1
|
Merces L, Ferro LMM, Nawaz A, Sonar P. Advanced Neuromorphic Applications Enabled by Synaptic Ion-Gating Vertical Transistors. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2305611. [PMID: 38757653 PMCID: PMC11251569 DOI: 10.1002/advs.202305611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/07/2023] [Indexed: 05/18/2024]
Abstract
Bioinspired synaptic devices have shown great potential in artificial intelligence and neuromorphic electronics. Low energy consumption, multi-modal sensing and recording, and multifunctional integration are critical aspects limiting their applications. Recently, a new synaptic device architecture, the ion-gating vertical transistor (IGVT), has been successfully realized and timely applied to perform brain-like perception, such as artificial vision, touch, taste, and hearing. In this short time, IGVTs have already achieved faster data processing speeds and more promising memory capabilities than many conventional neuromorphic devices, even while operating at lower voltages and consuming less power. This work focuses on the cutting-edge progress of IGVT technology, from outstanding fabrication strategies to the design and realization of low-voltage multi-sensing IGVTs for artificial-synapse applications. The fundamental concepts of artificial synaptic IGVTs, such as signal processing, transduction, plasticity, and multi-stimulus perception are discussed comprehensively. The contribution draws special attention to the development and optimization of multi-modal flexible sensor technologies and presents a roadmap for future high-end theoretical and experimental advancements in neuromorphic research that are mostly achievable by the synaptic IGVTs.
Collapse
Affiliation(s)
- Leandro Merces
- Research Center for MaterialsArchitectures, and Integration of Nanomembranes (MAIN)Chemnitz University of Technology09126ChemnitzGermany
| | - Letícia Mariê Minatogau Ferro
- Research Center for MaterialsArchitectures, and Integration of Nanomembranes (MAIN)Chemnitz University of Technology09126ChemnitzGermany
| | - Ali Nawaz
- Center for Sensors and DevicesBruno Kessler Foundation (FBK)Trento38123Italy
| | - Prashant Sonar
- School of Chemistry and PhysicsQueensland University of Technology (QUT)BrisbaneQLD4000Australia
- Centre for Materials ScienceQueensland University of Technology2 George StreetBrisbaneQLD4000Australia
| |
Collapse
|
2
|
Su J, Li Y, Xie D, Jiang J. Vertical 0.6 V sub-10 nm oxide-homojunction transistor gated by a silk fibroin/sodium alginate crosslinking hydrogel for pain-sensitization enhancement emulation. MATERIALS HORIZONS 2023; 10:1745-1756. [PMID: 36809465 DOI: 10.1039/d2mh01431a] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The sensory nervous system of humans mainly depends on continuous training and memory to improve the pain-perceptional abilities for the complex noxious information in the real world and make appropriate responses. Unfortunately, the solid-state device for emulating this pain recognition with ultralow voltage operation still remains to be a great challenge. Herein, a vertical transistor with an ultrashort channel of ∼9.6 nm and ultralow voltage of ∼0.6 V based on protonic silk fibroin/sodium alginate crosslinking hydrogel electrolyte is successfully demonstrated. Such a hydrogel electrolyte with high ionic conductivity allows the transistor to work in an ultralow voltage, while the vertical transistor structure makes it have an ultrashort channel. Pain perception, memory, and sensitization can be integrated into this vertical transistor. Furthermore, using the photogating effect of light stimulus, the device displays multi-state pain-sensitization enhancement abilities through Pavlovian training. Most importantly, the cortical reorganization that reveals a close relationship among the pain stimulus, memory, and sensitization is finally realized. Therefore, this device can provide a great opportunity for multi-dimensional pain assessment, which is of great significance for the new generation of bio-inspired intelligent electronics, such as bionic robots, and smart medical equipment.
Collapse
Affiliation(s)
- Jingya Su
- Hunan Key Laboratory of Nanophotonics and Devices, Hunan Key Laboratory of Super Microstructure and Ultrafast Process, School of Physics and Electronics, Central South University, Changsha, Hunan 410083, China.
| | - Yanran Li
- Hunan Key Laboratory of Nanophotonics and Devices, Hunan Key Laboratory of Super Microstructure and Ultrafast Process, School of Physics and Electronics, Central South University, Changsha, Hunan 410083, China.
| | - Dingdong Xie
- Hunan Key Laboratory of Nanophotonics and Devices, Hunan Key Laboratory of Super Microstructure and Ultrafast Process, School of Physics and Electronics, Central South University, Changsha, Hunan 410083, China.
| | - Jie Jiang
- Hunan Key Laboratory of Nanophotonics and Devices, Hunan Key Laboratory of Super Microstructure and Ultrafast Process, School of Physics and Electronics, Central South University, Changsha, Hunan 410083, China.
| |
Collapse
|
3
|
Kazim MA, Strahl A, Moritz S, Arlt S, Niemeier A. Chronic pain in osteoarthritis of the hip is associated with selective cognitive impairment. Arch Orthop Trauma Surg 2023; 143:2189-2197. [PMID: 35511355 PMCID: PMC10030427 DOI: 10.1007/s00402-022-04445-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/10/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Chronic pain of various origin is known to be associated with selective cognitive impairment. Osteoarthritis (OA) of the hip is one of the leading causes of chronic pain in the adult population, but its association with cognitive performance has not been evaluated. Here, we investigate the effect of chronic pain due to unilateral OA of one hip and no further source of chronic pain on cognitive performance. MATERIALS AND METHODS A neuropsychological test battery, consisting of the Mini-Mental State Examination, Rey-Osterrieth complex figure test, Rivermead behavioural memory test, d2 test of attention, and F-A-S test was applied in 148 patients and 82 healthy pain-free control individuals. The influence of potentially confounding factors such as depression and anxiety was examined. RESULTS Patients with OA of the hip showed decreased performance in specific neuropsychological tests. Performance in verbal and visual short-term and long-term memory and selective attention tests was significantly poorer compared to healthy controls. Whereas the executive functions "updating", "set shifting", "response inhibition" and "reflection" appear intact, "problem solving" and "planning" were impaired. None of the confounders showed any influence on cognitive performance in both study groups. CONCLUSION We conclude that chronic pain secondary to end-stage hip OA is associated with selective cognitive impairment. Future studies are required to investigate the effect of total hip arthroplasty on cognitive performance.
Collapse
Affiliation(s)
- Murteza Ali Kazim
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - André Strahl
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Andreas Niemeier
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| |
Collapse
|
4
|
Kikui S, Miyahara J, Sugiyama H, Kohashi M, Ota K, Danno D, Kashiwaya Y, Takeshima T. A Combination of Indomethacin Farnesyl and Amitriptyline Is Effective for Continuous Interictal Pain with Probable Chronic Paroxysmal Hemicrania. Intern Med 2022; 61:413-417. [PMID: 34176839 PMCID: PMC8866799 DOI: 10.2169/internalmedicine.7511-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 26-year-old woman with a history of migraine reported right-sided, severe stabbing orbital pain with cranial autonomic symptoms (CASs) for approximately 2 years. The attack duration was approximately 30 minutes, with a frequency of twice per day. Taking loxoprofen was ineffective. Six months earlier, moderate pressing continuous interictal pain without CASs had developed. Indomethacin farnesyl completely resolved the attacks but had no effect on the interictal pain. The patient was diagnosed with probable chronic paroxysmal hemicrania in accordance with the International Classification of Headache Disorders (ICHD-3) (third version). Continuous interictal pain gradually disappeared with a combination of indomethacin farnesyl and amitriptyline.
Collapse
Affiliation(s)
- Shoji Kikui
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Junichi Miyahara
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Hanako Sugiyama
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Mutsuo Kohashi
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Kuniko Ota
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Daisuke Danno
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | | | - Takao Takeshima
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| |
Collapse
|
5
|
Nayar D, Mahapatro M, Nayar P. Role of Yoga as an Adjunct in the Management of Migraine Headache-Current Status and Future Indications. Int J Yoga 2022; 15:12-18. [PMID: 35444373 PMCID: PMC9015090 DOI: 10.4103/ijoy.ijoy_173_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/04/2022] Open
Abstract
Migraine headache is a painful, disabling condition afflicting 7% of the population. The long-term effort of coping with a chronic headache disorder predisposes the individual to other psychiatric illnesses, ischemic cerebrovascular disease as well as medicine overuse headache. The use of nonpharmacological methods to reduce the stress and pain associated with headache can improve the overall quality of life and reduce the burden of the disease. To examine the utility of yoga as an adjunct to pharmacological treatment of migraine headache. The review article is based on the secondary literature collected through the Google Scholar database between the years 2010 and 2020. Several themes were identified regarding the burden of migraine/headache and the need for the integration of yoga into the existing healthcare system. Despite the limitations and the need for greater scientific rigor, there have been consistent reports of the beneficial effects of yoga in the reduction of stress, anxiety, depression, and an enhanced quality of life, as well as better pain management in chronic diseases. Studies on the role of yoga in the treatment of migraine have been few in number. They have consistently shown that yoga can be a valuable adjunct to the existing pharmacological interventions in the management of migraine headache. In recent years, the Indian government has made enormous strides in establishing yoga outreach programs throughout the country. The need of the hour is to integrate evidence-based yoga with the wellness centers and noncommunicable diseases treatment plan. It can help to reduce the burden on the existing health care resources.
Collapse
Affiliation(s)
- D Nayar
- MBBS Intern, Kasturba Medical College, Manipal, Karnataka, India
| | - M Mahapatro
- Department of Social Sciences, National Institute of Health and Family Welfare, New Delhi, India
| | - P Nayar
- Department of Psychiatry, Mata Chanan Devi Hospital, New Delhi, India,Address for correspondence: Dr. Nayar P, A3/7, JanakPuri, New Delhi - 110 058, India. E-mail:
| |
Collapse
|
6
|
Liu H, Ran Y, Dang L, Yang R, Sun S, Zhang M, Li K, Chen C, Dong Z, Yu S. Clinical features and outcomes of new daily persistent headache in patients in China and comparison with medication overuse headache: a double-center retrospective study. PAIN MEDICINE 2021. [DOI: 10.31636/pmjua.v6i1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: This study examined the clinical features and outcomes of NDPH patients and comparison with medication-overuse headache (MOH) in Mainland China.
Methods: This retrospective study observed patients with NDPH and medication-overuse headache (MOH) visiting two outpatient clinics between November 2011 and December 2019. Clinical information was collected and all patients were followed by telephone.
Results: The study recruited 73 NDPH and 638 MOH patients. The NDPH patients included 39 males (39/73, 53.4%) and 34 females (34/73, 46.6%), with an average age of 37.4 years and average headache duration of 10.6 years. Headache-precipitating factors included infection (11/73, 15.1%) and stress (22/73, 30.1%). Compared to MOH patients, NDPH patients had a male predominance (53.4% vs. 22.6%, p<0.001), younger age of CDH onset (26.7±12.3 vs. 41.4±11.3 years, p<0.001), and longer duration of CDH (10.6±11.8 vs. 6.1±6.2 years, p=0.023). In 62 NDPH patients followed up for 31 months, on average, therapeutic responses were more effective in NDPH patients with trigger factors than in those without trigger factors (71.4% vs. 32.4%; p = 0.002); the odds ratio (OR) of an effective outcome was 5.25 (1.73–17.84, p = 0.005).
Conclusions: NDPH is significantly different from MOH, with a male predominance, younger age of CDH onset, and longer duration of CDH. The presence of trigger factors is an independent predictor of better treatment effect in NDPH patients.
Collapse
|
7
|
Kim S, Bae DW, Park SG, Park JW. The impact of Pain-related emotions on migraine. Sci Rep 2021; 11:577. [PMID: 33436778 PMCID: PMC7804193 DOI: 10.1038/s41598-020-80094-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
The response to pain is highly individual and can be influenced by complex emotional perception. This study aims to investigate the status of the pain-related emotional response, and the influence on headache characteristics and disability in migraine. We studied the pain-related emotional response in 145 consecutive migraine patients using the Pain Anxiety Symptoms Scale (PASS), the Pain Catastrophizing Scale (PCS), and the Pain Sensitivity Questionnaire (PSQ) and compared them with 106 healthy controls. We investigated the relationship between emotional factors and migraine characteristics. The effect of pain-related emotion on migraine-related disability assessed with the Headache Impact Test-6 (HIT-6) and the Migraine Disability Assessment (MIDAS). Migraine patients showed significantly higher scores on total PASS (p < 0.001), PCS (p < 0.001) and PSQ (p = 0.002) compared to the healthy controls. The HIT-6 was weakly correlated with PASS (r = 0.390, p < 0.001) and PCS (r = 0.354, p < 0.001). PASS-Total (p = 0.001), headache frequency (p = 0.003), and HADS-Anxiety (p = 0.028) were independent variables associated with HIT-6. Headache frequency (p < 0.001) was an independent variable associated with MIDAS. The structural equation model indicated that headache severity has direct loading on emotion and subsequently influenced migraine-related disability. Disability has a significant effect on the frequency of abortive medication use. Migraine patients have altered emotional responses to pain perception. Pain-related anxiety made an important contribution to headache-related disability. The present results suggest that the management of disability by considering various pain-related emotional factors may be necessary for the therapeutic aspects of migraine.
Collapse
Affiliation(s)
- Seonghoon Kim
- Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae-Woong Bae
- Department of Neurology, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Gue Park
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Jeong-Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
8
|
David MCMM, Santos BSD, Barros WMA, Silva TRLD, Franco CIF, Matos RJBD. Neuroimaging investigation of memory changes in migraine: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:370-379. [PMID: 32609194 DOI: 10.1590/0004-282x20200025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Individuals with migraine usually complain about lower memory performance. Diagnostic methods such as neuroimaging may help in the understanding of possible morphologic and functional changes related to the memory of those individuals. Therefore, the aim of this review is to analyze the available literature on neuroimaging changes related to memory processing in migraine. METHODS We searched the following databases: Pubmed/Medline, Psycinfo, Science Direct, Cochrane and Web of Science. We used articles without restriction of year of publication. The combination of descriptors used for this systematic review of literature were Neuroimaging OR Imaging OR Brain AND Migraine OR Chronic Migraine AND Memory. RESULTS Of the 306 articles found, nine were selected and all used magnetic resonance imaging (MRI). The studies used structural and functional MRI techniques with a predominance of 3 Tesla equipment and T1-weighted images. According to the results obtained reported by these studies, migraine would alter the activity of memory-related structures, such as the hippocampus, insula and frontal, parietal and temporal cortices, thereby suggesting a possible mechanism by which migraine would influence memory, especially in relation to the memory of pain. CONCLUSIONS Migraine is associated to global dysfunction of multisensory integration and memory processing. This condition changes the activity of structures in various regions related to memory of pain, prospective memory, as well as in short- and long-term verbal and visuospatial memories. However, it is necessary to perform studies with larger samples in association with cognitive tests, and without the interference of medications to verify possible alterations and to draw more concrete conclusions.
Collapse
Affiliation(s)
| | | | - Waleska Maria Almeida Barros
- Universidade Federal de Pernambuco, Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, Recife PE, Brazil
| | | | | | - Rhowena Jane Barbosa de Matos
- Universidade Federal de Pernambuco, Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, Recife PE, Brazil
- Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Núcleo de Educação Física e Ciências do Esporte, Vitória de Santo Antão PB, Brazil
| |
Collapse
|
9
|
Eye Movements in Response to Pain-Related Feelings in the Presence of Low and High Cognitive Loads. Behav Sci (Basel) 2020; 10:bs10050092. [PMID: 32443887 PMCID: PMC7287850 DOI: 10.3390/bs10050092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 11/21/2022] Open
Abstract
The affective dimension of pain contributes to pain perception. Cognitive load may influence pain-related feelings. Eye tracking has proven useful for detecting cognitive load effects objectively by using relevant eye movement characteristics. In this study, we investigated whether eye movement characteristics differ in response to pain-related feelings in the presence of low and high cognitive loads. A set of validated, control, and pain-related sounds were applied to provoke pain-related feelings. Twelve healthy young participants (six females) performed a cognitive task at two load levels, once with the control and once with pain-related sounds in a randomized order. During the tasks, eye movements and task performance were recorded. Afterwards, the participants were asked to fill out questionnaires on their pain perception in response to the applied cognitive loads. Our findings indicate that an increased cognitive load was associated with a decreased saccade peak velocity, saccade frequency, and fixation frequency, as well as an increased fixation duration and pupil dilation range. Among the oculometrics, pain-related feelings were reflected only in the pupillary responses to a low cognitive load. The performance and perceived cognitive load decreased and increased, respectively, with the task load level and were not influenced by the pain-related sounds. Pain-related feelings were lower when performing the task compared with when no task was being performed in an independent group of participants. This might be due to the cognitive engagement during the task. This study demonstrated that cognitive processing could moderate the feelings associated with pain perception.
Collapse
|
10
|
Martin LJ, Acland EL, Cho C, Gandhi W, Chen D, Corley E, Kadoura B, Levy T, Mirali S, Tohyama S, Khan S, MacIntyre LC, Carlson EN, Schweinhardt P, Mogil JS. Male-Specific Conditioned Pain Hypersensitivity in Mice and Humans. Curr Biol 2019; 29:192-201.e4. [DOI: 10.1016/j.cub.2018.11.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/24/2018] [Accepted: 11/09/2018] [Indexed: 12/19/2022]
|
11
|
Kao GS, Bhandari RP, Huestis SE, Golianu B. Traumatic Stress and Pediatric Pain: Towards a Neurobiological Stress-Health Perspective. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:249-255. [PMID: 32318154 PMCID: PMC7163901 DOI: 10.1007/s40653-017-0145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This theoretical review aims to present the limited findings on traumatic stress and pain in children and adolescents, highlight recent discoveries regarding neurobiological processes, and suggest an alternative stress-health perspective in the future study and conceptualization of pediatric pain and traumatic stress based on results. Current literature highlights a positive correlation between pain and trauma symptoms in youth and suggests a complex relationship that may have mutually maintaining dynamics and intertwined physiological processes. Developmentally sensitive, longitudinal, process-oriented designs assessing neurobiological alterations and stress responses should be utilized in the examination of the trauma-pain relationship. Such investigations may provide a more unified explanation of the relationship between chronic pain and traumatic stress.
Collapse
Affiliation(s)
- Grace S. Kao
- Stanford Children’s Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
- Departments of Pediatrics and Anesthesiology, Perioperative and Pain Medicine, Baylor College of Medicine, Houston, TX USA
- Texas Children’s Hospital, 6621 Fannin St., #A3300, Houston, TX 77030 USA
| | - Rashmi Parekh Bhandari
- Stanford Children’s Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Samantha E. Huestis
- Stanford Children’s Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Brenda Golianu
- Stanford Children’s Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| |
Collapse
|
12
|
Abstract
Hemicrania continua (HC) is an indomethacin-responsive primary headache disorder which is currently classified under the heading of trigeminal autonomic cephalalgias (TACs). It is a highly misdiagnosed and underreported primary headache. The pooled mean delay of diagnosis of HC is 8.0 ± 7.2 years. It is not rare. We noted more than 1000 cases in the literature. It represents 1.7% of total headache patients attending headache or neurology clinic. Just like other TACs, it is characterized by strictly unilateral pain in the trigeminal distribution, cranial autonomic features in the same area and agitation during exacerbations/attacks. It is different from other TACs in one aspect. While all other TACs are episodic, HC patients have continuous headaches with superimposed severe exacerbations. The central feature of HC is continuous background headache. However, the patients may be worried only for superimposed exacerbations. Focusing only on exacerbations and ignoring continuous background headache are the most important factors for the misdiagnosis of HC. A large number of patients may have migrainous features during exacerbation phase. Up to 70% patients may fulfill the diagnostic criteria for migraine during exacerbations. Besides migraine, its exacerbations can mimic a large number of other primary and secondary headaches. The other specific feature of HC is a remarkable response to indomethacin. However, a large number of patients develop side effects because of the long-term use of indomethacin. A few other medications may also be effective in a subset of patients with HC. Various surgical interventions have been suggested for patients who are intolerant to indomethacin. Several aspects of HC are still not defined. There is a great heterogeneity in types of patients or articles on the HC in the literature. Diagnostic criteria have been modified several times over the years. The current diagnostic criteria are too restrictive in some aspects. We suggest a more accommodating type of criteria for the appendix of International Classification of Headache Disorder (ICHD).
Collapse
Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
| | - Payal Patel
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
13
|
Psychosocial Issues in Children with Cancer: The Role of Patient Advocacy and Its Impact on Care. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
14
|
Inhibition of the cAMP/PKA/CREB Pathway Contributes to the Analgesic Effects of Electroacupuncture in the Anterior Cingulate Cortex in a Rat Pain Memory Model. Neural Plast 2016; 2016:5320641. [PMID: 28090359 PMCID: PMC5206448 DOI: 10.1155/2016/5320641] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/30/2016] [Accepted: 10/24/2016] [Indexed: 12/20/2022] Open
Abstract
Pain memory is considered as endopathic factor underlying stubborn chronic pain. Our previous study demonstrated that electroacupuncture (EA) can alleviate retrieval of pain memory. This study was designed to observe the different effects between EA and indomethacin (a kind of nonsteroid anti-inflammatory drugs, NSAIDs) in a rat pain memory model. To explore the critical role of protein kinase A (PKA) in pain memory, a PKA inhibitor was microinjected into anterior cingulate cortex (ACC) in model rats. We further investigated the roles of the cyclic adenosine monophosphate (cAMP), PKA, cAMP response element-binding protein (CREB), and cAMP/PKA/CREB pathway in pain memory to explore the potential molecular mechanism. The results showed that EA alleviates the retrieval of pain memory while indomethacin failed. Intra-ACC microinjection of a PKA inhibitor blocked the occurrence of pain memory. EA reduced the activation of cAMP, PKA, and CREB and the coexpression levels of cAMP/PKA and PKA/CREB in the ACC of pain memory model rats, but indomethacin failed. The present findings identified a critical role of PKA in ACC in retrieval of pain memory. We propose that the proper mechanism of EA on pain memory is possibly due to the partial inhibition of cAMP/PKA/CREB signaling pathway by EA.
Collapse
|
15
|
Memory impairment in chronic pain patients and the related neuropsychological mechanisms: a review. Acta Neuropsychiatr 2014; 26:195-201. [PMID: 25279415 DOI: 10.1017/neu.2013.47] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study provides a comprehensive review of the literature on memory impairment and the potential effective factors in patients with chronic pain. METHODS A literature search of databases PubMed, EMBASE, SpringerLink, and PsycINFO until September 2012 was conducted using the keywords ‘memory’ and ‘chronic pain’. The study emphasises on publications over the past 20 years. RESULTS Memory impairment in chronic pain patients is substantial, but the aspects of memory (e.g. working memory, long-term memory, and autobiographical memory) in chronic pain patients and the potentially related factors (e.g. age, level of education, pain conditions, emotion, neural network, and use of analgesics) are modest. Memory impairment is interpreted with the attention-narrowing hypothesis and the capacity-reduction hypothesis. CONCLUSIONS The currently available data and theory have explained memory impairment in chronic pain patients, but many controversies remain. Future research should focus on the subclinical characteristics of chronic pain, enlarging the sample size, and emphasise on the experimental intervention method and the cognitive neuroscience method.
Collapse
|
16
|
Liu X, Liu Y, Li L, Hu Y, Wu S, Yao S. Overgeneral autobiographical memory in patients with chronic pain. PAIN MEDICINE 2014; 15:432-9. [PMID: 24506230 DOI: 10.1111/pme.12355] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Overgenerality and delay of the retrieval of autobiographical memory (AM) are well documented in a range of clinical conditions, particularly in patients with emotional disorder. The present study extended the investigation to chronic pain, attempting to identify whether the retrieval of AM in patients with chronic pain tends to be overgeneral or delayed. DESIGN With an observational cross-sectional design, we evaluated the AM both in patients with chronic pain and healthy controls by Autobiographical Memory Test. Pain conditions were assessed using the pain diagnostic protocol, the short-form McGill Pain Questionnaire (SF-MPQ), and the Pain Self-Efficacy Questionnaire (PSEQ). Emotion was assessed using the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory. SUBJECTS AND SETTINGS Subjects included 176 outpatients with chronic pain lasting for at least 6 months and 170 healthy controls. RESULTS 1) Compared with the healthy group, the chronic pain group had more overgeneral memories (OGMs) (F = 29.061, P < 0.01) and longer latency (F = 13.602, P < 0.01). 2) In the chronic pain group, the stepwise multiple regression models for variables predicting OGM were significant (P < 0.01). Specifically, the variance in OGM scores could be predicted by the BDI score (9.7%), pain chronicity (4.3%), PSEQ score (7.1%), and Affective Index (of SF-MPQ) score (2.7%). 3) In the chronic pain group, the stepwise multiple regression models for variables predicting latency were significant (P < 0.05). Specifically, the variance in latency could be predicted by age (3.1%), pain chronicity (2.7%), pain duration (4.3%), and PSEQ score (2.0%). CONCLUSIONS The retrieval of AM in patients with chronic pain tends to be overgeneral and delayed, and the retrieval style of AM may be contributed to negative emotions and chronic pain conditions.
Collapse
Affiliation(s)
- Xianhua Liu
- School of Education Science, Hunan Normal University, Changsha, China; Department of Educational Science, Hengyang Normal University, Hengyang, China
| | | | | | | | | | | |
Collapse
|
17
|
Paroxysmal hemicrania: a retrospective study of a consecutive series of 22 patients and a critical analysis of the diagnostic criteria. J Headache Pain 2013; 14:26. [PMID: 23566235 PMCID: PMC3620407 DOI: 10.1186/1129-2377-14-26] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 12/04/2022] Open
Abstract
Background Paroxysmal hemicrania (PH) is a probably underreported primary headache disorder. It is characterized by repeated attacks of severe, strictly unilateral pain lasting 2 to 30 minutes localized to orbital, supraorbital, and temporal areas accompanied by ipsilateral autonomic features. The hallmark of PH is the absolute cessation of the headache with indomethacin. However, these all features may not be present in all cases and a few cases may remain unclassified according to the 2nd Edition of The International classification of Headache Disorders (ICHD-II) criteria for PH. Methods Twenty-two patients were included in this retrospective observation. Results We describe 17 patients, observed over six years, who fulfilled the ICHD-II criteria for PH. In parallel, we identified five more patients in whom one of the features of the diagnostic criteria for PH was missing. Two patients did not show any evidence of cranial autonomic feature during the attacks of headache. Another two patients did not fulfill the criteria for PH as the maximum attack frequency was less than five. One patient had an incomplete response to indomethacin. Conclusion A subset of patients may not have all the defined features of PH and there is a need for refinement of the existing diagnostic criteria.
Collapse
|
18
|
Abstract
Postamputation pain (PAP) is highly prevalent after limb amputation but remains an extremely challenging pain condition to treat. A large part of its intractability stems from the myriad pathophysiological mechanisms. A state-of-art understanding of the pathophysiologic basis underlying postamputation phenomena can be broadly categorized in terms of supraspinal, spinal, and peripheral mechanisms. Supraspinal mechanisms involve somatosensory cortical reorganization of the area representing the deafferentated limb and are predominant in phantom limb pain and phantom sensations. Spinal reorganization in the dorsal horn occurs after deafferentataion from a peripheral nerve injury. Peripherally, axonal nerve damage initiates inflammation, regenerative sprouting, and increased "ectopic" afferent input which is thought by many to be the predominant mechanism involved in residual limb pain or neuroma pain, but may also contribute to phantom phenomena. To optimize treatment outcomes, therapy should be individually tailored and mechanism based. Treatment modalities include injection therapy, pharmacotherapy, complementary and alternative therapy, surgical therapy, and interventions aimed at prevention. Unfortunately, there is a lack of high quality clinical trials to support most of these treatments. Most of the randomized controlled trials in PAP have evaluated medications, with a trend for short-term Efficacy noted for ketamine and opioids. Evidence for peripheral injection therapy with botulinum toxin and pulsed radiofrequency for residual limb pain is limited to very small trials and case series. Mirror therapy is a safe and cost-effective alternative treatment modality for PAP. Neuromodulation using implanted motor cortex stimulation has shown a trend toward effectiveness for refractory phantom limb pain, though the evidence is largely anecdotal. Studies that aim to prevent PA P using epidural and perineural catheters have yielded inconsistent results, though there may be some benefit for epidural prevention when the infusions are started more than 24 hours preoperatively and compared with nonoptimized alternatives. Further investigation into the mechanisms responsible for and the factors associated with the development of PAP is needed to provide an evidence-based foundation to guide current and future treatment approaches.
Collapse
Affiliation(s)
- Eugene Hsu
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven P Cohen
- Johns Hopkins School of Medicine and Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
19
|
Prakash S, Saini S, Rana KR, Mahato P. Refining clinical features and therapeutic options of new daily persistent headache: a retrospective study of 63 patients in India. J Headache Pain 2012; 13:477-85. [PMID: 22644215 PMCID: PMC3464463 DOI: 10.1007/s10194-012-0461-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/08/2012] [Indexed: 11/22/2022] Open
Abstract
The aim of this retrospective study was to provide data on the clinical features and treatment outcomes of patients with NDPH (fulfilling Kung et al.'s criteria). A total of 63 patients were observed during a 5-yr period (2007-2012). More than one-third (35 %) patients had migrainous features; 65 % patients fulfilled the ICHD-II criteria. Both groups were similar in most clinical and epidemiological features. However, migrainous features were more common in patients with a prior history of episodic migraine (though statistically not significant). After a median follow-up of 9 months, 37 % patients showed "excellent" response (no or less than 1 headache per month). Another 30 % patients had "good" response (>50 % reduction in headache frequency or days per month). Excellent response was more in patients with a history of less than 6 months duration (statistically not significant). Patients with a recognized trigger showed better prognosis. Response was better in patients who received intravenous therapy of methyl prednisolone and sodium valproate. We suggest prospective and controlled studies to confirm our observations.
Collapse
Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Medical College, SSG Hospital, O-19, Doctor's Quarter, Jail Road, Baroda, Gujarat, India, 390001.
| | | | | | | |
Collapse
|
20
|
Prakash S, Golwala P. A proposal for revision of hemicrania continua diagnostic criteria based on critical analysis of 62 patients. Cephalalgia 2012; 32:860-8. [PMID: 22751966 DOI: 10.1177/0333102412452043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Misdiagnosis of hemicrania continua (HC) is common. It is diagnosed according to the criteria of the International Headache Society (IHS), but in clinical practice, these criteria seem too restrictive and many hemicrania continua-like headaches remain unclassified. SUBJECTS AND METHODS We retrospectively studied the patients fulfilling the IHS criteria for HC. In addition, we identified a group of patients who met all criteria minus cranial autonomic features (HC-A) or minus a complete response to indomethacin (HC-I). We compared epidemiological profiles, clinical features and therapeutic responses to drug(s) between the groups. In addition, we reviewed the literature and critically analysed the diagnostic criteria for HC. RESULTS Sixty-two patients with a putative diagnosis of HC were identified. Thirty patients (48%) fulfilled the IHS criteria for HC. Thirty-two (52%) patients failed to satisfy one of the features of HC. Thirteen patients (21%) did not show any evidence of cranial autonomic feature during the episodes of the exacerbations (HC-A). Another 19 patients (31%) did not show a complete response to indomethacin (HC-I). Epidemiological and clinical features of all three groups were compared. None of the differences were statistically significant. In review of the literature, we noted that cranial autonomic features, a sense of restlessness/agitation during exacerbations, and response to indomethacin (marked to complete) are the specific features of HC. However, these features may not all be present in all cases. CONCLUSION Present diagnostic criteria are too restrictive. We suggest adding the site of pain in the criteria, as described for trigeminal autonomic cephalalgias. Cranial autonomic features, a sense of restlessness during exacerbations, and marked to complete response to indomethacin are three characteristics features of HC. We suggest that the presence of any two may be sufficient to diagnose HC.
Collapse
Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Medical College, SSG Hospital, Baroda, Gujarat, India.
| | | |
Collapse
|
21
|
|
22
|
Subedi B, Grossberg GT. Phantom limb pain: mechanisms and treatment approaches. PAIN RESEARCH AND TREATMENT 2011; 2011:864605. [PMID: 22110933 PMCID: PMC3198614 DOI: 10.1155/2011/864605] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 07/01/2011] [Indexed: 12/31/2022]
Abstract
The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.
Collapse
Affiliation(s)
- Bishnu Subedi
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | | |
Collapse
|