101
|
Landmann G, Dumat W, Egloff N, Gantenbein AR, Matter S, Pirotta R, Sándor PS, Schleinzer W, Seifert B, Sprott H, Stockinger L, Riederer F. Bilateral Sensory Changes and High Burden of Disease in Patients With Chronic Pain and Unilateral Nondermatomal Somatosensory Deficits: A Quantitative Sensory Testing and Clinical Study. Clin J Pain 2017; 33:746-755. [PMID: 27841837 PMCID: PMC5438869 DOI: 10.1097/ajp.0000000000000456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Widespread sensory deficits resembling hemihypoesthesia occur in 20% to 40% of chronic pain patients on the side of pain, independent of pain etiology, and have been termed nondermatomal sensory deficits (NDSDs). Sensory profiles have rarely been investigated in NDSDs. MATERIALS AND METHODS Quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS) was performed in the face, hand, and foot of the painful body side and in contralateral regions in chronic pain patients. Twenty-five patients with NDSDs and 23 without NDSDs (termed the pain-only group) were included after exclusion of neuropathic pain. Comprehensive clinical and psychiatric evaluations were carried out. RESULTS NDSD in chronic pain was associated with high burden of disease and more widespread pain. Only in the NDSD group were significantly higher thresholds for mechanical and painful stimuli found in at least 2 of 3 regions ipsilateral to pain. In addition, we found a bilateral loss of function for temperature and vibration detection, and a gain of function for pressure pain in certain regions in patients with NDSD. Sensory loss and gain of function for pressure pain correlated with pain intensity in several regions. DISCUSSION This may indicate a distinct sensory profile in chronic non-neuropathic pain and NDSD, probably attributable to altered central pain processing and sensitization. The presence of NDSD in chronic non-neuropathic pain may be regarded as a marker for higher burden of pain disease.
Collapse
Affiliation(s)
- Gunther Landmann
- Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland
| | - Wolfgang Dumat
- Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland
| | - Niklaus Egloff
- Psychosomatic Division, C.L. Lory-Haus, Department of General Internal Medicine, Inselspital, University Hospital, Bern, Switzerland
| | | | - Sibylle Matter
- Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland
| | - Roberto Pirotta
- Department of Psychiatry, University Hospital, Zurich, Switzerland
| | - Peter S. Sándor
- University of Zurich, Zurich, Switzerland
- ANNR Neurology, RehaClinic, Baden, Switzerland
| | | | - Burkhardt Seifert
- Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Heiko Sprott
- University of Zurich, Zurich, Switzerland
- Medical practice Hottingen, Zurich, Switzerland
| | - Lenka Stockinger
- Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland
| | - Franz Riederer
- University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital, Zurich, Switzerland
- Neurological Center Rosenhuegel & Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| |
Collapse
|
102
|
Congenital deafness is associated with specific somatosensory deficits in adolescents. Sci Rep 2017; 7:4251. [PMID: 28652589 PMCID: PMC5484691 DOI: 10.1038/s41598-017-04074-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/09/2017] [Indexed: 12/25/2022] Open
Abstract
Hearing and touch represent two distinct sensory systems that both rely on the transformation of mechanical force into electrical signals. Here we used a battery of quantitative sensory tests to probe touch, thermal and pain sensitivity in a young control population (14–20 years old) compared to age-matched individuals with congenital hearing loss. Sensory testing was performed on the dominant hand of 111 individuals with normal hearing and 36 with congenital hearing loss. Subjects with congenital deafness were characterized by significantly higher vibration detection thresholds at 10 Hz (2-fold increase, P < 0.001) and 125 Hz (P < 0.05) compared to controls. These sensory changes were not accompanied by any major change in measures of pain perception. We also observed a highly significant reduction (30% compared to controls p < 0.001) in the ability of hearing impaired individual’s ability to detect cooling which was not accompanied by changes in warm detection. At least 60% of children with non-syndromic hearing loss showed very significant loss of vibration detection ability (at 10 Hz) compared to age-matched controls. We thus propose that many pathogenic mutations that cause childhood onset deafness may also play a role in the development or functional maintenance of somatic mechanoreceptors.
Collapse
|
103
|
Lindbäck Y, Tropp H, Enthoven P, Gerdle B, Abbott A, Öberg B. Altered somatosensory profile according to quantitative sensory testing in patients with degenerative lumbar spine disorders scheduled for surgery. BMC Musculoskelet Disord 2017. [PMID: 28623897 PMCID: PMC5474047 DOI: 10.1186/s12891-017-1581-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Somatosensory profiling in affected and non-affected body regions can strengthen our insight regarding the underlying pain mechanisms, which can be valuable in treatment decision making and to improve outcomes, in patients with degenerative lumbar spine disorders pre-surgery. The aim was to describe somatosensory profiles in patients with degenerative lumbar spine disorders, to identify the proportion with altered somatosensory profile, and to analyze demographic characteristics, self-reported function, pain, and health pre- and 3 months post-surgery. Methods In this prospective cohort study in a Spine Clinic, 105 patients scheduled for surgery for spinal stenosis, disc herniation, degenerative disc disease, or spondylolisthesis were consecutively recruited. Exclusion criteria were; indication for acute surgery or previous surgery at the same spinal level or severe grade of pathology. Quantitative sensory testing (QST) and self-reported function, pain, and health was measured pre- and 3 months post-surgery. The somatosensory profile included cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold and pressure pain threshold in affected and non-affected body regions. Results On a group level, the patients’ somatosensory profiles were within the 95% confidence interval (CI) from normative reference data means. On an individual level, an altered somatosensory profile was defined as having two or more body regions (including a non-affected region) with QST values outside of normal ranges for reference data. The 23 patients (22%) with altered somatosensory profiles, with mostly loss of function, were older (P = 0.031), more often female (P = 0.005), had higher back and leg pain (P = 0.016, 0.020), lower mental health component summary score (SF-36 MCS) (P = 0.004) and larger pain distribution (P = 0.047), compared to others in the cohort. Post-surgery there was a tendency to worse pain, function and health in the group with altered somatosensory profile pre-surgery. Conclusions On a group level, patients with degenerative lumbar spine disorders scheduled for surgery were within normal range for the QST measurements compared to reference values. On an individual level, an altered somatosensory profile outside of normal range in both affected and non-affected body regions occurred in 22% of patients, which may indicate disturbed somatosensory function. Those patients had mostly loss of sensory function and had worse self-reported outcome pre-surgery, compared to the rest of the cohort. Future prospective studies are needed to further examine whether these dimensions can be useful in predicting post-surgery outcome and guide need of additional treatments.
Collapse
Affiliation(s)
- Yvonne Lindbäck
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden. .,, .
| | - Hans Tropp
- Department of Spinal Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Paul Enthoven
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.,
| | - Björn Gerdle
- Pain and Rehabilitation Center, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Allan Abbott
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.,Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, 4229, Australia.,
| | - Birgitta Öberg
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.,
| |
Collapse
|
104
|
The long-term reliability of static and dynamic quantitative sensory testing in healthy individuals. Pain 2017; 158:1217-1223. [DOI: 10.1097/j.pain.0000000000000901] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
105
|
Symptom profiles in the painDETECT Questionnaire in patients with peripheral neuropathic pain stratified according to sensory loss in quantitative sensory testing. Pain 2017; 157:1810-1818. [PMID: 27093432 DOI: 10.1097/j.pain.0000000000000588] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The painDETECT Questionnaire (PDQ) is commonly used as a screening tool to discriminate between neuropathic pain (NP) and nociceptive pain, based on the self-report of symptoms, including pain qualities, numbness, and pain to touch, cold, or heat. However, there are minimal data about whether the PDQ is differentially sensitive to different sensory phenotypes in NP. The aim of the study was to analyze whether the overall PDQ score or its items reflect phenotypes of sensory loss in NP as determined by quantitative sensory testing. An exploratory analysis in the Innovative Medicines Initiative Europain and Neuropain database was performed. Data records of 336 patients identified with NP were grouped into sensory profiles characterized by (1) no loss of sensation, (2) loss of thermal sensation, (3) loss of mechanical sensation, and (4) loss of thermal and mechanical sensation. painDETECT Questionnaire profiles were analyzed in a 2-factor analysis of variance. Patients with loss of thermal sensation (2 and 4) significantly more often reported pain evoked by light touch, and patients with loss of mechanical sensation (3 and 4) significantly more often reported numbness and significantly less often burning sensations and pain evoked by light touch. Although the PDQ was not designed to assess sensory loss, single items reflect thermal and/or mechanical sensory loss at group level, but because of substantial variability, the PDQ does not allow for individual allocation of patients into sensory profiles. It will be useful to develop screening tools according to the current definition of NP.
Collapse
|
106
|
Abstract
There is tremendous interpatient variability in the response to analgesic therapy (even for efficacious treatments), which can be the source of great frustration in clinical practice. This has led to calls for "precision medicine" or personalized pain therapeutics (ie, empirically based algorithms that determine the optimal treatments, or treatment combinations, for individual patients) that would presumably improve both the clinical care of patients with pain and the success rates for putative analgesic drugs in phase 2 and 3 clinical trials. However, before implementing this approach, the characteristics of individual patients or subgroups of patients that increase or decrease the response to a specific treatment need to be identified. The challenge is to identify the measurable phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics. In this article, we present evidence on the most promising of these phenotypic characteristics for use in future research, including psychosocial factors, symptom characteristics, sleep patterns, responses to noxious stimulation, endogenous pain-modulatory processes, and response to pharmacologic challenge. We provide evidence-based recommendations for core phenotyping domains and recommend measures of each domain.
Collapse
|
107
|
Usefulness of laser-evoked potentials and quantitative sensory testing in the diagnosis of neuropathic spinal cord injury pain: a multiple case study. Spinal Cord 2017; 55:575-582. [PMID: 28117333 DOI: 10.1038/sc.2016.191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/12/2016] [Accepted: 12/18/2016] [Indexed: 12/18/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES The aim of this study was to investigate the contribution of laser-evoked potentials (LEPs) and quantitative sensory testing (QST) to the diagnosis of neuropathic pain in patients with spinal cord injury (SCI) and inconclusive magnetic resonance imaging (MRI) findings. SETTING A multidisciplinary pain center. METHODS QST (DFNS protocol) and Tm-YAG-laser stimulation of the skin were applied within the pain site corresponding with dermatomes of altered sensation. Available MRI scans were reviewed. RESULTS Thirteen individuals (50±16 years) with SCI were examined. In four cases with no detectable neural lesion on MRI, all QST but three LEP were abnormal. In four patients with poorly defined spinal lesion on MRI, all QST but three LEP only were abnormal. In four cases where pain was not matching adequately with MRI lesions, all patients had abnormal LEP and QST. In one patient showing a spinal cord atrophy, LEP was normal but QST was abnormal. Findings supported the diagnoses at-level (n=5) and below-level (n=8) SCI pain. Spinothalamic tract function assessed by LEP was normal in three cases, but QST was abnormal in all cases. CONCLUSIONS As QST is a psychophysical examination depending on patient cooperation, we suggest that the combination of QST and LEP might be a valuable diagnostic tool to detect lesions of the somatosensory system in a subgroup of patients with neuropathic spinal cord injury pain and inconclusive MRI findings.
Collapse
|
108
|
Crane AM, Feuer W, Felix ER, Levitt RC, McClellan AL, Sarantopoulos KD, Galor A. Evidence of central sensitisation in those with dry eye symptoms and neuropathic-like ocular pain complaints: incomplete response to topical anaesthesia and generalised heightened sensitivity to evoked pain. Br J Ophthalmol 2017; 101:1238-1243. [PMID: 28100479 DOI: 10.1136/bjophthalmol-2016-309658] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/13/2016] [Accepted: 12/17/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate how closely neuropathic-like ocular pain (NOP) symptoms align with a metric of central sensitisation (ie, the presence of persistent ocular pain after topical anaesthetic placement) in individuals with dry eye (DE) symptoms. DESIGN Cross-sectional study of 224 individuals with DE symptoms seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding DE symptoms, NOP descriptors and evoked pain sensitivity testing on the forehead and forearm, followed by a comprehensive ocular surface examination including corneal mechanical sensitivity testing. Subsequent analyses were performed to examine for differences between those with and without ocular pain after topical anaesthetic placement. RESULTS The mean age was 62 years with 91% being men. DE symptoms and NOP symptoms were higher in subjects with persistent ocular pain after anaesthesia. Most DE signs were not related to persistent pain, with the exception of meibum quality. Individuals with persistent ocular pain also demonstrated greater sensitivity to evoked pain at testing sites on the forehead and forearm. When examining receiver operator characteristic curves considering persistent pain as a gold standard for central sensitisation within the corneal pathway, intensity of ocular pain ratings, Ocular Surface Disease Index scores and sensitivity to light provided the most robust relationships, each with an area under the curve of 0.72. CONCLUSIONS Individuals with DE symptoms and persistent ocular pain after topical proparacaine (a marker of central sensitisation to pain) more frequently report NOP-like symptoms and demonstrate increased sensitivity to evoked pain.
Collapse
Affiliation(s)
- Ashley M Crane
- Miami Veterans Administration Medical Center, Miami, Florida, USA.,Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - William Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Elizabeth R Felix
- Miami Veterans Administration Medical Center, Miami, Florida, USA.,Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Roy C Levitt
- Miami Veterans Administration Medical Center, Miami, Florida, USA.,Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA.,John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Konstantinos D Sarantopoulos
- Miami Veterans Administration Medical Center, Miami, Florida, USA.,Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, Florida, USA.,Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| |
Collapse
|
109
|
|
110
|
Barbalinardo S, Loer SA, Goebel A, Perez RSGM. The Treatment of Longstanding Complex Regional Pain Syndrome with Oral Steroids. PAIN MEDICINE 2017; 17:337-43. [PMID: 26814238 DOI: 10.1093/pm/pnv002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evaluate the effectiveness of oral steroids in relieving pain in patients with Complex Regional Pain Syndrome (CRPS) of more than 3 months duration. DESIGN Service evaluation/Open label uncontrolled trial. SETTING Two pain outpatient clinics specialized in CRPS diagnosis and treatment in the period 2009-2012. SUBJECTS Thirty-one patients diagnosed with CRPS with the Budapest criteria in two specialized centers, with a disease duration of more than 3 months and not responsive to standard treatment were included. METHODS Patients were treated with oral prednisolone in both centers [100 mg daily tapered by 25 mg every 4 days to zero (Σ1g) at center 1 (C1) and 60 mg daily for 2 weeks lowered 20 mg every 4 days to zero (Σ1.06g) at center 2 (C2)]. The average pain intensity was recorded by patients using a numeric rating scale before the treatment start, and 6 weeks after treatment onset (treatment duration was respectively 16 days and 22 days at the two centers). RESULTS Overall the authors observed no significant reduction in the average pain intensity (P = 0.059), but 2 patients had a consistent reduction in pain intensity with return to baseline pain levels 9 weeks after treatment onset, and 1 patient had ongoing stable pain relief of >50%. CONCLUSIONS This study provides indications that the efficacy of oral corticosteroids is limited in treating CRPS of more than 3 months duration who did not respond to previous treatment. Randomized controlled studies (with enriched designs), or single subject designs would be required to identify the possible existence of a patient subgroup with a specific disease profile that may benefit from a steroid treatment.
Collapse
|
111
|
Kostek M, Polaski A, Kolber B, Ramsey A, Kranjec A, Szucs K. A Protocol of Manual Tests to Measure Sensation and Pain in Humans. J Vis Exp 2016. [PMID: 28060280 DOI: 10.3791/54130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Numerous qualitative and quantitative techniques can be used to test sensory nerves and pain in both research and clinical settings. The current study demonstrates a quantitative sensory testing protocol using techniques to measure tactile sensation and pain threshold for pressure and heat using portable and easily accessed equipment. These techniques and equipment are ideal for new laboratories and clinics where cost is a concern or a limiting factor. We demonstrate measurement techniques for the following: cutaneous mechanical sensitivity on the arms and legs (von-Frey filaments), radiant and contact heat sensitivity (with both threshold and qualitative assessments using the Visual Analog Scale (VAS)), and mechanical pressure sensitivity (algometer, with both threshold and the VAS). The techniques and equipment described and demonstrated here can be easily purchased, stored, and transported by most clinics and research laboratories around the world. A limitation of this approach is a lack of automation or computer control. Thus, these processes can be more labor intensive in terms of personnel training and data recording than the more sophisticated equipment. We provide a set of reliability data for the demonstrated techniques. From our description, a new laboratory should be able to set up and run these tests and to develop their own internal reliability data.
Collapse
Affiliation(s)
- Matthew Kostek
- Chronic Pain Research Consortium, Duquesne University; Department of Physical Therapy, Duquesne University
| | - Anna Polaski
- Chronic Pain Research Consortium, Duquesne University; Department of Biological Sciences, Duquesne University
| | - Benedict Kolber
- Chronic Pain Research Consortium, Duquesne University; Department of Biological Sciences, Duquesne University
| | - Austin Ramsey
- Chronic Pain Research Consortium, Duquesne University
| | - Alexander Kranjec
- Chronic Pain Research Consortium, Duquesne University; Department of Psychology, Duquesne University
| | - Kimberly Szucs
- Chronic Pain Research Consortium, Duquesne University; Department of Occupational Therapy, Duquesne University;
| |
Collapse
|
112
|
Quantitative sensory testing using DFNS protocol in Europe: an evaluation of heterogeneity across multiple centers in patients with peripheral neuropathic pain and healthy subjects. Pain 2016; 157:750-758. [PMID: 26630440 DOI: 10.1097/j.pain.0000000000000433] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Quantitative sensory testing (QST) in accordance with the DFNS (German Research Network on Neuropathic Pain) protocol assesses the function of afferent nerve fibers on the basis of 13 parameters. Within the consortia IMI (Innovative Medicines Initiative) Europain and Neuropain, QST results from pain research units experienced in QST across Europe can be compared for the first time. Aim of this analysis was to identify possible biases in the QST assessment between 10 centers from 8 different European countries. In total, 188 healthy subjects, 217 patients with painful polyneuropathy, and 150 patients with painful peripheral nerve injury were included in the analysis. Mixed effects models were constructed for each of the 11 normally distributed QST parameters with z-value as the dependent variable, and center as the random effect. The I statistic for heterogeneity was calculated, an index ranging from 0% (no heterogeneity) to 100% (perfect heterogeneity). Data from healthy subjects were comparable with the existing reference data base. Patients with polyneuropathy mainly displayed loss of sensory function, whereas patients with peripheral nerve injury often showed sensory loss combined with mechanical hyperalgesia. Heterogeneity was overall low between different centers and parameters. There was no systematic heterogeneity for patients with painful peripheral nerve injury and painful polyneuropathy. For healthy subjects, only blunt pressure pain threshold showed a considerable heterogeneity of 42% (95% confidence interval: 0%-66%). In conclusion, QST of both healthy subjects and patients with peripheral neuropathic pain is largely homogenous within the European centers, an essential prerequisite for performing multicenter QST-based studies.
Collapse
|
113
|
Bouhassira D, Attal N. Translational neuropathic pain research: A clinical perspective. Neuroscience 2016; 338:27-35. [DOI: 10.1016/j.neuroscience.2016.03.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 12/31/2022]
|
114
|
Differing Psychologically Derived Clusters in People With Chronic Low Back Pain are Associated With Different Multidimensional Profiles. Clin J Pain 2016; 32:1015-1027. [DOI: 10.1097/ajp.0000000000000363] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
115
|
Ohnesorge H, Alpes A, Baron R, Gierthmühlen J. Influence of intraoperative remifentanil and sufentanil on sensory perception: a randomized trial. Curr Med Res Opin 2016; 32:1797-1805. [PMID: 27388980 DOI: 10.1080/03007995.2016.1211517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The clinical relevance of pro- and hyperalgesic effects of opioids is still a matter of debate. Particularly for remifentanil, an increased postoperative need for analgesics has been demonstrated suggesting opioid-induced hyperalgesia as a possible cause. The aim of the study was therefore to investigate the effect of intraoperatively applied remifentanil compared to sufentanil on somatosensory thresholds investigated with the quantitative sensory testing (QST) battery of the German Research Network on Neuropathic Pain (DFNS). RESEARCH DESIGN AND METHODS Twenty-three patients undergoing surgery of the female breast were randomly assigned to intraoperative remifentanil (0.4 μg × kg-1 × min-1) or sufentanil (0.25 μg × kg-1 bolus, 0.15 μg × kg-1, repetition after 60 min) application. Anesthesia was maintained BIS-guided (Bispectral indexTM) with propofol and postoperative analgesia was ensured with paracetamol (max. 3 g/24 h). Quantitative sensory testing was performed in the region of dermatome Th 5 in the mid-axillary line preoperatively and 20 h postoperatively. CLINICAL TRIAL REGISTRATION The study was registered at the German registry for clinical studies (DRKS00009002). MAIN OUTCOME MEASURES Comparison of somatosensory thresholds before versus after surgery and application of intraoperative remifentanil or sufentanil. RESULTS Sixteen patients could be finally included in the analysis. No differences of mechanical or thermal detection or pain thresholds were observed between pre- and postoperative testing or between remifentanil and sufentanil. CONCLUSION A change of somatosensory thresholds or a clinically relevant opioid-induced hyperalgesia in the selected small patient sample (segmental resections or mastectomy with or without sentinel lymph node biopsy, surgery length <90 minutes, sufficient postoperative pain medication with paracetamol due to rather low postoperative pain intensities) with remifentanil or sufentanil was not detected 20 h after surgery.
Collapse
Affiliation(s)
- H Ohnesorge
- a Department of Anaesthesiology and Intensive Care Medicine , University Hospital Schleswig-Holstein , Campus Kiel , Kiel , Germany
| | - A Alpes
- b Division of Neurological Pain Research and Therapy, Department of Neurology , University Hospital Schleswig-Holstein , Campus Kiel , Kiel , Germany
| | - R Baron
- b Division of Neurological Pain Research and Therapy, Department of Neurology , University Hospital Schleswig-Holstein , Campus Kiel , Kiel , Germany
| | - J Gierthmühlen
- b Division of Neurological Pain Research and Therapy, Department of Neurology , University Hospital Schleswig-Holstein , Campus Kiel , Kiel , Germany
| |
Collapse
|
116
|
Wodarski R, Delaney A, Ultenius C, Morland R, Andrews N, Baastrup C, Bryden LA, Caspani O, Christoph T, Gardiner NJ, Huang W, Kennedy JD, Koyama S, Li D, Ligocki M, Lindsten A, Machin I, Pekcec A, Robens A, Rotariu SM, Voß S, Segerdahl M, Stenfors C, Svensson CI, Treede RD, Uto K, Yamamoto K, Rutten K, Rice AS. Cross-centre replication of suppressed burrowing behaviour as an ethologically relevant pain outcome measure in the rat: a prospective multicentre study. Pain 2016; 157:2350-65. [PMID: 27643836 PMCID: PMC5028161 DOI: 10.1097/j.pain.0000000000000657] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 12/11/2022]
Abstract
Burrowing, an ethologically relevant rodent behaviour, has been proposed as a novel outcome measure to assess the global impact of pain in rats. In a prospective multicentre study using male rats (Wistar, Sprague-Dawley), replication of suppressed burrowing behaviour in the complete Freund adjuvant (CFA)-induced model of inflammatory pain (unilateral, 1 mg/mL in 100 µL) was evaluated in 11 studies across 8 centres. Following a standard protocol, data from participating centres were collected centrally and analysed with a restricted maximum likelihood-based mixed model for repeated measures. The total population (TP-all animals allocated to treatment; n = 249) and a selected population (SP-TP animals burrowing over 500 g at baseline; n = 200) were analysed separately, assessing the effect of excluding "poor" burrowers. Mean baseline burrowing across studies was 1113 g (95% confidence interval: 1041-1185 g) for TP and 1329 g (1271-1387 g) for SP. Burrowing was significantly suppressed in the majority of studies 24 hours (7 studies/population) and 48 hours (7 TP, 6 SP) after CFA injections. Across all centres, significantly suppressed burrowing peaked 24 hours after CFA injections, with a burrowing deficit of -374 g (-479 to -269 g) for TP and -498 g (-609 to -386 g) for SP. This unique multicentre approach first provided high-quality evidence evaluating suppressed burrowing as robust and reproducible, supporting its use as tool to infer the global effect of pain on rodents. Second, our approach provided important informative value for the use of multicentre studies in the future.
Collapse
Affiliation(s)
- Rachel Wodarski
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, United Kingdom
- Eli Lilly and Company, Erl Wood Manor, Windlesham, United Kingdom
| | - Ada Delaney
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Camilla Ultenius
- Neuroscience CNSP iMED, AstraZeneca R&D Södertälje, Södertälje, Sweden
| | - Rosie Morland
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Nick Andrews
- Department of Neurobiology, Boston Children's Hospital, MA, USA
| | - Catherine Baastrup
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - Luke A. Bryden
- CNS Disease Division Research Germany, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach an der Riss, Germany
| | - Ombretta Caspani
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim (CBTM), Heidelberg University, Mannheim, Germany
| | - Thomas Christoph
- Department of Pharmacology and Biomarker Development, Translational Science and Strategy, Grünenthal GmbH, Aachen, Germany
| | - Natalie J. Gardiner
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Wenlong Huang
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | | | - Suguru Koyama
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corporation, Shizuoka, Japan
| | - Dominic Li
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Marcin Ligocki
- Eli Lilly and Company, Erl Wood Manor, Windlesham, United Kingdom
| | | | - Ian Machin
- Deal, Kent, United Kingdom. L. A. Bryden is now with the Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom. W. Huang is now with the Institute of Medical Sciences, University of Aberdeen, United Kingdom. C. Stenfors is now with the R&D CNS Research, Orion Corporation, Orion Pharma, Espoo, Finland
| | - Anton Pekcec
- CNS Disease Division Research Germany, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach an der Riss, Germany
| | - Angela Robens
- Department of Pharmacology and Biomarker Development, Translational Science and Strategy, Grünenthal GmbH, Aachen, Germany
| | - Sanziana M. Rotariu
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Sabrina Voß
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim (CBTM), Heidelberg University, Mannheim, Germany
| | - Marta Segerdahl
- Neuroscience CNSP iMED, AstraZeneca R&D Södertälje, Södertälje, Sweden
- H. Lundbeck A/S, Valby, Denmark
| | - Carina Stenfors
- Neuroscience CNSP iMED, AstraZeneca R&D Södertälje, Södertälje, Sweden
| | - Camilla I. Svensson
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim (CBTM), Heidelberg University, Mannheim, Germany
| | - Katsuhiro Uto
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corporation, Shizuoka, Japan
| | - Kazumi Yamamoto
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corporation, Shizuoka, Japan
| | - Kris Rutten
- Department of Pharmacology and Biomarker Development, Translational Science and Strategy, Grünenthal GmbH, Aachen, Germany
| | - Andrew S.C. Rice
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| |
Collapse
|
117
|
Arendt-Nielsen L. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states. Scand J Pain 2016; 13:125-126. [DOI: 10.1016/j.sjpain.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction(SMI), School of Medicine , Aalborg University , Aalborg E , Denmark
| |
Collapse
|
118
|
Pérez de Vega MJ, Gómez-Monterrey I, Ferrer-Montiel A, González-Muñiz R. Transient Receptor Potential Melastatin 8 Channel (TRPM8) Modulation: Cool Entryway for Treating Pain and Cancer. J Med Chem 2016; 59:10006-10029. [PMID: 27437828 DOI: 10.1021/acs.jmedchem.6b00305] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
TRPM8 ion channels, the primary cold sensors in humans, are activated by innocuous cooling (<28 °C) and cooling compounds (menthol, icilin) and are implicated in sensing unpleasant cold stimuli as well as in mammalian thermoregulation. Overexpression of these thermoregulators in prostate cancer and in other life-threatening tumors, along with their contribution to an increasing number of pathological conditions, opens a plethora of medicinal chemistry opportunities to develop receptor modulators. This Perspective seeks to describe current known modulators for this ion channel because both agonists and antagonists may be useful for the treatment of most TRPM8-mediated pathologies. We primarily focus on SAR data for the different families of compounds and the pharmacological properties of the most promising ligands. Furthermore, we also address the knowledge about the channel structure, although still in its infancy, and the role of the TRPM8 protein signalplex to channel function and dysfunction. We finally outline the potential future prospects of the challenging TRPM8 drug discovery field.
Collapse
Affiliation(s)
| | - Isabel Gómez-Monterrey
- Dipartimento di Farmacia, Università "Federico II" de Napoli , Via D. Montesano 49, 80131, Naples, Italy
| | - Antonio Ferrer-Montiel
- Instituto de Biología Molecular y Celular. Universitas Miguel Hernández . 03202 Alicante, Spain
| | | |
Collapse
|
119
|
Springer J, Karlsson P, Madsen C, Johnsen B, Finnerup N, Jensen T, Nikolajsen L. Functional and structural assessment of patients with and without persistent pain after thoracotomy. Eur J Pain 2016; 21:238-249. [DOI: 10.1002/ejp.919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 12/12/2022]
Affiliation(s)
- J.S. Springer
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
- Department of Neurology; Aarhus University Hospital; Denmark
| | - P. Karlsson
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
| | - C.S. Madsen
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
| | - B. Johnsen
- Department of Clinical Neurophysiology; Aarhus University Hospital; Denmark
| | - N.B. Finnerup
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
| | - T.S. Jensen
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
- Department of Neurology; Aarhus University Hospital; Denmark
| | - L. Nikolajsen
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
- Department of Anaesthesiology; Aarhus University Hospital; Denmark
| |
Collapse
|
120
|
Who is healthy? Aspects to consider when including healthy volunteers in QST--based studies-a consensus statement by the EUROPAIN and NEUROPAIN consortia. Pain 2016; 156:2203-2211. [PMID: 26075963 DOI: 10.1097/j.pain.0000000000000227] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Clinical and human experimental pain studies often include so-called "healthy" controls in investigations of sensory abnormalities, using quantitative sensory testing (QST) as an outcome measure. However, the criteria for what is considered "healthy" vary among the different studies and between study centers and investigators, partly explaining the high variability of the results. Therefore, several aspects should be considered during inclusion of healthy volunteers in QST-based trials to have homogenous groups of healthy controls with less variability between human experimental studies, so that results are less likely to be false negative or false positive because of subject-related factors. The EUROPAIN and NEUROPAIN consortia aimed to define factors influencing the variability in selection of healthy subjects in QST-based studies before the start of both projects and to give recommendations how to minimize it based on the current literature and expertise of the participants. The present suggestions for inclusion criteria of healthy volunteers into QST-based trials describe a 2-level approach including standardized questionnaires enabling the collection of relevant information on sociodemographic data, medical history, current health status, coping strategies in dealing with pain, and the motivation of the volunteer to participate in the study. These suggestions are believed to help researchers interpret their results in comparison with others and improve the quality of clinical studies including healthy volunteers as controls or in human experimental pain studies. They aim to reduce any confounding factors. Furthermore, the acquired information will allow post hoc analyses of variance for different potential influencing factors.
Collapse
|
121
|
Baselgia LT, Bennett DL, Silbiger RM, Schmid AB. Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Arch Phys Med Rehabil 2016; 98:480-486. [PMID: 27449322 PMCID: PMC5324720 DOI: 10.1016/j.apmr.2016.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 06/22/2016] [Accepted: 06/26/2016] [Indexed: 12/13/2022]
Abstract
Objective To examine differences in somatosensory phenotypes of patients with positive and negative neurodynamic tests and compare these with healthy participants. Design Case-control study. Setting University department. Participants Patients with electrodiagnostically confirmed carpal tunnel syndrome (CTS) (n=53) and people without CTS (n=26) participated in this study (N=79). Patients with CTS were subgrouped according to the results of the upper limb neurodynamic tests biasing the median nerve into patients with positive or negative neurodynamic tests. Interventions Not applicable. Main Outcome Measure All participants underwent quantitative sensory testing in the median innervated territory of their hand. Results Only 46% of patients with CTS had positive neurodynamic tests. No differences were identified between groups for pain thresholds (P>.247). However, patients with CTS had increased mechanical (P<.0001) and thermal detection thresholds (P<.0001) compared with people without CTS. Patients with negative neurodynamic tests had a more pronounced vibration detection deficit (mean, 7.43±0.59) than people without CTS (mean, 7.89±0.22; P=.001). Interestingly, warm detection was the only domain differentiating positive (mean, 4.03°C±2.18°C) and negative neurodynamic test groups (6.09°C±3.70°C, P=.032), with patients with negative neurodynamic tests demonstrating increased loss of function. Conclusions Patients with negative neurodynamic tests seem to have a more severe dysfunction of the unmyelinated fiber population. Our findings suggest that neurodynamic tests should not be used in isolation to judge neural involvement. Rather, they should be interpreted in the context of loss of function tests of the small fiber domain.
Collapse
Affiliation(s)
- Larissa T Baselgia
- Institute of Physiotherapy, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - David L Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Headington, UK
| | | | - Annina B Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Headington, UK; School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
| |
Collapse
|
122
|
|
123
|
|
124
|
|
125
|
Tracy LM, Georgiou-Karistianis N, Gibson SJ, Giummarra MJ. Location, location, location: Variation in sensitivity to pain across the body. Eur J Pain 2016; 20:1721-1729. [PMID: 27221216 DOI: 10.1002/ejp.895] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is evidence that sensitivity to noxious stimuli differs between the sexes and across the body, but few studies have investigated differences in the perception and experience of acute pain stimuli across the body in healthy individuals. METHODS We recruited 52 healthy participants, aged 18-36 (50% men) and administered 39, 42 and 45 °C stimuli at four body sites bilaterally to examine differences in the experience of pain intensity and unpleasantness between body sites via an 11-point numerical rating scale. RESULTS Noxious and innocuous thermal heat stimuli were perceived as significantly more intense when delivered to the wrist (M = 3.98, SD = 1.93) and back (M = 4.07, SD = 1.98) compared to the shoulder (M = 3.45, SD = 1.91) and leg (M = 3.46, SD = 1.87). Pain unpleasantness ratings yielded similar findings; stimuli were perceived as more unpleasant when administered to the wrist (M = 2.83, SD = 1.93) and lower back (M = 3.04, SD = 2.11) compared to the shoulder (M = 2.63, SD = 1.85) and leg (M = 2.26, SD = 1.82). CONCLUSIONS These findings suggest that painful thermal stimuli delivered to the wrist and back are perceived as more intense and unpleasant compared with other body sites in healthy persons. These differences may be due to variations in receptor density, or the relative importance of these sites for daily living and survival. SIGNIFICANCE Moreover, these insights are helpful for the design of studies investigating pain experience in healthy persons in experimental or clinical settings. WHAT DOES THIS STUDY ADD?: We tested sensitivity to acute suprathreshold thermal stimulations across a range of body sites to investigate for potential variability. We found significant differences in the perceived intensity and unpleasantness of noxious and innocuous thermal stimuli at the wrist and lower back, compared with the shoulder and leg. These results suggest that pain experience is driven by receptor density or the relative functional importance of these sites.
Collapse
Affiliation(s)
- L M Tracy
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia.
- Caulfield Pain Management and Research Centre, Caulfield, Australia.
| | - N Georgiou-Karistianis
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia
| | - S J Gibson
- Caulfield Pain Management and Research Centre, Caulfield, Australia
- National Aging Research Institute, Parkville, Australia
| | - M J Giummarra
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia
- Caulfield Pain Management and Research Centre, Caulfield, Australia
- School of Public Health & Preventative Medicine, Monash University, Clayton, Australia
| |
Collapse
|
126
|
Altered pressure pain thresholds and increased wind-up in adult patients with chronic back pain with a history of childhood maltreatment: a quantitative sensory testing study. Pain 2016; 157:1799-1809. [DOI: 10.1097/j.pain.0000000000000586] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
127
|
Widerström-Noga E, Felix ER, Adcock JP, Escalona M, Tibbett J. Multidimensional Neuropathic Pain Phenotypes after Spinal Cord Injury. J Neurotrauma 2016; 33:482-92. [DOI: 10.1089/neu.2015.4040] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eva Widerström-Noga
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Florida
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, Florida
- Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Elizabeth R. Felix
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, Florida
- Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - James P. Adcock
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Florida
- Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Maydelis Escalona
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Florida
- Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
| | - Jacqueline Tibbett
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Florida
- Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida
- Department of Physiology and Biophysics, Miller School of Medicine, University of Miami, Miami, Florida
| |
Collapse
|
128
|
McDonnell A, Schulman B, Ali Z, Dib-Hajj SD, Brock F, Cobain S, Mainka T, Vollert J, Tarabar S, Waxman SG. Inherited erythromelalgia due to mutations inSCN9A:natural history, clinical phenotype and somatosensory profile. Brain 2016; 139:1052-65. [DOI: 10.1093/brain/aww007] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 12/04/2015] [Indexed: 12/12/2022] Open
|
129
|
Starkweather AR, Heineman A, Storey S, Rubia G, Lyon DE, Greenspan J, Dorsey SG. Methods to measure peripheral and central sensitization using quantitative sensory testing: A focus on individuals with low back pain. Appl Nurs Res 2016; 29:237-41. [DOI: 10.1016/j.apnr.2015.03.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/14/2015] [Accepted: 03/21/2015] [Indexed: 01/25/2023]
|
130
|
|
131
|
Chronic sensory stroke with and without central pain is associated with bilaterally distributed sensory abnormalities as detected by quantitative sensory testing. Pain 2016; 157:194-202. [DOI: 10.1097/j.pain.0000000000000354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
132
|
Karmann AJ, Maihöfner C, Lautenbacher S, Sperling W, Kornhuber J, Kunz M. The Role of Prefrontal Inhibition in Regulating Facial Expressions of Pain: A Repetitive Transcranial Magnetic Stimulation Study. THE JOURNAL OF PAIN 2015; 17:383-91. [PMID: 26705973 DOI: 10.1016/j.jpain.2015.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/01/2015] [Accepted: 12/03/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED Although research on facial expressions of pain has a long history, little is known about the cerebral mechanisms regulating these expressions. It has been suggested that the medial prefrontal cortex (mPFC) might be involved in regulating/inhibiting the degree to which pain is facially displayed. To test whether such a prefrontal regulation does indeed take place, we reduced medial prefrontal excitability via repetitive transcranial magnetic stimulation (rTMS) and assessed its effect on facial expressions. In a within-subject design, facial and subjective responses to experimental pain as well as "situational" pain catastrophizing were assessed in 35 healthy participants; once after receiving low-frequency rTMS over the mPFC (1 Hz) and once after sham stimulation. Compared with sham stimulation, rTMS over the mPFC resulted in enhanced facial expressions of pain, whereas self-report and pain catastrophizing did not change. The current data show that reducing medial prefrontal excitability (via low-frequency rTMS) makes individuals facially more expressive to pain. This finding indicates that the mPFC is crucially involved in the inhibition of facial expressions of pain. Because this effect was independent of changes in self-report and pain catastrophizing suggests that this inhibitory mechanism is mainly governing the facial expression and not the underlying experience of pain. PERSPECTIVE Using rTMS, it was shown that the mPFC is causally involved in the downregulation or silencing of one's facial expression of pain. This might explain why individuals with low mPFC functioning (eg, patients with dementia) are facially more expressive in response to pain.
Collapse
Affiliation(s)
- Anna Julia Karmann
- Department of Physiological Psychology, Otto-Friedrich University Bamberg, Bamberg, Germany.
| | | | - Stefan Lautenbacher
- Department of Physiological Psychology, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Wolfgang Sperling
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Miriam Kunz
- Department of Physiological Psychology, Otto-Friedrich University Bamberg, Bamberg, Germany; Department of General Practice, Gerontology Section, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
133
|
|
134
|
[Diagnostic comparison of thermal parameters of quantitative sensory testing and laser stimulation in postherpetic neuralgia]. Schmerz 2015; 30:89-91. [PMID: 26589714 DOI: 10.1007/s00482-015-0079-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
135
|
Pain relief with lidocaine 5% patch in localized peripheral neuropathic pain in relation to pain phenotype. Pain 2015; 156:2234-2244. [DOI: 10.1097/j.pain.0000000000000266] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
136
|
Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain. Pain 2015; 156:1874-1884. [DOI: 10.1097/j.pain.0000000000000244] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
137
|
|
138
|
[Neuropathic pain. How to open the blackbox]. Schmerz 2015; 29:479-80, 482-5. [PMID: 26264897 DOI: 10.1007/s00482-015-0028-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article, without presuming to be comprehensive, gives a brief outline of the development of research on neuropathic pain in Germany. Current clinical research on this subject focusses on the validation of human models, patient phenotyping, mechanism-based classification and treatment as well as on molecular pathomechanisms. This clinical research is based to a large extent on the work of several internationally recognized basic researchers in the 1990s. In particular, findings from system physiology led to the analysis of clinical phenotypes and the underlying pathophysiology. In parallel, basic research achieved international top levels through the development of innovative methods. Close cooperation, building of consortia and European networking made major contributions to the success of this research.
Collapse
|
139
|
Weinkauf B, Deising S, Obreja O, Hoheisel U, Mense S, Schmelz M, Rukwied R. Comparison of nerve growth factor-induced sensitization pattern in lumbar and tibial muscle and fascia. Muscle Nerve 2015; 52:265-72. [PMID: 25521275 DOI: 10.1002/mus.24537] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Nerve growth factor (NGF) induces profound hyperalgesia. In this study we explored patterns of NGF sensitization in muscle and fascia of distal and paraspinal sites. METHODS We injected 1 µg of NGF into human (n = 8) tibialis anterior and erector spinae muscles and their fasciae. The spatial extent of pressure sensitization, pressure pain threshold, and mechanical hyperalgesia (150 kPa, 10 s) was assessed at days 0.25, 1, 3, 7, 14, and 21. Chemical sensitization was explored by acidic buffer injections (pH 4, 100 µl) at days 7 and 14. RESULTS The mechanical hyperalgesia area was larger in tibial fascia than in muscle. Pressure pain thresholds were lower, tonic pressure pain ratings, and citrate buffer evoked pain higher in fascia than in muscle. CONCLUSIONS Spatial mechanical sensitization differs between muscle and fascia. Thoracolumbar fasciae appear more sensitive than tibial fasciae and may be major contributors to low back pain, but the temporal sensitization profile is similar between paraspinal and distal sites. Muscle Nerve 52: 265-272, 2015.
Collapse
Affiliation(s)
- Benjamin Weinkauf
- Department of Orthopedics and Traumatology, University Medical Center Mannheim, Mannheim, Germany.,Department of Anesthesiology and Intensive Care Medicine Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Saskia Deising
- Department of Anesthesiology and Intensive Care Medicine Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Otilia Obreja
- Department of Anesthesiology and Intensive Care Medicine Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ulrich Hoheisel
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany
| | - Siegfried Mense
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Schmelz
- Department of Anesthesiology and Intensive Care Medicine Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Roman Rukwied
- Department of Anesthesiology and Intensive Care Medicine Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|
140
|
Wong JN, Olson JL, Morhart MJ, Chan KM. Electrical stimulation enhances sensory recovery: a randomized controlled trial. Ann Neurol 2015; 77:996-1006. [PMID: 25727139 DOI: 10.1002/ana.24397] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 02/15/2015] [Accepted: 02/22/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Brief postsurgical electrical stimulation (ES) has been shown to enhance peripheral nerve regeneration in animal models following axotomy and crush injury. However, whether this treatment is beneficial in humans with sensory nerve injury has not been tested. The goal of this study was to test the hypothesis that ES would enhance sensory nerve regeneration following digital nerve transection compared to surgery alone. METHODS Patients with complete digital nerve transection underwent epineurial nerve repair. After coaptation of the severed nerve ends, fine wire electrodes were implanted before skin closure. Postoperatively, patients were randomized to receiving either 1 hour of 20Hz continuous ES or sham stimulation in a double-blinded manner. Patients were followed monthly for 6 months by a blinded evaluator to monitor physiological recovery of spatial discrimination, pressure threshold, and quantitative small fiber sensory testing. Functional disability was measured using the Disability of Arm, Shoulder, and Hand questionnaire. RESULTS A total of 36 patients were recruited, with 18 in each group. Those in the ES group showed consistently greater improvements in all sensory modalities by 5 to 6 months postoperatively compared to the controls. Although there was a trend of greater functional improvements in the ES group, it was not statistically significant (p > 0.01). INTERPRETATION Postsurgical ES enhanced sensory reinnervation in patients who sustained complete digital nerve transection. The conferred benefits apply to a wide range of sensory functions.
Collapse
Affiliation(s)
- Joshua N Wong
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry
| | - Jaret L Olson
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry
| | - Michael J Morhart
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry.,Center for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
141
|
|
142
|
|
143
|
Üçeyler N, Valet M, Kafke W, Tölle TR, Sommer C. Local and systemic cytokine expression in patients with postherpetic neuralgia. PLoS One 2014; 9:e105269. [PMID: 25127283 PMCID: PMC4134309 DOI: 10.1371/journal.pone.0105269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/17/2014] [Indexed: 01/06/2023] Open
Abstract
Background Postherpetic neuralgia (PHN) is the painful complication of a varicella zoster virus reactivation. We investigated the systemic and local gene expression of pro- and anti-inflammatory cytokine expression in patients with PHN. Methods Thirteen patients with PHN at the torso (Th4-S1) were recruited. Skin punch biopsies were obtained from the painful and the contralateral painless body area for intraepidermal nerve fiber density (IENFD) and cytokine profiling. Additionally, blood was withdrawn for systemic cytokine expression and compared to blood values of healthy controls. We analyzed the gene expression of selected pro- and anti-inflammatory cytokines (tumor necrosis factor-alpha [TNF] and interleukins [IL]-1β, IL-2, and IL-8). Results IENFD was lower in affected skin compared to unaffected skin (p<0.05), while local gene expression of pro- and anti-inflammatory cytokines did not differ except for two patients who had 7fold higher IL-6 and 10fold higher IL-10 gene expression in the affected skin compared to the contralateral unaffected skin sample. Also, the systemic expression of cytokines in patients with PHN and in healthy controls was similar. Conclusion While the systemic and local expression of the investigated pro- and anti-inflammatory cytokines was not different from controls, this may have been influenced by study limitations like the low number of patients and different disease durations. Furthermore, other cytokines or pain mediators need to be considered.
Collapse
Affiliation(s)
- Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany
- * E-mail:
| | - Michael Valet
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Waldemar Kafke
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Thomas R. Tölle
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| |
Collapse
|
144
|
Knutti IA, Suter MR, Opsommer E. Test-retest reliability of thermal quantitative sensory testing on two sites within the L5 dermatome of the lumbar spine and lower extremity. Neurosci Lett 2014; 579:157-62. [PMID: 25064700 DOI: 10.1016/j.neulet.2014.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/25/2014] [Accepted: 07/11/2014] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Quantitative sensory testing (QST) is widely used in human research to investigate the integrity of the sensory function in patients with pain of neuropathic origin, or other causes such as low back pain. Reliability of QST has been evaluated on both sides of the face, hands and feet as well as on the trunk (Th3-L3). In order to apply these tests on other body-parts such as the lower lumbar spine, it is important first to establish reliability on healthy individuals. The aim of this study was to investigate intra-rater reliability of thermal QST in healthy adults, on two sites within the L5 dermatome of the lumbar spine and lower extremity. METHODS Test-retest reliability of thermal QST was determined at the L5-level of the lumbar spine and in the same dermatome on the lower extremity in 30 healthy persons under 40 years of age. Results were analyzed using descriptive statistics and intraclass correlation coefficient (ICC). Values were compared to normative data, using Z-transformation. RESULTS Mean intraindividual differences were small for cold and warm detection thresholds but larger for pain thresholds. ICC values showed excellent reliability for warm detection and heat pain threshold, good-to-excellent reliability for cold pain threshold and fair-to-excellent reliability for cold detection threshold. ICC had large ranges of confidence interval (95%). CONCLUSION In healthy adults, thermal QST on the lumbar spine and lower extremity demonstrated fair-to-excellent test-retest reliability.
Collapse
Affiliation(s)
- I A Knutti
- Bern University of Applied Sciences (BFH), Health, Murtenstrasse 10, 3008 Bern, Switzerland; University of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Av. de Beaumont 21, 1011 Lausanne, Switzerland.
| | - M R Suter
- Pain Center, Department of Anesthesiology, University Hospital Center (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - E Opsommer
- University of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Av. de Beaumont 21, 1011 Lausanne, Switzerland.
| |
Collapse
|
145
|
Preclinical assessment of pain: improving models in discovery research. Curr Top Behav Neurosci 2014; 20:101-20. [PMID: 25012511 DOI: 10.1007/7854_2014_330] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To date, animal models have not sufficiently "filtered" targets for new analgesics, increasing the failure rate and cost of drug development. Preclinical assessment of "pain" has historically relied on measures of evoked behavioral responses to sensory stimuli in animals. Such measures can often be observed in decerebrated animals and therefore may not sufficiently capture affective and motivational aspects of pain, potentially diminishing translation from preclinical studies to the clinical setting. Further, evidence indicates that there are important mechanistic differences between evoked behavioral responses of hypersensitivity and ongoing pain, limiting evaluation of mechanisms that could mediate aspects of clinically relevant pain. The mechanisms underlying ongoing pain in preclinical models are currently being explored and may serve to inform decisions towards the transition from drug discovery to drug development for a given target.
Collapse
|
146
|
Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in patients with ‘unexplained’ chronic pain: an update. Expert Opin Pharmacother 2014; 15:1671-83. [DOI: 10.1517/14656566.2014.925446] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|