifest themselves.

Dull heartache

Dull pain in the region of the heart is not only a sign of cardiac pathology. This symptom may indicate problems with the spine and lungs.Its causes can be:

• manifestations of mitral valve disease;
• some forms of myocarditis;
• symptoms of neurocirculatory dystonia.

Unlike other causes, dull heart pain has one distinguishing feature – it is long-lasting and regular.

Active work, stressful situations, hypothermia or overeating can provoke an attack.

Causes and consequences of acute pain in the heart

Acute pain in the region of the heart, which is also called strong or sharp, is a clear sign of pericarditis or angina pectoris.It is almost always a sign of a pre-infarction state, accompanied by weakness and malaise. At the same time, women may experience severe nausea and echoes of pain in the abdomen.

This heart pain is often confused with pleurisy manifestations, since the condition is accompanied by a severe cough.

A burning sensation in the chest

Feelings of burning pain can be a sign of both neurosis, gastrointestinal disorders, esophageal pathologies, and heart attack.For a more precise definition, it is worth paying attention to the general symptoms described above. Did a burning pain appear after physical, psychological stress? Most likely, you are dealing with angina pectoris.

Pain with intense breathing

Often, a deep breath, even in a young person, can cause acute chest pain. At the same time, there is a feeling of fullness. However, this does not always indicate heart problems. Such pains can be provoked by herpetic or intercostal neuralgia, thoracalgia, precordial syndrome, which have nothing to do with cardiac activity.Well, if the pain and lack of air in the lungs become stronger, you should immediately contact a cardiologist.

If the pain radiates to the left arm

Painful “echo” that appears in the left hand after physical exertion and stress may indicate the development of coronary heart disease. Painful attacks can be acute or compressive in nature, there is pain in the armpit, heart rate increases, signs of hypertension and arrhythmia appear.

Pain while driving

If the heart hurts while walking, discomfort appears during physical exertion – this is a clear sign of coronary heart disease. Pain syndrome is almost always accompanied by shortness of breath, disturbances and interruptions in the work of the heart (the feeling that the heart is about to stop).

Pain in the region of the heart: causes

Heart pain has many reasons, the main ones are:

• myocardial cell necrosis or infarction, pain can be of a different nature;
• the inflammatory process caused by infection, or myocarditis is characterized by aching, pressing, dull pain;
• ischemia and angina pectoris, causing aching, constricting, pressing pain;
• inflammatory processes in the heart bag, which determine the nature of pain, such as aching, dull, cutting, painful sensations also occur on inhalation;
• mitral valve prolapse with aching, pressing pain;
• high pressure, giving a feeling of heaviness in the chest;
• hypertrophic processes in the heart muscle with stitching, aching, pulling, sharp manifestations of pain during exertion;
• myocardial dystrophy, causing aching, sharp, pressing pain.

How to help yourself with pain in the heart?

During an attack of pain in the heart, the main thing is not to panic and try to calm down. It is best to take a horizontal position or sit comfortably with your elbows on a support. It is worth removing or loosening everything that can make breathing difficult: collar, tie, belt. Be sure to take 1 nitroglycerin tablet under the tongue. The pain should subside in 15 minutes. If nitroglycerin does not help, do not hesitate, urgently call an ambulance, perhaps the patient has developed a myocardial infarction.

If the pain in the heart appears for the first time, do not rush to diagnose yourself, it may not be a manifestation of cardiac pathology at all. It is necessary to take Corvalol or Validol in a dosage of 40 drops and take the most comfortable position, limiting movement and relaxing.

Turn to professionals

At the CBCP Center for Circulatory Pathology, you can undergo a complete hardware examination.Our specialists will diagnose and prescribe treatment appropriate to your condition. Do not self-medicate, this can significantly worsen the situation. Trust the highly qualified specialists of our center. You can make an appointment online or by phone: +7 (495) 640-57-56.

90,000 For what diseases there is pain in the right hypochondrium

Each of us at least once encountered a rather commonplace symptom, pain under the ribs. Meds editorial office.ru decided to figure out in what cases painful sensations of a similar nature arise.

Pain under the ribs on the right side indicates pathological processes, injuries or diseases of internal organs located under the diaphragm behind the two lower ribs on the right. Painful sensations in this place are often found, since vital organs, nerve endings, and blood vessels are located there. Here the liver and gallbladder, part of the colon and duodenum, the tail part of the pancreas, one kidney and the adrenal gland, and the loops of the thin esophagus are “concentrated”.

Types and differences

According to the degree of intensity, acute and chronic forms are divided. The nature of the pain indicates the “culprit” of its occurrence. Experts share several types:

• aching pain in the right hypochondrium;
• sharp;
• baking;
• blunt;
• stabbing;
• night;
• squeezing;
• pulsating;
• expanding;
• pulling.

Unpleasant sensations appear suddenly or gradually due to an unhealthy lifestyle. Severe intense pain requires immediate emergency medical attention. In any case, if undesirable symptoms appear, it is better for the patient to consult a gastroenterologist or therapist.

Causes of pain in the right hypochondrium

Mostly the root causes of pain are diseases of the biliary tract and hepatic pathologies. Main pathological conditions:

• hepatitis of various origins;
• cirrhosis;
• malignant or benign tumor;
• helminthiasis;
• fatty degeneration;
• liver failure;
• poisoning with toxins;
• gallstone disease;
• lack of blood circulation due to cardiovascular diseases;
• colitis and intestinal infections;
• cholecystitis;
• kidney disease;
• rib fractures;
• intercostal neuralgia;
• appendicitis;
• peptic ulcer;
• pancreatitis.

Then there is pain in the right hypochondrium

Certain factors influence the development of painful sensations. Other symptoms appear that indicate a malfunction in the body – heaviness in the stomach, nausea, weakness, upset stools, impaired appetite, fever.

After eating, the production and advancement of bile along the biliary tract is accelerated, blood flow to the liver increases, and peristalsis increases.Therefore, food, especially fatty and plentiful, provokes pain. The nature of pain differs in the sources that caused it.

After significant physical exertion, the body also malfunctions. Strong overload, especially after eating, will lead to intercostal pain. Stress is considered to be another provocateur of pain.
During pregnancy, mainly in the third trimester, pain on the right side is not uncommon. This is due to the congestion of bile and the expansion of the bile duct. Taking hormonal contraceptives sometimes provokes unpleasant stabbing pains at the end of the menstrual cycle.

What to do

Pain in the right side requires medical attention. Do not self-medicate as there are serious problems behind the different types of pain. Taking painkillers worsens the patient’s condition, is the culprit of internal bleeding. If unpleasant sensations appear in the right side, it is necessary to call a doctor or
independently go to the hospital for diagnostics.

It is important to determine the source of painful manifestations.For this, an ultrasound examination is performed, clinical blood and urine tests are taken, if necessary, an X-ray of a given area is performed. If required, a consultation with a surgeon, cardiologist, endocrinologist, neuropathologist is appointed. After the diagnosis is made, therapy is carried out by a specialized specialist. Treatment is most often carried out with drugs. With cholecystitis, surgery is required. Effective dietary food, rejection of spicy, fatty and spicy foods. The attending physician will prescribe the necessary medications and tell you about the principles of proper nutrition, depending on the identified disease.

Acute pain in the lower abdomen on the left, on the right – causes of sharp, sharp and stabbing pain

20 August 2018

Pain is the body’s defensive reaction, its cry for help when something goes wrong and something goes wrong.

Pain is a defensive reaction of the body, its cry for help when something goes wrong and something goes wrong.

Depending on the duration of the course, there are acute and chronic pain. The nature of the pain can be stabbing, cutting, sharp, cramping, encircling, bursting, dull, aching .

In today’s article we will tell you what acute pain in the lower abdomen is, what are the causes of painful sensations and when they can occur.

Acute pain in the lower abdomen is a fairly common complaint of both men and women and children.The causes of acute pain in the lower abdomen can sometimes lie in banal food poisoning, and sometimes they can also indicate a serious, life-threatening surgical pathology.

Next, we will figure out what are the main causes of acute pain in the lower abdomen, what can be indicated by pain in the lower abdomen on the right and left, what pathology is accompanied by stabbing and sharp acute pain.

Acute pain in the lower abdomen on the left

To understand the reasons for acute pain in the left side of the lower abdomen, you should know which organs are projected here.So, the region of the lower abdomen on the left consists of the suprapubic region and the left iliac region.

• Projected here:
• sigmoid colon (section of the large intestine),
• part of the bladder,
• left ureter,
• left uterine appendages in women.

Therefore, most often acute pain in the lower abdomen on the left is associated with the defeat of these particular organs.

• Acute pain in the left side of the lower abdomen may indicate the presence of the following diseases:
• Bowel diseases such as inflammation of the sigmoid colon (sigmoiditis), diverticulosis of the sigmoid colon, irritable bowel syndrome, ulcerative colitis, Crohn’s disease, intestinal obstruction, polyps, malignant neoplasms of the intestine.
• Urological diseases, eg cystitis, urethritis, urolithiasis, pyelonephritis, renal colic.
• Diseases of the reproductive system, separately endometritis, endometriosis, oophoritis, acute adnexitis, ovarian cyst, ovarian apoplexy, malignant neoplasms of the uterine appendages, ectopic pregnancy, rupture of the fallopian tube, threatened miscarriage, or spontaneous abortion in women may also cause acute pain … Prostatitis, epididymitis, malignant neoplasms of the prostate are the causes of acute pain in the lower abdomen on the left in men.
• Neurological diseases such as pinching of the sciatic nerve, intervertebral hernia.

Acute pain in the lower abdomen on the left can also occur with intestinal infections, separately with dysentery, parasitosis (helminthic invasion, ascariasis), peritonitis, the presence of a contraceptive coil, pathologically painful menstruation and, of course, with injuries.

Acute pain in the lower abdomen on the right

• Acute pain in the lower abdomen on the right is also often associated with damage to the organs that are projected here, namely:
• cecum (part of the large intestine) and appendix (appendix),
• right ureter,
• part of the bladder,
• Right uterine appendages in women.

Acute pain in the right side in the lower abdomen may indicate intestinal diseases, genitourinary pathology, urological, oncological, neurological diseases.

As you know, acute pain in the lower abdomen on the right is the most characteristic symptom of appendicitis (inflammation of the appendix), which, in the absence of immediate surgical care, can lead to peritonitis.

Often, acute pain in the right side of the lower abdomen is observed with an enlarged liver, with a violation or pathological course of pregnancy, with parasitosis (helminthic invasion, ascariasis), sexually transmitted diseases, intestinal infections, constipation, mesenteric thrombosis, adhesive disease, etc.

What sharp stabbing pain in the lower abdomen can talk about

The pain can be different for character and strength – sharp stabbing pain in the lower abdomen, cutting, dagger, bursting, dull, aching. Not only localization, but also the nature of the pain helps to suspect this or that disease, therefore it is very important to clarify this point with the patient.

• So, acute stabbing pain in the lower abdomen can be the result of the following reasons:
• Temporary muscle spasm.
• Inflammatory bowel, urinary and reproductive system diseases.
• Pathological course of pregnancy.

Acute stabbing pain in the lower abdomen can accompany a normal pregnancy. In this case, it is physiological and is associated with an increase in the uterus, as a result of which individual muscle fibers contract. In any case, with frequent stabbing pains, it is necessary to consult a doctor and find out the exact cause.

As evidenced by a sharp sharp pain in the lower abdomen

Sharp acute pain in the lower abdomen is a common symptom of surgical pathology.

So, with appendicitis, there can be a sharp sharp pain in the lower abdomen on the right, with apoplexy of the ovary, the pain is sharp and often radiates to the perineum, with peritonitis it is diffuse.

Sharp acute pain in the lower abdomen can also be observed during pregnancy outside the uterus, with ruptures of the fallopian tubes, with torsion of the ovarian legs, with mesenteric thrombosis, renal colic, with spontaneous abortion, or its threat, with premature placental abruption, acute prostatitis in men, etc.

In the event of a sharp sharp or stabbing pain in the lower abdomen, you should immediately consult a doctor, as it may indicate a serious, often even life-threatening pathology.

Pain in the ovaries with apoplexy, polycystic, cyst – Make an appointment

From the metro station Nakhimovsky Prospekt (5 minutes walk)

From the Nakhimovsky Prospekt metro station, exit to Azovskaya Street, then after 250-300 meters turn left onto Sivashskaya Street, then after 40-50 meters turn right into the courtyard.

From the children’s clinic and maternity hospital in Zyuzino (10 minutes walk)

From the children’s clinic and maternity hospital in Zyuzino, you need to go to Azovskaya street, then turn to Bolotnikovskaya street and, before reaching the narcological clinical hospital N17, turn left into the courtyard.

From the metro station Nagornaya (15 minutes)

From the Nagornaya metro station you can get to our medical center in 15 minutes, having traveled 1 metro stop.

From Varshavskaya metro station (19 minutes walk)

From the Varshavskaya metro station, it is convenient to take trolleybuses 52 and 8 from the stop “Bolotnikovskaya ulitsa, 1” to the stop Moskvoretsky market, then 550 meters on foot

From metro Kakhovskaya (19 minutes walk)

From the Kakhovskaya metro station, go to Chongarskiy Boulevard, follow Azovskaya Street, turn right onto Bolotnikovskaya Street, then after 40-50 meters (behind house number 20, turn to the left into the courtyard)

From the metro station Chertanovskaya district Chertanovo (20 minutes)

From Chertanovo district to our medical center can be reached from Metro Chertanovskaya in 20 minutes or on foot in 35-40 minutes.

From Profsoyuznaya metro station (25 minutes)

Exit from the Profsoyuznaya metro station to Profsoyuznaya street. Further from Nakhimovsky Prospekt, from the Metro Profsoyuznaya stop, drive 7 stops to the Metro Nakhimovsky Prospekt stop. Further along Azovskaya street 7 minutes on foot.

From Kaluzhskaya metro station (30 minutes)

From the Kaluzhskaya metro station, you can take trolleybus 72 in 30 minutes. Exit from the metro to Profsoyuznaya street, from the Kaluzhskaya metro stop proceed to the Chongarskiy boulevard stop, then 7 minutes walk along Simferopol boulevard

From the prefecture of the SOUTH-WEST (YUZAO) district (30 minutes on foot)

From Sevastopolsky Avenue, turn onto Bolotnikovskaya Street, not reaching the narcological clinical hospital N17 100 meters, turn left into the courtyard.

From the metro station Novye Cheryomushki (40 minutes)

Exit from the Novye Cheryomushki metro station on the street. Gribaldi, then at the stop on Profsoyuznaya Street “Metro Novye Cheryomushki” by trolleybus N60 proceed to the stop Chongarsky Boulevard, then 7 minutes walk along Simferopol Boulevard

90,000 stitching pain in the joints of the hands

stitching pain in the joints of the hands

Joint pains by types are subdivided into mechanical, initial, nocturnal, reflected. All of them lead to depression, anxiety, anxiety, insomnia, decreased activity of movements, and the progression of joint diseases.

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Pain in the joints of the hands limits their mobility, makes it impossible to perform work associated with fine motor skills for a long time. A person can be bothered by pain both during movement and at rest, there is reddening of the skin over the pathological joint, edema and a local increase in temperature.Varieties of pain in the joints of the hands. By the nature of the pathological process, the following groups of joint damage are distinguished: Arthritis – inflammation of the synovial membrane of the joint. Arthrosis is a lesion of the cartilaginous structures of the joint. Periarthritis is an inflammation of the soft tissues surrounding the joint (tendons, bursae, muscles). What diseases cause pain in the elbow joint of the right arm? Causes of pain in the joint of the thumb. What causes pain in the wrist joint of the hand? Diagnosis and treatment of joint problems in the therapy clinic of the Yusupov hospital.Pain in the joints of the arms and legs: causes and treatment of pathology. Content ↓ [show]. Why is there pain in the elbow joint of the right arm (left arm)? Pain in the elbow joint of the right arm, treatment for epicondylitis. Pain in the elbow joint of the right arm, treatment for arthrosis. Pain in the elbow joint of the right arm, treatment for arthritis. Possible causes of arm pain. Arm pain can be physiological in nature and can be caused by muscle fatigue after heavy or unusual exertion. It occurs due to the accumulation of products of anaerobic metabolism (lactate) in the muscle tissue and disappears within two to three days.After significant physical exertion exceeding the muscle endurance threshold, delayed pain may occur (1-2 days after exercise). Pain in the joints of the hands is a dangerous symptom, especially if a person cannot lift and hold a load that he previously lifted with ease, finds it difficult to perform household activities: combing, dressing and eating. Causes of occurrence. Injuries. These include bruises, dislocations, fractures, stretching of the capsule of the joints. Injuries are received from impact, falling on the arm, excessive stress.The appearance of injuries is facilitated by metabolic and hormonal disorders, in which the joint tissues lose their elasticity and become thinner. When injured, the pain is usually sharp, and the mobility of the joint is limited. Arthritis. Arthritis of the joints of the fingers – remedies for treatment, how to treat. Useful and relevant articles on the website of the Elamed company. Apparatus and devices for home and medical institutions. Consultation by phone: 8 (800) 350-04-13. pain, and if at first it occurs with movements of the hands, fingers, then later pain in the joints torments the patient even at rest; discomfort and stiffness in the affected joints and fingers; limitation of mobility of the hands, stiffness in the hands, as if they were wearing a narrow glove, especially in the morning; reaction to changes in atmospheric pressure, weather changes, dampness; a local increase in the temperature of the hands (an indicator of inflammation) The elbow joint is involved in every movement of the hand: grasping, throwing, supporting, hitting and lifting weights are not possible without a healthy elbow.Therefore, elbow pain limits the patient’s daily life and performance. The elbow joint treatment method depends on the patient’s background. Medical center Gelenk Klinik in Germany in Freiburg conducts both conservative and. Pain in the joints of the arms and legs can be the first symptom of serious illness. The feeling of aches, burning, limitation of the motor functions of the arms and legs are complaints that are voiced by patients with the following diseases: rheumatoid arthritis; arthrosis. Acute pain in the joints of the arms and legs requires prompt relief to relieve the patient’s condition.As a first aid, it is recommended to perform some actions: Provide rest to the limbs. So, pain in the joints of the hands can occur due to inflammatory processes or degenerative-dystrophic changes in the joints or in the tissues that surround them. Hand pain can also be muscular or neurogenic, and it is rarely possible to independently determine the cause that causes them. As already mentioned, the causes of pain in the hands can be very different. They often occur as a result of injuries: severe bruises, bone fractures, sprains and ruptures of muscles, tendons and ligaments.Often, the muscles of the arms hurt due to excessive physical exertion, which led to overstrain of the muscle fibers. In addition, pain in the hands is caused by Why does pain in the joints of the hands occur and how to cope with it? Simple tasks like picking up a toothbrush or turning a doorknob can become difficult when osteoarthritis or rheumatoid arthritis affects the joints of the arm. The joints of the fingers and wrists can become too painful, stiff and weak to function properly. To prevent the progression of diseases, you need to seek medical help immediately after the onset of the symptoms described in the article.Causes of pain in the joints of the hands and fingers.

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axinia cream for joints
folk remedies for the treatment of joints of the hands
tablets for pain in joints name

Active ingredients of natural origin are selected so that they quickly and effectively act directly on the site of pain.