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Knox PJ, Simon CB, Hicks GE. Preliminary Characterization of Age and Chronic Low Back Pain Effects on Multimodal Pain Sensitivity: A Comparison Study in Older Adults with and Without Chronic Low Back Pain. THE JOURNAL OF PAIN 2024; 25:104509. [PMID: 38484855 PMCID: PMC11283989 DOI: 10.1016/j.jpain.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 04/29/2024]
Abstract
Though pain sensitivity impairments contribute to chronic pain in younger adults, it is unclear if pain hypersensitivity manifests with aging and is heightened in the geriatric chronic low back pain population. The cross-sectional study preliminarily addressed this gap by measuring pain sensitivity in older adults with chronic low back pain (n = 25) as well as pain-free sex-matched older (n = 25) and younger adults (n = 25). Pain sensitivity was quantified by 8 distinct measures that were subdivided as static (ie, pressure pain thresholds, heat pain thresholds, fixed mechanical pain, and fixed cold pain) and dynamic pain sensitivity (ie, mechanical temporal summation, thermal ramp and hold, heat pain aftersensations, and conditioned pain modulation). Test-retest reliability values for pain sensitivity ranged from moderate to excellent (intraclass correlation coefficients ≥ .500; p's < .05). The main effect for the group was significant (partial η2 = .413, P < .001), revealing between-group differences in pain sensitivity on 5 out of 8 tests (p's ≤ .043). Predominantly, both older adult groups demonstrated increased pain facilitation and decreased pain inhibition during dynamic pain sensitivity testing compared to pain-free younger adults (p's ≤ .044). Despite qualitative differences, static and dynamic pain sensitivity responses were statistically similar between older adults with and without chronic LBP (p's > .05). Findings suggest pain sensitivity can be reliably measured in older adults and that pain hypersensitivity develops with chronological aging, providing partial support for the theory that pain hypersensitivity may impact geriatric chronic pain populations. Further study is needed to more definitively parse out whether pain hypersensitivity is comparatively heightened in older adults with chronic LBP beyond the influence of chronological aging. PERSPECTIVE: This article establishes that surrogate measures of centrally mediated pain sensitization are heightened with aging. Impaired endogenous pain modulation may influence chronic pain development, maintenance, treatment efficacy, and/or ensuing disability, necessitating research to comprehensively characterize how pain hypersensitivity contributes to geriatric chronic pain conditions.
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Affiliation(s)
- Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
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Presto P, Sehar U, Kopel J, Reddy PH. Mechanisms of pain in aging and age-related conditions: Focus on caregivers. Ageing Res Rev 2024; 95:102249. [PMID: 38417712 DOI: 10.1016/j.arr.2024.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Pain is a complex, subjective experience that can significantly impact quality of life, particularly in aging individuals, by adversely affecting physical and emotional well-being. Whereas acute pain usually serves a protective function, chronic pain is a persistent pathological condition that contributes to functional deficits, cognitive decline, and emotional disturbances in the elderly. Despite substantial progress that has been made in characterizing age-related changes in pain, complete mechanistic details of pain processing mechanisms in the aging patient remain unknown. Pain is particularly under-recognized and under-managed in the elderly, especially among patients with Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other age-related conditions. Furthermore, difficulties in assessing pain in patients with AD/ADRD and other age-related conditions may contribute to the familial caregiver burden. The purpose of this article is to discuss the mechanisms and risk factors for chronic pain development and persistence, with a particular focus on age-related changes. Our article also highlights the importance of caregivers working with aging chronic pain patients, and emphasizes the urgent need for increased legislative awareness and improved pain management in these populations to substantially alleviate caregiver burden.
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Affiliation(s)
- Peyton Presto
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Respiratory Effects of Biased Ligand Oliceridine in Older Volunteers: A Pharmacokinetic-Pharmacodynamic Comparison with Morphine. Anesthesiology 2023; 138:249-263. [PMID: 36538359 DOI: 10.1097/aln.0000000000004473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Oliceridine is a G protein-biased µ-opioid, a drug class that is associated with less respiratory depression than nonbiased opioids, such as morphine. The authors quantified the respiratory effects of oliceridine and morphine in elderly volunteers. The authors hypothesized that these opioids differ in their pharmacodynamic behavior, measured as effect on ventilation at an extrapolated end-tidal Pco2 at 55 mmHg, V̇E55. METHODS This four-arm double-blind, randomized, crossover study examined the respiratory effects of intravenous 0.5 or 2 mg oliceridine and 2 or 8 mg morphine in 18 healthy male and female volunteers, aged 55 to 89 yr, on four separate occasions. Participants' CYP2D6 genotypes were determined, hypercapnic ventilatory responses were obtained, and arterial blood samples were collected before and for 6 h after treatment. A population pharmacokinetic-pharmacodynamic analysis was performed on V̇E55, the primary endpoint; values reported are median ± standard error of the estimate. RESULTS Oliceridine at low dose was devoid of significant respiratory effects. High-dose oliceridine and both morphine doses caused a rapid onset of respiratory depression with peak effects occurring at 0.5 to 1 h after opioid dosing. After peak effect, compared with morphine, respiratory depression induced by oliceridine returned faster to baseline. The effect-site concentrations causing a 50% depression of V̇E55 were 29.9 ± 3.5 ng/ml (oliceridine) and 21.5 ± 4.6 ng/ml (morphine), the blood effect-site equilibration half-lives differed by a factor of 5: oliceridine 44.3 ± 6.1 min and morphine 214 ± 27 min. Three poor CYP2D6 oliceridine metabolizers exhibited a significant difference in oliceridine clearance by about 50%, causing higher oliceridine plasma concentrations after both low- and high-dose oliceridine, compared with the other participants. CONCLUSIONS Oliceridine and morphine differ in their respiratory pharmacodynamics with a more rapid onset and offset of respiratory depression for oliceridine and a smaller magnitude of respiratory depression over time. EDITOR’S PERSPECTIVE
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Oto T, Urata K, Hayashi Y, Hitomi S, Shibuta I, Iwata K, Iinuma T, Shinoda M. Age-Related Differences in Transient Receptor Potential Vanilloid 1 and 2 Expression Patterns in the Trigeminal Ganglion Neurons Contribute to Changes in the Palatal Mucosal Heat Pain Sensitivity. TOHOKU J EXP MED 2022; 256:283-290. [PMID: 35296569 DOI: 10.1620/tjem.2022.j004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tatsuki Oto
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | - Kentaro Urata
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | | | - Suzuro Hitomi
- Department of Physiology, Nihon University School of Dentistry
| | - Ikuko Shibuta
- Department of Physiology, Nihon University School of Dentistry
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry
| | - Toshimitsu Iinuma
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
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Tinnirello A, Mazzoleni S, Santi C. Chronic Pain in the Elderly: Mechanisms and Distinctive Features. Biomolecules 2021; 11:biom11081256. [PMID: 34439922 PMCID: PMC8391112 DOI: 10.3390/biom11081256] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Chronic pain is a major issue affecting more than 50% of the older population and up to 80% of nursing homes residents. Research on pain in the elderly focuses mainly on the development of clinical tools to assess pain in patients with dementia and cognitive impairment or on the efficacy and tolerability of medications. In this review, we searched for evidence of specific pain mechanisms or modifications in pain signals processing either at the cellular level or in the central nervous system. Methods: Narrative review. Results: Investigation on pain sensitivity led to conflicting results, with some studies indicating a modest decrease in age-related pain sensitivity, while other researchers found a reduced pain threshold for pressure stimuli. Areas of the brain involved in pain perception and analgesia are susceptible to pathological changes such as gliosis and neuronal death and the effectiveness of descending pain inhibitory mechanisms, particularly their endogenous opioid component, also appears to deteriorate with advancing age. Hyperalgesia is more common at older age and recovery from peripheral nerve injury appears to be delayed. In addition, peripheral nociceptors may contribute minimally to pain sensation at either acute or chronic time points in aged populations. Conclusions: Elderly subjects appear to be more susceptible to prolonged pain development, and medications acting on peripheral sensitization are less efficient. Pathologic changes in the central nervous system are responsible for different pain processing and response to treatment. Specific guidelines focusing on specific pathophysiological changes in the elderly are needed to ensure adequate treatment of chronic pain conditions.
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Affiliation(s)
- Andrea Tinnirello
- Anesthesiology and Pain Medicine Department, ASST Franciacorta, Ospedale di Iseo, 25049 Iseo, Italy
- Correspondence: ; Tel.: +39-030-7103-395
| | - Silvia Mazzoleni
- Second Division of Anesthesiology, Intensive Care & Emergency Medicine, University of Brescia at Spedali Civili Hospital, Piazzale Spedali Civili 1, 25100 Brescia, Italy; (S.M.); (C.S.)
| | - Carola Santi
- Second Division of Anesthesiology, Intensive Care & Emergency Medicine, University of Brescia at Spedali Civili Hospital, Piazzale Spedali Civili 1, 25100 Brescia, Italy; (S.M.); (C.S.)
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Johnson AJ, Wilson AT, Laffitte Nodarse C, Montesino-Goicolea S, Valdes-Hernandez PA, Somerville J, Peraza JA, Fillingim RB, Bialosky J, Cruz-Almeida Y. Age Differences in Multimodal Quantitative Sensory Testing and Associations With Brain Volume. Innov Aging 2021; 5:igab033. [PMID: 34616958 PMCID: PMC8489433 DOI: 10.1093/geroni/igab033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Somatosensory function is critical for successful aging. Prior studies have shown declines in somatosensory function with age; however, this may be affected by testing site, modality, and biobehavioral factors. While somatosensory function declines are associated with peripheral nervous system degradation, little is known regarding correlates with the central nervous system and brain structure in particular. The objectives of this study were to examine age-related declines in somatosensory function using innocuous and noxious stimuli, across 2 anatomical testing sites, with considerations for affect and cognitive function, and associations between somatosensory function and brain structure in older adults. RESEARCH DESIGN AND METHODS A cross-sectional analysis included 84 "younger" (n = 22, age range: 19-24 years) and "older" (n = 62, age range: 60-94 years) healthy adults who participated in the Neuromodulatory Examination of Pain and Mobility Across the Lifespan study. Participants were assessed on measures of somatosensory function (quantitative sensory testing), at 2 sites (metatarsal and thenar) using standardized procedures, and completed cognitive and psychological function measures and structural magnetic resonance imaging. RESULTS Significant age × test site interaction effects were observed for warmth detection (p = .018,η p 2 = 0.10) and heat pain thresholds (p = .014,η p 2 = 0.12). Main age effects were observed for mechanical, vibratory, cold, and warmth detection thresholds (ps < .05), with older adults displaying a loss of sensory function. Significant associations between somatosensory function and brain gray matter structure emerged in the right occipital region, the right temporal region, and the left pericallosum. DISCUSSION AND IMPLICATIONS Our findings indicate healthy older adults display alterations in sensory responses to innocuous and noxious stimuli compared to younger adults and, furthermore, these alterations are uniquely affected by anatomical site. These findings suggest a nonuniform decline in somatosensation in older adults, which may represent peripheral and central nervous system alterations part of aging processes.
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Affiliation(s)
- Alisa J Johnson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Abigail T Wilson
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Brooks Rehabilitation–College of Public Health and Health Professions Research Collaboration, Gainesville, Florida, USA
| | - Chavier Laffitte Nodarse
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Soamy Montesino-Goicolea
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Pedro A Valdes-Hernandez
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Jessie Somerville
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Julio A Peraza
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Joel Bialosky
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Brooks Rehabilitation–College of Public Health and Health Professions Research Collaboration, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
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Malekpour A, Rahmanifar F. Conventional histomorphometry and fast free of acrylamide clearing tissue (FACT) visualization of sciatic nerve in chicken ( Gallus domesticus). VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2021; 12:167-173. [PMID: 34345382 PMCID: PMC8328249 DOI: 10.30466/vrf.2019.98930.2361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/17/2019] [Indexed: 11/06/2022]
Abstract
Histomorphometry and use of the fast free of acrylamide clearing tissue (FACT) protocol were studied on the sciatic nerve in chicken (Gallus domesticus). In the first part of the study, the sciatic nerves of 20 chickens of four age groups (7, 14, 26 and 40 days) were studied (n=5 birds per age class). Their sciatic nerve samples were stained with Hematoxylin and Eosin and Masson's trichrome and were histomorphometrically evaluated. In the second part of the study, FACT protocol was applied on the sciatic nerve of a 26 days old chicken. After clearing of 1.00 mm-thick sciatic nerve sections, they were immunolabelled using Hoechst for nuclei staining and recorded by a Z-stack motorized fluorescent microscope. In the conventional histo-morphometry, the epineurium, perineurium and endoneurium were thicker and the nerve bundle diameter was bigger in the left sciatic nerve of chicken of all age groups compared to the right sciatic nerve. On the contrary, the axon diameter and the myelinated nerve fiber diameter were bigger, the myelin sheath was thicker, the nodes of Ranvier intervals were higher and the density of myelinated nerve fibers was also higher in the right sciatic nerve compared to the left one. In conclusion, histomorphometric parameters in the left and right sciatic nerve during chicken growth were significantly different. Furthermore, the FACT protocol could be used for the 3D imaging of the chicken sciatic nerve and its immunostained evaluation.
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Affiliation(s)
- Abdolrasoul Malekpour
- DVM Graduate, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.,Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Farhad Rahmanifar
- Department of Basic Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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Daguet I, Bergeron-Vezina K, Harvey MP, Martel M, Coulombe-Leveque A, Leonard G. Decreased Initial Peak Pain Sensation with Aging: A Psychophysical Study. J Pain Res 2020; 13:2333-2341. [PMID: 33061548 PMCID: PMC7519834 DOI: 10.2147/jpr.s257791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Aging is associated with an impairment of diverse physiological functions, including nociception. For example, older adults in comparison to young adults, show an overall increase in pain thresholds, reflecting a decline in pain sensitivity and changes in the nociceptive pathways. These results are, however, debated as they were not always replicated depending on the stimulus modality, duration, and location. The aim of the current study was to determine how the temporal evolution of pain intensity during a continuous tonic heat pain test is influenced by aging. More specifically, we wanted to 1) assess the effect of age on initial peak and late-phase pain and 2) determine whether potential age effects depend on the stimulation site. Participants and Methods 13 young adults (average of 27.9 years old) and 13 older adults (average of 67.5 years old) participated in this study. Experimental heat pain was evoked on an appendicular (forearm) and axial (lower-back) body region, using a thermode (2-minute stimulation at a constant, individually-adjusted temperature). During the nociceptive stimulation, participants used a computerized visual analogue scale to continuously rate their pain. Results We show that initial peak (0-30 seconds) pain sensation was significantly lower in older adults compared to young adults, while late-phase (30-120 seconds) pain sensation was similar across the two age groups. These results hold true for both stimulation sites, suggesting the existence of an age effect on both appendicular and axial body regions. Conclusion The lower magnitude of initial peak pain observed in older adults, which affects both appendicular and axial body regions, could reflect generalized peripheral or central alterations of the nociceptive system in older adults. These alterations in older adults could have significant clinical impacts, such as an increased vulnerability to injury or an underestimation of the severity of their pain condition.
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Affiliation(s)
- Ines Daguet
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC, Canada
| | - Kayla Bergeron-Vezina
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC, Canada
| | - Marie-Philippe Harvey
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC, Canada
| | - Marylie Martel
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC, Canada
| | - Alexia Coulombe-Leveque
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Guillaume Leonard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
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Ayinde O, Ross JDC. Factors associated with severity and resolution of intramuscular injection site pain following treatment for uncomplicated gonorrhoea: a prospective cohort study of GToG trial participants. Sex Health 2020; 17:SH19176. [PMID: 32594971 DOI: 10.1071/sh19176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/30/2020] [Indexed: 11/23/2022]
Abstract
Background:Intramuscular injection (IMI) pain reduces the acceptability of treatment, but data identifying those at highest risk of severe pain following an injection are limited. This study identified factors associated with the severity, duration and resolution of IMI pain following treatment for uncomplicated gonorrhoea. Methods: Data from a subset of participants (aged 16-70 years) recruited between October 2014 and November 2016 into the 'Gentamicin for the treatment of gonorrhoea' trial in England were analysed. Pain was measured using a visual analogue scale (VAS) immediately after injection. Self-reported duration of pain was collected at a scheduled 2-week follow-up visit. Results: Overall, 688 participants (82% male), reported a median pain VAS score of 23.5 (range 0-100), which was moderate-severe (VAS score >30) in 38% (262/688) of participants. Age [adjusted odds ratio (aOR) 0.86 per 5-yearly increase, (0.78-0.94)], gender [female cf. male, aOR 1.62 (1.18-2.24)], ethnicity [Asian cf. Caucasian, aOR 2.79 (1.72-4.51)], body mass index [aOR 0.80 per 5 kgm-2 increase, (0.72-0.89)] and antibiotic regimen [gentamicin cf. ceftriaxone, aOR 3.92, (3.12-4.93)] were associated with moderate-severe injection pain. The median duration of pain was 2 h (range 0-648). Gender [female cf. male, adjusted hazard ratio (aHR) 0.76 (0.57-1.00)], ethnicity [Mixed race cf. Caucasian, aHR 0.64 (0.45-0.92)], self-reported pain [aHR 0.97 per 10 mm VAS score increase, (0.95-0.99)] and symptom status [asymptomatic cf. symptomatic aHR 1.35 (1.12-1.64)] were associated with pain resolution. Conclusions: IMI pain is influenced by specific demographic, anthropometric and clinical factors. Knowledge of these factors will help identify those most at risk of pain.
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Cunha TC, Matos FDS, Paranhos LR, Bernardino ÍDM, Moura CCG. Influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain: a systematic review of randomized clinical trials. BMC Oral Health 2020; 20:175. [PMID: 32571285 PMCID: PMC7310418 DOI: 10.1186/s12903-020-01164-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/12/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Preliminary canal enlargement (glide path preparation) may play a significant role in the development of pain. The aim of this systematic review of randomized clinical trials was to assess the influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain. METHODS A search was performed in June 2019 in six electronic databases (PubMed, Scopus, LILACS, SciELO, Embase and Web of Science) and two grey literature databases (OpenGrey and OpenThesis). The bibliographic references of the eligible articles were also hand-searched. The included clinical studies assessed the occurrence and intensity of intraoperative and/or postoperative pain after root canal preparation without glide path preparation (WGP) or with glide path preparation using manual (M-GP), continuous rotary (CR-GP), or reciprocating (R-GP) instruments. The primary outcome was the occurrence and intensity of intraoperative and postoperative pain, while analgesic consumption was the secondary outcome. The full texts of the eligible studies were analyzed by two reviewers who performed calibration exercises to verify the risk of bias and quality of the individual studies using the Joanna Briggs Institute Critical Appraisal tool. RESULTS From 1283 identified articles, only six studies were included in the qualitative analysis of the results, with a total sample of 884 patients/teeth. Three studies presented a high risk of bias, while three studies presented a moderate risk. Two studies reported that CR-GP causes lower pain levels than M-GP and WGP, and three studies showed no differences between CR-GP and R-GP. Regarding analgesic consumption, two studies found no differences among glide path kinematics, and one study reported lower consumption for CR-GP than for M-GP. Because of the limited number of studies and methodological differences, no statistical analyses were performed for the glide path kinematics comparisons. CONCLUSIONS Compelling evidence indicating a significantly different occurrence and intensity of pain among glide path kinematics is lacking. The systematic review protocol was registered in the PROSPERO database [CRD42020139989].
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Affiliation(s)
- Thaís Christina Cunha
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Felipe de Souza Matos
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Luiz Renato Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Av. Pará, 1720, Bloco 2G, sala 1, Umuarama, Uberlândia, MG, CEP 38405-320, Brazil.
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Zhou S, Lithfous S, Després O, Pebayle T, Bi X, Dufour A. Involvement of Frontal Functions in Pain Tolerance in Aging: Evidence From Neuropsychological Assessments and Gamma-Band Oscillations. Front Aging Neurosci 2020; 12:131. [PMID: 32536860 PMCID: PMC7266988 DOI: 10.3389/fnagi.2020.00131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 04/20/2020] [Indexed: 11/13/2022] Open
Abstract
Reduced pain tolerance may be one of the possible explanations for high prevalence of chronic pain among older people. We hypothesized that age-related alterations in pain tolerance are associated with functioning deterioration of the frontal cortex during normal aging. Twenty-one young and 41 elderly healthy participants underwent a tonic heat pain test, during which cerebral activity was recorded using electroencephalography (EEG). Elderly participants were divided into two subgroups according to their scores on executive tests, high performers (HPs; n = 21) and low performers (LPs; n = 20). Pain measures [exposure times (ETs) and perceived pain ratings] and cerebral activity were compared among the three groups. ETs were significantly lower in elderly LPs than in young participants and elderly HPs. Electroencephalographic analyses showed that gamma-band oscillations (GBOs) were significantly increased in pain state for all subjects, especially in the frontal sites. Source analysis showed that GBO increase in elderly LPs was contributed not only by frontal but also by central, parietal, and occipital regions. These findings suggest that better preservation of frontal functions may result in better pain tolerance by elderly subjects.
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Affiliation(s)
- Shu Zhou
- Laboratoire de Neurosciences Cognitives et Adaptatives, UMR 7364 - Université de Strasbourg - CNRS, Strasbourg, France.,Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ségolène Lithfous
- Laboratoire de Neurosciences Cognitives et Adaptatives, UMR 7364 - Université de Strasbourg - CNRS, Strasbourg, France
| | - Olivier Després
- Laboratoire de Neurosciences Cognitives et Adaptatives, UMR 7364 - Université de Strasbourg - CNRS, Strasbourg, France
| | - Thierry Pebayle
- Centre d'Investigations Neurocognitives et Neurophysiologiques, UMS 3489 - Université de Strasbourg - CNRS, Strasbourg, France
| | - Xiaoying Bi
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - André Dufour
- Laboratoire de Neurosciences Cognitives et Adaptatives, UMR 7364 - Université de Strasbourg - CNRS, Strasbourg, France.,Centre d'Investigations Neurocognitives et Neurophysiologiques, UMS 3489 - Université de Strasbourg - CNRS, Strasbourg, France
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12
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Sandström A, Bixo M, Johansson M, Bäckström T, Turkmen S. Effect of hysterectomy on pain in women with endometriosis: a population-based registry study. BJOG 2020; 127:1628-1635. [PMID: 32437082 DOI: 10.1111/1471-0528.16328] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess pain symptoms before and after hysterectomy in women with endometriosis. DESIGN A population-based registry study. SETTING Sweden. POPULATION Women aged 18-45 years who underwent hysterectomy for endometriosis between 2010 and 2015. METHODS Pain symptoms before hysterectomy and 12 months after surgery were collected from the Swedish National Quality Register for Gynaecological Surgery (GynOp). Pain symptoms were also assessed by follow-up surveys after a median follow-up period of 63 months. MAIN OUTCOME MEASURES Pelvic or lower abdominal pain after hysterectomy. RESULTS The study included 137 women. The proportion of women experiencing pain of any severity decreased by 28% after hysterectomy (P < 0.001). The proportion of women with severe pain symptoms decreased by 76% after hysterectomy (P < 0.001). The majority of women (84%) were satisfied with the surgical result. Presence of severe pain symptoms after the hysterectomy was associated with less satisfaction (P < 0.001). Pain symptoms after surgery, patient satisfaction and the patient's perceived improvement were not significantly different between women whose ovarian tissue was preserved and women who underwent bilateral oophorectomy. CONCLUSIONS We observed a significant, long-lasting reduction in pain symptoms after hysterectomy among women with endometriosis. Hysterectomy, with the possibility of ovarian preservation, may be a valuable option for women with endometriosis who suffer from severe pain symptoms. TWEETABLE ABSTRACT Hysterectomy is a valuable option for women with endometriosis and severe pain symptoms.
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Affiliation(s)
- A Sandström
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden.,Department of Obstetrics and Gynaecology, Sundsvall County Hospital, Sundsvall, Sweden
| | - M Bixo
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - M Johansson
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - T Bäckström
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - S Turkmen
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden.,Department of Obstetrics and Gynaecology, Sundsvall County Hospital, Sundsvall, Sweden
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Population Pharmacokinetic/Pharmacodynamic Modeling of O-Desmethyltramadol in Young and Elderly Healthy Volunteers. Drugs Aging 2019; 36:747-758. [PMID: 31161580 DOI: 10.1007/s40266-019-00681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Age-related changes in the concentration-effect relationship of (+)-O-desmethyl-tramadol [(+)-ODM], tramadol's active metabolite, are not documented in the elderly. OBJECTIVE The objective of this study was to characterize, in elderly and young subjects, the (+)-ODM pharmacokinetic and pharmacodynamic relationship to examine the effect of age after single-dose administration of tramadol 200 mg extended-release tablets. METHODS A population analysis of a double-blind, randomized, placebo-controlled, two-period cross-over study including 13 elderly (aged ≥75 years) subjects with mild renal insufficiency and 16 young (aged 18-40 years) subjects was conducted. For 48 h post-dose, blood samples were collected and pain tolerance thresholds measured using an electrically stimulated pain model. A pharmacokinetic/pharmacodynamic model incorporating a one-compartment pharmacokinetic model for (+)-ODM parameterized with first-order formation rate, clearance (CL/fm), volume of distribution (V/fm) and a sigmoid maximum effect (Emax) model incorporating baseline (E0) and placebo effect was used. RESULTS Maximum plasma concentrations of (+)-ODM occurred later and plasma concentrations declined more slowly in the elderly than in young subjects. In the elderly, V/fm was 76% larger and CL/fm 16% slower. Baseline (E0) and sensitivity (C50) for pain tolerance were similar between young and elderly subjects. However, the Emax parameter was 2.5 times higher in the elderly and maximum possible treatment-related effect was 169 (135-221) in the young and 194 (149-252) in the elderly; that is, 15% higher in the elderly. CONCLUSIONS This exploratory analysis suggests that age-related differences exist in the distribution and elimination of (+)-ODM, including a 76% larger distribution outside the central compartment and 16% slower clearance of (+)-ODM. These pharmacokinetic changes are associated with a 15% higher maximum possible treatment-related effect and carry the potential for greater efficacy but also the potential for increased side effects at the same dose in elderly subjects. Clinicaltrials.gov identifier: NCT02329561.
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Després O, Lithfous S, Pebayle T, Casadio C, Dufour A. Effects of thermosensory aging well demonstrated by cold stimulations with high temporal resolution. Muscle Nerve 2019; 60:141-146. [PMID: 30945307 DOI: 10.1002/mus.26482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The method of limits (MLi) is the most commonly used paradigm to measure the threshold of thermal stimuli. However, the threshold measured by MLi is dependent on reaction time (RT). Because RT in adults increases with age, the inclusion of RT in the MLi paradigm may result in an overestimation of thermal threshold in the older individuals. METHODS A device with a very rapid cooling rate (300°C/s) was employed to measure cool thresholds by using the method of levels (MLe), a method independent of RT, in 11 older patients and 14 younger adults. RESULTS Compared with the MLi, the MLe resulted in a greater than 2°C gain in threshold measurement accuracy in older patients. DISCUSSION The MLe confirmed that cool perception threshold is dependent on age. The use of MLe provides new opportunities for the study of mechanisms underlying age-associated alterations in thermal perception. Muscle Nerve 60: 141-146, 2019.
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Affiliation(s)
- Olivier Després
- Laboratory of Cognitive and Adaptive Neuroscience, UMR 7364 CNRS - UNISTRA, 12 rue Goethe, 67000, Strasbourg, France
| | - Ségolène Lithfous
- Laboratory of Cognitive and Adaptive Neuroscience, UMR 7364 CNRS - UNISTRA, 12 rue Goethe, 67000, Strasbourg, France
| | - Thierry Pebayle
- Center for Neurocognitive and Neurophysiological Investigations, UMS 3489 CNRS - UNISTRA, Strasbourg, France
| | - Claudia Casadio
- Center for Neurocognitive and Neurophysiological Investigations, UMS 3489 CNRS - UNISTRA, Strasbourg, France
| | - André Dufour
- Laboratory of Cognitive and Adaptive Neuroscience, UMR 7364 CNRS - UNISTRA, 12 rue Goethe, 67000, Strasbourg, France
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The Vicious Cycle of Chronic Pain in Aging Requires Multidisciplinary Non-pharmacological Approach to Treatment. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0126-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Eltumi HG, Tashani OA. Effect of Age, Sex and Gender on Pain Sensitivity: A Narrative Review. ACTA ACUST UNITED AC 2017. [DOI: 10.2174/1876386301710010044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction:
An increasing body of literature on sex and gender differences in pain sensitivity has been accumulated in recent years. There is also evidence from epidemiological research that painful conditions are more prevalent in older people. The aim of this narrative review is to critically appraise the relevant literature investigating the presence of age and sex differences in clinical and experimental pain conditions.
Methods:
A scoping search of the literature identifying relevant peer reviewed articles was conducted on May 2016. Information and evidence from the key articles were narratively described and data was quantitatively synthesised to identify gaps of knowledge in the research literature concerning age and sex differences in pain responses.
Results:
This critical appraisal of the literature suggests that the results of the experimental and clinical studies regarding age and sex differences in pain contain some contradictions as far as age differences in pain are concerned. While data from the clinical studies are more consistent and seem to point towards the fact that chronic pain prevalence increases in the elderly findings from the experimental studies on the other hand were inconsistent, with pain threshold increasing with age in some studies and decreasing with age in others.
Conclusion:
There is a need for further research using the latest advanced quantitative sensory testing protocols to measure the function of small nerve fibres that are involved in nociception and pain sensitivity across the human life span.
Implications:
Findings from these studies should feed into and inform evidence emerging from other types of studies (e.g. brain imaging technique and psychometrics) suggesting that pain in the older humans may have unique characteristics that affect how old patients respond to intervention.
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PainVision® Apparatus for Assessment of Efficacy of Pulsed Radiofrequency Combined with Pharmacological Therapy in the Treatment of Postherpetic Neuralgia and Correlations with Measurements. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5670219. [PMID: 28357404 PMCID: PMC5357555 DOI: 10.1155/2017/5670219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/24/2017] [Indexed: 12/18/2022]
Abstract
Objective. PainVision device was a developed application for the evaluation of pain intensity. The objective was to assess the efficacy and safety of pulsed radiofrequency (PRF) combined with pharmacological therapy in the treatment of postherpetic neuralgia (PHN). We also discussed the correlation of the measurements. Method. Forty patients with PHN were randomized for treatment with PRF combined with pharmacological therapy (PRF group, n = 20) or pharmacological therapy (control group, n = 20) at postoperative 48 hours. The efficacy measure was pain degree (PD) that was assessed by PainVision and visual analog scale (VAS), short form Mcgill pain questionnaire (SF-Mcgill), and numeric rate scale sleep interference score (NRSSIS). Correlations between PD, VAS, SF-Mcgill, and NRSSIS were determined. Results. The PD for persistent pain (PP) and breakthrough pain (BTP) at postoperative 48 hours assessed by PainVision were significantly lower in PRF group than in control group (PD-PP, P < 0.01; PD-BTP, P < 0.01). PD and VAS were highly correlated for both persistent pain (r = 0.453, ρ = 0.008) and breakthrough pain (r = 0.64, ρ = 0.001). Conclusion. PRF was well tolerated and superior to isolated pharmacological therapy in the treatment of PHN. PainVision device showed great value in the evaluation of pain intensity and PD had an excellent correlation with VAS and SF-Mcgill.
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El Tumi H, Johnson M, Dantas P, Maynard M, Tashani O. Age-related changes in pain sensitivity in healthy humans: A systematic review with meta-analysis. Eur J Pain 2017; 21:955-964. [DOI: 10.1002/ejp.1011] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 01/30/2023]
Affiliation(s)
- H. El Tumi
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
- University of Benghazi; Benghazi Libya
| | - M.I. Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
| | - P.B.F. Dantas
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
- Universidade Federal do Rio Grande do Norte; Natal Brazil
| | - M.J. Maynard
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
| | - O.A. Tashani
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
- University of Benghazi; Benghazi Libya
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Advanced Age Does Not Worsen Recovery or Long-Term Morbidity After Postmastectomy Breast Reconstruction. Ann Plast Surg 2016; 76:164-9. [DOI: 10.1097/sap.0000000000000512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Kayaoglu G, Gürel M, Saricam E, Ilhan MN, Ilk O. Predictive Model of Intraoperative Pain during Endodontic Treatment: Prospective Observational Clinical Study. J Endod 2016; 42:36-41. [DOI: 10.1016/j.joen.2015.09.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/14/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022]
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Bedeutung präoperativer Angst für den postoperativen Verlauf bei urologischen Patienten. Schmerz 2015; 30:166-73. [DOI: 10.1007/s00482-015-0023-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Medical care of the geriatric patient is an important area of focus as the population ages and life expectancy increases. In particular, critical care of the geriatric patient will be especially affected, because geriatric patients will consume most critical care beds in the future and subsequently require increased use of resources. This review focuses on the physiologic effects of aging on all body systems. Focus on frailty and its effect on recovery from critical illness and its potential to modify the course of patient care will be important areas of research in the future.
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Affiliation(s)
- Maurice F Joyce
- Department of Anesthesiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - John Adam Reich
- Department of Anesthesiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
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Hadjistavropoulos T, Herr K, Prkachin KM, Craig KD, Gibson SJ, Lukas A, Smith JH. Pain assessment in elderly adults with dementia. Lancet Neurol 2014; 13:1216-27. [DOI: 10.1016/s1474-4422(14)70103-6] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Varrassi G, Fusco M, Coaccioli S, Paladini A. Chronic pain and neurodegenerative processes in elderly people. Pain Pract 2014; 15:1-3. [PMID: 25353291 DOI: 10.1111/papr.12254] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Zhou S, Kemp J, Després O, Pebayle T, Dufour A. The association between inhibition and pain tolerance in the elderly: Evidence from event-related potentials. Eur J Pain 2014; 19:669-76. [DOI: 10.1002/ejp.588] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2014] [Indexed: 11/11/2022]
Affiliation(s)
- S. Zhou
- Laboratoire de Neurociences Cogntitives et Adaptatives; UMR 7364; CNRS; Université de Strasbourg; France
| | - J. Kemp
- Laboratoire de Neurociences Cogntitives et Adaptatives; UMR 7364; CNRS; Université de Strasbourg; France
| | - O. Després
- Laboratoire de Neurociences Cogntitives et Adaptatives; UMR 7364; CNRS; Université de Strasbourg; France
| | - T. Pebayle
- Centre d'Investigations Neurocognitives et Neurophysiologiques; UMS 3489; CNRS; Université de Strasbourg; France
| | - A. Dufour
- Laboratoire de Neurociences Cogntitives et Adaptatives; UMR 7364; CNRS; Université de Strasbourg; France
- Centre d'Investigations Neurocognitives et Neurophysiologiques; UMS 3489; CNRS; Université de Strasbourg; France
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