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Ruimonte-Crespo J, Plaza-Manzano G, Díaz-Arribas MJ, Navarro-Santana MJ, López-Marcos JJ, Fabero-Garrido R, Seijas-Fernández T, Valera-Calero JA. Aerobic Exercise and Neuropathic Pain: Insights from Animal Models and Implications for Human Therapy. Biomedicines 2023; 11:3174. [PMID: 38137395 PMCID: PMC10740819 DOI: 10.3390/biomedicines11123174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
This narrative review explores the complex relationship between aerobic exercise (AE) and neuropathic pain (NP), particularly focusing on peripheral neuropathies of mechanical origin. Pain, a multifaceted phenomenon, significantly impacts functionality and distress. The International Association for the Study of Pain's definition highlights pain's biopsychosocial nature, emphasizing the importance of patient articulation. Neuropathic pain, arising from various underlying processes, presents unique challenges in diagnosis and treatment. Our methodology involved a comprehensive literature search in the PubMed and SCOPUS databases, focusing on studies relating AE to NP, specifically in peripheral neuropathies caused by mechanical forces. The search yielded 28 articles and 1 book, primarily animal model studies, providing insights into the efficacy of AE in NP management. Results from animal models demonstrate that AE, particularly in forms like no-incline treadmill and swimming, effectively reduces mechanical allodynia and thermal hypersensitivity associated with NP. AE influences neurophysiological mechanisms underlying NP, modulating neurotrophins, cytokines, and glial cell activity. These findings suggest AE's potential in attenuating neurophysiological alterations in NP. However, human model studies are scarce, limiting the direct extrapolation of these findings to human neuropathic conditions. The few available studies indicate AE's potential benefits in peripheral NP, but a lack of specificity in these studies necessitates further research. In conclusion, while animal models show promising results regarding AE's role in mitigating NP symptoms and influencing underlying neurophysiological mechanisms, more human-centric research is required. This review underscores the need for targeted clinical trials to fully understand and harness AE's therapeutic potential in human neuropathic pain, especially of mechanical origin.
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Affiliation(s)
- Jorge Ruimonte-Crespo
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-C.); (M.J.D.-A.); (M.J.N.-S.); (J.J.L.-M.); (R.F.-G.); (T.S.-F.); (J.A.V.-C.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-C.); (M.J.D.-A.); (M.J.N.-S.); (J.J.L.-M.); (R.F.-G.); (T.S.-F.); (J.A.V.-C.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - María José Díaz-Arribas
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-C.); (M.J.D.-A.); (M.J.N.-S.); (J.J.L.-M.); (R.F.-G.); (T.S.-F.); (J.A.V.-C.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-C.); (M.J.D.-A.); (M.J.N.-S.); (J.J.L.-M.); (R.F.-G.); (T.S.-F.); (J.A.V.-C.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - José Javier López-Marcos
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-C.); (M.J.D.-A.); (M.J.N.-S.); (J.J.L.-M.); (R.F.-G.); (T.S.-F.); (J.A.V.-C.)
- Faculty of Life and Natural Sciences, Nebrija University, 28015 Madrid, Spain
| | - Raúl Fabero-Garrido
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-C.); (M.J.D.-A.); (M.J.N.-S.); (J.J.L.-M.); (R.F.-G.); (T.S.-F.); (J.A.V.-C.)
| | - Tamara Seijas-Fernández
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-C.); (M.J.D.-A.); (M.J.N.-S.); (J.J.L.-M.); (R.F.-G.); (T.S.-F.); (J.A.V.-C.)
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-C.); (M.J.D.-A.); (M.J.N.-S.); (J.J.L.-M.); (R.F.-G.); (T.S.-F.); (J.A.V.-C.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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2
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Fourré A, Monnier F, Ris L, Telliez F, Michielsen J, Roussel N, Hage R. Low-back related leg pain: is the nerve guilty? How to differentiate the underlying pain mechanism. J Man Manip Ther 2023; 31:57-63. [PMID: 35735104 PMCID: PMC10013353 DOI: 10.1080/10669817.2022.2092266] [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: 10/17/2022] Open
Abstract
Low back pain (LBP) that radiates to the leg is not always related to a lesion or a disease of the nervous system (neuropathic pain): it might be nociceptive (referred) pain. Unfortunately, patients with low-back related leg pain are often given a variety of diagnoses (e.g. 'sciatica'; 'radicular pain'; pseudoradicular pain"). This terminology causes confusion and challenges clinical reasoning. It is essential for clinicians to understand and recognize predominant pain mechanisms. This paper describes pain mechanisms related to low back-related leg pain and helps differentiate these mechanisms in practice using clinical based scenarios. We illustrate this by using two clinical scenarios including patients with the same symptoms in terms of pain localization (i.e. low-back related leg pain) but with different underlying pain mechanisms (i.e. nociceptive versus neuropathic pain).
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Affiliation(s)
- Antoine Fourré
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium.,Traitement Formation Thérapie Manuelle (TFTM), Physiotherapy Center, Brussels, Belgium
| | - Félix Monnier
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Laurence Ris
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Frédéric Telliez
- Institut d'Ingénierie de la Santé-UFR de Médecine, Centre Universitaire de Recherche en Santé-Laboratoire Péritox, Université de Picardie Jules Verne, Amiens, France
| | - Jef Michielsen
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium.,Orthopedic Department, University Hospital, Antwerp, Belgium
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium
| | - Renaud Hage
- Traitement Formation Thérapie Manuelle (TFTM), Physiotherapy Center, Brussels, Belgium.,Centre de Recherche et de Formation (CeREF), HELHa, Mons, Belgium
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Kritikou P, Vadalouca A, Rekatsina M, Varrassi G, Siafaka I. The Diagnostic Odyssey of Patients with Chronic Neuropathic Pain-Expert Opinion of Greek Pain Specialists. Clin Pract 2023; 13:166-176. [PMID: 36826157 PMCID: PMC9955431 DOI: 10.3390/clinpract13010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/06/2023] [Accepted: 01/25/2023] [Indexed: 01/29/2023] Open
Abstract
The diagnosis of chronic neuropathic pain requires a laborious process and can be a very long journey for the patients, one that can be characterized as an "odyssey." Our aim was to describe the "diagnostic odyssey" associated with chronic neuropathic pain in the Greek context. Specialized clinicians working at dedicated chronic pain and palliative care centers were asked to participate in a survey regarding the diagnostic process in Greece. In total, 44 respondents provided information on the organization of their centers, the diagnostic process, and the perceived obstacles involved in the diagnosis of chronic neuropathic pain. Most respondents reported that their centers were not fully or efficiently organized and believed that additional specialized healthcare personnel should be employed. Raising public awareness about the existence of such centers was also considered key. The two main obstacles in reaching a diagnosis were the difficulty non-experts had in recognizing chronic neuropathic pain and the lack of acknowledgement that chronic neuropathic pain is a condition that needs to be addressed. When considering these responses in light of the extended socioeconomic burden associated with chronic neuropathic pain, efforts should be made to limit the "diagnostic odyssey" of chronic neuropathic pain in Greece. The aim of this study is to explore the experience of patients with chronic neuropathic pain in Greece from the viewpoint of pain specialists. A better organization of pain and palliative care centers, facilitation of communication with previously treating clinicians, increased personnel, utilization of a chronic pain registry, and guidelines development can aid in this venture. Keypoints: The diagnosis of chronic neuropathic pain in Greece is a laborious and time-consuming process that needs to be refined; Greek clinicians believe that their centers were not fully or efficiently organized and think that additional specialized healthcare personnel should be employed; Patient comorbidities and retards in visiting a clinic at the onset of symptoms delay the diagnosis of neuropathic pain and may complicate subsequent care; The diagnostic delay has been reported as three years between the onset of symptoms and seeking general medical help and another nine years before a referral to a pain specialist; Neuropathic pain is associated with patient distress and socioeconomic burdens, and diagnostic delays prolong the condition, may allow it to worsen, and utilize valuable healthcare resources without providing effective solutions.
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Affiliation(s)
- Persefoni Kritikou
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), 11523 Athens, Greece
- Correspondence:
| | - Athina Vadalouca
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), 11523 Athens, Greece
- Pain and Palliative Care Center, Athens Medical Center, Private Hospital, 11523 Athens, Greece
| | - Martina Rekatsina
- Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Ioanna Siafaka
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), 11523 Athens, Greece
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Comparative Efficacy of Tapentadol versus Tapentadol Plus Duloxetine in Patients with Chemotherapy-Induced Peripheral Neuropathy (CIPN): A Randomized Non-Inferiority Clinical Trial. Cancers (Basel) 2022; 14:cancers14164002. [PMID: 36010995 PMCID: PMC9406344 DOI: 10.3390/cancers14164002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a common complication due to treatment with many commonly used anti-cancer agents. CIPN is a mainly sensory neuropathy that can be characterized by the appearance of motor and autonomic alterations. Clinicians may offer duloxetine (DLX) for patients with cancer experiencing CIPN. Our aim was to assess the non-inferiority of the analgesic effect and safety of tapentadol (TP) alone compared to duloxetine plus tapentadol administered to patients with CIPN. Methods: A total of 114 patients were enrolled in the study and randomized to receive tapentadol in a dosage of 50 to 500 mg/day (n = 56) or tapentadol plus duloxetine in a dosage of 60 to 120 mg/day (n = 58) for a period of 4 weeks. We evaluated the analgesia efficacy, defined as a decrease in pain on the NRS between the first administration and 28 days later. Secondary endpoints included analgesia efficacy at 28 and 42 days, defined by a decrease in DN4 and LEPs, decrease in quality of life, and the incidence of any serious or non-serious adverse events after the first administration. Results: In this randomized, double-blind trial comparing TP and TP plus DLX for CIPN management, TP was feasible and non-inferior to the association with DLX as far as the reduction of pain after chemotherapy at 28 days is concerned. Scores on other rating scales evaluating the quality of life, anxiety and depression, and the characteristics of pain revealed similar improvements associated with tapentadol versus duloxetine at these time points. Conclusion: The use of TP is a safe and effective analgesic therapy in patients with CIPN. Positive effects of TP were noted on the patients’ quality-of-life assessments.
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Story MR, Nout-Lomas YS, Aboellail TA, Selberg KT, Barrett MF, Mcllwraith CW, Haussler KK. Dangerous Behavior and Intractable Axial Skeletal Pain in Performance Horses: A Possible Role for Ganglioneuritis (14 Cases; 2014-2019). Front Vet Sci 2021; 8:734218. [PMID: 34957274 PMCID: PMC8702524 DOI: 10.3389/fvets.2021.734218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Dangerous behavior is considered an undesired trait, often attributed to poor training or bad-tempered horses. Unfortunately, horses with progressive signs of dangerous behavior are often euthanized due to concerns for rider safety and limitations in performance. However, this dangerous behavior may actually originate from chronic axial skeleton pain. This case series describes the medical histories and clinical presentations of horses presented for performance limitations and dangerous behavior judged to be related to intractable axial skeleton pain. Material and Methods: Fourteen horses that developed severe performance limitations resulting in euthanasia were included. A complete spinal examination and behavioral responses, gait and neurologic evaluations, diagnostic imaging, gross pathologic and histopathologic examinations of the axial skeleton were performed on all horses. A tentative diagnosis of the affected spinal region was formulated using medical records, owner and trainer complaints, and antemortem examination findings. The selected spinal regions were further examined with gross and histopathologic evaluations of the associated osseous, soft tissue and neural tissues. Results: Ten horses showed severe behavioral responses during the myofascial and mobilization examinations. Based on an aggregate evaluation, the cervicothoracic and lumbosacral regions were the most common regions believed to be the primary area of concern. All horses had moderate to severe ganglionitis present at multiple vertebral levels. Subdural and epidural hemorrhage or hematomas were a common finding (71%) in the cervicothoracic and lumbosacral regions. Discussion: In this case series, neuropathic (i.e., structural) pain was judged to be the underlying cause of dangerous behavior. The dorsal root ganglia (DRG) serve an important role in relaying peripheral sensory information to the central nervous system and ganglionitis has been associated with neuropathic pain syndromes. This series highlights the need for more in-depth understanding of pain behavior and its clinical presentation and progression in chronic or severely affected horses. Limitations of the study are the lack of age-matched control DRG and the incomplete collection of DRG from every vertebral level of interest.
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Affiliation(s)
- Melinda R Story
- Department of Clinical Sciences, Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Yvette S Nout-Lomas
- Department of Clinical Sciences, Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Tawfik A Aboellail
- Department of Microbiology, Immunology, and Pathology, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, CO, United States
| | - Kurt T Selberg
- Department of Clinical Sciences, Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States.,Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, CO, United States
| | - Myra F Barrett
- Department of Clinical Sciences, Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States.,Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, CO, United States
| | - C Wayne Mcllwraith
- Department of Clinical Sciences, Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Kevin K Haussler
- Department of Clinical Sciences, Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
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Improving assessment and management of pain in hemophilia: an Italian Delphi consensus statement. Blood Rev 2021; 51:100885. [PMID: 34544642 DOI: 10.1016/j.blre.2021.100885] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 08/06/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022]
Abstract
Comprehensive evidence-based guidelines and well-validated assessment scales for pain in people with hemophilia (PwH) are needed. Here, we report 28 statements covering five topics on pain assessment and management in pediatric and adult PwH that were developed by 60 Italian hemophilia specialists during a Delphi consensus process. Overall, a clear consensus was achieved for 19 of the 28 statements. Consensus was reached on all statements on the topic of pain assessment and quality of life (QoL), including the need for regular pain assessment on a quantitative scale, the importance of distinguishing between different pain types, and the need to evaluate the impact of pain on patient QoL. The other four topics concerned acute and chronic pain management in adults and in children. Consensus was reached on statements regarding non-pharmacologic treatment and the use of first-line paracetamol (acetaminophen). There was a lack of consensus regarding the use of non-steroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, or opioids.
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7
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Oh J. Evaluation and diagnosis of neuropathic pain. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.7.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Thorough evaluation and an accurate diagnosis of neuropathic pain are essential for effective treatment. The therapeutic approach and choice of medication for neuropathic pain are different from those for other kinds of nociceptive pain. Therefore, this study aimed to present the current evaluation and diagnostic methods for neuropathic pain.Current Concepts: Grading of the certainty of the presence of neuropathic pain according to the results of clinical history, neurological examination, and confirmatory tests improves the diagnosis of neuropathic pain. The Leeds Assessment of Neuropathic Symptoms and Signs, Neuropathic Pain Questionnaire, Douleur Neuropathique en 4 Questions, and PainDETECT are mainly used for neuropathic pain screening. During physical examination, sensory nerve function tests are more critical than other nervous system examination items, including the test of the sense of touch with a cotton swab and the sense of vibration with a tuning fork. In addition, pain sensation using pins and temperature sensation using cold metal are tested to check for nociceptive pathway abnormalities. Diagnostic tests include imaging tests, nerve conduction tests, and other neurophysiological tests, such as quantitative sensory function tests, autonomic nerve function tests, and blood tests.Discussion and Conclusion: To diagnose neuropathic pain, physicians should first determine whether patient symptoms match the characteristics of neuropathic pain. If there is a possibility of neuropathic pain, physicians should perform a neurological screening examination and a proper diagnostic test to identify the cause of pain.
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Zucchella C, Mantovani E, De Icco R, Tassorelli C, Sandrini G, Tamburin S. Non-invasive Brain and Spinal Stimulation for Pain and Related Symptoms in Multiple Sclerosis: A Systematic Review. Front Neurosci 2020; 14:547069. [PMID: 33328843 PMCID: PMC7715002 DOI: 10.3389/fnins.2020.547069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Neuropathic and nociceptive pain frequently affect patients with multiple sclerosis (MS), with a prevalence close to 90% and significant impact on general health and quality of life. Pharmacological strategies are widely used to treat pain in MS, but their effectiveness and side-effects are controversial. Among non-pharmacological treatments for pain, non-invasive brain and spinal stimulation (NIBSS) has shown promising preliminary results in MS. Objective: Systematic review to investigate the effect of NIBSS for the management of pain in MS. Methods: A literature search using Pubmed, Science Direct and Web of Science was conducted from databases inception to February 21, 2020 for studies assessing the analgesic effect of NIBSS on pain in MS. Results: A total of 279 records were title- and abstract-screened, nine were assessed for full text and included. The NIBSS techniques explored were transcranial direct current stimulation (N = 5), transcranial magnetic stimulation (N = 2), transcranial random noise stimulation (N =1), transcutaneous spinal direct current stimulation (N = 1). The targets were the primary motor cortex (M1; N = 4), the left dorsolateral pre-frontal cortex (DLPFC; N = 3), the spinal cord (N = 1), unspecified brain target (N = 1). The study designs were randomized (N = 7), open label (N = 1), single case report (N = 1). Despite the differences in study design, target and NIBSS technique that impeded a meta-analysis, all the studies converge in showing a significant improvement of pain after active NIBSS with less consistent effects on other symptoms of the pain-related cluster (depression, fatigue, cognition) and quality of life. Conclusions: Excitatory NIBSS over M1, left DLPFC and spinal cord appear to be the most effective protocols for pain in MS. Open questions include the use of neurophysiological or neuroimaging surrogate outcome measures, the stratification of patients according to the clinical profiles and underlying pathogenetic mechanisms and the combination of NIBSS to pharmacological treatment, neurorehabilitation, or psychotherapy to improve the clinical effect. The duration of the effect to NIBSS and the feasibility and efficacy of telemedicine NIBSS protocols are other open key questions.
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Affiliation(s)
- Chiara Zucchella
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto De Icco
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Sandrini
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefano Tamburin
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Di Lernia D, Lacerenza M, Ainley V, Riva G. Altered Interoceptive Perception and the Effects of Interoceptive Analgesia in Musculoskeletal, Primary, and Neuropathic Chronic Pain Conditions. J Pers Med 2020; 10:E201. [PMID: 33138185 PMCID: PMC7712753 DOI: 10.3390/jpm10040201] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic pain (CP) severely disrupts the daily life of millions. Interoception (i.e., sensing the physiological condition of the body) plays a pivotal role in the aetiology and maintenance of CP. As pain is inherently an interoceptive signal, interoceptive frameworks provide important, but underutilized, approaches to this condition. Here we first investigated three facets of interoceptive perception in CP, compared with pain-free controls. We then introduce a novel interoceptive treatment and demonstrate its capacity to reduce pain severity in CP, potentially providing complementary analgesic treatments. Study 1 measured interoceptive accuracy, confidence and sensibility in patients (N = 60) with primary, secondary musculoskeletal, and neuropathic CP. Compared with matched controls, CP participants exhibited significantly lower interoceptive accuracy and interoceptive confidence. Pain severity was predicted positively by interoceptive accuracy, anxiety and depression, and negatively by interoceptive confidence. Study 2 tested a promising new interoceptive treatment for CP, in a single-blind between-subjects design (N = 51) with primary, secondary musculoskeletal, and neuropathic CP patients. The treatment specifically activates the C-Tactile system, by means of controlled stimulation of interoceptive unmyelinated afferents, at 3 cm/s with a force of 2.5 mN. This treatment led to significant pain reduction (mean 23%) in the CP treatment group after only 11 min, while CP controls who received comparable but non-interoceptive stimulation reported no change in pain intensity. These studies highlight the importance of interoceptive approaches to CP and demonstrate the potential of this novel method of C-Tactile stimulation to provide complementary analgesic treatments.
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Affiliation(s)
- Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan, Italy;
- Humane Technology Lab., Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan, Italy
| | - Marco Lacerenza
- Neurology and Pain Center, Humanitas San Pio X Clinic, 20159 Milan, Italy;
| | - Vivien Ainley
- Lab of Action and Body, Royal Holloway University of London, Egham TW20 0EX, UK;
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan, Italy;
- Humane Technology Lab., Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan, Italy
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco, 2, 20149 Milan, Italy
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Chiaramonte R, Romano M, Vecchio M. A Systematic Review of the Diagnostic Methods of Small Fiber Neuropathies in Rehabilitation. Diagnostics (Basel) 2020; 10:E613. [PMID: 32825514 PMCID: PMC7554909 DOI: 10.3390/diagnostics10090613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
This systematic review describes the several methods to diagnose and measure the severity of small fiber neuropathies and aims to guide the physician to define all the diagnostic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science. Two reviewers independently reviewed and came to consensus on which articles met inclusion/exclusion criteria. The authors excluded all the duplicates, animals' studies, and included the English articles in which the diagnostic measures were finalized to assess the effectiveness of rehabilitation and pharmacologic treatment of patients with small fiber neuropathies. The search identified a total of 975 articles with the keywords "small fiber neuropathy" AND "rehabilitation" OR "therapy" OR "treatment". Seventy-eight selected full-text were analyzed by the reviewers. Forty-one publications met the inclusion criteria and were included in the systematic review. Despite the range of diagnostic tools for the assessment of small fiber neuropathy, other robust trials are needed. In addition, always different diagnostic approaches are used, a unique protocol could be important for the clinicians. More research is needed to build evidence for the best diagnostic methodologies and to delineate a definitive diagnostic protocol.
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Affiliation(s)
- Rita Chiaramonte
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95125 Catania, Italy
| | - Marcello Romano
- Neurology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, 90100 Palermo, Italy;
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95125 Catania, Italy
- Rehabilitation Unit, AOU Policlinico Vittorio Emanuele, University of Catania, 95125 Catania, Italy
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Waldman OV, Hao SP, Houck JR, Lee NJ, Baumhauer JF, Oh I. Operative Intervention Does Not Change Pain Perception in Patients With Diabetic Foot Ulcers. Clin Diabetes 2020; 38:132-140. [PMID: 32327885 PMCID: PMC7164984 DOI: 10.2337/cd19-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Researchers investigated pain perception in patients with diabetic foot ulcers (DFUs) by analyzing pre- and postoperative physical function (PF), pain interference (PI), and depression domains of the Patient-Reported Outcome Measurement Information System (PROMIS). They hypothesized that 1) because of painful diabetic peripheral neuropathy (DPN), a majority of patients with DFUs would have high PROMIS PI scores unchanged by operative intervention, and 2) the initially assessed PI, PF, and depression levels would be correlated with final outcomes. Seventy-five percent of patients with DFUs reported pain, most likely because of painful DPN. Those who reported high PI and low PF were likely to report depression. PF, PI, and depression levels were unchanged after operative intervention or healing of DFUs.
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Affiliation(s)
- Olivia V Waldman
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Stephanie P Hao
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Jeff R Houck
- Department of Physical Therapy, George Fox University, Newburg, OR
| | - Nicolette J Lee
- Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Judith F Baumhauer
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Irvin Oh
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
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Rosenberger DC, Blechschmidt V, Timmerman H, Wolff A, Treede RD. Challenges of neuropathic pain: focus on diabetic neuropathy. J Neural Transm (Vienna) 2020; 127:589-624. [PMID: 32036431 PMCID: PMC7148276 DOI: 10.1007/s00702-020-02145-7] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
Abstract
Neuropathic pain is a frequent condition caused by a lesion or disease of the central or peripheral somatosensory nervous system. A frequent cause of peripheral neuropathic pain is diabetic neuropathy. Its complex pathophysiology is not yet fully elucidated, which contributes to underassessment and undertreatment. A mechanism-based treatment of painful diabetic neuropathy is challenging but phenotype-based stratification might be a way to develop individualized therapeutic concepts. Our goal is to review current knowledge of the pathophysiology of peripheral neuropathic pain, particularly painful diabetic neuropathy. We discuss state-of-the-art clinical assessment, validity of diagnostic and screening tools, and recommendations for the management of diabetic neuropathic pain including approaches towards personalized pain management. We also propose a research agenda for translational research including patient stratification for clinical trials and improved preclinical models in relation to current knowledge of underlying mechanisms.
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Affiliation(s)
- Daniela C Rosenberger
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Vivian Blechschmidt
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Hans Timmerman
- Department of Anesthesiology, Pain Center, University Medical Center of Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - André Wolff
- Department of Anesthesiology, Pain Center, University Medical Center of Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
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OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity. Toxins (Basel) 2019; 11:toxins11060359. [PMID: 31226803 PMCID: PMC6628414 DOI: 10.3390/toxins11060359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/20/2019] [Accepted: 06/18/2019] [Indexed: 11/17/2022] Open
Abstract
Spasticity is a muscle tone disorder associated with different neurological conditions. Spasticity could be associated with pain, high disability, poor functional recovery, and reduced quality of life. Botulinum neurotoxin type A (BoNT-A) is considered a first-line treatment for spasticity and, more recently, it also represents a therapeutic option for various chronic pain conditions. In this open label study, we aim to evaluate the effect of the BoNT-A on the spinal nociception in patients affected by spasticity of the lower limbs with associated pain with predominantly neuropathic features. Ten patients with stroke, 10 with multiple sclerosis and 5 with spinal cord injury were enrolled in the study. They were tested with clinical scales (neuropathic pain scale inventory (NPSI), numerical rating scale (NRS), modified Ashworth scale (MAS) and with the nociceptive withdrawal reflex at lower limbs to explore the spinal temporal summation threshold at baseline and 30 day after BoNT-A injection. OnabotulinumtoxinA (50 to 200 units per site) was injected in the lower limb muscles according to the distribution of spasticity. No significant differences were found at baseline for neurophysiological features across groups. After the BoNT-A injection, we recorded a significant reduction in MAS and NRS scores. Regarding the neurophysiological parameters, we described a significant increase in the temporal summation threshold after the BoNT-A injection. Our data supports the hypothesis that peripherally injected OnabotulinumtoxinA modulates the excitability of spinal cord nociceptive pathways. This activity may take place irrespective of the effect of the drug on spasticity.
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López-de-Uralde-Villanueva I, Gil-Martínez A, Candelas-Fernández P, de Andrés-Ares J, Beltrán-Alacreu H, La Touche R. Validity and reliability of the Spanish-language version of the self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Mayoral V, Pérez-Hernández C, Muro I, Leal A, Villoria J, Esquivias A. Diagnostic accuracy of an identification tool for localized neuropathic pain based on the IASP criteria. Curr Med Res Opin 2018; 34:1465-1473. [PMID: 29661030 DOI: 10.1080/03007995.2018.1465905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Based on the clear neuroanatomical delineation of many neuropathic pain (NP) symptoms, a simple tool for performing a short structured clinical encounter based on the IASP diagnostic criteria was developed to identify NP. This study evaluated its accuracy and usefulness. METHODS A case-control study was performed in 19 pain clinics within Spain. A pain clinician used the experimental screening tool (the index test, IT) to assign the descriptions of non-neuropathic (nNP), non-localized neuropathic (nLNP), and localized neuropathic (LNP) to the patients' pain conditions. The reference standard was a formal clinical diagnosis provided by another pain clinician. The accuracy of the IT was compared with that of the Douleur Neuropathique en 4 questions (DN4) and the Leeds Assessment of Neuropathic Signs and Symptoms (LANSS). RESULTS Six-hundred and sixty-six patients were analyzed. There was a good agreement between the IT and the reference standard (kappa =0.722). The IT was accurate in distinguishing between LNP and nLNP (83.2% sensitivity, 88.2% specificity), between LNP and the other pain categories (nLNP + nNP) (80.0% sensitivity, 90.7% specificity), and between NP and nNP (95.5% sensitivity, 89.1% specificity). The accuracy in distinguishing between NP and nNP was comparable with that of the DN4 and the LANSS. The IT took a median of 10 min to complete. CONCLUSIONS A novel instrument based on an operationalization of the IASP criteria can not only discern between LNP and nLNP, but also provide a high level of diagnostic certainty about the presence of NP after a short clinical encounter.
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Affiliation(s)
- Víctor Mayoral
- a Pain Clinic , Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat , Barcelona , Spain
| | | | - Inmaculada Muro
- c Pain Clinic , Complejo Hospitalario de Cáceres , Cáceres , Spain
| | - Ana Leal
- d Medical Department , Grünenthal Pharma, S.A. , Madrid , Spain
| | - Jesús Villoria
- e Department of Design and Biometrics , Medicxact, S.L. , Alpedrete , Spain
| | - Ana Esquivias
- d Medical Department , Grünenthal Pharma, S.A. , Madrid , Spain
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Timmerman H, Wilder-Smith OH, Steegers MA, Vissers KC, Wolff AP. The added value of bedside examination and screening QST to improve neuropathic pain identification in patients with chronic pain. J Pain Res 2018; 11:1307-1318. [PMID: 30022849 PMCID: PMC6044357 DOI: 10.2147/jpr.s154698] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background The assessment of a neuropathic pain component (NePC) to establish the neurological criteria required to comply with the clinical description is based on history taking, clinical examination, and quantitative sensory testing (QST) and includes bedside examination (BSE). The objective of this study was to assess the potential association between the clinically diagnosed presence or absence of an NePC, BSE, and the Nijmegen–Aalborg screening QST (NASQ) paradigm in patients with chronic (≥3 months) low back and leg pain or with neck shoulder arm pain or in patients with chronic pain due to suspected peripheral nerve damage. Methods A total of 291 patients participated in the study. Pain (absence or presence of neuro-pathic pain) was assessed independently by two physicians and compared with BSE (measurements of touch [finger, brush], heat, cold, pricking [safety pin, von Frey hair], and vibration). The NASQ paradigm (pressure algometry, electrical pain thresholds, and conditioned pain modulation) was assessed in 58 patients to generate new insights. Results BSE revealed a low association of differences between patients with either absent or present NePC: heat, cold, and pricking sensations with a von Frey hair were statistically significantly less common in patients with present NePC. NASQ did not reveal any differences between patients with and without an NePC. Conclusion Currently, a standardized BSE appears to be more useful than the NASQ paradigm when distinguishing between patients with and without an NePC.
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Affiliation(s)
- Hans Timmerman
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands,
| | - Oliver Hg Wilder-Smith
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands, .,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Monique Ah Steegers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kris Cp Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - André P Wolff
- Department of Anesthesiology, Pain Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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17
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Timmerman H, Wolff AP, Bronkhorst EM, Wilder-Smith OHG, Schenkels MJ, van Dasselaar NT, Huygen FJPM, Steegers MAH, Vissers KCP. Avoiding Catch-22: validating the PainDETECT in a in a population of patients with chronic pain. BMC Neurol 2018; 18:91. [PMID: 29958535 PMCID: PMC6026336 DOI: 10.1186/s12883-018-1094-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/22/2018] [Indexed: 12/19/2022] Open
Abstract
Background Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system and is a major therapeutic challenge. Several screening tools have been developed to help physicians detect patients with neuropathic pain. These have typically been validated in populations pre-stratified for neuropathic pain, leading to a so called “Catch-22 situation:” “a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule”. The validity of screening tools needs to be proven in patients with pain who were not pre-stratified on basis of the target outcome: neuropathic pain or non-neuropathic pain. This study aims to assess the validity of the Dutch PainDETECT (PainDETECT-Dlv) in a large population of patients with chronic pain. Methods A cross-sectional multicentre design was used to assess PainDETECT-Dlv validity. Included where patients with low back pain radiating into the leg(s), patients with neck-shoulder-arm pain and patients with pain due to a suspected peripheral nerve damage. Patients’ pain was classified as having a neuropathic pain component (yes/no) by two experienced physicians (“gold standard”). Physician opinion based on the Grading System was a secondary comparison. Results In total, 291 patients were included. Primary analysis was done on patients where both physicians agreed upon the pain classification (n = 228). Compared to the physician’s classification, PainDETECT-Dlv had a sensitivity of 80% and specificity of 55%, versus the Grading System it achieved 74 and 46%. Conclusion Despite its internal consistency and test-retest reliability the PainDETECT-Dlv is not an effective screening tool for a neuropathic pain component in a population of patients with chronic pain because of its moderate sensitivity and low specificity. Moreover, the indiscriminate use of the PainDETECT-Dlv as a surrogate for clinical assessment should be avoided in daily clinical practice as well as in (clinical-) research. Catch-22 situations in the validation of screening tools can be prevented by not pre-stratifying the patients on basis of the target outcome before inclusion in a validation study for screening instruments. Trial registration The protocol was registered prospectively in the Dutch National Trial Register: NTR 3030. Electronic supplementary material The online version of this article (10.1186/s12883-018-1094-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hans Timmerman
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Huispost 549, PO Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - André P Wolff
- Department of Anesthesiology, Pain Center, University of Groningen, University medical center Groningen, Groningen, the Netherlands
| | - Ewald M Bronkhorst
- Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands
| | - Oliver H G Wilder-Smith
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Huispost 549, PO Box 9101, 6500, HB, Nijmegen, the Netherlands.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Marcel J Schenkels
- Bernhoven Ziekenhuis, Department of Anesthesiology, Uden, the Netherlands
| | - Nick T van Dasselaar
- Reinier de Graaf Gasthuis, Department of Anesthesiology, Pain Medicine and Palliative Care, Delft, the Netherlands
| | - Frank J P M Huygen
- ErasmusMC, Department of Anesthesiology, University Center of Pain Medicine, Rotterdam, the Netherlands
| | - Monique A H Steegers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Huispost 549, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Huispost 549, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
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Roussel NA. Gaining insight into the complexity of pain in patients with haemophilia: State-of-the-art review on pain processing. Haemophilia 2018; 24 Suppl 6:3-8. [DOI: 10.1111/hae.13509] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Affiliation(s)
- N. A. Roussel
- Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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Investigating the validity of the DN4 in a consecutive population of patients with chronic pain. PLoS One 2017; 12:e0187961. [PMID: 29190718 PMCID: PMC5708633 DOI: 10.1371/journal.pone.0187961] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/30/2017] [Indexed: 11/19/2022] Open
Abstract
Neuropathic pain is clinically described as pain caused by a lesion or disease of the somatosensory nervous system. The aim of this study was to assess the validity of the Dutch version of the DN4, in a cross-sectional multicentre design, as a screening tool for detecting a neuropathic pain component in a large consecutive, not pre-stratified on basis of the target outcome, population of patients with chronic pain. Patients' pain was classified by two independent (pain-)physicians as the gold standard. The analysis was initially performed on the outcomes of those patients (n = 228 out of 291) in whom both physicians agreed in their pain classification. Compared to the gold standard the DN4 had a sensitivity of 75% and specificity of 76%. The DN4-symptoms (seven interview items) solely resulted in a sensitivity of 70% and a specificity of 67%. For the DN4-signs (three examination items) it was respectively 75% and 75%. In conclusion, because it seems that the DN4 helps to identify a neuropathic pain component in a consecutive population of patients with chronic pain in a moderate way, a comprehensive (physical-) examination by the physician is still obligate.
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Passavanti MB, Pota V, Sansone P, Aurilio C, De Nardis L, Pace MC. Chronic Pelvic Pain: Assessment, Evaluation, and Objectivation. PAIN RESEARCH AND TREATMENT 2017; 2017:9472925. [PMID: 29359045 PMCID: PMC5735788 DOI: 10.1155/2017/9472925] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/06/2017] [Accepted: 10/15/2017] [Indexed: 12/20/2022]
Abstract
Chronic Pelvic Pain (CPP) and Chronic Pelvic Pain Syndrome (CPPS) have a significant impact on men and women of reproductive and nonreproductive age, with a considerable burden on overall quality of life (QoL) and on psychological, functional, and behavioural status. Moreover, diagnostic and therapeutic difficulties are remarkable features in many patients. Therefore evaluation, assessment and objectivation tools are often necessary to properly address each patient and consequently his/her clinical needs. Here we review the different tools for pain assessment, evaluation, and objectivation; specific features regarding CPP/CPPS will be highlighted. Also, recent findings disclosed with neuroimaging investigations will be reviewed as they provide new insights into CPP/CPPS pathophysiology and may serve as a tool for CPP assessment and objectivation.
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Affiliation(s)
- Maria Beatrice Passavanti
- Department of Woman, Child, General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Vincenzo Pota
- Department of Woman, Child, General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Pasquale Sansone
- Department of Woman, Child, General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Caterina Aurilio
- Department of Woman, Child, General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Lorenzo De Nardis
- Department of Woman, Child, General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Maria Caterina Pace
- Department of Woman, Child, General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
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Wu C, Xie N, Liu H, Zhang H, Zhang L, Lian Y. A new target for the treatment of trigeminal neuralgia with botulinum toxin type A. Neurol Sci 2017; 39:599-602. [PMID: 29086125 DOI: 10.1007/s10072-017-3171-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/25/2017] [Indexed: 02/04/2023]
Abstract
Trigeminal neuralgia (TN) is typically treated pharmacologically with anticonvulsants, but these can be ineffective, or can lose their effectiveness over time. In recent years, botulinum toxin type A (BoNT-A), when injected subcutaneously across multiple sites, can effectively treat TN. However, approximately 30% of TN cases are refractory to subcutaneous BoNT-A treatment. We report here the case of a 79-year-old female patient with TN presenting as severe, episodic pain in the lower left gingival area. She was on anticonvulsant therapy (carbamazepine) for about 3 years prior to BoNT-A treatment. Despite initial relief, the pain not only recurred, but also began to worsen, even as her carbamazepine dose was increased substantially. We injected 50 U of BoNT-A into the oral mucosa of the painful gingival area, but the patient's pain was unaffected. We then changed to an intramuscular injection protocol and injected the same dose of BoNT-A into the left masseter, which produced a good therapeutic effect for about 5 months; she was then administered a second treatment (intra-masseter), and at a 2-week follow-up, still reported being pain-free. This case and a survey of the literature suggest that BoNT-A injection protocols maybe closely correlated with their clinical efficacy in cases of TN, possibly due to the ability of BoNT-A to be transported retrogradely along trigeminal nerve axons. We believe that finding the optimal BoNT-A therapy injection protocol(s) will significantly reduce the number of refractory cases of TN.
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Affiliation(s)
- Chuanjie Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Nanchang Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Hongbo Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Haifeng Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Lu Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Sansone P, Passavanti MB, Fiorelli A, Aurilio C, Colella U, De Nardis L, Donatiello V, Pota V, Pace MC. Efficacy of the topical 5% lidocaine medicated plaster in the treatment of chronic post-thoracotomy neuropathic pain. Pain Manag 2017; 7:189-196. [DOI: 10.2217/pmt-2016-0060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: To assess the efficacy of the topical 5% lidocaine medicated plaster (Versatis®, Grünenthal GmbH, Aachen, Germany) in patients with post-thoracotomy neuropathic pain. Patients & methods: Patients were randomized to receive the topical 5% lidocaine medicated plaster (n = 33) or non-medicated placebo plasters (n = 30) for 12 h every day for 8 weeks. Laser-evoked potentials (LEPs) were measured, and various questionnaires/scales completed. Results: Numeric Rating Scale pain scores improved significantly (p < 0.01) more in topical 5% lidocaine medicated plaster than in placebo recipients. The same was true for N2 and P2 LEP latency and amplitude, and other parameters. Conclusion: The study included neurophysiological findings and confirmed the efficacy of the topical 5% lidocaine medicated plaster in patients with chronic post-thoracotomy neuropathic pain.
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Affiliation(s)
- Pasquale Sansone
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Maria Beatrice Passavanti
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - Caterina Aurilio
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Umberto Colella
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Lorenzo De Nardis
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Valerio Donatiello
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Vincenzo Pota
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Maria Caterina Pace
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
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Abstract
Pain in multiple sclerosis (MS) is a common manifestation, made up of complex phenomenon involving intricate neurophysiological processing at central levels of the pain pathway. Our understanding of the clinical and neurophysiological mechanisms of central/neuropathic pain related to MS continues to improve with improved imaging techniques but remains a challenging area of research. The advancements in imaging techniques for lesion evaluation of the various neuroanatomic structures have improved our detection, diagnosis, and understanding of MS pain and help validate subjective symptoms. This article will discuss the updated criteria of MS neuropathic pain and critically review some of the latest research into imaging correlations of MS pain syndromes. And discuss how advanced MRI imaging techniques (such as functional magnetic resonance imaging [fMRI], 3D imaging, fluid attenuated inversion recovery [FLAIR*], and diffusion tensor imaging [DTI]) have detailed neuropathic pain with a focus on migraines and trigeminal neuralgias and will highlight some of the ongoing limitations, variabilities, and deficiencies.
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Affiliation(s)
- Amir Mazhari
- Neurology and Neurosciences Associates, 701 White Pond Drive, Suite 300, Akron, OH, 44302, USA.
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24
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Pérez C, Margarit C, Sánchez-Magro I, de Antonio A, Villoria J. Chronic Pain Features Relate to Quality of Life More than Physiopathology: A Cross-Sectional Evaluation in Pain Clinics. Pain Pract 2017; 17:866-878. [PMID: 27782366 DOI: 10.1111/papr.12533] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/11/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the impact of chronic pain physiopathology on health-related quality of life (HR-QoL), considering the influence of pain features and psychosocial adjustment (intensity, interference, psychological comorbidities, and sleep quality). DESIGN A cross-sectional study involving 1,025 noncancer patients with predominantly neuropathic, nociceptive, or mixed chronic pain conditions was conducted in 88 pain clinics within Spain. The EuroQol-5 Dimensions instrument (EQ-5D) was used to measure HR-QoL. The Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS), and sleep scale developed for the MOS study (MOS-SQ) were used to measure pain features and psychosocial adjustment. Multivariate analyses were used to model HR-QoL measures. RESULTS All patients reported very low HR-QoL. The mean EQ-5D index scores were 0.33, 0.36, and 0.37 in the mixed, neuropathic, and nociceptive pain groups, respectively. The differences did not reach statistical significance (P = 0.057). Patients with nociceptive pain had less pain (least pain intensity score: 4.7 vs. 5.2 in the other groups; P = 0.006), less interference with daily activities (BPI average interference score: 6.3 vs. 6.6 and 6.7 in the neuropathic and mixed pain groups, respectively; P = 0.013), less anxiety (HADS score: 8.5 vs. 9.6 and 9.7 in the same respective groups; P = 0.001), and fewer sleep problems (MOS-SQ sleep problems index: 46.8 vs. 52.2 and 50.2 in the same respective groups; P = 0.005). In the adjusted analyses, HR-QoL measures were explained by pain intensity, anxiety, and sleep quality, but not by physiopathological pain type. CONCLUSIONS Pain features, particularly intensity, have a greater impact than pain physiopathology on HR-QoL. Distinct physiopathological mechanisms give rise to different pain features that, in turn, may mediate the HR-QoL of patients with chronic pain. This could be used to improve pain management strategies.
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Affiliation(s)
| | - César Margarit
- Pain Clinic, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Ana de Antonio
- Department of Statistical Design and Biometrics, Medicxact SL, Alpedrete, Spain
| | - Jesús Villoria
- Department of Statistical Design and Biometrics, Medicxact SL, Alpedrete, Spain
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López-de-Uralde-Villanueva I, Gil-Martínez A, Candelas-Fernández P, de Andrés-Ares J, Beltrán-Alacreu H, La Touche R. Validity and reliability of the Spanish-language version of the self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale. Neurologia 2016; 33:505-514. [PMID: 27939112 DOI: 10.1016/j.nrl.2016.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/15/2016] [Accepted: 10/17/2016] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) scale is a tool designed to identify patients with pain with neuropathic features. OBJECTIVE To assess the validity and reliability of the Spanish-language version of the S-LANSS scale. METHODS Our study included a total of 182 patients with chronic pain to assess the convergent and discriminant validity of the S-LANSS; the sample was increased to 321 patients to evaluate construct validity and reliability. The validated Spanish-language version of the ID-Pain questionnaire was used as the criterion variable. All participants completed the ID-Pain, the S-LANSS, and the Numerical Rating Scale for pain. Discriminant validity was evaluated by analysing sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Construct validity was assessed with factor analysis and by comparing the odds ratio of each S-LANSS item to the total score. Convergent validity and reliability were evaluated with Pearson's r and Cronbach's alpha, respectively. RESULTS The optimal cut-off point for S-LANSS was ≥12 points (AUC=.89; sensitivity=88.7; specificity=76.6). Factor analysis yielded one factor; furthermore, all items contributed significantly to the positive total score on the S-LANSS (P<.05). The S-LANSS showed a significant correlation with ID-Pain (r=.734, α=.71). CONCLUSION The Spanish-language version of the S-LANSS is valid and reliable for identifying patients with chronic pain with neuropathic features.
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Affiliation(s)
- I López-de-Uralde-Villanueva
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Grupo de Investigación Motion in Brains, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, España; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, España; Facultad de Ciencias de la Salud, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
| | - A Gil-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Grupo de Investigación Motion in Brains, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, España; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - P Candelas-Fernández
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | - J de Andrés-Ares
- Unidad del Dolor, Servicio de Anestesiología, Hospital Universitario La Paz, Madrid, España
| | - H Beltrán-Alacreu
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Grupo de Investigación Motion in Brains, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, España
| | - R La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Grupo de Investigación Motion in Brains, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, España; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, España
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Shanthanna H, Gilron I, Thabane L, Devereaux PJ, Bhandari M, AlAmri R, Rajarathinam M, Kamath S. Gabapentinoids for chronic low back pain: a protocol for systematic review and meta-analysis of randomised controlled trials. BMJ Open 2016; 6:e013200. [PMID: 28186946 PMCID: PMC5128988 DOI: 10.1136/bmjopen-2016-013200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a common condition and causes significant pain, distress and disability across the world. It is multifactorial in aetiology and is challenging to manage. Although the underlying mechanism of pain is predominantly non-specific, many argue that there is a substantial neuropathic pain element. Neuropathic pain is more severe, with significant disability. Gabapentinoids, including gabapentin and pregabalin, have proven efficacy in some neuropathic pain conditions. Despite no clear evidence, a substantial population of patients with CLBP are treated with gabapentinoids. OBJECTIVES We aim to assess whether the use of gabapentinoids is effective and safe in the treatment of predominant CLBP, by conducting a systematic review and meta-analysis of randomised control trials (RCTs). METHODOLOGY We will search the databases of MEDLINE, EMBASE and Cochrane for RCTs published in English language and have used gabapentinoids for the treatment of CLBP. Study selection and data extraction will be performed independently by paired reviewers using structured electronic forms, piloted between pairs of reviewers. The review outcomes will be guided by Initiative on Methods, Measurement and Pain Assessment in Clinical Trials guidelines, with pain relief as the primary outcome. We propose to carry out meta-analysis if there are three or more studies in a particular outcome domain, using a random effects model. Pooled outcomes will be reported as weighted mean differences or standardised mean differences and risk ratios with their corresponding 95% CIs, for continuous outcomes and dichotomous outcomes, respectively. Rating of quality of evidence will be reported using GRADE summary of findings table. DISCUSSION The proposed systematic review will be able to provide valuable evidence to help decision-making in the use of gabapentinoids for the treatment of CLBP. This will help advance patient care and potentially highlight limitations in existing evidence to direct future research. ETHICS AND DISSEMINATION Being a systematic review, this study would not necessitate ethical review and approval. We plan to report and publish our study findings in a high impact medical journal, with online access. TRIAL REGISTRATION NUMBER CRD42016034040.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesiology, McMaster University, Michael DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Ian Gilron
- Department of Anesthesiology and Biomedical Sciences, Queen's University, Kingston, Ontario, Canada
| | - Lehana Thabane
- Department of Anesthesiology, McMaster University, Michael DeGroote School of Medicine, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Philip J Devereaux
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Rizq AlAmri
- Department of Anesthesiology, McMaster University, Michael DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Manikandan Rajarathinam
- Department of Anesthesiology, McMaster University, Michael DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Sriganesh Kamath
- Department of Anesthesiology, McMaster University, Michael DeGroote School of Medicine, Hamilton, Ontario, Canada
- Department of Neuroanesthesia, National Institute of Mental Health and Neurosciences, Bangalore, India
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Kalliomäki ML, Puolakka P, Huhtala H, Sisto T, Järvelä K. Bedside diagnosis of persistent post-sternotomy pain. Acta Anaesthesiol Scand 2016; 60:969-76. [PMID: 26919717 DOI: 10.1111/aas.12704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 01/19/2016] [Accepted: 01/23/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND The prevalence of persistent post-sternotomy pain (PPSP) varies largely and has been mainly studied using questionnaires. We decided to perform a systematic qualitative and quantitative sensory examination study on a power-calculated sample of patients who had undergone sternotomy for cardiac surgery. Pain was diagnosed as PPSP if the patient complained of sternal pain that had developed after surgery together with corresponding sensory disturbances. PATIENTS AND METHODS One hundred elective patients undergoing coronary artery bypass via sternotomy were recruited for dynamic sensory mapping 4-6 months after surgery. Sensory testing was performed using thermal rollers, a cotton stick and pinprick. The intensity of sensation was registered as a score on a numeric rating scale. The area of sensory dysfunction on the chest wall was traced onto paper and calculated with the help of a computer-based program. The patient also answered a validated pain questionnaire. RESULTS Altogether 90 patients took part in the examination. Thirteen (15.4%) of the patients had pain and formed the PPSP group, while the remaining patients formed the non-PPSP group. Both groups had sensory abnormalities over the chest wall (69% of all patients). Sensory disturbances were more common, more profound and extended over a larger skin area in the PPSP group. Furthermore, daily activity performance in the PPSP group was poorer compared to the non-PPSP group. CONCLUSION PPSP is a clinical diagnosis easily achieved using simple diagnostic tools and a medical history. Severity and extent of sensory abnormalities were found to be greater in the PPSP group.
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Affiliation(s)
- M.-L. Kalliomäki
- Department of Anaesthesia; Tampere University Hospital; Tampere Finland
| | - P. Puolakka
- Department of Anaesthesia; Tampere University Hospital; Tampere Finland
| | - H. Huhtala
- School of Health Sciences; University of Tampere; Tampere Finland
| | - T. Sisto
- Heart Centre; Tampere University Hospital; Tampere Finland
| | - K. Järvelä
- Heart Centre; Tampere University Hospital; Tampere Finland
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Khan JS, Rai A, Sundara Rajan R, Jackson TD, Bhatia A. A scoping review of perineural steroids for the treatment of chronic postoperative inguinal pain. Hernia 2016; 20:367-76. [DOI: 10.1007/s10029-016-1487-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/19/2016] [Indexed: 11/25/2022]
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An observational study assessing peripheral neuropathy related to multiple myeloma. Neurol Sci 2016; 37:1141-3. [DOI: 10.1007/s10072-016-2542-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/26/2016] [Indexed: 01/27/2023]
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