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Zhang Y, Luo Y, Wu Q, Han M, Wang H, Kang F. Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Conditioned Pain Modulation in Trigeminal Neuralgia Patients. Pain Ther 2024:10.1007/s40122-024-00654-x. [PMID: 39259413 DOI: 10.1007/s40122-024-00654-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Conditioned pain modulation (CPM) is a quantitative estimation of the capacity for endogenous pain modulation. Reduced CPM enables chronic painful event development or exacerbates pre-existing pain symptoms. Emerging reports indicate that patients with trigeminal neuralgia (TN) have dysregulated endogenous pain modulation. Transauricular vagus nerve stimulation (taVNS) is known to alleviate both acute and chronic pain symptoms. Its role in modulation or management of TN remains unknown. Here, we evaluated the taVNS efficacy in modulating CPM among TN patients. Conclusions from this investigation may facilitate establishment of novel non-invasive adjunctive approaches to treating TN patients. METHODS All research work was conducted at the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital). In all, we recruited 62 study participants, 31 TN patients and 31 healthy volunteers, for a 2-day experimental test. At the beginning of the experiment (Day 1), all subjects received 30 min of active taVNS. On Day 2, they received sham taVNS with the same duration and intensity. Meanwhile, technicians documented participant pressure pain thresholds (PPT) and CPM values at baseline, and at 15 and 30 min post-active or sham taVNS. RESULTS A 30-min active taVNS exposure substantially elevated the PPT and CPM effect (P < 0.05) among TN patients, and we also observed a notable rise in the PPT and CPM effect (P < 0.05) among healthy controls. Additionally, there were no serious adverse events from the administered treatment. CONCLUSION Exposure to 30 min of active taVNS strongly augmented the CPM effect and elevated the PPT among TN patients and healthy controls. These effects were not observed with sham stimulation. Despite the limitations inherent to survey studies, such as duration and compliance biases, we consider that taVNS is a promising, safe, and cost-effective therapy. In future investigations, we recommend assessment of long-term taVNS application and its effects on CPM and clinical pain. TRIAL REGISTRATION ChiCTR2300078673 ( www.Chictr.org.cn ).
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Affiliation(s)
- Yu Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Yiyuan Luo
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Qixing Wu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Mingming Han
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Haitao Wang
- School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, People's Republic of China.
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.
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Thielen H, Welkenhuyzen L, Tuts N, Vangkilde S, Lemmens R, Wibail A, Lafosse C, Huenges Wajer IMC, Gillebert CR. Why am I overwhelmed by bright lights? The behavioural mechanisms of post-stroke visual hypersensitivity. Neuropsychologia 2024; 198:108879. [PMID: 38570111 DOI: 10.1016/j.neuropsychologia.2024.108879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/15/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
After stroke, patients can experience visual hypersensitivity, an increase in their sensitivity for visual stimuli as compared to their state prior to the stroke. Candidate behavioural mechanisms for these subjective symptoms are atypical bottom-up sensory processing and impaired selective attention, but empirical evidence is currently lacking. In the current study, we aimed to investigate the relationship between post-stroke visual hypersensitivity and sensory thresholds, sensory processing speed, and selective attention using computational modelling of behavioural data. During a whole/partial report task, participants (51 stroke patients, 76 orthopedic patients, and 77 neurotypical adults) had to correctly identify a single target letter that was presented alone (for 17-100 ms) or along a distractor (for 83ms). Performance on this task was used to estimate the sensory threshold, sensory processing speed, and selective attention abilities of each participant. In the stroke population, both on a group and individual level, there was evidence for impaired selective attention and -to a lesser extent- lower sensory thresholds in patients with post-stroke visual hypersensitivity as compared to neurotypical adults, orthopedic patients, or stroke patients without post-stroke sensory hypersensitivity. These results provide a significant advancement in our comprehension of post-stroke visual hypersensitivity and can serve as a catalyst for further investigations into the underlying mechanisms of sensory hypersensitivity after other types of acquired brain injury as well as post-injury hypersensitivity for other sensory modalities.
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Affiliation(s)
- H Thielen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - L Welkenhuyzen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department Psychology, Hospital East-Limbourgh, Genk, Belgium; TRACE, Centre for Translational Psychological Research (TRACE), KU Leuven - Hospital East-Limbourgh, Genk, Belgium
| | - N Tuts
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - S Vangkilde
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - R Lemmens
- Experimental Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - A Wibail
- Neurology, Hospital East-Limbourgh, Genk, Belgium
| | - C Lafosse
- Paramedical and Scientific Director, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - I M C Huenges Wajer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands; Experimental Psychology, Utrecht University, the Netherlands
| | - C R Gillebert
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium; TRACE, Centre for Translational Psychological Research (TRACE), KU Leuven - Hospital East-Limbourgh, Genk, Belgium.
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Thielen H, Huenges Wajer IMC, Tuts N, Welkenhuyzen L, Lafosse C, Gillebert CR. The Multi-Modal Evaluation of Sensory Sensitivity (MESSY): Assessing a commonly missed symptom of acquired brain injury. Clin Neuropsychol 2024; 38:377-411. [PMID: 37291083 DOI: 10.1080/13854046.2023.2219024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
Objective: Sensory hypersensitivity is common after acquired brain injury. Since appropriate diagnostic tools are lacking, these complaints are overlooked by clinicians and available literature is limited to light and noise hypersensitivity after concussion. This study aimed to investigate the prevalence of sensory hypersensitivity in other modalities and after other types of brain injury. Method: We developed the Multi-Modal Evaluation of Sensory Sensitivity (MESSY), a patient-friendly questionnaire that assesses sensory sensitivity across multiple sensory modalities. 818 neurotypical adults (mean age = 49; 244 male) and 341 chronic acquired brain injury patients (including stroke, traumatic brain injury, and brain tumour patients) (mean age = 56; 126 male) completed the MESSY online. Results: The MESSY had a high validity and reliability in neurotypical adults. Post-injury sensory hypersensitivity (examined using open-ended questions) was reported by 76% of the stroke patients, 89% of the traumatic brain injury patients, and 82% of the brain tumour patients. These complaints occurred across all modalities with multisensory, visual, and auditory hypersensitivity being the most prevalent. Patients with post-injury sensory hypersensitivity reported a higher sensory sensitivity severity on the multiple-choice items of the MESSY as compared to neurotypical adults and acquired brain injury patients without post-injury sensory hypersensitivity (across all sensory modalities) (effect sizes (partial eta squared) ranged from .06 to .22). Conclusions: These results show that sensory hypersensitivity is prevalent after different types of acquired brain injury as well as across several sensory modalities. The MESSY can improve recognition of these symptoms and facilitate further research.
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Affiliation(s)
- Hella Thielen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Irene M C Huenges Wajer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Nora Tuts
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lies Welkenhuyzen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department Psychology, Hospital East-Limbourgh, Genk, Belgium
- TRACE, Centre for Translational Psychological Research (TRACE), Genk, Belgium
| | - Cristophe Lafosse
- Paramedical and Scientific Director, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Celine R Gillebert
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE, Centre for Translational Psychological Research (TRACE), Genk, Belgium
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Cecchetto C, Leleu A, Calce RP, Arnhardt S, Parma V, de Groot JHB, Freiherr J, Gentili C, Zou L, Thunell E, Fischmeister FPS, Rekow D, Dal Bò E. Consistent social odor representation across 7 languages: the Social Odor Scale translation and validation. Chem Senses 2024; 49:bjae035. [PMID: 39311704 DOI: 10.1093/chemse/bjae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024] Open
Abstract
The Social Odor Scale (SOS) is a 12-item questionnaire initially developed and validated in Italian and German to investigate self-reported awareness of social odors, which are odors emanating from the human body that convey diverse information and evoke various emotional responses. The scale includes a total score and 3 subscales representing social odors in the respective categories: romantic partner, familiar, and strangers. Here, we aimed to (i) replicate the validation of the Italian and German versions of the SOS, (ii) translate and validate the SOS into multiple additional languages (French, English, Dutch, Swedish, Chinese), and (iii) explore whether the factor structure of each translated version aligns with the original versions. Confirmatory Factor Analysis (CFA) supported the scale's structure, yielding a good fit across all languages. Notable differences in SOS mean scores were observed among the different languages: Swedish participants exhibited lower social odor awareness compared to the other groups, whereas Chinese participants reported higher social odor awareness compared to Dutch and Swedish participants. Furthermore, SOS scores correlated with respondents' geographical location, with higher (i.e. northern) latitudes linked to lower social odor awareness. These results corroborate the SOS as a valid and reliable instrument, especially for the SOS total score and the Familiar and Partner factors, emphasizing the influence of individual and geographic factors on social odor awareness.
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Affiliation(s)
- Cinzia Cecchetto
- Department of General Psychology, University of Padua, Padua, Italy
| | - Arnaud Leleu
- Development of Olfactory Communication and Cognition Lab, Centre des Sciences du Goût et de l'Alimentation, Université de Bourgogne, CNRS, INRAe, Institut Agro, Dijon, France
| | - Roberta P Calce
- Institute of Research in Psychology (IPSY) and Institute of Neuroscience (IoNS), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Sally Arnhardt
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Valentina Parma
- Monell Chemical Senses Center, 3500 Market Street, Philadelphia, PA 19104, United States
| | - Jasper H B de Groot
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Jessica Freiherr
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
- Sensory Analytics and Technologies, Fraunhofer Institute for Process Engineering and Packaging IVV, Giggenhauser Strasse 35, 85354 Freising, Germany
| | - Claudio Gentili
- Department of General Psychology, University of Padua, Padua, Italy
| | - Laiquan Zou
- Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Evelina Thunell
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden
| | - Florian Ph S Fischmeister
- Developmental and Interventional Neuroimaging Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Diane Rekow
- Development of Olfactory Communication and Cognition Lab, Centre des Sciences du Goût et de l'Alimentation, Université de Bourgogne, CNRS, INRAe, Institut Agro, Dijon, France
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany
| | - Elisa Dal Bò
- Department of General Psychology, University of Padua, Padua, Italy
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Labus JS, Wang C, Mayer EA, Gupta A, Oughourlian T, Kilpatrick L, Tillisch K, Chang L, Naliboff B, Ellingson BM. Sex-specific brain microstructural reorganization in irritable bowel syndrome. Pain 2023; 164:292-304. [PMID: 35639426 PMCID: PMC9691795 DOI: 10.1097/j.pain.0000000000002699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT Preliminary evidence suggests that there are sex differences in microstructural brain organization among individuals with irritable bowel syndrome (IBS). The aim of this study was to further investigate sex-dependent differences in brain microstructure and organization in a large sample of well-phenotyped participants with IBS compared with healthy controls. We hypothesized that female patients with IBS would show evidence for increased axonal strength and myelination within and between brain regions concerned with pain and sensory processing, when compared with males with IBS. We also hypothesized that female compared with male IBS subjects show greater levels of somatic awareness and sensory sensitivity consistent with multisystem sensory sensitivity. Diffusion tensor images and clinical assessments were obtained in 100 healthy controls (61 females) and 152 IBS (107 females) on a 3T Siemens Trio. Whole brain voxel-wise differences in fractional anisotropy, mean, radial and axial diffusivity, and track density as differences in somatic awareness and sensory sensitivity were assessed using the general linear model. Female compared with male IBS participants showed extensive microstructural alterations in sensorimotor, corticothalamic, and basal ganglia circuits involved in pain processing and integration of sensorimotor information. Together with the observed increases in symptom severity, somatic awareness, and sensory sensitivity, the findings support the hypotheses that the etiology and maintenance of symptoms in females with IBS may be driven by greater central sensitivity for multiple sensory stimuli.
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Affiliation(s)
- Jennifer S. Labus
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Emeran A Mayer
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Arpana Gupta
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Talia Oughourlian
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Lisa Kilpatrick
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kirsten Tillisch
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Lin Chang
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Bruce Naliboff
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Benjamin M. Ellingson
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Wang D, Frey-Law LA. Multisensory sensitivity differentiates between multiple chronic pain conditions and pain-free individuals. Pain 2023; 164:e91-e102. [PMID: 35588150 PMCID: PMC11075969 DOI: 10.1097/j.pain.0000000000002696] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT Multisensory sensitivity (MSS) to nonpainful stimuli has been identified as a risk factor for the presence of coexisting chronic pain conditions. However, it remains unclear whether MSS can differentiate pain phenotypes involving different levels of central sensitivity. Both pain-free and those with chronic pain, particularly fibromyalgia (FM), migraine, or low back pain (LBP) were recruited, with pain comorbidities assessed. MSS was highest in FM, followed by migraine, then LBP, and lowest in pain-free individuals (adjusted between condition Cohen d = 0.32-1.2, P ≤ 0.0007). However, when secondly grouping patients by the total number of pain comorbidities reported, those with a single pain condition (but not FM) did not have significantly elevated MSS vs pain-free individuals (adj d= 0.17, P = 0.18). Elevated MSS scores produced increased odds of having 2 or more pain comorbidities; OR [95% CI] =2.0 [1.15, 3.42], without, and 5.6 [2.74, 11.28], with FM ( P ≤ 0.0001). Furthermore, those with low MSS levels were 55% to 87% less likely to have ≥ 2 pain comorbidities with or without FM (OR 0.45 [0.22, 0.88]-0.13 [0.05, 0.39]; P ≤ 0.0001). Our findings support that MSS can differentiate between pain phenotypes with different degrees of expected central mechanism involvement and also serve as a risk and resilience marker for total coexisting chronic pain conditions. This supports the use of MSS as a marker of heightened central nervous system processing and thus may serve as a clinically feasible assessment to better profile pain phenotypes with the goal of improving personalized treatment.
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Affiliation(s)
- Dan Wang
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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Rao EM, Lawrence MM, Hayek SM, Klatzky RL, Carroll BT. Assessing sensory hypersensitivity in interventional pain patients: a pilot study. Reg Anesth Pain Med 2023:rapm-2022-103972. [PMID: 36635044 DOI: 10.1136/rapm-2022-103972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Affiliation(s)
- Elizabeth Marley Rao
- Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Melinda M Lawrence
- Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Anesthesiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Salim M Hayek
- Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Anesthesiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Roberta L Klatzky
- Department of Psychology, Human Computer Interaction Institute, Neuroscience Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Bryan T Carroll
- Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Sensory processing sensitivity in adolescents reporting chronic pain: an exploratory study. Pain Rep 2023; 8:e1053. [PMID: 36699990 PMCID: PMC9829261 DOI: 10.1097/pr9.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Sensory processing sensitivity (SPS) describes a genetically influenced trait characterized by greater depth of information processing, lower sensory threshold, and ease of overstimulation. It is hypothesized that SPS plays a crucial role in the context of chronic pain.Objectives: This exploratory study examined SPS as a correlate of pain intensity and pain-related disability in a sample of adolescents reporting chronic pain. Methods Adolescents reporting chronic pain were contacted through social media and through specialized pain clinics. Participants completed online questionnaires on their levels of SPS, pain features, emotion regulation, and quality of life. A series of analysis of variances (ANOVAs) were calculated to detect differences between 3 SPS groups (ie, high, medium, and low sensitivity) regarding emotion regulation, quality of life, and pain features. Multiple linear regressions were conducted to predict pain intensity, pain-related disability, and quality of life. Results In total, 103 participants completed the survey (68.9% female, Mage 17.9). Back pain was the most frequently reported pain location. Proportion of highly sensitive individuals was large (45.68%). The ANOVA revealed significant differences between sensitivity groups related to quality-of-life subscales, namely, for physical (F(2, 100) = 7.42, P < 0.001), emotional (F(2, 100) = 6.11, P < 0.001), and school functioning (F(2, 100) = 3.75, P = 0.03). High sensitivity was not predictive of pain but of health-related quality of life. Conclusions Our results indicate that SPS is an important and prevalent characteristic to consider in the context of chronic pain in adolescents, specifically regarding the quality of life.
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Sensory Processing Difficulties in Children and Adolescents with Obsessive-Compulsive and Anxiety Disorders. Res Child Adolesc Psychopathol 2023; 51:223-232. [PMID: 36149521 PMCID: PMC9867656 DOI: 10.1007/s10802-022-00962-w] [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: 04/17/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 01/26/2023]
Abstract
Altered sensory processing has been linked to symptoms of obsessive-compulsive disorder (OCD) and anxiety disorders (ADs) in youth, but few studies have examined sensory processing in clinical samples and no study has analyzed self-report data from youth meeting diagnostic criteria for OCD or ADs. This study included 86 youth with OCD, 82 youth with ADs, and 46 youth without psychiatric disorders. Participants completed the adolescent version of the Sensory Profile and scales measuring three symptom dimensions of OCD, four symptom dimensions of anxiety, and symptoms of major depression. Results showed that different forms of sensory processing difficulties (sensitivity, avoidance, low registration) were adequately captured by one broad sensory processing factor. Youth with OCD and ADs reported statistically significantly more sensory difficulties than youth without psychiatric disorders, but the two clinical groups did not differ from each other. Altered sensory processing in the clinical groups was not explained by the presence of neurodevelopmental disorders. Sensory difficulties were moderately to strongly related to all self-reported symptom dimensions, and uniquely related to the OCD dimension of symmetry/ordering and the anxiety dimensions of panic and social anxiety. Most youth in the clinical groups were classified as having difficulties with sensory processing. The present study shows that sensory processing difficulties are common in youth with OCD and ADs, not explained by co-occurring neurodevelopmental disorders, and linked to a host of internalizing symptoms. More research is needed to identify whether sensory processing difficulties precede, follow, or mutually reinforce the development of OCD and ADs in youth.
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Molot J, Sears M, Marshall LM, Bray RI. Neurological susceptibility to environmental exposures: pathophysiological mechanisms in neurodegeneration and multiple chemical sensitivity. REVIEWS ON ENVIRONMENTAL HEALTH 2022; 37:509-530. [PMID: 34529912 DOI: 10.1515/reveh-2021-0043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/13/2021] [Indexed: 05/23/2023]
Abstract
The World Health Organization lists air pollution as one of the top five risks for developing chronic non-communicable disease, joining tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity. This review focuses on how host defense mechanisms against adverse airborne exposures relate to the probable interacting and overlapping pathophysiological features of neurodegeneration and multiple chemical sensitivity. Significant long-term airborne exposures can contribute to oxidative stress, systemic inflammation, transient receptor subfamily vanilloid 1 (TRPV1) and subfamily ankyrin 1 (TRPA1) upregulation and sensitization, with impacts on olfactory and trigeminal nerve function, and eventual loss of brain mass. The potential for neurologic dysfunction, including decreased cognition, chronic pain and central sensitization related to airborne contaminants, can be magnified by genetic polymorphisms that result in less effective detoxification. Onset of neurodegenerative disorders is subtle, with early loss of brain mass and loss of sense of smell. Onset of MCS may be gradual following long-term low dose airborne exposures, or acute following a recognizable exposure. Upregulation of chemosensitive TRPV1 and TRPA1 polymodal receptors has been observed in patients with neurodegeneration, and chemically sensitive individuals with asthma, migraine and MCS. In people with chemical sensitivity, these receptors are also sensitized, which is defined as a reduction in the threshold and an increase in the magnitude of a response to noxious stimulation. There is likely damage to the olfactory system in neurodegeneration and trigeminal nerve hypersensitivity in MCS, with different effects on olfactory processing. The associations of low vitamin D levels and protein kinase activity seen in neurodegeneration have not been studied in MCS. Table 2 presents a summary of neurodegeneration and MCS, comparing 16 distinctive genetic, pathophysiological and clinical features associated with air pollution exposures. There is significant overlap, suggesting potential comorbidity. Canadian Health Measures Survey data indicates an overlap between neurodegeneration and MCS (p < 0.05) that suggests comorbidity, but the extent of increased susceptibility to the other condition is not established. Nevertheless, the pathways to the development of these conditions likely involve TRPV1 and TRPA1 receptors, and so it is hypothesized that manifestation of neurodegeneration and/or MCS and possibly why there is divergence may be influenced by polymorphisms of these receptors, among other factors.
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Affiliation(s)
- John Molot
- Family Medicine, University of Ottawa Faculty of Medicine, North York, ON, Canada
| | | | | | - Riina I Bray
- Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Ferrillo M, Giudice A, Marotta N, Fortunato F, Di Venere D, Ammendolia A, Fiore P, de Sire A. Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci 2022; 23:12164. [PMID: 36293017 PMCID: PMC9602546 DOI: 10.3390/ijms232012164] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen-ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.
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Affiliation(s)
- Martina Ferrillo
- Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Pietro Fiore
- Neurological Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS Institute of Bari, 70124 Bari, Italy
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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12
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Metz C, McCracken P, Hanmer J. Common Patient-Reported Outcomes Within the Food and Drug Administration Voice of the Patient Reports. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1743-1751. [PMID: 35577642 DOI: 10.1016/j.jval.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Proponents of disease-specific patient-reported outcome measurements (PROMs) often argue disease-agnostic measures do not adequately capture their patient population's experience. Patient-Reported Outcomes Measurement Information System (PROMIS) provides a disease-agnostic domain set that may adequately cover many diseases. This study seeks to investigate whether PROMIS's quality of life domain coverage can span patient-reported outcomes (PROs) elicited from patients across unrelated diseases. METHODS The Food and Drug Administration Voice of the Patient reports were an initiative to elevate patient voices regarding their condition and associated treatments. Two reviewers extracted patient-reported health-related (quality of life) domains from the reports and categorized them into PROMIS domains or non-PROMIS domains. Domain coverage was summarized for each report. Any extracted PROs not covered by PROMIS domains were placed in an "other" category and analyzed for common themes. RESULTS Across 26 reports, PROMIS covered 216 of 374 (70%) of the reports' PRO domains. The heritable bleeding disorders report had the highest coverage (82%). Human immunodeficiency virus had the lowest coverage (50%). The most common PROMIS domain, "ability to participate in social roles," appeared in 25 reports (96%). The most common domains not included in PROMIS were stigma, sensitivities, and sensory deficits as evident in 19 (73%), 18 (69%), and 18 reports (69%), respectively. If the top 3 unincluded domains were amended into PROMIS, the total domain coverage would increase to 84%. CONCLUSIONS PRO domains elicited in the Food and Drug Administration Voice of the Patient reports were widely captured by PROMIS, suggesting domains patients experience contain enough overlap to be recorded by appropriate PROMIS domains. PROMIS could increase its coverage by adding domains.
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Affiliation(s)
- Cameron Metz
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Polly McCracken
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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13
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De Gucht V, Woestenburg DHA, Wilderjans TF. The Different Faces of (High) Sensitivity, Toward a More Comprehensive Measurement Instrument. Development and Validation of the Sensory Processing Sensitivity Questionnaire (SPSQ). J Pers Assess 2022; 104:784-799. [PMID: 35175164 DOI: 10.1080/00223891.2022.2032101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The main purpose of the study was the development of the Sensory Processing Sensitivity Questionnaire (SPSQ), designed to measure Sensory Processing Sensitivity, defined as a person's sensitivity to subtle stimuli, the depth with which these stimuli are processed, and its impact on emotional reactivity. The item pool generated for the development of the SPSQ consisted of 60 items. After exploratory factor analysis, 43 items remained, divided into six specific factors: (1) Sensory Sensitivity to Subtle Internal and External Stimuli, (2) Emotional and Physiological Reactivity, (3) Sensory Discomfort, (4) Sensory Comfort, (5) Social-Affective Sensitivity, and (6) Esthetic Sensitivity. Confirmatory factor analysis indicated that a higher-order bi-factor model consisting of two higher-order factors (a positive and negative dimension), a general sensitivity factor and six specific factors had the best fit. Strong positive associations were found between Emotional and Physiological Reactivity, the negative higher-order dimension, and Neuroticism; the same holds for the association between Esthetic Sensitivity, the positive higher-order dimension, and Openness. Emotional and Physiological Reactivity and the negative higher-order dimension showed clear associations with clinical outcomes. The relationships between the SPSQ and similar scales - the Highly Sensitive Person Scale and part of the Adult Temperament Questionnaire - were in the expected direction.
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Affiliation(s)
- Véronique De Gucht
- Research Group of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Dion H A Woestenburg
- Methodology and Statistics Research Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands
| | - Tom F Wilderjans
- Methodology and Statistics Research Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leids Universitair Medisch Centrum (LUMC), Leiden, The Netherlands.,Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KULeuven, Leuven, Belgium
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14
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Wang D, Casares S, Eilers K, Hitchcock S, Iverson R, Lahn E, Loux M, Schnetzer C, Frey-Law LA. Assessing Multisensory Sensitivity Across Scales: Using the Resulting Core Factors to Create the Multisensory Amplification Scale. THE JOURNAL OF PAIN 2022; 23:276-288. [PMID: 34461307 PMCID: PMC11065416 DOI: 10.1016/j.jpain.2021.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
Multisensory sensitivity (MSS), observed in some chronic pain patients, may reflect a generalized central nervous system sensitivity. While several surveys measure aspects of MSS, there remains no gold standard. We explored the underlying constructs of 4 MSS-related surveys (80 items in total) using factor analyses using REDCap surveys (N = 614, 58.7% with pain). Four core- and 6 associated-MSS factors were identified from the items assessed. None of these surveys addressed all major sensory systems and most included additional related constructs. A revised version of the Somatosensory Amplification Scale was developed, encompassing 5 core MSS systems: vision, hearing, smell, tactile, and internal bodily sensations: the 12-item Multisensory Amplification Scale (MSAS). The MSAS demonstrated good internal consistency (alpha = 0.82), test-retest reliability (ICC3,1 = 0.90), and construct validity in the original and in a new, separate cohort (R = 0.54-0.79, P < .0001). Further, the odds of having pain were 2-3.5 times higher in the highest sex-specific MSAS quartile relative to the lowest MSAS quartile, after adjusting for age, sex, BMI, and pain schema (P < .03). The MSAS provides a psychometrically comprehensive, brief, and promising tool for measuring the core-dimensions of MSS. PERSPECTIVE: Multiple multisensory sensitivity (MSS) tools are used, but without exploration of their underlying domains. We found several measures lacking core MSS domains, thus we modified an existing scale to encompass 5 core MSS domains: light, smell, sound, tactile, and internal bodily sensations using only 12 items, with good psychometric properties.
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Affiliation(s)
- Dan Wang
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Sabrina Casares
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Karen Eilers
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Shannon Hitchcock
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ryan Iverson
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ethan Lahn
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Megan Loux
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Colton Schnetzer
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
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15
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Schuttert I, Timmerman H, Petersen KK, McPhee ME, Arendt-Nielsen L, Reneman MF, Wolff AP. The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review. J Clin Med 2021; 10:5931. [PMID: 34945226 PMCID: PMC8703986 DOI: 10.3390/jcm10245931] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022] Open
Abstract
Central sensitisation is assumed to be one of the underlying mechanisms for chronic low back pain. Because central sensitisation is not directly assessable in humans, the term 'human assumed central sensitisation' (HACS) is suggested. The objectives were to investigate what definitions for HACS have been used, to evaluate the methods to assess HACS, to assess the validity of those methods, and to estimate the prevalence of HACS. Database search resulted in 34 included studies. Forty different definition references were used to define HACS. This review uncovered twenty quantitative methods to assess HACS, including four questionnaires and sixteen quantitative sensory testing measures. The prevalence of HACS in patients with chronic low back pain was estimated in three studies. The current systematic review highlights that multiple definitions, assessment methods, and prevalence estimates are stated in the literature regarding HACS in patients with chronic low back pain. Most of the assessment methods of HACS are not validated but have been tested for reliability and repeatability. Given the lack of a gold standard to assess HACS, an initial grading system is proposed to standardize clinical and research assessments of HACS in patients with a chronic low back.
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Affiliation(s)
- Ingrid Schuttert
- Pain Center, Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, 9750 RA Groningen, The Netherlands; (I.S.); (H.T.)
| | - Hans Timmerman
- Pain Center, Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, 9750 RA Groningen, The Netherlands; (I.S.); (H.T.)
| | - Kristian K. Petersen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (K.K.P.); (M.E.M.); (L.A.-N.)
| | - Megan E. McPhee
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (K.K.P.); (M.E.M.); (L.A.-N.)
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (K.K.P.); (M.E.M.); (L.A.-N.)
- Department of Medical Gastroenterology (Mech-Sense), Aalborg University Hospital, DK-9220 Aalborg, Denmark
| | - Michiel F. Reneman
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, 9750 RA Groningen, The Netherlands;
| | - André P. Wolff
- Pain Center, Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, 9750 RA Groningen, The Netherlands; (I.S.); (H.T.)
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16
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Malinakova K, Novak L, Trnka R, Tavel P. Sensory Processing Sensitivity Questionnaire: A Psychometric Evaluation and Associations with Experiencing the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412962. [PMID: 34948569 PMCID: PMC8700833 DOI: 10.3390/ijerph182412962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/19/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
Sensory processing sensitivity (SPS) is a common human neurobiological trait that is related to many areas of human life. This trait has recently received increased public interest. However, solid scientific research on SPS is lagging behind. Progress in this area is also hindered by a lack of comprehensive research tools suitable for a rapid assessment of SPS. Thus, the aim of this study was to offer a newly developed tool, the Sensory Processing Sensitivity Questionnaire (SPSQ), and to assess its psychometric properties and associations with emotional and relational variables measured during the first wave of the COVID-19 pandemic. We found the tool to have good psychometric characteristics: high temporal stability (r = 0.95) and excellent internal consistency (Cronbach’s α = 0.92; McDonald’s ω = 0.92). The fit of the SPSQ bi-factor model was satisfactory: χ2 (88.0) = 506.141; p < 0.001; CFI = 0.993; TLI = 0.990; RMSEA = 0.070; SRMR = 0.039. Testing of configural, metric, scalar and strict invariance suggested that the SPSQ assesses SPS equivalently between males and females. The scale’s validity was supported via a strong association with an existing SPS measure. Further, we observed higher total SPSQ scores among women, students and religious respondents, and we found that more sensitive respondents reported higher feelings of anxiety and more deterioration in relationships during the COVID-19 pandemic. Thus, this study also identifies people with this trait as being potentially more vulnerable during periods of an increased presence of global stressors.
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Affiliation(s)
- Klara Malinakova
- Olomouc University Social Health Institute, Palacký University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.T.); (P.T.)
- Correspondence: ; Tel.: +420-731-646-963
| | - Lukas Novak
- Olomouc University Social Health Institute, Palacký University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.T.); (P.T.)
| | - Radek Trnka
- Olomouc University Social Health Institute, Palacký University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.T.); (P.T.)
- Department of Science, Prague College of Psychosocial Studies, Hekrova 805, 149 00 Prague, Czech Republic
| | - Peter Tavel
- Olomouc University Social Health Institute, Palacký University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.T.); (P.T.)
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17
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den Boer C, Terluin B, van der Wouden JC, Blankenstein AH, van der Horst HE. Tests for central sensitization in general practice: a Delphi study. BMC FAMILY PRACTICE 2021; 22:206. [PMID: 34666688 PMCID: PMC8527602 DOI: 10.1186/s12875-021-01539-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 08/19/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Central sensitization (CS) may explain the persistence of symptoms in patients with chronic pain and persistent physical symptoms (PPS). There is a need for assessing CS in the consultation room. In a recently published systematic review, we made an inventory of tests for CS. In this study we aimed to assess which tests might have added value, might be feasible and thus be suitable for use in general practice. METHODS We conducted a Delphi study consisting of two e-mail rounds to reach consensus among experts in chronic pain and PPS. We invited 40 national and international experts on chronic pain and PPS, 27 agreed to participate. We selected 12 tests from our systematic review and additional searches; panellists added three more tests in the first round. We asked the panellists, both clinicians and researchers, to rate these 15 tests on technical feasibility for use in general practice, added value and to provide an overall judgement for suitability in general practice. RESULTS In two rounds the panellists reached consensus on 14 of the 15 tests: three were included, eleven excluded. Included were the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments. No consensus was reached on the Sensory Hypersensitivity Scale. CONCLUSION In a Delphi study among an international panel of experts, three tests for measuring CS were considered to be suitable for use in general practice: the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments.
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Affiliation(s)
- Carine den Boer
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Berend Terluin
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Annette H Blankenstein
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Martucci KT, Weber KA, Mackey SC. Spinal Cord Resting State Activity in Individuals With Fibromyalgia Who Take Opioids. Front Neurol 2021; 12:694271. [PMID: 34421798 PMCID: PMC8371264 DOI: 10.3389/fneur.2021.694271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
Chronic pain coincides with myriad functional alterations throughout the brain and spinal cord. While spinal cord mechanisms of chronic pain have been extensively characterized in animal models and in vitro, to date, research in patients with chronic pain has focused only very minimally on the spinal cord. Previously, spinal cord functional magnetic resonance imaging (fMRI) identified regional alterations in spinal cord activity in patients (who were not taking opioids) with fibromyalgia, a chronic pain condition. Here, in patients with fibromyalgia who take opioids (N = 15), we compared spinal cord resting-state fMRI data vs. patients with fibromyalgia not taking opioids (N = 15) and healthy controls (N = 14). We hypothesized that the opioid (vs. non-opioid) patient group would show greater regional alterations in spinal cord activity (i.e., the amplitude of low frequency fluctuations or ALFF, a measure of regional spinal cord activity). However, we found that regional spinal cord activity in the opioid group was more similar to healthy controls, while regional spinal cord activity in the non-opioid group showed more pronounced differences (i.e., ventral increases and dorsal decreases in regional ALFF) vs. healthy controls. Across patient groups, self-reported fatigue correlated with regional differences in spinal cord activity. Additionally, spinal cord functional connectivity and graph metrics did not differ among groups. Our findings suggest that, contrary to our main hypothesis, patients with fibromyalgia who take opioids do not have greater alterations in regional spinal cord activity. Thus, regional spinal cord activity may be less imbalanced in patients taking opioids compared to patients not taking opioids.
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Affiliation(s)
- Katherine T. Martucci
- Human Affect and Pain Neuroscience Laboratory, Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Kenneth A. Weber
- Systems Neuroscience and Pain Laboratory, Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Sean C. Mackey
- Systems Neuroscience and Pain Laboratory, Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, United States
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Sherman K, Woyach V, Eisenach JC, Hopp FA, Cao F, Hogan QH, Dean C. Heterogeneity in patterns of pain development after nerve injury in rats and the influence of sex. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2021; 10:100069. [PMID: 34381929 PMCID: PMC8339380 DOI: 10.1016/j.ynpai.2021.100069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
The genesis of neuropathic pain is complex, as sensory abnormalities may differ between patients with different or similar etiologies, suggesting mechanistic heterogeneity, a concept that is largely unexplored. Yet, data are usually grouped for analysis based on the assumption that they share the same underlying pathogenesis. Sex is a factor that may contribute to differences in pain responses. Neuropathic pain is more prevalent in female patients, but pre-clinical studies that can examine pain development in a controlled environment have typically failed to include female subjects. This study explored patterns of development of hyperalgesia-like behavior (HLB) induced by noxious mechanical stimulation in a neuropathic pain model (spared nerve injury, SNI) in both male and female rats, and autonomic dysfunction that is associated with chronic pain. HLB was analyzed across time, using both discrete mixture modeling and rules-based longitudinal clustering. Both methods identified similar groupings of hyperalgesia trajectories after SNI that were not evident when data were combined into groups by sex only. Within the same hyperalgesia development group, mixed models showed that development of HLB in females was delayed relative to males and reached a magnitude similar to or higher than males. The data also indicate that sympathetic tone (as indicated by heart rate variability) drops below pre-SNI level before or at the onset of development of HLB. This study classifies heterogeneity in individual development of HLB and identifies sexual dimorphism in the time course of development of neuropathic pain after nerve injury. Future studies addressing mechanisms underlying these differences could facilitate appropriate pain treatments.
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Affiliation(s)
- Katherine Sherman
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
| | - Victoria Woyach
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
- Department of Anesthesiology, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53226, United States
| | - James C. Eisenach
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Francis A. Hopp
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
| | - Freddy Cao
- College of Nursing, University of Wisconsin – Milwaukee, Milwaukee, WI 53222, United States
| | - Quinn H. Hogan
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
- Department of Anesthesiology, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53226, United States
| | - Caron Dean
- Research Division, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, United States
- Department of Anesthesiology, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53226, United States
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Chacón A, Pérez-Chacón M, Borda-Mas M, Avargues-Navarro ML, López-Jiménez AM. Cross-Cultural Adaptation and Validation of the Highly Sensitive Person Scale to the Adult Spanish Population (HSPS-S). Psychol Res Behav Manag 2021; 14:1041-1052. [PMID: 34285606 PMCID: PMC8286783 DOI: 10.2147/prbm.s321277] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/03/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose This article describes a cross-cultural adaptation of the Highly Sensitive Person Scale (HSPS) to the adult Spanish population, and psychometric analysis of its validation and reliability. Methods Convenience sampling by participant accessibility was used. The original version was adapted culturally and linguistically using the back-translation method, and a pilot study was done with 88 participants. Data processing and analysis was performed with the SPSS v.25 and LISREL v.9.2 statistical packages. The psychometric properties were studied in a sample of 8358 participants using exploratory factor analysis and confirmatory factor analysis, and examining factorial invariance and internal consistency. Results The results confirmed a Spanish version with 27 items in five-dimensions: sensitivity to overstimulation (SOS), aesthetic sensitivity (AES), low sensory threshold (LST), fine psychophysiological discrimination (FPD) and harm avoidance (HA). Invariance across gender of this factor structure was demonstrated and reliability indices were good. Conclusion These findings demonstrate that the HSPS is an appropriate tool for evaluating high sensitivity in the adult Spanish population.
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Affiliation(s)
- Antonio Chacón
- International School of Doctoral Studies, University of Seville, Seville, 41013, Spain
| | - Manuela Pérez-Chacón
- International School of Doctoral Studies, University of Seville, Seville, 41013, Spain
| | - Mercedes Borda-Mas
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, 41018, Spain
| | - María Luisa Avargues-Navarro
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, 41018, Spain
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Eger T, Wörner F, Simon U, Konrad S, Wolowski A. Dental Anxiety and Higher Sensory Processing Sensitivity in a Sample of German Soldiers with Inflammatory Periodontal Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041584. [PMID: 33567560 PMCID: PMC7915768 DOI: 10.3390/ijerph18041584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/17/2022]
Abstract
(1) Background: Dental anxiety with disease value usually leads to avoidance of dental treatment. For the initial diagnosis of the level of anxiety, questionnaires such as the Hierarchical Anxiety Questionnaire (HAQ) are suitable. The construct of sensory processing sensitivity (SPS) describes a general trait in which people with a higher degree of SPS perceive information more strongly and process it more thoroughly. (2) Methods: This cross-sectional study evaluated the relationship between dental anxiety and higher levels of SPS in 116 soldiers referred with different stages of periodontitis for mandatory dental fitness before military deployment. (3) Results: The proportion of patients with periodontitis in stage III + IV was 39% and in stage I + II was 27%. The mean cumulative values of the questionnaires were 20.9 ± 10.6 for HAQ and 27.7 ± 16.0 for SPS. Eleven moderately anxious patients had a SPS value of 37.4 ± 13.5 and 10 highly anxious patients had a value of 36.3 ± 14.1. Patients diagnosed with stage III + IV periodontitis showed significantly higher values on the SPS subscale Low Sensory Threshold (LST), which describes overstimulation by external sensory stimuli, compared to patients with stage I + II periodontitis. Dental anxiety showed moderately significant correlations with the SPS subscale Ease of Excitation (EOE), which measures emotional reactivity to physiological stimuli. (4) Conclusions: Due to the frequency of dental anxiety and higher sensitivity in patients with severe periodontitis, it is useful to record said frequency.
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Affiliation(s)
- Thomas Eger
- Department of XXIII Dentistry-Periodontology, Bundeswehr Central Hospital Koblenz, Ruebenacherstrasse 170, 56072 Koblenz, Germany;
- Correspondence: ; Tel.: +49-261-281-43000
| | - Felix Wörner
- Department of XXIII Dentistry-Periodontology, Bundeswehr Central Hospital Koblenz, Ruebenacherstrasse 170, 56072 Koblenz, Germany;
| | - Ursula Simon
- Department of VI Center for Mental Health and Psychiatry, Bundeswehr Central Hospital Koblenz, Ruebenacherstrasse 170, 56072 Koblenz, Germany;
| | - Sandra Konrad
- Department of Personality Psychology and Psychological Diagnostics, Faculty of Humanities and Social Sciences, Helmut-Schmidt-University/University of the Bundeswehr Hamburg, Gebäude H4, Holstenhofweg 85, 22043 Hamburg, Germany;
| | - Anne Wolowski
- Department of Prosthodontics and Biomaterials, Albert-Schweitzer-Campus 1, University Hospital and Faculty of Medicine Muenster, 48149 Muenster, Germany;
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Wang D, Merkle SL, Lee JE, Sluka KA, Rakel B, Graven-Nielsen T, Frey-Law LA. Multisensory Sensitivity is Related to Deep-Tissue but Not Cutaneous Pain Sensitivity in Healthy Individuals. J Pain Res 2020; 13:2493-2508. [PMID: 33116791 PMCID: PMC7548328 DOI: 10.2147/jpr.s267972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Some individuals with chronic pain find daily life sensations (eg, noise, light, or touch) aversive. This amplification of multisensory sensations has been associated with centrally mediated plasticity; for example, greater multisensory sensitivity (MSS) occurs in patients with fibromyalgia than rheumatoid arthritis. However, whether MSS preferentially relates to pain measures which reflect central influences (eg, dynamic quantitative sensory testing (QST) or referred pain), or whether the MSS-pain relationship requires priming from chronic pain, is unknown. Thus, this cross-sectional study investigated the relationships between MSS assessed in a pain-free state and evoked pain sensitivity. METHODS Experimental intramuscular infusion pain and multiple static and dynamic QST were assessed in 465 healthy, pain-free adults: pain thresholds using pressure (PPTs) and heat (HPTs), temporal summation of pain (TSP) using pressure, heat or punctate stimuli, and conditioned pain modulation (CPM) using pressure or heat test stimuli. MSS was assessed using 7 items from Barsky's Somatosensory Amplification Scale. Differences in pain and QST between sex-specific MSS quartiles were assessed, adjusting for multiple comparisons. All participants completed at least one intramuscular infusion condition, but not all were asked to complete each QST (n=166-465). RESULTS Both static and dynamic QST differed between highest and lowest MSS quartiles using pressure stimuli: lower PPTs (adjusted-p<0.01); increased pressure TSP (adjusted-p=0.02); lower pressure CPM (adjusted-p=0.01). However, none of the heat or punctate QST measures (HPTs, TSP, or CPM) differed between MSS quartiles (adjusted-p>0.05). Odds of experiencing TSP or referred pain was not greater, whereas CPM was 8-fold less likely, in those with highest MSS. CONCLUSION Normal variation in non-noxious MSS is related to both static and dynamic pain sensitivity, without sensitization associated with chronic pain, but is dependent on the QST stimulus. Thus, common influences on MSS and pain sensitivity may involve central mechanisms but are likely more complex than previously recognized.
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Affiliation(s)
- Dan Wang
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Shannon L Merkle
- United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, USA
| | - Jennifer E Lee
- Department of Psychology, Mount Mercy University, Cedar Rapids, IA, USA
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Barbara Rakel
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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23
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Aykan S, Vatansever G, Doğanay-Erdoğan B, Kalaycıoğlu C. Development of Sensory Sensitivity Scales (SeSS): Reliability and validity analyses. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103612. [PMID: 32092640 DOI: 10.1016/j.ridd.2020.103612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although adults are known to have sensory sensitivity differences, existing sensitivity scales have been mostly developed for children. The limited number of adult scales measure social/emotional features and modalities together. AIMS To develop scales for adults that evaluate visual, auditory and somatosensory sensitivities as separate domains and independent of social/emotional features. METHODS AND PROCEDURES Two consecutive studies (visual-auditory part and somatosensory part) were conducted using the same methods. Both studies included a pilot (n1 = 405 and n2 = 294) and a main group (n1 = 425 and n2 = 603). An exploratory factor analysis produced a single-factor solution for the visual and auditory domains and a three-factor solution for the somatosensory domain (touch, pain, and itch) of Sensory Sensitivity Scales. OUTCOMES AND RESULTS A confirmatory factor analysis revealed good construct validity in the the visual (CFI = .973, TLI = .965, and RMSEA = .075) auditory (CFI = .943, TLI = .927, and RMSEA = .074) and somatosensory (CFI = .955, TLI = .946, and RMSEA = .048) scales. The categories were internally consistent (αv = .86, αa = .79, αs = .69). As an indicator of convergent validity, higher autistic traits were related to higher sensitivity (rs-v = .17, rs-a = .25, rs-s = .14). CONCLUSIONS AND IMPLICATIONS Sensory Sensitivity Scales (SeSS) can be used to screen sensory sensitivity variability or identify and follow up the outcome of sensory interventions in adults.
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Affiliation(s)
- Simge Aykan
- Department of Physiology, Ankara University School of Medicine, Ankara, Turkey.
| | - Gözde Vatansever
- Department of Interdisciplinary Neuroscience, Institute of Health Sciences, Ankara University, Ankara, Turkey.
| | - Beyza Doğanay-Erdoğan
- Department of Interdisciplinary Neuroscience, Institute of Health Sciences, Ankara University, Ankara, Turkey; Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey.
| | - Canan Kalaycıoğlu
- Department of Physiology, Ankara University School of Medicine, Ankara, Turkey; Department of Interdisciplinary Neuroscience, Institute of Health Sciences, Ankara University, Ankara, Turkey.
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Clauw DJ, Essex MN, Pitman V, Jones KD. Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management. Postgrad Med 2019; 131:185-198. [DOI: 10.1080/00325481.2019.1574403] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Daniel J. Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Verne Pitman
- Global Medical Affairs, US Medical Affairs, Pfizer Inc, New York, NY, USA
| | - Kim D. Jones
- School of Nursing, Linfield College, Portland, OR, USA
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25
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Martucci KT, Weber KA, Mackey SC. Altered Cervical Spinal Cord Resting-State Activity in Fibromyalgia. Arthritis Rheumatol 2019; 71:441-450. [PMID: 30281205 DOI: 10.1002/art.40746] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/27/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Altered afferent input and central neural modulation are thought to contribute to fibromyalgia symptoms, and these processes converge within the spinal cord. We undertook this study to investigate the hypothesis that, using resting-state functional magnetic resonance imaging (rs-fMRI) of the cervical spinal cord, we would observe altered frequency-dependent activity in fibromyalgia. METHODS Cervical spinal cord rs-fMRI was conducted in fibromyalgia patients (n = 16) and healthy controls (n = 17). We analyzed the amplitude of low-frequency fluctuations (ALFF), a measure of low-frequency oscillatory power, for frequencies of 0.01-0.198 Hz and frequency sub-bands to determine regional and frequency-specific alterations in fibromyalgia. Functional connectivity and graph metrics were also analyzed. RESULTS As compared to healthy controls (n = 14), greater ventral and lesser dorsal mean ALFF of the cervical spinal cord was observed in fibromyalgia patients ( n = 15) (uncorrected P < 0.05) for frequencies of 0.01-0.198 Hz and all sub-bands. Additionally, lesser mean ALFF within the right dorsal quadrant (corrected P < 0.05) for frequencies of 0.01-0.198 Hz and sub-band frequencies of 0.073-0.198 Hz was observed in fibromyalgia. Regional mean ALFF was not correlated with pain; however, regional lesser mean ALFF was correlated with fatigue in patients (r = 0.763, P = 0.001). Functional connectivity and graph metrics were similar between groups. CONCLUSION Our results indicate unbalanced activity between the ventral and dorsal cervical spinal cord in fibromyalgia. Increased ventral neural processes and decreased dorsal neural processes may reflect the presence of central sensitization and contribute to fatigue and other bodily symptoms in fibromyalgia.
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Affiliation(s)
- Katherine T Martucci
- Stanford University, Stanford, California, and Duke University, Durham, North Carolina
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26
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den Boer C, Dries L, Terluin B, van der Wouden JC, Blankenstein AH, van Wilgen CP, Lucassen P, van der Horst HE. Central sensitization in chronic pain and medically unexplained symptom research: A systematic review of definitions, operationalizations and measurement instruments. J Psychosom Res 2019; 117:32-40. [PMID: 30665594 DOI: 10.1016/j.jpsychores.2018.12.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Central sensitization (CS), a mechanism explaining the persistence of symptoms, has been the focus of many research projects. Explanations given to patients with chronic pain are often based on this mechanism. It is hypothesized that CS also plays an important role in the persistence of medically unexplained symptoms (MUS). However, definitions and operationalizations of CS vary. We conducted a systematic review of definitions, operationalizations and measurement instruments of CS. METHODS We searched in PubMed, EMBASE, PsycINFO, Cinahl and The Cochrane Library till September 2017 and included papers that addressed CS in relation to chronic pain and/or MUS. Two reviewers independently selected, analysed and classified information from the selected publications. We performed a thematic analysis of definitions and operationalizations. We listed the measurement instruments. RESULTS We included 126 publications, 79 publications concerned chronic pain, 47 publications concerned MUS. Definitions of CS consistently encompass the theme hyperexcitability of the central nervous system (CNS). Additional themes are variably present: CNS locations, nature of sensory input, reduced inhibition and activation and modulation of the NDMA receptor. Hyperalgesia and allodynia are widely mentioned as operationalizations of CS. Quantitative sensory testing (QST) and (f)MRI are the most reported measurement instruments. CONCLUSIONS There is consensus that hyperexcitability is the central mechanism of CS. Operationalizations are based on this mechanism and additional components. There are many measurement instruments available, whose clinical value has still to be determined. There were no systematic differences in definitions and operationalizations between the publications addressing MUS and those addressing chronic pain.
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Affiliation(s)
- Carine den Boer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands.
| | - Linne Dries
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
| | - Berend Terluin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
| | - Johannes C van der Wouden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
| | - Annette H Blankenstein
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
| | - C Paul van Wilgen
- Transcare, transdisciplinary pain management centre, Groningen, the Netherlands; Pain in Motion International Research Group, Department of Physiotherapy, Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Peter Lucassen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community care, Nijmegen, the Netherlands
| | - Henriëtte E van der Horst
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
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28
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Coronado RA, George SZ. The Central Sensitization Inventory and Pain Sensitivity Questionnaire: An exploration of construct validity and associations with widespread pain sensitivity among individuals with shoulder pain. Musculoskelet Sci Pract 2018; 36:61-67. [PMID: 29751194 PMCID: PMC6671673 DOI: 10.1016/j.msksp.2018.04.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/21/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Central Sensitization Inventory (CSI) and Pain Sensitivity Questionnaire (PSQ) are alternatives to quantitative sensory testing (QST) for inferring central sensitization. OBJECTIVE Explore 1) comparative validity of the CSI and PSQ with QST (construct validity) and pain-related psychological questionnaires (concurrent validity), and 2) associations with widespread pain sensitivity. METHODS Seventy-eight participants with unilateral shoulder pain less than 6 months (mean ± SD age = 39.0 ± 14.5 years, N (%) females = 36 (46.2%)) completed the CSI, PSQ, psychological questionnaires, and underwent QST for local and remote pressure pain thresholds (PPT), heat pain threshold, and suprathreshold heat pain ratings. Data from 25 age and sex-matched healthy participants (mean ± SD age = 35.2 ± 11.1 year, N (%) females = 13 (52.0%)) were used to determine a composite index for widespread pressure pain sensitivity in the shoulder pain group. Analyses included correlations between measures and between-group comparisons. RESULTS Only the PSQ was associated with remote PPT (rho range = -0.25 to -0.27). Both the CSI and PSQ were associated with resilience (rho range = -0.29 to -0.39), anxiety (rho range = 0.25 to 0.66), and negative affect (rho range = 0.27 to 0.67). Neither the CSI nor PSQ were associated with widespread pain sensitivity (p > 0.05). Resilience (adjusted OR = 0.41, 95% CI = 0.18; 0.94) was a distinctive feature for widespread pain sensitivity. CONCLUSIONS These preliminary findings challenge the exclusive use of the CSI or PSQ for inferring central sensitization among individuals with shoulder pain.
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Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue S, MCE-South, Suite 4200, Nashville, TN 37232, USA.
| | - Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, 2400 Pratt Street, Room 0311 Terrace Level, Durham, NC 27705, USA.
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Williams DA. Phenotypic Features of Central Sensitization. JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH 2018; 23:e12135. [PMID: 30479469 PMCID: PMC6251410 DOI: 10.1111/jabr.12135] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The current manuscript reviews approaches for phenotyping central sensitization (CS). METHODS The manuscript covers the concept of diagnostic phenotyping, use of endophenotypes, biomarkers, and symptom clusters. Specifically, the components of CS that include general sensory sensitivity (assessed by quantitative sensory testing) and a symptom cluster denoting sleep difficulties, pain, affect, cognitive difficulties, and low energy (S.P.A.C.E.). RESULTS Each of the assessment domains are described with reference to CS and their presence in chronic overlapping pain conditions (COPCs) - conditions likely influenced by CS. CONCLUSIONS COPCs likely represent clinical diagnostic phenotypes of CS. Components of CS can also be assessed using QST or self-report instruments designed to assess single elements of CS or more general composite indices.
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Affiliation(s)
- David A Williams
- Department of Anesthesiology, University of Michigan Health System, 24 Frank Lloyd Wright Drive, P.O. Box 385, Lobby M, Ann Arbor, MI 48106
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30
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Bijlenga D, Tjon-Ka-Jie JYM, Schuijers F, Kooij JJS. Atypical sensory profiles as core features of adult ADHD, irrespective of autistic symptoms. Eur Psychiatry 2017; 43:51-57. [PMID: 28371743 DOI: 10.1016/j.eurpsy.2017.02.481] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Abnormal sensory sensitivity is a feature of autism-spectrum disorder (ASD), but is also reported in attention-deficit/hyperactivity disorder (ADHD). In many cases, ADHD and ASD are comorbid. This study investigated the prevalence of sensory hyper- and hyposensitivity among adults with ADHD, controlling for autistic symptoms. METHOD One hundred and sixteen adults diagnosed with ADHD completed the Adolescent/Adult Sensory Profile-NL (AASP-NL) and the Autism-spectrum Quotient (AQ) questionnaires. Prevalences of hyper- and hyposensitivity and autism-spectrum symptoms were compared to norm values. Multivariate binary logistic regressions were used to determine the association of autistic symptoms, age, gender, ADHD subtype, self-reported severity of ADHD symptoms, comorbid disorders, and use of medication on the sensory hypo- and hypersensitivity in adults with ADHD. RESULTS Adults with ADHD had more autistic symptoms, and they had both more hyper- and hyposensitivity compared to norm groups. This was especially apparent in the Activity level and Auditory sensory modalities. Sensory hypo- and hypersensitivity were both related to an increased ADHD score, even showing a dose-response relationship, but not to any autistic symptom or comorbid disorder. As much as 43% of the females with ADHD reported sensory hypo- and/or hypersensitivity, compared to 22% of the men. CONCLUSIONS Sensory hypo- and hypersensitivity may be viewed as key features of adult ADHD, especially in females, regardless of any autistic symptoms. Future research should be directed at the implications of this sensory dysregulation for the understanding of the pathophysiology of (female) ADHD, and on the usefulness of assessment of atypical sensory profiles in the diagnostic procedure of ADHD in adults.
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Affiliation(s)
- D Bijlenga
- PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands.
| | - J Y M Tjon-Ka-Jie
- PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands
| | - F Schuijers
- PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands
| | - J J S Kooij
- PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands
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