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Papers by Joseph Riley
Pesquisa Brasileira em Odontopediatria e Clínica Integrada, 2021
Objective: To describe the dental practice patterns related to caries prevention in children aged... more Objective: To describe the dental practice patterns related to caries prevention in children aged 6-18 years and associated factors. Material and Methods: Dentists (n=162) from Araraquara, Brazil, completed two paper questionnaires: (1) one about characteristics of their practice and their patient population; and (2) a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the National Dental Practice-Based Research Network. Regression analyses were used for data analysis (p<0.05). Results: Dentists reported using in-office fluoride (IOF) and dental sealants (DS) in 74.2% and 45.1% of their pediatric patients, respectively. Regression analysis showed that female dentists (p=0.035 for DS; p=0.044 for IOF; p=0.011 for non-prescription fluoride rinse), those with advanced degrees (p=0.032 for prescription of fluoride), those who graduated from a private dental school (p=0.018 for chlorhexidine rinse), those who provided caries prevention regimens (p<0.001 for DS; p=0.004 for IOF; p=0.013 for nonprescription fluoride rinse), those with a greater percentage of patients interested in a caries prevention regimen (p=0.007 for non-prescription fluoride rinse), those working in a private practice model (p=0.047 for prescription of fluoride) were more likely to recommend some type of preventive methods to their pediatric patients. Conclusion: Dentists reported recommending IOF to most of their pediatric patients. Certain dentists', practices', and patients' characteristics were associated to some caries prevention regimens recommended by dentists.
Brazilian Oral Research, 2021
Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian denti... more Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian dentists. This study aimed to determine the prevalence of CRA use by dentists and factors associated with its use, as well as to quantify dentists' ratings of the importance of specific factors when treatment planning. Dentists registered at the Regional Council of Dentistry of São Paulo State-Araraquara region were sent two paper questionnaires that comprised: a) characteristics of dentists themselves, their practices, and their patients; and b) the translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the U.S. National Dental Practice-Based Research Network. Participants were 206 dentists who currently practiced in Araraquara and treated dental caries. Descriptive statistics and multiple logistic regression analyses were used for data analysis. Thirty-six percent of the dentists reported they perform CRA and, among them, 36% indicated they record the assessment on a special form that is kept in the patient chart. More years since dental school graduation (OR = 1.1, p = 0.002) and holding an advanced academic degree (OR=2.6, p=0.005) were associated with a higher likelihood of performing CRA, whereas exclusively using a private practice model (OR = 0.5, p = 0.016) was associated with a lower likelihood of performing CRA. The current oral hygiene and commitment to return for follow-up were the most important risk factors for treatment planning. In conclusion, CRA was not a routine procedure in daily practice among the majority of participating dentists. Specific demographic, practice and academic education characteristics were associated with performing CRA.
Brazilian Journal of Oral Sciences, 2020
Little is known about dental practice patterns of caries prevention in adults among Brazilian den... more Little is known about dental practice patterns of caries prevention in adults among Brazilian dentists. Aim: To quantify procedures used for caries prevention for adult patients among dentists from a Brazilian community. Methods: Dentists (n=197) who reported that at least 10% of their patients are more than 18 years old participated in the first Brazilian study that used a translated version of the “Assessment of Caries Diagnosis and Caries Treatment” from the U.S. National Dental Practice-Based Research Network. A questionnaire about characteristics of their practice and patient population were also completed by the dentists. Generalized linear regression models and a hierarchal clustering procedure were used (p<0.05). Results: In-office fluoride application was the preventive method most often reported. The main predictors for recommending some preventive agent were: female dentist (dental sealant; in-office fluoride; non-prescription fluoride) and percentage of patients inter...
The journal of pain : official journal of the American Pain Society, Jan 28, 2017
This study tested the hypothesis that older adults would have a stronger response for substance P... more This study tested the hypothesis that older adults would have a stronger response for substance P (facilitatory) but weaker response to β-endorphin (inhibitory), both in magnitude and time-course. Eight younger and 9 older adults underwent 3 experimental sessions using well-validated laboratory pain models: cold pressor task (CPT), contact heat pain (HP), and a non-painful control. Blood was collected through an indwelling catheter at baseline and 3, 15, 30, 45, and 60-minutes post-stimuli administration. Older adults had higher baseline levels of both neuropeptides suggesting increased peripheral activity compared to younger adults. Following CPT, older adults demonstrated a quick and strong release of substance P with dramatic recovery, whereas young adults maintained a constant low-grade response. Unlike substance P, β-endorphin increased between 3 and 15 minutes for both groups with the upsurge substantially higher for older adults. Following HP, younger adults had an immediate ...
The Journal of the American Dental Association, 2015
OBJECTIVES-(1) quantify 12-month failures of restorations that were repaired or replaced at basel... more OBJECTIVES-(1) quantify 12-month failures of restorations that were repaired or replaced at baseline; (2) test the hypothesis that no significant differences exist in failure percentages between repaired and replaced restorations after 12 months; (3) test the hypothesis that certain dentist's, patient's and restoration's characteristics are significantly associated with the incidence of restoration failure.
Journal of Orthopaedic & Sports Physical Therapy, 2015
![Research paper thumbnail of Corrigendum to “Experimental pain sensitivity differs as a function of clinical pain severity in symptomatic knee osteoarthritis” [Osteoarthritis and Cartilage 2013;21:1243–1252]](https://attachments.academia-assets.com/110164162/thumbnails/1.jpg)
](Osteoarthritis and Cartilage, 2013
Medicine & Science in Sports & Exercise, 2014
Despite many studies investigating exercise-induced hypoalgesia, there is limited understanding o... more Despite many studies investigating exercise-induced hypoalgesia, there is limited understanding of the optimal intensity of aerobic exercise in producing hypoalgesic effects across different types of pain stimuli. Given that not all individuals are willing or capable of engaging in high intensity aerobic exercise, whether moderate intensity aerobic exercise is associated with a hypoalgesic response and whether this response generalizes to multiple pain induction techniques needs to be substantiated. Purpose-This study's purpose is to test for differences in the magnitude of pressure and heat pain modulation induced by moderate (MAE) and vigorous (VAE) intensity aerobic exercise. Methods-Twelve healthy young males and 15 females completed one training session and three testing sessions consisting of 25 minutes of either 1) stationary cycling at 70% heart rate reserve (HRR), 2) stationary cycling at 50% HRR, or 3) quiet rest (control). Pain testing was conducted on both forearms prior to and immediately following each condition and included the following tests: pressure pain thresholds (PPT), suprathreshold pressure pain test, static continuous heat test, and repetitive pulse heat pain test. Repeated measures ANOVAs were conducted on each pain measure. Results-VAE and MAE reduced pain ratings during static continuous heat stimuli and repetitive heat pulse stimuli, with VAE producing larger effects. VAE also increased PPTs, while neither exercise influenced suprathreshold pressure pain ratings. Conclusion-These results suggest that MAE is capable of producing a hypoalgesic effect using continuous and repetitive pulse heat stimuli. However, a dose-response effect was evident as VAE produced larger effects than MAE.
The Journal of Pain, 2011
The Journal of Pain, 2009
N-methyl-D-aspartic acid (NMDA) receptors play an important role in the development of hypersensi... more N-methyl-D-aspartic acid (NMDA) receptors play an important role in the development of hypersensitivity to colonic/rectal and somatic stimuli following inflammation or tissue injury (hypersensitive). Our objective was to investigate the role of NMDA NR1 receptors in the spinal cord (T10-L1; L4-S1) of a subset of rats that remain hypersensitive following histological resolution of TNBS-induced colitis compared to saline treated rats and rats that had recovered both behaviorally and histologically. We hypothesized that there would be increased expression of NMDA NR1 subunits in hypersensitive rats in comparison to these two control groups. Male Sprague-Dawley rats (150g-250g) were treated with intracolonic 20mg/ rat trinitrobenzene sulfonic acid (TNBS) in 50% ethanol or saline. Animals underwent nociceptive visceral/somatic pain testing 16 weeks after TNBS administration. Animals were sacrificed and their spinal cord (T10-L1; L4-S1) was retrieved and 2-dimensional polyacrylamide gel electrophoresis and immunohistocytochemistry techniques were used to investigate spinal-NMDA receptor activation 16 weeks following TNBS colitis. NR1001 was the only NMDA NR1 receptor subunit that was expressed in recovered and control rats, whereas hypersensitive animals expressed NR1011 and RN111 as well as NR1001 subunits. Immunohistochemistry analysis demonstrated increased expression of NMDA NR1-N1, C1, and C2-plus expression in lamina I & II of spinal cord (T10-L1; L4-S1) in hypersensitive rats but not in recovered/control rats. Selective increases in the expression of the NMDA NR1 splice variants occur in hypersensitive rats following resolution of TNBS colitis, suggesting that the NMDA NR1 receptor may play an important role in the development of neuronal plasticity and central sensitization. The recombination of NR1 splice variants may serve as a key functional protein that maintains hypersensitivity/pain in these rats.
The Journal of Pain, 2005
Journal of Behavioral Medicine, 2012
The current study tested the hypothesis that conditioned pain modulation is mediated by the relea... more The current study tested the hypothesis that conditioned pain modulation is mediated by the release of endogenous opioids with a placebo-controlled (sugar pill) study of naltrexone (50 mg) in 33 healthy volunteers over two counterbalanced sessions. Pain modulation consisted of rating of heat pain (palm) during concurrent cold water immersion (foot). Compared to baseline heat pain ratings, concurrent foot immersion lowered pain intensity ratings, which suggests an inhibitory effect, was reduced with naltrexone, suggesting at least partial dependence of inhibition on endogenous opioids. An exploratory analysis revealed that individual differences in catastrophizing moderated the effects of naltrexone; endogenous opioid blockade abolished modulation in subjects lower in catastrophizing while modulation was unaffected by naltrexone among high catastrophizers. The results suggest a role of endogenous opioids in endogenous
Journal of Sport and Exercise Psychology, 2005
This study examined whether specific participant characteristics (age, sex, BMI, exercise history... more This study examined whether specific participant characteristics (age, sex, BMI, exercise history, and self-efficacy) differentially predicted adherence to exercise programs of moderate vs. higher levels of intensity and frequency. Sedentary adults (N = 379) were randomly assigned in a 2 × 2 design to walk 30 min/day at a frequency of either 3 to 4 days/week or 5 to 7 days/week, at an intensity of either 45–55% or 65–75% of maximum heart rate reserve. Exercise adherence was assessed via daily exercise logs completed during Months 2–6 of the exercise program. The major finding of this study was that participants with higher levels of past exercise showed better adherence to higher intensity exercise but tended to have poorer adherence to moderate intensity exercise. Our results suggest that a person’s previous experience with exercise should be considered when prescribing higher intensity exercise, and that individuals with an extensive exercise history can be prescribed higher inten...
Public health reports (Washington, D.C. : 1974)
Accomplishing the Healthy People 2010 goal of eliminating disparities in oral disease will requir... more Accomplishing the Healthy People 2010 goal of eliminating disparities in oral disease will require a better understanding of the patterns of health care associated with orofacial pain. This study examined factors associated with pain-related acute oral health care. The authors used data on 698 participants in the Florida Dental Care Study, a study of oral health among dentate adults aged 45 years and older at baseline. Fifteen percent of the respondents reported having had at least one dental visit as the result of orofacial pain. The majority of the respondents reportedly delayed contacting a dentist for at least one day; however, there was no difference between respondents reporting pain as the initiating symptom and those with other problems. Once respondents decided that dental services were needed, those with a painful symptom were nearly twice as likely as those without pain to want to be seen immediately. Rural adults were more likely than urban adults to report having receiv...
Pain, 2002
The purpose of this study was to examine racial/ethnic-related differences in a four-stage model ... more The purpose of this study was to examine racial/ethnic-related differences in a four-stage model of the processing of chronic pain. The subjects were 1557 chronic pain patients (White=1084, African American=473) evaluated at a pain management clinic at a large southeastern university medical center. Using an analysis of covariance controlling for pain duration and education, African American patients reported significantly higher levels of pain unpleasantness, emotional response to pain, and pain behavior, but not pain intensity than Whites. Differences were largest for the unpleasantness and emotion measures, particularly depression and fear. The groups differed by approximately 1.0 visual analogue scale unit, a magnitude that may be clinically significant. Racial/ethnic differences in the linear relationship between stages were also tested using structural equation modeling and LISREL-8. The results indicate differences in linear associations between pain measures with African Americans showing a stronger link between emotions and pain behavior than Whites.
Pain, 2009
Recent meta-analyses find various magnitudes of placebo analgesia effects in placebo mechanism tr... more Recent meta-analyses find various magnitudes of placebo analgesia effects in placebo mechanism trials versus placebo control trials, which have led to debate. To further investigate the magnitude of placebo analgesia in placebo mechanism trials the databases ''PubMed", ''PsycINFO" and ''Web of Science" (2002-2007) were searched with the term ''placebo analgesia". Twenty-one articles including 24 studies fulfilled the selection criteria (concerning: mechanisms, control, placebo treatment, randomization and pain measures). The validity of studies was assessed by the authors and effect sizes were calculated via difference scores. The magnitude of placebo analgesia in placebo mechanism studies was large (d = 1.00) and about five times larger than placebo analgesia effects in placebo control studies (d = 0.15-0.27). Differences in magnitude between the two types of studies appear to result from different types of suggestions given for pain relief. The magnitude of placebo effects was larger in studies that used long-term pain stimuli >20 s (d = 0.96) as opposed to short-term stimuli (d = 0.81) and the largest placebo effects were found in studies wherein hyperalgesia was present (d = 1.88). These results replicate our previous finding that placebo analgesic effects are higher in mechanism studies than in placebo control studies. However, since magnitudes of placebo analgesic effects are highly variable it may be valuable to investigate the factors and mechanisms that contribute to this variability as well as differences in magnitudes across types of studies.
Psychosomatic Medicine, 2001
The current study investigated whether the relationship between sex and experimental pain report ... more The current study investigated whether the relationship between sex and experimental pain report was explained by systolic blood pressure (SBP) at rest or during pain task, by gender-role socialization as assessed by the Bem Sex Role Inventory, or both. The influence of gender-role socialization on pain report is often inferred but rarely studied. Methods: Fifty female and 54 male healthy, young adults completed the Bem Sex Role Inventory and then underwent a cold pressor task. Blood pressure was assessed before and during pain testing. Results: Univariate analyses indicated significant sex-related differences in pain threshold and pain tolerance. Baseline SBP was positively related to pain tolerance but did not explain sex differences, in accord with previous research. The Bem Sex Role Inventory demonstrated a relationship with pain, but did not explain sex differences. Conclusions: We suggest that context-specific measures of gender are needed to assess gender-related pain behaviors in specific situations. Results from the current study support our contention that gender is part of sex as commonly measured. Also, blood pressure does not appear to fully account for sex-related differences in pain.
Pain, 2002
A previous meta-analysis of clinical analgesic trial studies showed generally low magnitudes of p... more A previous meta-analysis of clinical analgesic trial studies showed generally low magnitudes of placebo analgesia (N. Engl. J. Med. 344 (2001) 1594). However, as studies included in their analysis used only placebo as a control condition, we conducted two meta-analyses, one in which 23 studies used only placebo as a control condition, and one in which 14 studies investigated placebo analgesic mechanisms. Magnitudes of placebo analgesic effects were much higher in the latter (mean effect size=0.95) as compared to the former (mean effect size=0.15) and were significantly different (P=0.003). This difference as well as differences in effect sizes within studies of placebo mechanisms may be parsimoniously explained by differences in expected pain levels produced by placebo suggestions and by conditioning. Furthermore, some of the studies of placebo analgesic mechanisms indicate that the magnitude of placebo analgesia is higher when the placebo analgesic effect is induced via suggestion combined with conditioning than via suggestion alone or conditioning alone. Based on these findings, we suggest that placebo analgesic effects are most optimally conceptualized in terms of perception of the placebo agent, and therefore a new definition of placebo response is proposed.
Journal of Occupational Rehabilitation, 1997
However, the reliability and validity of current assessment methods have not been unequivocally d... more However, the reliability and validity of current assessment methods have not been unequivocally demonstrated. This study focused on the detection of submaximal efforts and determination of the stability of the coefficient of variation (CV) in 20 asymptomatic subjects. The coefficient of variation of peak torque (CVpeak) and coefficient of variation of average torque (CVave) were obtained from maximal and submaximal torque curves during fast isokinetic (180 deg/s) leg extension strength tests. Significant differences between effort levels (maximal and submaximal) were found for CVpeak and CVave on both days of testing (p < .001). On Day 1 of testing, using an optimized 10% CVpeak cutoff resulted in a submaximal effort detection rate of 75% with an overall (maximal and submaximal efforts) correct classification rate of 88%. Correlation coefficients indicated relatively moderate stability using the CVpeak calculated using five trials for both maximal (r = .47, p < ,05) and submaximal (r = .78, p < .001) effort conditions. Findings suggest that use of an increased number of repetitions to calculate the CV may result in more stable measures.
Journal of Esthetic and Restorative Dentistry, 2006
To investigate the effectiveness of alternative treatments to the replacement of resinbased compo... more To investigate the effectiveness of alternative treatments to the replacement of resinbased composite (RBC) restorations through a prospective longitudinal cohort clinical study. Materials and Methods: Forty patients aged 27 to 77 years (mean = 55) with 88 RBC restorations, with one or more features that deviated from ideal, participated in the study. They were assigned to five treatment groups: repair (N = 25), sealing of defective margins (N = 13), resurfacing (N = 18), replacement (N = 16), and the no-treatment group (N = 16). The replacement and no-treatment groups served as comparison groups and received random assignment. Two clinicians examined the quality of the restorations (N = 88) prior to the assigned treatment, and at subsequent recalls (1 and 2 years) using a modified Ryge criteria (Alfa, Bravo, and Charlie, meaning clinically excellent, clinically acceptable with one or more features that deviated from ideal, and clinically unacceptable, respectively) that observed (1) color, (2) marginal adaptation, (3) anatomic form, (4) surface roughness, (5) marginal staining, (6) bulk discoloration, (7) contact, (8) secondary caries, (9) postoperative sensitivity, and (10) luster. Results: At 1-and 2-year recalls, 66 (75%) and 58 (66%) restorations were examined. Kruskal-Wallis Test showed significant differences for marginal adaptation and marginal staining for both 1-and 2-year recall exams (p < .05). The repair, sealant, and replacement groups presented significant improvement when compared with the no-treatment group for marginal adaptation. The repair and replacement groups showed superior results when compared with the no-treatment group for marginal staining. Conclusion: RBC restorations that present less-than-ideal marginal adaptation and stained margins are better off being repaired. CLINICAL SIGNIFICANCE Repair of resin-based composite (RBC) restorations is a conservative option for treatment of RBC restorations with inadequate marginal adaptation and marginal staining.
Pesquisa Brasileira em Odontopediatria e Clínica Integrada, 2021
Objective: To describe the dental practice patterns related to caries prevention in children aged... more Objective: To describe the dental practice patterns related to caries prevention in children aged 6-18 years and associated factors. Material and Methods: Dentists (n=162) from Araraquara, Brazil, completed two paper questionnaires: (1) one about characteristics of their practice and their patient population; and (2) a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the National Dental Practice-Based Research Network. Regression analyses were used for data analysis (p<0.05). Results: Dentists reported using in-office fluoride (IOF) and dental sealants (DS) in 74.2% and 45.1% of their pediatric patients, respectively. Regression analysis showed that female dentists (p=0.035 for DS; p=0.044 for IOF; p=0.011 for non-prescription fluoride rinse), those with advanced degrees (p=0.032 for prescription of fluoride), those who graduated from a private dental school (p=0.018 for chlorhexidine rinse), those who provided caries prevention regimens (p<0.001 for DS; p=0.004 for IOF; p=0.013 for nonprescription fluoride rinse), those with a greater percentage of patients interested in a caries prevention regimen (p=0.007 for non-prescription fluoride rinse), those working in a private practice model (p=0.047 for prescription of fluoride) were more likely to recommend some type of preventive methods to their pediatric patients. Conclusion: Dentists reported recommending IOF to most of their pediatric patients. Certain dentists', practices', and patients' characteristics were associated to some caries prevention regimens recommended by dentists.
Brazilian Oral Research, 2021
Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian denti... more Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian dentists. This study aimed to determine the prevalence of CRA use by dentists and factors associated with its use, as well as to quantify dentists' ratings of the importance of specific factors when treatment planning. Dentists registered at the Regional Council of Dentistry of São Paulo State-Araraquara region were sent two paper questionnaires that comprised: a) characteristics of dentists themselves, their practices, and their patients; and b) the translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the U.S. National Dental Practice-Based Research Network. Participants were 206 dentists who currently practiced in Araraquara and treated dental caries. Descriptive statistics and multiple logistic regression analyses were used for data analysis. Thirty-six percent of the dentists reported they perform CRA and, among them, 36% indicated they record the assessment on a special form that is kept in the patient chart. More years since dental school graduation (OR = 1.1, p = 0.002) and holding an advanced academic degree (OR=2.6, p=0.005) were associated with a higher likelihood of performing CRA, whereas exclusively using a private practice model (OR = 0.5, p = 0.016) was associated with a lower likelihood of performing CRA. The current oral hygiene and commitment to return for follow-up were the most important risk factors for treatment planning. In conclusion, CRA was not a routine procedure in daily practice among the majority of participating dentists. Specific demographic, practice and academic education characteristics were associated with performing CRA.
Brazilian Journal of Oral Sciences, 2020
Little is known about dental practice patterns of caries prevention in adults among Brazilian den... more Little is known about dental practice patterns of caries prevention in adults among Brazilian dentists. Aim: To quantify procedures used for caries prevention for adult patients among dentists from a Brazilian community. Methods: Dentists (n=197) who reported that at least 10% of their patients are more than 18 years old participated in the first Brazilian study that used a translated version of the “Assessment of Caries Diagnosis and Caries Treatment” from the U.S. National Dental Practice-Based Research Network. A questionnaire about characteristics of their practice and patient population were also completed by the dentists. Generalized linear regression models and a hierarchal clustering procedure were used (p<0.05). Results: In-office fluoride application was the preventive method most often reported. The main predictors for recommending some preventive agent were: female dentist (dental sealant; in-office fluoride; non-prescription fluoride) and percentage of patients inter...
The journal of pain : official journal of the American Pain Society, Jan 28, 2017
This study tested the hypothesis that older adults would have a stronger response for substance P... more This study tested the hypothesis that older adults would have a stronger response for substance P (facilitatory) but weaker response to β-endorphin (inhibitory), both in magnitude and time-course. Eight younger and 9 older adults underwent 3 experimental sessions using well-validated laboratory pain models: cold pressor task (CPT), contact heat pain (HP), and a non-painful control. Blood was collected through an indwelling catheter at baseline and 3, 15, 30, 45, and 60-minutes post-stimuli administration. Older adults had higher baseline levels of both neuropeptides suggesting increased peripheral activity compared to younger adults. Following CPT, older adults demonstrated a quick and strong release of substance P with dramatic recovery, whereas young adults maintained a constant low-grade response. Unlike substance P, β-endorphin increased between 3 and 15 minutes for both groups with the upsurge substantially higher for older adults. Following HP, younger adults had an immediate ...
The Journal of the American Dental Association, 2015
OBJECTIVES-(1) quantify 12-month failures of restorations that were repaired or replaced at basel... more OBJECTIVES-(1) quantify 12-month failures of restorations that were repaired or replaced at baseline; (2) test the hypothesis that no significant differences exist in failure percentages between repaired and replaced restorations after 12 months; (3) test the hypothesis that certain dentist's, patient's and restoration's characteristics are significantly associated with the incidence of restoration failure.
Journal of Orthopaedic & Sports Physical Therapy, 2015
Osteoarthritis and Cartilage, 2013
Medicine & Science in Sports & Exercise, 2014
Despite many studies investigating exercise-induced hypoalgesia, there is limited understanding o... more Despite many studies investigating exercise-induced hypoalgesia, there is limited understanding of the optimal intensity of aerobic exercise in producing hypoalgesic effects across different types of pain stimuli. Given that not all individuals are willing or capable of engaging in high intensity aerobic exercise, whether moderate intensity aerobic exercise is associated with a hypoalgesic response and whether this response generalizes to multiple pain induction techniques needs to be substantiated. Purpose-This study's purpose is to test for differences in the magnitude of pressure and heat pain modulation induced by moderate (MAE) and vigorous (VAE) intensity aerobic exercise. Methods-Twelve healthy young males and 15 females completed one training session and three testing sessions consisting of 25 minutes of either 1) stationary cycling at 70% heart rate reserve (HRR), 2) stationary cycling at 50% HRR, or 3) quiet rest (control). Pain testing was conducted on both forearms prior to and immediately following each condition and included the following tests: pressure pain thresholds (PPT), suprathreshold pressure pain test, static continuous heat test, and repetitive pulse heat pain test. Repeated measures ANOVAs were conducted on each pain measure. Results-VAE and MAE reduced pain ratings during static continuous heat stimuli and repetitive heat pulse stimuli, with VAE producing larger effects. VAE also increased PPTs, while neither exercise influenced suprathreshold pressure pain ratings. Conclusion-These results suggest that MAE is capable of producing a hypoalgesic effect using continuous and repetitive pulse heat stimuli. However, a dose-response effect was evident as VAE produced larger effects than MAE.
The Journal of Pain, 2011
The Journal of Pain, 2009
N-methyl-D-aspartic acid (NMDA) receptors play an important role in the development of hypersensi... more N-methyl-D-aspartic acid (NMDA) receptors play an important role in the development of hypersensitivity to colonic/rectal and somatic stimuli following inflammation or tissue injury (hypersensitive). Our objective was to investigate the role of NMDA NR1 receptors in the spinal cord (T10-L1; L4-S1) of a subset of rats that remain hypersensitive following histological resolution of TNBS-induced colitis compared to saline treated rats and rats that had recovered both behaviorally and histologically. We hypothesized that there would be increased expression of NMDA NR1 subunits in hypersensitive rats in comparison to these two control groups. Male Sprague-Dawley rats (150g-250g) were treated with intracolonic 20mg/ rat trinitrobenzene sulfonic acid (TNBS) in 50% ethanol or saline. Animals underwent nociceptive visceral/somatic pain testing 16 weeks after TNBS administration. Animals were sacrificed and their spinal cord (T10-L1; L4-S1) was retrieved and 2-dimensional polyacrylamide gel electrophoresis and immunohistocytochemistry techniques were used to investigate spinal-NMDA receptor activation 16 weeks following TNBS colitis. NR1001 was the only NMDA NR1 receptor subunit that was expressed in recovered and control rats, whereas hypersensitive animals expressed NR1011 and RN111 as well as NR1001 subunits. Immunohistochemistry analysis demonstrated increased expression of NMDA NR1-N1, C1, and C2-plus expression in lamina I & II of spinal cord (T10-L1; L4-S1) in hypersensitive rats but not in recovered/control rats. Selective increases in the expression of the NMDA NR1 splice variants occur in hypersensitive rats following resolution of TNBS colitis, suggesting that the NMDA NR1 receptor may play an important role in the development of neuronal plasticity and central sensitization. The recombination of NR1 splice variants may serve as a key functional protein that maintains hypersensitivity/pain in these rats.
The Journal of Pain, 2005
Journal of Behavioral Medicine, 2012
The current study tested the hypothesis that conditioned pain modulation is mediated by the relea... more The current study tested the hypothesis that conditioned pain modulation is mediated by the release of endogenous opioids with a placebo-controlled (sugar pill) study of naltrexone (50 mg) in 33 healthy volunteers over two counterbalanced sessions. Pain modulation consisted of rating of heat pain (palm) during concurrent cold water immersion (foot). Compared to baseline heat pain ratings, concurrent foot immersion lowered pain intensity ratings, which suggests an inhibitory effect, was reduced with naltrexone, suggesting at least partial dependence of inhibition on endogenous opioids. An exploratory analysis revealed that individual differences in catastrophizing moderated the effects of naltrexone; endogenous opioid blockade abolished modulation in subjects lower in catastrophizing while modulation was unaffected by naltrexone among high catastrophizers. The results suggest a role of endogenous opioids in endogenous
Journal of Sport and Exercise Psychology, 2005
This study examined whether specific participant characteristics (age, sex, BMI, exercise history... more This study examined whether specific participant characteristics (age, sex, BMI, exercise history, and self-efficacy) differentially predicted adherence to exercise programs of moderate vs. higher levels of intensity and frequency. Sedentary adults (N = 379) were randomly assigned in a 2 × 2 design to walk 30 min/day at a frequency of either 3 to 4 days/week or 5 to 7 days/week, at an intensity of either 45–55% or 65–75% of maximum heart rate reserve. Exercise adherence was assessed via daily exercise logs completed during Months 2–6 of the exercise program. The major finding of this study was that participants with higher levels of past exercise showed better adherence to higher intensity exercise but tended to have poorer adherence to moderate intensity exercise. Our results suggest that a person’s previous experience with exercise should be considered when prescribing higher intensity exercise, and that individuals with an extensive exercise history can be prescribed higher inten...
Public health reports (Washington, D.C. : 1974)
Accomplishing the Healthy People 2010 goal of eliminating disparities in oral disease will requir... more Accomplishing the Healthy People 2010 goal of eliminating disparities in oral disease will require a better understanding of the patterns of health care associated with orofacial pain. This study examined factors associated with pain-related acute oral health care. The authors used data on 698 participants in the Florida Dental Care Study, a study of oral health among dentate adults aged 45 years and older at baseline. Fifteen percent of the respondents reported having had at least one dental visit as the result of orofacial pain. The majority of the respondents reportedly delayed contacting a dentist for at least one day; however, there was no difference between respondents reporting pain as the initiating symptom and those with other problems. Once respondents decided that dental services were needed, those with a painful symptom were nearly twice as likely as those without pain to want to be seen immediately. Rural adults were more likely than urban adults to report having receiv...
Pain, 2002
The purpose of this study was to examine racial/ethnic-related differences in a four-stage model ... more The purpose of this study was to examine racial/ethnic-related differences in a four-stage model of the processing of chronic pain. The subjects were 1557 chronic pain patients (White=1084, African American=473) evaluated at a pain management clinic at a large southeastern university medical center. Using an analysis of covariance controlling for pain duration and education, African American patients reported significantly higher levels of pain unpleasantness, emotional response to pain, and pain behavior, but not pain intensity than Whites. Differences were largest for the unpleasantness and emotion measures, particularly depression and fear. The groups differed by approximately 1.0 visual analogue scale unit, a magnitude that may be clinically significant. Racial/ethnic differences in the linear relationship between stages were also tested using structural equation modeling and LISREL-8. The results indicate differences in linear associations between pain measures with African Americans showing a stronger link between emotions and pain behavior than Whites.
Pain, 2009
Recent meta-analyses find various magnitudes of placebo analgesia effects in placebo mechanism tr... more Recent meta-analyses find various magnitudes of placebo analgesia effects in placebo mechanism trials versus placebo control trials, which have led to debate. To further investigate the magnitude of placebo analgesia in placebo mechanism trials the databases ''PubMed", ''PsycINFO" and ''Web of Science" (2002-2007) were searched with the term ''placebo analgesia". Twenty-one articles including 24 studies fulfilled the selection criteria (concerning: mechanisms, control, placebo treatment, randomization and pain measures). The validity of studies was assessed by the authors and effect sizes were calculated via difference scores. The magnitude of placebo analgesia in placebo mechanism studies was large (d = 1.00) and about five times larger than placebo analgesia effects in placebo control studies (d = 0.15-0.27). Differences in magnitude between the two types of studies appear to result from different types of suggestions given for pain relief. The magnitude of placebo effects was larger in studies that used long-term pain stimuli >20 s (d = 0.96) as opposed to short-term stimuli (d = 0.81) and the largest placebo effects were found in studies wherein hyperalgesia was present (d = 1.88). These results replicate our previous finding that placebo analgesic effects are higher in mechanism studies than in placebo control studies. However, since magnitudes of placebo analgesic effects are highly variable it may be valuable to investigate the factors and mechanisms that contribute to this variability as well as differences in magnitudes across types of studies.
Psychosomatic Medicine, 2001
The current study investigated whether the relationship between sex and experimental pain report ... more The current study investigated whether the relationship between sex and experimental pain report was explained by systolic blood pressure (SBP) at rest or during pain task, by gender-role socialization as assessed by the Bem Sex Role Inventory, or both. The influence of gender-role socialization on pain report is often inferred but rarely studied. Methods: Fifty female and 54 male healthy, young adults completed the Bem Sex Role Inventory and then underwent a cold pressor task. Blood pressure was assessed before and during pain testing. Results: Univariate analyses indicated significant sex-related differences in pain threshold and pain tolerance. Baseline SBP was positively related to pain tolerance but did not explain sex differences, in accord with previous research. The Bem Sex Role Inventory demonstrated a relationship with pain, but did not explain sex differences. Conclusions: We suggest that context-specific measures of gender are needed to assess gender-related pain behaviors in specific situations. Results from the current study support our contention that gender is part of sex as commonly measured. Also, blood pressure does not appear to fully account for sex-related differences in pain.
Pain, 2002
A previous meta-analysis of clinical analgesic trial studies showed generally low magnitudes of p... more A previous meta-analysis of clinical analgesic trial studies showed generally low magnitudes of placebo analgesia (N. Engl. J. Med. 344 (2001) 1594). However, as studies included in their analysis used only placebo as a control condition, we conducted two meta-analyses, one in which 23 studies used only placebo as a control condition, and one in which 14 studies investigated placebo analgesic mechanisms. Magnitudes of placebo analgesic effects were much higher in the latter (mean effect size=0.95) as compared to the former (mean effect size=0.15) and were significantly different (P=0.003). This difference as well as differences in effect sizes within studies of placebo mechanisms may be parsimoniously explained by differences in expected pain levels produced by placebo suggestions and by conditioning. Furthermore, some of the studies of placebo analgesic mechanisms indicate that the magnitude of placebo analgesia is higher when the placebo analgesic effect is induced via suggestion combined with conditioning than via suggestion alone or conditioning alone. Based on these findings, we suggest that placebo analgesic effects are most optimally conceptualized in terms of perception of the placebo agent, and therefore a new definition of placebo response is proposed.
Journal of Occupational Rehabilitation, 1997
However, the reliability and validity of current assessment methods have not been unequivocally d... more However, the reliability and validity of current assessment methods have not been unequivocally demonstrated. This study focused on the detection of submaximal efforts and determination of the stability of the coefficient of variation (CV) in 20 asymptomatic subjects. The coefficient of variation of peak torque (CVpeak) and coefficient of variation of average torque (CVave) were obtained from maximal and submaximal torque curves during fast isokinetic (180 deg/s) leg extension strength tests. Significant differences between effort levels (maximal and submaximal) were found for CVpeak and CVave on both days of testing (p < .001). On Day 1 of testing, using an optimized 10% CVpeak cutoff resulted in a submaximal effort detection rate of 75% with an overall (maximal and submaximal efforts) correct classification rate of 88%. Correlation coefficients indicated relatively moderate stability using the CVpeak calculated using five trials for both maximal (r = .47, p < ,05) and submaximal (r = .78, p < .001) effort conditions. Findings suggest that use of an increased number of repetitions to calculate the CV may result in more stable measures.
Journal of Esthetic and Restorative Dentistry, 2006
To investigate the effectiveness of alternative treatments to the replacement of resinbased compo... more To investigate the effectiveness of alternative treatments to the replacement of resinbased composite (RBC) restorations through a prospective longitudinal cohort clinical study. Materials and Methods: Forty patients aged 27 to 77 years (mean = 55) with 88 RBC restorations, with one or more features that deviated from ideal, participated in the study. They were assigned to five treatment groups: repair (N = 25), sealing of defective margins (N = 13), resurfacing (N = 18), replacement (N = 16), and the no-treatment group (N = 16). The replacement and no-treatment groups served as comparison groups and received random assignment. Two clinicians examined the quality of the restorations (N = 88) prior to the assigned treatment, and at subsequent recalls (1 and 2 years) using a modified Ryge criteria (Alfa, Bravo, and Charlie, meaning clinically excellent, clinically acceptable with one or more features that deviated from ideal, and clinically unacceptable, respectively) that observed (1) color, (2) marginal adaptation, (3) anatomic form, (4) surface roughness, (5) marginal staining, (6) bulk discoloration, (7) contact, (8) secondary caries, (9) postoperative sensitivity, and (10) luster. Results: At 1-and 2-year recalls, 66 (75%) and 58 (66%) restorations were examined. Kruskal-Wallis Test showed significant differences for marginal adaptation and marginal staining for both 1-and 2-year recall exams (p < .05). The repair, sealant, and replacement groups presented significant improvement when compared with the no-treatment group for marginal adaptation. The repair and replacement groups showed superior results when compared with the no-treatment group for marginal staining. Conclusion: RBC restorations that present less-than-ideal marginal adaptation and stained margins are better off being repaired. CLINICAL SIGNIFICANCE Repair of resin-based composite (RBC) restorations is a conservative option for treatment of RBC restorations with inadequate marginal adaptation and marginal staining.