1
|
Soldatelli M, Franco ÁDO, Picon F, Duarte JÁ, Scherer R, Bandeira J, Zortea M, Torres ILDS, Fregni F, Caumo W. Primary somatosensory cortex and periaqueductal gray functional connectivity as a marker of the dysfunction of the descending pain modulatory system in fibromyalgia. Korean J Pain 2023; 36:113-127. [PMID: 36581601 PMCID: PMC9812696 DOI: 10.3344/kjp.22225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 12/31/2022] Open
Abstract
Background Resting-state functional connectivity (rs-FC) may aid in understanding the link between pain-modulating brain regions and the descending pain modulatory system (DPMS) in fibromyalgia (FM). This study investigated whether the differences in rs-FC of the primary somatosensory cortex in responders and non-responders to the conditioned pain modulation test (CPM-test) are related to pain, sleep quality, central sensitization, and the impact of FM on quality of life. Methods This cross-sectional study included 33 females with FM. rs-FC was assessed by functional magnetic resonance imaging. Change in the numerical pain scale during the CPM-test assessed the DPMS function. Subjects were classified either as non-responders (i.e., DPMS dysfunction, n = 13) or responders (n = 20) to CPM-test. A generalized linear model (GLM) and a receiver operating characteristic (ROC) curve analysis were performed to check the accuracy of the rs-FC to differentiate each group. Results Non-responders showed a decreased rs-FC between the left somatosensory cortex (S1) and the periaqueductal gray (PAG) (P < 0.001). The GLM analysis revealed that the S1-PAG rs-FC in the left-brain hemisphere was positively correlated with a central sensitization symptom and negatively correlated with sleep quality and pain scores. ROC curve analysis showed that left S1-PAG rs-FC offers a sensitivity and specificity of 85% or higher (area under the curve, 0.78, 95% confidence interval, 0.63-0.94) to discriminate who does/does not respond to the CPM-test. Conclusions These results support using the rs-FC patterns in the left S1-PAG as a marker for predicting CPM-test response, which may aid in treatment individualization in FM patients.
Collapse
Affiliation(s)
- Matheus Soldatelli
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Álvaro de Oliveira Franco
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felipe Picon
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Psychiatry, Faculdade de Medicina, UFRGS, Porto Alegre, Brazil
- ADHD Outpatient Program, HCPA, Porto Alegre, Brazil
| | - Juliana Ávila Duarte
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Internal Medicine, UFRGS, Porto Alegre, Brazil
| | - Ricardo Scherer
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Janete Bandeira
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maxciel Zortea
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Iraci Lucena da Silva Torres
- Laboratory of Pharmacology in Pain and Neuromodulation: Pre-clinical Investigations, Experimental Research Center, HCPA, Porto Alegre, Brazil
| | - Felipe Fregni
- Pain and Palliative Care Service, HCPA, Porto Alegre, Brazil
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Pain and Palliative Care Service, HCPA, Porto Alegre, Brazil
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, USA
| |
Collapse
|
2
|
Xiong HY, Zheng JJ, Wang XQ. Non-invasive Brain Stimulation for Chronic Pain: State of the Art and Future Directions. Front Mol Neurosci 2022; 15:888716. [PMID: 35694444 PMCID: PMC9179147 DOI: 10.3389/fnmol.2022.888716] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/27/2022] [Indexed: 12/13/2022] Open
Abstract
As a technique that can guide brain plasticity, non-invasive brain stimulation (NIBS) has the potential to improve the treatment of chronic pain (CP) because it can interfere with ongoing brain neural activity to regulate specific neural networks related to pain management. Treatments of CP with various forms of NIBS, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), using new parameters of stimulation have achieved encouraging results. Evidence of moderate quality indicates that high-frequency rTMS of the primary motor cortex has a clear effect on neuropathic pain (NP) and fibromyalgia. However, evidence on its effectiveness regarding pain relief in other CP conditions is conflicting. Concerning tDCS, evidence of low quality supports its benefit for CP treatment. However, evidence suggesting that it exerts a small treatment effect on NP and headaches is also conflicting. In this paper, we describe the underlying principles behind these commonly used stimulation techniques; and summarize the results of randomized controlled trials, systematic reviews, and meta-analyses. Future research should focus on a better evaluation of the short-term and long-term effectiveness of all NIBS techniques and whether they decrease healthcare use, as well as on the refinement of selection criteria.
Collapse
Affiliation(s)
- Huan-Yu Xiong
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | | | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| |
Collapse
|
3
|
Weissman-Fogel I, Granovsky Y, Bar-Shalita T. Sensory Over-Responsiveness among Healthy Subjects is Associated with a Pronociceptive State. Pain Pract 2017; 18:473-486. [PMID: 28782305 DOI: 10.1111/papr.12619] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/28/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Chronic pain patients show hypersensitivity to sensory nonpainful stimuli. Sensory over-responsiveness (SOR) to innocuous daily stimuli, experienced as painful, is prevalent in 10% of the healthy population. This altered sensory processing may be an expression of overfacilitation, or a less efficient pain-inhibitory process in the pain pathways. We therefore aimed to investigate specifically the pain-inhibitory system of subjects with SOR who are otherwise healthy, not studied as of yet. METHODS Thirty healthy subjects, divided into an SOR group (n = 14) and a non-SOR group (n = 16) based on responses to the Sensory Responsiveness Questionnaire, were psychophysically tested in order to evaluate (1) hyperalgesic responses; (2) adaptation/sensitization to 14 phasic heat stimuli; (3) habituation; (4) 6-minute after-sensations; and (5) conditioned pain modulation (CPM) (ie, phasic heat stimuli applied with and without hand immersion in a hot water bath). RESULTS The SOR group differed from the non-SOR group in (1) a steeper escalation in NPS ratings to temperature increase (P = 0.003), indicating hyperalgesia; (2) increased sensitization (P < 0.001); (3) habituation responses (P < 0.001); (4) enhanced pain ratings during the after-sensation (P = 0.006); and (5) no group difference was found in CPM. CONCLUSIONS SOR is associated with a pronociceptive state, expressed by amplification of experimental pain, yet with sufficient inhibitory processes. Our results support previous findings of enhanced facilitation of pain-transmitting pathways but also reveal preserved inhibitory mechanisms, although they were slower to react.
Collapse
Affiliation(s)
- Irit Weissman-Fogel
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Yelena Granovsky
- Department of Neurology, Rambam Health Care Campus and the Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion, Haifa, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Schreiber KL, Loggia ML, Kim J, Cahalan CM, Napadow V, Edwards RR. Painful After-Sensations in Fibromyalgia are Linked to Catastrophizing and Differences in Brain Response in the Medial Temporal Lobe. THE JOURNAL OF PAIN 2017; 18:855-867. [PMID: 28300650 PMCID: PMC6102715 DOI: 10.1016/j.jpain.2017.02.437] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 02/17/2017] [Accepted: 02/27/2017] [Indexed: 12/19/2022]
Abstract
Fibromyalgia (FM) is a complex syndrome characterized by chronic widespread pain, hyperalgesia, and other disabling symptoms. Although the brain response to experimental pain in FM patients has been the object of intense investigation, the biological underpinnings of painful after-sensations (PAS), and their relation to negative affect have received little attention. In this cross-sectional cohort study, subjects with FM (n = 53) and healthy controls (n = 17) were assessed for PAS using exposure to a sustained, moderately painful cuff stimulus to the leg, individually calibrated to a target pain intensity of 40 of 100. Despite requiring lower cuff pressures to achieve the target pain level, FM patients reported more pronounced PAS 15 seconds after the end of cuff stimulation, which correlated positively with clinical pain scores. Functional magnetic resonance imaging revealed reduced deactivation of the medial temporal lobe (MTL; amygdala, hippocampus, parahippocampal gyrus) in FM patients, during pain stimulation, as well as in the ensuing poststimulation period, when PAS are experienced. Moreover, the functional magnetic resonance imaging signal measured during the poststimulation period in the MTL, as well as in the insular and anterior middle cingulate and medial prefrontal cortices, correlated with the severity of reported PAS by FM patients. These results suggest that the MTL plays a role in PAS in FM patients. PERSPECTIVE PAS are more common and severe in FM, and are associated with clinical pain and catastrophizing. PAS severity is also associated with less MTL deactivation, suggesting that the MTL, a core node of the default mode network, may be important in the prolongation of pain sensation in FM.
Collapse
Affiliation(s)
- Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Marco L Loggia
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Jieun Kim
- Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Christine M Cahalan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vitaly Napadow
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
5
|
To WT, James E, Ost J, Hart J, De Ridder D, Vanneste S. Differential effects of bifrontal and occipital nerve stimulation on pain and fatigue using transcranial direct current stimulation in fibromyalgia patients. J Neural Transm (Vienna) 2017; 124:799-808. [PMID: 28321566 DOI: 10.1007/s00702-017-1714-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/16/2017] [Indexed: 12/15/2022]
Abstract
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain frequently accompanied by other symptoms such as fatigue. Moderate improvement from pharmacological and non-pharmacological treatments have proposed non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) to the occipital nerve (more specifically the C2 area) or to the dorsolateral prefrontal cortex (DLPFC) as potential treatments. We aimed to explore the effectiveness of repeated sessions of tDCS (eight sessions) targeting the C2 area and DLPFC in reducing fibromyalgia symptoms, more specifically pain and fatigue. Forty-two fibromyalgia patients received either C2 tDCS, DLPFC tDCS or sham procedure (15 C2 tDCS-11 DLPFC tDCS-16 sham). All groups were treated with eight sessions (two times a week for 4 weeks). Our results show that repeated sessions of C2 tDCS significantly improved pain, but not fatigue, in fibromyalgia patients, whereas repeated sessions of DLPFC tDCS significantly improved pain as well as fatigue. This study shows that eight sessions of tDCS targeting the DLPFC have a more general relief in fibromyalgia patients than when targeting the C2 area, suggesting that stimulating different targets with eight sessions of tDCS can lead to benefits on different symptom dimensions of fibromyalgia.
Collapse
Affiliation(s)
- Wing Ting To
- Center for Brain Health, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 W Mockingbird Lane, Dallas, TX, 75235, USA.
| | - Evan James
- Lab for Clinical and Integrative Neuroscience, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Jan Ost
- Brai2n Clinic, St Augustinus, Antwerp, Belgium
| | - John Hart
- Center for Brain Health, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 W Mockingbird Lane, Dallas, TX, 75235, USA
| | - Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sven Vanneste
- Lab for Clinical and Integrative Neuroscience, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| |
Collapse
|
6
|
Gerardi MC, Atzeni F, Batticciotto A, Di Franco M, Rizzi M, Sarzi-Puttini P. The safety of pregabalin in the treatment of fibromyalgia. Expert Opin Drug Saf 2016; 15:1541-1548. [DOI: 10.1080/14740338.2016.1242575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maria Chiara Gerardi
- Rheumatology Unit, ASST-Fatebenefratelli-L, Sacco University Hospital, Milan, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, ASST-Fatebenefratelli-L, Sacco University Hospital, Milan, Italy
| | - Alberto Batticciotto
- Rheumatology Unit, ASST-Fatebenefratelli-L, Sacco University Hospital, Milan, Italy
| | - Manuela Di Franco
- Rheumatology Unit, Department of Internal Medicine and Medical Specialities, Sapienza, University of Rome, Rome, Italy
| | - Maurizio Rizzi
- Pulmonary Department, ASST-Fatebenefratelli-L, Sacco University Hospital, Milan, Italy
| | | |
Collapse
|
7
|
Ellingson LD, Stegner AJ, Schwabacher IJ, Koltyn KF, Cook DB. Exercise Strengthens Central Nervous System Modulation of Pain in Fibromyalgia. Brain Sci 2016; 6:brainsci6010008. [PMID: 26927193 PMCID: PMC4810178 DOI: 10.3390/brainsci6010008] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/02/2016] [Accepted: 02/17/2016] [Indexed: 01/01/2023] Open
Abstract
To begin to elucidate the mechanisms underlying the benefits of exercise for chronic pain, we assessed the influence of exercise on brain responses to pain in fibromyalgia (FM). Complete data were collected for nine female FM patients and nine pain-free controls (CO) who underwent two functional neuroimaging scans, following exercise (EX) and following quiet rest (QR). Brain responses and pain ratings to noxious heat stimuli were compared within and between groups. For pain ratings, there was a significant (p < 0.05) Condition by Run interaction characterized by moderately lower pain ratings post EX compared to QR (d = 0.39–0.41) for FM but similar to ratings in CO (d = 0.10–0.26), thereby demonstrating that exercise decreased pain sensitivity in FM patients to a level that was analogous to pain-free controls. Brain responses demonstrated a significant within-group difference in FM patients, characterized by less brain activity bilaterally in the anterior insula following QR as compared to EX. There was also a significant Group by Condition interaction with FM patients showing less activity in the left dorsolateral prefrontal cortex following QR as compared to post-EX and CO following both conditions. These results suggest that exercise appeared to stimulate brain regions involved in descending pain inhibition in FM patients, decreasing their sensitivity to pain. Thus, exercise may benefit patients with FM via improving the functional capacity of the pain modulatory system.
Collapse
Affiliation(s)
- Laura D Ellingson
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA.
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, Madison, WI 53706, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Isaac J Schwabacher
- William S. Middleton Memorial Veterans Hospital, Madison, WI 53706, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Kelli F Koltyn
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, WI 53706, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA.
| |
Collapse
|
8
|
Gerardi MC, Batticciotto A, Talotta R, Di Franco M, Atzeni F, Sarzi-Puttini P. Novel pharmaceutical options for treating fibromyalgia. Expert Rev Clin Pharmacol 2016; 9:559-565. [DOI: 10.1586/17512433.2016.1145052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
9
|
Trigeminal nerve stimulation (TNS) for fibromyalgia: a case study. Epilepsy Behav 2014; 32:100-1. [PMID: 24530850 DOI: 10.1016/j.yebeh.2014.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 01/20/2014] [Indexed: 11/20/2022]
|
10
|
Abstract
Fibromyalgia is a primary brain disorder or a result of peripheral dysfunctions inducing brain alterations, with underlying mechanisms that partially overlap with other painful conditions. Although there are methodologic variations, neuroimaging studies propose neural correlations to clinical findings of abnormal pain modulation in fibromyalgia. Growing evidences of specific differences of brain activations in resting states and pain-evoked conditions confirm clinical hyperalgesia and impaired inhibitory descending systems, and also demonstrate cognitive-affective influences on painful experiences, leading to augmented pain-processing. Functional data of neural activation abnormalities parallel structural findings of gray matter atrophy, alterations of intrinsic connectivity networks, and variations in metabolites levels along multiple pathways. Data from positron-emission tomography, single-photon-emission-computed tomography, blood-oxygen-level-dependent, voxel-based morphometry, diffusion tensor imaging, default mode network analysis, and spectroscopy enable the understanding of fibromyalgia pathophysiology, and favor the future establishment of more tailored treatments.
Collapse
Affiliation(s)
- Liliana Lourenço Jorge
- Hospital Israelita Albert Einstein and Instituto de Reabilitação Lucy Montoro, Avenida Albert Einstein, 627 3rd Floor Block D, 05651901, Morumbi, Sao Paulo, Brazil.
| | | |
Collapse
|
11
|
Affiliation(s)
- Francis J Dunne
- North East London Foundation Trust, Goodmayes Hospital, Ilford, Essex IG3 8XJ and
| | - Ciaran A Dunne
- Royal Bournemouth and Christchurch Hospitals, Bournemouth
| |
Collapse
|
12
|
Ellingson LD, Shields MR, Stegner AJ, Cook DB. Physical activity, sustained sedentary behavior, and pain modulation in women with fibromyalgia. THE JOURNAL OF PAIN 2012; 13:195-206. [PMID: 22245361 PMCID: PMC3272134 DOI: 10.1016/j.jpain.2011.11.001] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 10/10/2011] [Accepted: 11/02/2011] [Indexed: 12/14/2022]
Abstract
UNLABELLED Fibromyalgia (FM) has been conceptualized as a disorder of the central nervous system, characterized by augmented sensory processing and an inability to effectively modulate pain. We previously reported that physical activity is related to brain processing of pain, providing evidence for a potential mechanism of pain management. The purpose of this study was to extend our work by manipulating pain modulation and determining relationships to both physical activity and sustained sedentary behavior. Eleven women with FM completed accelerometer measures of physical activity and underwent functional magnetic resonance imaging of painful heat, administered alone and during distracting cognitive tasks. Results showed that physical activity was significantly (P < .005) and positively related to brain responses during distraction from pain in regions implicated in pain modulation including the dorsolateral prefrontal cortex (DLPFC), the dorsal posterior cingulate, and the periaqueductal grey. A significant negative relationship occurred in the left anterior insula. For sedentary time, significant negative relationships were observed in areas involved in both pain modulation and the sensory-discriminative aspects of pain including the DLPFC, thalamus, and superior frontal and pre- and post-central gyri. These results suggest that physical activity and sedentary behaviors are related to central nervous system regulation of pain in FM. PERSPECTIVE Our results support a promising benefit of physical activity and highlight the potentially deleterious effects of sustained sedentary behavior for pain regulation in FM. Studies aimed at increasing physical activity or reducing sedentary behavior and determining the impact of these on pain regulation are warranted.
Collapse
Affiliation(s)
- Laura D. Ellingson
- Department of Kinesiology, University of Wisconsin-Madison, Madison Wisconsin
| | - Morgan R. Shields
- Department of Kinesiology, University of Wisconsin-Madison, Madison Wisconsin
| | - Aaron J. Stegner
- Department of Kinesiology, University of Wisconsin-Madison, Madison Wisconsin
| | - Dane B. Cook
- William S. Middleton, Memorial Veterans Hospital, Madison Wisconsin
- Department of Kinesiology, University of Wisconsin-Madison, Madison Wisconsin
| |
Collapse
|
13
|
Chen J, Lariviere WR. The nociceptive and anti-nociceptive effects of bee venom injection and therapy: a double-edged sword. Prog Neurobiol 2010; 92:151-83. [PMID: 20558236 DOI: 10.1016/j.pneurobio.2010.06.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 03/31/2010] [Accepted: 06/08/2010] [Indexed: 12/23/2022]
Abstract
Bee venom injection as a therapy, like many other complementary and alternative medicine approaches, has been used for thousands of years to attempt to alleviate a range of diseases including arthritis. More recently, additional theraupeutic goals have been added to the list of diseases making this a critical time to evaluate the evidence for the beneficial and adverse effects of bee venom injection. Although reports of pain reduction (analgesic and antinociceptive) and anti-inflammatory effects of bee venom injection are accumulating in the literature, it is common knowledge that bee venom stings are painful and produce inflammation. In addition, a significant number of studies have been performed in the past decade highlighting that injection of bee venom and components of bee venom produce significant signs of pain or nociception, inflammation and many effects at multiple levels of immediate, acute and prolonged pain processes. This report reviews the extensive new data regarding the deleterious effects of bee venom injection in people and animals, our current understanding of the responsible underlying mechanisms and critical venom components, and provides a critical evaluation of reports of the beneficial effects of bee venom injection in people and animals and the proposed underlying mechanisms. Although further studies are required to make firm conclusions, therapeutic bee venom injection may be beneficial for some patients, but may also be harmful. This report highlights key patterns of results, critical shortcomings, and essential areas requiring further study.
Collapse
Affiliation(s)
- Jun Chen
- Institute for Biomedical Sciences of Pain and Institute for Functional Brain Disorders, Tangdu Hospital, The Fourth Military Medical University, 1 Xinsi Road, Baqiao District, Xi'an 710038, PR China.
| | | |
Collapse
|
14
|
Abstract
Pain is a complex subjective phenomenon that so far cannot be objectively quantified by any standardized procedure. This fact renders it also difficult to measure the efficacy of analgesic drugs. In recent years the application of functional magnetic resonance imaging (fMRI) has significantly increased our current knowledge about the brain physiological correlates of pain in humans. The technique is non-invasive and detects the increased blood flow into neuronally active brain regions based on the so-called BOLD (blood oxygenation level dependent) effect of T2-weighted MRI. This paper gives an overview of the application of pharmacological fMRI (phfMRI) as an approach to evaluate the efficacy of analgesics. In contrast to EEG- and MEG-based methods phfMRI allows more flexibility in the design of experimental paradigms and stimulus protocols to account for the diversity of clinical pain types (inflammatory pain, tactile allodynia etc.) or their dependence upon psychological circumstances (anxiety, depression, stress) in which pain occurs. However, in order to specifically refer results from phfMRI to the neuronal processes underlying pain, future research needs to increase the understanding of the mechanisms underlying the neurovascular coupling reaction represented by the BOLD technique. The same applies for the influence of cerebrovascular diseases on the BOLD response.
Collapse
|
15
|
Scott DL. Career lifetime advances in rheumatology. Clin Med (Lond) 2010; 10:156-9. [PMID: 20437989 PMCID: PMC4952090 DOI: 10.7861/clinmedicine.10-2-156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David L Scott
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, King's College, London.
| |
Collapse
|
16
|
Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. PAIN MEDICINE 2009; 10:663-72. [PMID: 19453963 DOI: 10.1111/j.1526-4637.2009.00613.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fibromyalgia is a chronic pain disorder that is characterized by diffuse musculoskeletal pain and sensitivity to mechanical stimulation. In this pilot clinical trial, we tested the effectiveness of low-dose naltrexone in treating the symptoms of fibromyalgia. DESIGN Participants completed a single-blind, crossover trial with the following time line: baseline (2 weeks), placebo (2 weeks), drug (8 weeks), and washout (2 weeks). PATIENTS Ten women meeting criteria for fibromyalgia and not taking an opioid medication. INTERVENTIONS Naltrexone, in addition to antagonizing opioid receptors on neurons, also inhibits microglia activity in the central nervous system. At low doses (4.5 mg), naltrexone may inhibit the activity of microglia and reverse central and peripheral inflammation. OUTCOME MEASURES Participants completed reports of symptom severity everyday, using a handheld computer. In addition, participants visited the lab every 2 weeks for tests of mechanical, heat, and cold pain sensitivity. RESULTS Low-dose naltrexone reduced fibromyalgia symptoms in the entire cohort, with a greater than 30% reduction of symptoms over placebo. In addition, laboratory visits showed that mechanical and heat pain thresholds were improved by the drug. Side effects (including insomnia and vivid dreams) were rare, and described as minor and transient. Baseline erythrocyte sedimentation rate predicted over 80% of the variance in drug response. Individuals with higher sedimentation rates (indicating general inflammatory processes) had the greatest reduction of symptoms in response to low-dose naltrexone. CONCLUSIONS We conclude that low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia.
Collapse
Affiliation(s)
- Jarred Younger
- School of Medicine, Department of Anesthesia, Division of Pain Management, Stanford University, 780 Welch Road, Suite 208, Palo Alto, CA 94304-1573, USA.
| | | |
Collapse
|
17
|
Absence of contralateral suppression of transiently evoked otoacoustic emissions in fibromyalgia syndrome. The Journal of Laryngology & Otology 2008; 122:1047-51. [DOI: 10.1017/s0022215107001569] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AbstractObjective:To assess contralateral suppression of transiently evoked otoacoustic emissions in patients with fibromyalgia syndrome and normal hearing.Methods:Twenty-four female patients with fibromyalgia syndrome and 24 healthy female controls with normal hearing were assessed using pure tone audiometry and transiently evoked otoacoustic emissions.Results:All patients with fibromyalgia syndrome and all controls had normal hearing on pure tone audiometry. In the patients with fibromyalgia syndrome, the mean transiently evoked otoacoustic emission amplitude was 15.5 ± 4.8 dB. The mean transiently evoked otoacoustic emission amplitudes after contralateral suppression was 15.5 ± 4.9 dB. There was no statistically significant difference between the transiently evoked otoacoustic emission amplitudes measured before and after contralateral suppression (p > 0.05). In the controls, the mean transiently evoked otoacoustic emission amplitude was 12 ± 5 dB. The mean transiently evoked otoacoustic emission amplitudes after contralateral suppression was 11 ± 4.7 dB. There was a statistically significant decrease in transiently evoked otoacoustic emission amplitudes after contralateral suppression (p < 0.01).Conclusion:The mechanisms related to contralateral suppression of transiently evoked otoacoustic emissions seem dysfunctional in fibromyalgia syndrome. This dysfunction may be at the brain stem level, where the medial superior olivary complex is located, or at the synapses of medial superior olivary complex fibres with the outer hair cells in the cochlea. Demonstration of lack of contralateral suppression of transiently evoked otoacoustic emissions can be used as a diagnostic tool in patients with fibromyalgia syndrome.
Collapse
|
18
|
Lundeberg T, Lund I. Are reviews based on sham acupuncture procedures in fibromyalgia syndrome (FMS) valid? Acupunct Med 2008; 25:100-6. [PMID: 17906605 DOI: 10.1136/aim.25.3.100] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In recent reviews regarding the efficacy of acupuncture in fibromyalgia syndrome (FMS) it has been concluded that acupuncture has no specific effect since the control procedure (superficial needling and/or needling away from 'specific' points) had similar effects. These conclusions may be questioned since superficial needling and/or needling away from specific trigger points is not inert. Also, manual acupuncture or mild electroacupuncture (EA) may not be sufficient to activate the endogenous pain inhibiting system. Patients with FMS suffer from allodynia, fatigue and muscle ache, which is partly explained by peripheral and central sensitisation. Sensitisation results in augmented and altered stimulus responses whereby light stimulation of the skin has as strong an effect as regular needling on the pain inhibitory system in FMS. Central sensitisation in FMS is also associated with expanded receptive fields of central neurons resulting in a larger topographic distribution of the pain. This would suggest that control procedures using needling away from the 'specific site' might have as strong an effect as needling within the most painful area. Also, repeated nociceptive input from muscles (as obtained by de qi) results in expansion of receptive fields which in turn may result in activation of descending pain inhibition outside the stimulated myotome. Sensitisation to pain, such as in FMS, may also be related to abnormalities in descending efferent pathways. As there is likely to be an imbalance between excitatory and inhibitory systems in FMS, stronger stimulation may therefore be needed to activate the descending pain inhibitory system. In studies using mild manual acupuncture or weak EA stimulation optimal pain inhibition may therefore not have been obtained. When conducting studies on acupuncture, the clinical condition or syndrome needs to be taken into account and the control procedure designed accordingly.
Collapse
Affiliation(s)
- Thomas Lundeberg
- Rehabilitation Medicine, UniversityClinic, Danderyds Hospital, Stockholm, Sweden.
| | | |
Collapse
|