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Kutafina E, Becker S, Namer B. Measuring pain and nociception: Through the glasses of a computational scientist. Transdisciplinary overview of methods. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1099282. [PMID: 36926544 PMCID: PMC10013045 DOI: 10.3389/fnetp.2023.1099282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/04/2023] [Indexed: 02/12/2023]
Abstract
In a healthy state, pain plays an important role in natural biofeedback loops and helps to detect and prevent potentially harmful stimuli and situations. However, pain can become chronic and as such a pathological condition, losing its informative and adaptive function. Efficient pain treatment remains a largely unmet clinical need. One promising route to improve the characterization of pain, and with that the potential for more effective pain therapies, is the integration of different data modalities through cutting edge computational methods. Using these methods, multiscale, complex, and network models of pain signaling can be created and utilized for the benefit of patients. Such models require collaborative work of experts from different research domains such as medicine, biology, physiology, psychology as well as mathematics and data science. Efficient work of collaborative teams requires developing of a common language and common level of understanding as a prerequisite. One of ways to meet this need is to provide easy to comprehend overviews of certain topics within the pain research domain. Here, we propose such an overview on the topic of pain assessment in humans for computational researchers. Quantifications related to pain are necessary for building computational models. However, as defined by the International Association of the Study of Pain (IASP), pain is a sensory and emotional experience and thus, it cannot be measured and quantified objectively. This results in a need for clear distinctions between nociception, pain and correlates of pain. Therefore, here we review methods to assess pain as a percept and nociception as a biological basis for this percept in humans, with the goal of creating a roadmap of modelling options.
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Affiliation(s)
- Ekaterina Kutafina
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Faculty of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland
| | - Susanne Becker
- Clinical Psychology, Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barbara Namer
- Junior Research Group Neuroscience, Interdisciplinary Center for Clinical Research Within the Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Institute of Physiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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2
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Sympathetic skin response as an objective tool to estimate stimulus-associated arousal in a human model of hyperalgesia. Neurophysiol Clin 2022; 52:436-445. [DOI: 10.1016/j.neucli.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
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Rohel A, Desmons M, Leonard G, Desgagnés A, da Silva R, Simoneau M, Mercier C, Massé-Alarie H. The influence of experimental low back pain on neural networks involved in the control of lumbar erector spinae muscles. J Neurophysiol 2022; 127:1593-1605. [PMID: 35608262 DOI: 10.1152/jn.00030.2022] [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: 11/22/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) often modifies spine motor control, but the neural origin of these motor control changes remains largely unexplored. This study aimed to determine the impact of experimental low back pain on the excitability of cortical, subcortical, and spinal networks involved in the control of back muscles. METHOD Thirty healthy subjects were recruited and allocated to Pain (capsaicin and heat) or Control (heat) groups. Corticospinal excitability (motor-evoked potential-MEP) and intracortical networks were assessed by single- and paired-pulse transcranial magnetic stimulation, respectively. Electrical vestibular stimulation was applied to assess vestibulospinal excitability (vestibular MEP-VMEP), and the stretch reflex for excitability of the spinal or supraspinal loop (R1 and R2, respectively). Evoked back motor responses were measured before, during and after pain induction. Nonparametric rank-based ANOVA determined if pain modulated motor neural networks. RESULTS A decrease of R1 amplitude was present after the pain disappearance (p=0.01) whereas an increase was observed in the control group (p=0.03) compared to the R1 amplitude measured at pre-pain and pre-heat period, respectively (Group x Time interaction - p<0.001). No difference in MEP and VMEP amplitude was present during and after pain (p>0.05). CONCLUSION During experimental LBP, no change in cortical, subcortical, or spinal networks was observed. After pain disappearance, the reduction of the R1 amplitude without modification of MEP and VMEP amplitude suggest a reduction in spinal excitability potentially combined with an increase in descending drives. The absence of effect during pain needs to be further explored.
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Affiliation(s)
- Antoine Rohel
- Cirris research centre, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada.,Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Mikaël Desmons
- Cirris research centre, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada.,Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Guillaume Leonard
- Research Center on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
| | - Amélie Desgagnés
- Cirris research centre, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada.,Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Rubens da Silva
- BioNR Research Lab, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Martin Simoneau
- Cirris research centre, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada.,Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Catherine Mercier
- Cirris research centre, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada.,Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Hugo Massé-Alarie
- Cirris research centre, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada.,Faculty of Medicine, Université Laval, Quebec City, Canada
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Tonic pain alters functional connectivity of the descending pain modulatory network involving amygdala, periaqueductal gray, parabrachial nucleus and anterior cingulate cortex. Neuroimage 2022; 256:119278. [PMID: 35523367 PMCID: PMC9250649 DOI: 10.1016/j.neuroimage.2022.119278] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Resting state functional connectivity (FC) is widely used to assess functional brain alterations in patients with chronic pain. However, reports of FC accompanying tonic pain in pain-free persons are rare. A network we term the Descending Pain Modulatory Network (DPMN) is implicated in healthy and pathologic pain modulation. Here, we evaluate the effect of tonic pain on FC of specific nodes of this network: anterior cingulate cortex (ACC), amygdala (AMYG), periaqueductal gray (PAG), and parabrachial nuclei (PBN). METHODS In 50 pain-free participants (30F), we induced tonic pain using a capsaicin-heat pain model. functional MRI measured resting BOLD signal during pain-free rest with a 32°C thermode and then tonic pain where participants experienced a previously warm temperature combined with capsaicin. We evaluated FC from ACC, AMYG, PAG, and PBN with correlation of self-report pain intensity during both states. We hypothesized tonic pain would diminish FC dyads within the DPMN. RESULTS Of all hypothesized FC dyads, only PAG and subgenual ACC was weakly altered during pain (F=3.34; p=0.074; pain-free>pain d=0.25). After pain induction sACC-PAG FC became positively correlated with pain intensity (R=0.38; t=2.81; p=0.007). Right PBN-PAG FC during pain-free rest positively correlated with subsequently experienced pain (R=0.44; t=3.43; p=0.001). During pain, this connection's FC was diminished (paired t=-3.17; p=0.0026). In whole-brain analyses, during pain-free rest, FC between left AMYG and right superior parietal lobule and caudate nucleus were positively correlated with subsequent pain. During pain, FC between left AMYG and right inferior temporal gyrus negatively correlated with pain. Subsequent pain positively correlated with right AMYG FC with right claustrum; right primary visual cortex and right temporo-occipitoparietal junction Conclusion: We demonstrate sACC-PAG tonic pain FC positively correlates with experienced pain and resting right PBN-PAG FC correlates with subsequent pain and is diminished during tonic pain. Finally, we reveal PAG- and right AMYG-anchored networks which correlate with subsequently experienced pain intensity. Our findings suggest specific connectivity patterns within the DPMN at rest are associated with subsequently experienced pain and modulated by tonic pain. These nodes and their functional modulation may reveal new therapeutic targets for neuromodulation or biomarkers to guide interventions.
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van der Schaaf ME, Schmidt K, Kaur J, Gamer M, Wiech K, Forkmann K, Bingel U. Acquisition learning is stronger for aversive than appetitive events. Commun Biol 2022; 5:302. [PMID: 35379893 PMCID: PMC8979974 DOI: 10.1038/s42003-022-03234-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Appetitive and aversive learning are both key building blocks of adaptive behavior, yet knowledge regarding their differences is sparse. Using a capsaicin heat pain model in 36 healthy participants, this study directly compared the acquisition and extinction of conditioned stimuli (CS) predicting pain exacerbation and relief. Valence ratings show stronger acquisition during aversive compared to appetitive learning, but no differences in extinction. Skin conductance responses and contingency ratings confirmed these results. Findings were unrelated to individual differences in pain sensitivity or psychological factors. Our results support the notion of an evolutionarily hardwired preponderance to acquire aversive rather than appetitive cues as is protective for acute aversive states such as pain but may contribute to the development and maintenance of clinical conditions such as chronic pain, depression or anxiety disorders. In this study, acquisition and extinction of conditioned stimuli are compared in a capsaicin heat pain paradigm in healthy human participants. The results demonstrate a preponderance to acquire aversive rather than appetitive cues, which could initially have a protective function but eventually contribute to the maintenance of chronic pain.
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Affiliation(s)
- Marieke E van der Schaaf
- Radboud University Medical Centre, Department of Psychiatry, 6525 GA, Nijmegen, The Netherlands.,Radboud University, Donders Institute for Brain Behaviour and Cognition, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Katharina Schmidt
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany.
| | - Jaspreet Kaur
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Matthias Gamer
- Department of Psychology, University of Würzburg, Würzburg, Germany
| | - Katja Wiech
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Katarina Forkmann
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
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Provencher B, Northon S, Piché M. Segmental Chiropractic Spinal Manipulation Does not Reduce Pain Amplification and the Associated Pain-Related Brain Activity in a Capsaicin-Heat Pain Model. FRONTIERS IN PAIN RESEARCH 2021; 2:733727. [PMID: 35295444 PMCID: PMC8915690 DOI: 10.3389/fpain.2021.733727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Musculoskeletal injuries lead to sensitization of nociceptors and primary hyperalgesia (hypersensitivity to painful stimuli). This occurs with back injuries, which are associated with acute pain and increased pain sensitivity at the site of injury. In some cases, back pain persists and leads to central sensitization and chronic pain. Thus, reducing primary hyperalgesia to prevent central sensitization may limit the transition from acute to chronic back pain. It has been shown that spinal manipulation (SM) reduces experimental and clinical pain, but the effect of SM on primary hyperalgesia and hypersensitivity to painful stimuli remains unclear. The goal of the present study was to investigate the effect of SM on pain hypersensitivity using a capsaicin-heat pain model. Laser stimulation was used to evoke heat pain and the associated brain activity, which were measured to assess their modulation by SM. Eighty healthy participants were recruited and randomly assigned to one of the four experimental groups: inert cream and no intervention; capsaicin cream and no intervention; capsaicin cream and SM at T7; capsaicin cream and placebo. Inert or capsaicin cream (1%) was applied to the T9 area. SM or placebo were performed 25 min after cream application. A series of laser stimuli were delivered on the area of cream application (1) before cream application, (2) after cream application but before SM or placebo, and (3) after SM or placebo. Capsaicin cream induced a significant increase in laser pain (p < 0.001) and laser-evoked potential amplitude (p < 0.001). However, SM did not decrease the amplification of laser pain or laser-evoked potentials by capsaicin. These results indicate that segmental SM does not reduce pain hypersensitivity and the associated pain-related brain activity in a capsaicin-heat pain model.
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Affiliation(s)
- Benjamin Provencher
- Pain Neurophysiology Lab, Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Stéphane Northon
- Pain Neurophysiology Lab, Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Mathieu Piché
- Pain Neurophysiology Lab, Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Mathieu Piché
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Abstract
ABSTRACT Efficacy of treatment is heavily dependent on experience and expectations. Moreover, humans can generalize from one experience to a perceptually similar but novel situation. We investigated whether and how this applies to pain relief, using ecologically valid tonic pain stimuli treated by surreptitiously lowering the applied temperature. Using different face cues, participants experienced better treatment from one physician than another. Participants were then tested on 6 additional face cues perceptually lying between both faces. Our data from 2 independent samples (N = 18 and N = 39) show a treatment experience effect, ie, for physically identical treatments, the initially superior physician was reported to deliver stronger pain relief. More importantly, the other faces on the perceptual continuum showed a graded effect of pain relief, indicating placebo generalization. Introducing a paradigm feasible to induce placebo pain relief, we show that the generic learning principle of generalization can explain carryover effects between learned and novel treatment situations.
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Quesada C, Kostenko A, Ho I, Leone C, Nochi Z, Stouffs A, Wittayer M, Caspani O, Brix Finnerup N, Mouraux A, Pickering G, Tracey I, Truini A, Treede RD, Garcia-Larrea L. Human surrogate models of central sensitization: A critical review and practical guide. Eur J Pain 2021; 25:1389-1428. [PMID: 33759294 PMCID: PMC8360051 DOI: 10.1002/ejp.1768] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 12/11/2022]
Abstract
Background As in other fields of medicine, development of new medications for management of neuropathic pain has been difficult since preclinical rodent models do not necessarily translate to the clinics. Aside from ongoing pain with burning or shock‐like qualities, neuropathic pain is often characterized by pain hypersensitivity (hyperalgesia and allodynia), most often towards mechanical stimuli, reflecting sensitization of neural transmission. Data treatment We therefore performed a systematic literature review (PubMed‐Medline, Cochrane, WoS, ClinicalTrials) and semi‐quantitative meta‐analysis of human pain models that aim to induce central sensitization, and generate hyperalgesia surrounding a real or simulated injury. Results From an initial set of 1569 reports, we identified and analysed 269 studies using more than a dozen human models of sensitization. Five of these models (intradermal or topical capsaicin, low‐ or high‐frequency electrical stimulation, thermode‐induced heat‐injury) were found to reliably induce secondary hyperalgesia to pinprick and have been implemented in multiple laboratories. The ability of these models to induce dynamic mechanical allodynia was however substantially lower. The proportion of subjects who developed hypersensitivity was rarely provided, giving rise to significant reporting bias. In four of these models pharmacological profiles allowed to verify similarity to some clinical conditions, and therefore may inform basic research for new drug development. Conclusions While there is no single “optimal” model of central sensitization, the range of validated and easy‐to‐use procedures in humans should be able to inform preclinical researchers on helpful potential biomarkers, thereby narrowing the translation gap between basic and clinical data. Significance Being able to mimic aspects of pathological pain directly in humans has a huge potential to understand pathophysiology and provide animal research with translatable biomarkers for drug development. One group of human surrogate models has proven to have excellent predictive validity: they respond to clinically active medications and do not respond to clinically inactive medications, including some that worked in animals but failed in the clinics. They should therefore inform basic research for new drug development.
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Affiliation(s)
- Charles Quesada
- NeuroPain lab, Lyon Centre for Neuroscience Inserm U1028, Lyon, France.,Pain Center Neurological Hospital (CETD), Hospices Civils de Lyon, Lyon, France
| | - Anna Kostenko
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Idy Ho
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Zahra Nochi
- Danish Pain Research Center, Dept of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alexandre Stouffs
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | - Matthias Wittayer
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Ombretta Caspani
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Dept of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - André Mouraux
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | | | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Luis Garcia-Larrea
- NeuroPain lab, Lyon Centre for Neuroscience Inserm U1028, Lyon, France.,Pain Center Neurological Hospital (CETD), Hospices Civils de Lyon, Lyon, France
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Ilie MA, Caruntu C, Tampa M, Georgescu SR, Matei C, Negrei C, Ion RM, Constantin C, Neagu M, Boda D. Capsaicin: Physicochemical properties, cutaneous reactions and potential applications in painful and inflammatory conditions. Exp Ther Med 2019; 18:916-925. [PMID: 31384324 PMCID: PMC6639979 DOI: 10.3892/etm.2019.7513] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/21/2018] [Indexed: 12/14/2022] Open
Abstract
Capsaicin is a natural protoalkaloid recognized as the main pungent component in hot peppers (Capsicum annuum L.). The capsaicin receptor is highly expressed in the unmyelinated type C nerve fibers originating from small diameter sensory neurons in dorsal root ganglia and cranial nerve ganglia correspondents. Capsaicin and related vanilloids have a variety of effects on primary sensory neurons function, from sensory neuron excitation characterized by local burning sensation and neurogenic inflammation, followed by conduction blockage accompanied by reversible ultrastructural changes of peripheral nociceptive endings (desensitization), going as far as irreversible degenerative changes (neurotoxicity). The main role in capsaicin-induced neurogenic inflammation relies on the capsaicin sensitive, small diameter primary sensory neurons, therefore its evaluation could be used as a diagnostic instrument in functional alterations of cutaneous sensory nerve fibers. Moreover, capsaicin-induced desensitization and neurotoxicity explain the analgesic/anti-nociceptive and anti-inflammatory effects of topical capsaicin and its potential use in the management of painful and inflammatory conditions. In this study, we describe the effects of capsaicin on neurogenic inflammation and nociception, as well as its potential diagnostic value and therapeutic impact in various conditions involving impairment of sensory nerve fibers.
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Affiliation(s)
- Mihaela Adriana Ilie
- Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 020021, Romania.,Department of Biochemistry, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Constantin Caruntu
- Department of Physiology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 020021, Romania.,Department of Dermatology, 'Prof. N.C. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest 020475, Romania
| | - Mircea Tampa
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Simona-Roxana Georgescu
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Clara Matei
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Carolina Negrei
- Department of Toxicology, Faculty of Pharmacy, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 020956, Romania
| | - Rodica-Mariana Ion
- The National Institute for Research and Development in Chemistry and Petrochemistry - ICECHIM, Bucharest 060021, Romania
| | - Carolina Constantin
- Department of Immunology, 'Victor Babes' National Institute of Pathology, Bucharest 050096, Romania.,Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Monica Neagu
- Department of Immunology, 'Victor Babes' National Institute of Pathology, Bucharest 050096, Romania.,Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania.,Department of Biochemistry, Faculty of Biology, University of Bucharest, Bucharest 020125, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 020021, Romania.,Department of Dermatology, 'Prof. N.C. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest 020475, Romania
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Leppert W, Malec-Milewska M, Zajaczkowska R, Wordliczek J. Transdermal and Topical Drug Administration in the Treatment of Pain. Molecules 2018; 23:molecules23030681. [PMID: 29562618 PMCID: PMC6017304 DOI: 10.3390/molecules23030681] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/21/2022] Open
Abstract
The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An effective therapy for pain depends on the intensity and type of pain, the patients' age, comorbidities, and appropriate choice of analgesic, its dose and route of administration. This review is aimed at presenting current knowledge on analgesics administered by transdermal and topical routes for physicians, nurses, pharmacists, and other health care professionals dealing with patients suffering from pain. Analgesics administered transdermally or topically act through different mechanisms. Opioids administered transdermally are absorbed into vessels located in subcutaneous tissue and, subsequently, are conveyed in the blood to opioid receptors localized in the central and peripheral nervous system. Non-steroidal anti-inflammatory drugs (NSAIDs) applied topically render analgesia mainly through a high concentration in the structures of the joint and a provision of local anti-inflammatory effects. Topically administered drugs such as lidocaine and capsaicin in patches, capsaicin in cream, EMLA cream, and creams containing antidepressants (i.e., doxepin, amitriptyline) act mainly locally in tissues through receptors and/or ion channels. Transdermal and topical routes offer some advantages over systemic analgesic administration. Analgesics administered topically have a much better profile for adverse effects as they relieve local pain with minimal systemic effects. The transdermal route apart from the above-mentioned advantages and provision of long period of analgesia may be more convenient, especially for patients who are unable to take drugs orally. Topically and transdermally administered opioids are characterised by a lower risk of addiction compared to oral and parenteral routes.
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Affiliation(s)
- Wojciech Leppert
- Department of Palliative Medicine, Poznan University of Medical Sciences, Osiedle Rusa 55, 61-645 Poznan, Poland.
| | - Malgorzata Malec-Milewska
- Department of Anesthesiology and Intensive Care, Medical Centre of Postgraduate Education, 01-813 Warsaw, Poland.
| | - Renata Zajaczkowska
- Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, 31-008 Krakow, Poland.
- Department of Anesthesiology and Intensive Therapy, University Hospital, 31-501 Krakow, Poland.
| | - Jerzy Wordliczek
- Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, 31-008 Krakow, Poland.
- Department of Anesthesiology and Intensive Therapy, University Hospital, 31-501 Krakow, Poland.
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