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Chu YC, Chen SSS, Chen KB, Sun JS, Shen TK, Chen LK. Enhanced labor pain monitoring using machine learning and ECG waveform analysis for uterine contraction-induced pain. BioData Min 2024; 17:32. [PMID: 39243100 PMCID: PMC11380346 DOI: 10.1186/s13040-024-00383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 08/23/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVES This study aims to develop an innovative approach for monitoring and assessing labor pain through ECG waveform analysis, utilizing machine learning techniques to monitor pain resulting from uterine contractions. METHODS The study was conducted at National Taiwan University Hospital between January and July 2020. We collected a dataset of 6010 ECG samples from women preparing for natural spontaneous delivery (NSD). The ECG data was used to develop an ECG waveform-based Nociception Monitoring Index (NoM). The dataset was divided into training (80%) and validation (20%) sets. Multiple machine learning models, including LightGBM, XGBoost, SnapLogisticRegression, and SnapDecisionTree, were developed and evaluated. Hyperparameter optimization was performed using grid search and five-fold cross-validation to enhance model performance. RESULTS The LightGBM model demonstrated superior performance with an AUC of 0.96 and an accuracy of 90%, making it the optimal model for monitoring labor pain based on ECG data. Other models, such as XGBoost and SnapLogisticRegression, also showed strong performance, with AUC values ranging from 0.88 to 0.95. CONCLUSIONS This study demonstrates that the integration of machine learning algorithms with ECG data significantly enhances the accuracy and reliability of labor pain monitoring. Specifically, the LightGBM model exhibits exceptional precision and robustness in continuous pain monitoring during labor, with potential applicability extending to broader healthcare settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04461704.
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Affiliation(s)
- Yuan-Chia Chu
- Department of Information Management, Taipei Veterans General Hospital, Taipei, 11267, Taiwan, R.O.C
- Big Data Center, Taipei Veterans General Hospital, Taipei, 11267, Taiwan, R.O.C
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, 11219, Taiwan, R.O.C
| | - Saint Shiou-Sheng Chen
- Division of Urology, Taipei City Hospital Renai Branch, Taipei, 106243, Taiwan, R.O.C
- Commission for General Education, National Taiwan University of Science and Technology, Taipei, 10607, Taiwan, R.O.C
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang-Ming Chiao Tung University School of Medicine, Taipei, 11221, Taiwan, R.O.C
- General Education Center, University of Taipei, Taipei, 10617, Taiwan, R.O.C
| | - Kuen-Bao Chen
- College of Medicine, China Medical University, Taichung, 40402, Taiwan, R.O.C
- Department of Anesthesiology, North Dist, China Medical University Hospital, No.2, Yude Rd, Taichung City, 404327, Taiwan, R.O.C
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, 10617, Taiwan, R.O.C
- Department of Orthopedic Surgery, En Chu Kong Hospital, New Taipei City, Taiwan, R.O.C
| | - Tzu-Kuei Shen
- Vice President & CTO, R&D and Production Department, V5med Inc., Hsinchu, 30078, Taiwan, R.O.C
| | - Li-Kuei Chen
- College of Medicine, China Medical University, Taichung, 40402, Taiwan, R.O.C..
- Department of Anesthesiology, North Dist, China Medical University Hospital, No.2, Yude Rd, Taichung City, 404327, Taiwan, R.O.C..
- Anhe Rd, Xitun Dist, Dainthus MFM Clinic Anhe, No. 118-18, Taichung City, 407, Taiwan, R.O.C..
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deBettencourt C, Zhu X. Lumbar Sympathetic Block for Treatment of Knee Pain From Synovial Plica Syndrome: A Case Report. A A Pract 2024; 18:e01810. [PMID: 38949224 DOI: 10.1213/xaa.0000000000001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Lumbar sympathetic blocks (LSBs) are used to treat sympathetically mediated pain in the lower extremities, kidneys, ureters, and genitals. LSBs use local anesthetic to block the sympathetic system to modulate pain response. In this case report, an avid runner was diagnosed with synovial plica syndrome. His pain was refractory to arthroscopic plica excision, physical therapy, nonsteroidal anti-inflammatory drugs, and intraarticular steroid injections. He received 3 rounds of LSB resulting in significant and sustained pain relief. This case suggests that LSB successfully treated knee pain from synovial plica syndrome and there may be a sympathetic component to this disease state.
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Affiliation(s)
| | - Xiaoying Zhu
- Department of Anesthesiology and Pain Medicine, University of Virginia Health System, Charlottesville, Virginia
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Kim HI, Jung DH, Lee SJ, Lee YC, Lee SK, Kim GH, Nam HJ, Lee S, Byon HJ, Shin SK. Associations between Clinicopathological Characteristics and Intraoperative Opioid Requirements during Endoscopic Submucosal Dissection with Monitored Anesthesia Care: A Retrospective Study. J Clin Med 2024; 13:3119. [PMID: 38892830 PMCID: PMC11172858 DOI: 10.3390/jcm13113119] [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: 05/09/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background and study aims: Endoscopic submucosal dissection is used to treat early gastric neoplasms. Compared with other endoscopic procedures, it requires higher doses of opioids, leading to adverse events during monitored anesthesia care. We investigated the correlations between clinicopathological characteristics and intraprocedural opioid requirements in patients who underwent endoscopic submucosal dissection under monitored anesthesia care. Patients and methods: The medical records of patients who underwent endoscopic submucosal dissection under monitored anesthesia care were retrospectively reviewed. The dependent variable was the total dose of fentanyl administered during the dissection, while independent variables were patient demographics, the American Society of Anesthesiologists physical status classification, preoperative vital sign data, and the pathological characteristics of the neoplasm. Correlations between variables were examined using multiple regression analysis. Results: The study included 743 patients. The median total fentanyl dose was 100 mcg. Younger age (coefficient -1.37; 95% confidence interval [CI] -1.78 to -0.95), male sex (16.12; 95% CI 6.99-25.24), baseline diastolic blood pressure (0.44; 95% CI 0.04-0.85), neoplasm length (1.63; 95% CI 0.90-2.36), and fibrosis (28.59; 95% CI 17.77-39.42) were positively correlated with the total fentanyl dose. Total fentanyl dose was higher in the differentiated (16.37; 95% CI 6.40-26.35) and undifferentiated cancers group (32.53; 95% CI 16.95-48.11) than in the dysplasia group; no significant differences were observed among the others. The mid-anterior wall (22.69; 95% CI 1.25-44.13), mid-posterior wall (29.65; 95% CI 14.39-44.91), mid-greater curvature (28.77; 95% CI 8.56-48.98), and upper groups (30.06; 95% CI 5.01-55.12) had higher total fentanyl doses than the lower group, whereas doses did not significantly differ for the mid-lesser curvature group. Conclusions: We identified variables that influenced opioid requirements during monitored anesthesia care for endoscopic submucosal dissection. These may help predict the needed opioid doses and identify factors affecting intraprocedural opioid requirements.
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Affiliation(s)
- Hyun Il Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.I.K.); (S.J.L.); (H.J.N.)
| | - Da Hyun Jung
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
| | - Sung Jin Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.I.K.); (S.J.L.); (H.J.N.)
| | - Yong Chan Lee
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
| | - Ga Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
| | - Ho Jae Nam
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.I.K.); (S.J.L.); (H.J.N.)
| | - Sihak Lee
- Stanley Center for Psychiatric Research, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA;
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (H.I.K.); (S.J.L.); (H.J.N.)
| | - Sung Kwan Shin
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (D.H.J.); (Y.C.L.); (S.K.L.); (G.H.K.)
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Fabero-Garrido R, Rodríguez-Marcos I, del Corral T, Plaza-Manzano G, López-de-Uralde-Villanueva I. Effects of Respiratory Muscle Training on Functional Ability, Pain-Related Outcomes, and Respiratory Function in Individuals with Low Back Pain: Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3053. [PMID: 38892764 PMCID: PMC11172635 DOI: 10.3390/jcm13113053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/15/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: The aim of this meta-analysis was to determine the effects of respiratory muscle training (RMT) on functional ability, pain-related outcomes, and respiratory function in individuals with sub-acute and chronic low back pain (LBP). Methods: The study selection was as follows: (participants) adult individuals with >4 weeks of LBP; (intervention) RMT; (comparison) any comparison RMT (inspiratory or expiratory or mixed) versus control; (outcomes) postural control, lumbar disability, pain-related outcomes, pain-related fear-avoidance beliefs, respiratory muscle function, and pulmonary function; and (study design) randomized controlled trials. Results: 11 studies were included in the meta-analysis showing that RMT produces a statistically significant increase in postural control (mean difference (MD) = 21.71 [12.22; 31.21]; decrease in lumbar disability (standardized mean difference (SMD) = 0.55 [0.001; 1.09]); decrease in lumbar pain intensity (SMD = 0.77 [0.15; 1.38]; increase in expiratory muscle strength (MD = 8.05 [5.34; 10.76]); and increase in forced vital capacity (FVC) (MD = 0.30 [0.03; 0.58]) compared with a control group. However, RMT does not produce an increase in inspiratory muscle strength (MD = 18.36 [-1.61; 38.34]) and in forced expiratory volume at the first second (FEV1) (MD = 0.36 [-0.02; 0.75]; and in the FEV1/FVC ratio (MD = 1.55 [-5.87; 8.96]) compared with the control group. Conclusions: RMT could improve expiratory muscle strength and FVC, with a moderate quality of evidence, whereas a low quality of evidence suggests that RMT could improve postural control, lumbar disability, and pain intensity in individuals with sub-acute and chronic LBP. However, more studies of high methodological quality are needed to strengthen the results of this meta-analysis.
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Affiliation(s)
- Raúl Fabero-Garrido
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
| | - Iván Rodríguez-Marcos
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
| | - Tamara del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Singh H, Rajarathinam M. Stellate ganglion block beyond chronic pain: A literature review on its application in painful and non-painful conditions. J Anaesthesiol Clin Pharmacol 2024; 40:185-191. [PMID: 38919437 PMCID: PMC11196062 DOI: 10.4103/joacp.joacp_304_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 06/27/2024] Open
Abstract
Cervical sympathetic or stellate ganglion blocks (SGBs) have been commonly used in the treatment of painful conditions like complex regional pain syndrome (CRPS). However, there is literature to suggest its utility in managing non-painful conditions as well. The focus of this literature review is to provide an overview of indications for SGB for painful and non-painful conditions. We identified published journal articles in the past 25 years from Embase and PubMed databases with the keywords "cervical sympathetic block, stellate ganglion blocks, cervical sympathetic chain, and cervical sympathetic trunk". A total of 1556 articles were obtained from a literature search among which 311 articles were reviewed. Among painful conditions, there is a lack of evidence in favor of or against the use of SGB for CRPS despite its common use. SGB can provide postoperative analgesia in selective surgeries and can be effective in temporary pain control of refractory angina and the acute phase of herpes zoster infection. Among non-painful conditions, SGB may have beneficial effects on the management of post-traumatic stress disorder (PTSD), refractory ventricular arrhythmias, hot flashes in postmenopausal women, and breast cancer-related lymphedema. Additionally, there have been various case reports illustrating the benefits of SGB in the management of cerebral vasospasm, upper limb erythromelalgia, thalamic and central post-stroke pain, palmar hyperhidrosis, orofacial pain, etc. In our review of literature, we found that SGB can be useful in the management of various non-painful conditions beyond the well-known treatment for CRPS, although further studies are required to prove its efficacy.
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Affiliation(s)
- Heena Singh
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
| | - Manikandan Rajarathinam
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
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Xu Z, Soh Z, Kurota Y, Kimura Y, Hirano H, Sasaoka T, Yoshino A, Tsuji T. Neuroimaging-based evidence for sympathetic correlation between brain activity and peripheral vasomotion during pain anticipation. Sci Rep 2024; 14:3383. [PMID: 38337009 PMCID: PMC10858222 DOI: 10.1038/s41598-024-53921-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024] Open
Abstract
Anticipation of pain engenders anxiety and fear, potentially shaping pain perception and governing bodily responses such as peripheral vasomotion through the sympathetic nervous system (SNS). Sympathetic innervation of vascular tone during pain perception has been quantified using a peripheral arterial stiffness index; however, its innervation role during pain anticipation remains unclear. This paper reports on a neuroimaging-based study designed to investigate the responsivity and attribution of the index at different levels of anticipatory anxiety and pain perception. The index was measured in a functional magnetic resonance imaging experiment that randomly combined three visual anticipation cues and painful stimuli of two intensities. The peripheral and cerebral responses to pain anticipation and perception were quantified to corroborate bodily responsivity, and their temporal correlation was also assessed to identify the response attribution of the index. Contrasting with the high responsivity across levels of pain sensation, a low responsivity of the index across levels of anticipatory anxiety revealed its specificity across pain experiences. Discrepancies between the effects of perception and anticipation were validated across regions and levels of brain activity, providing a brain basis for peripheral response specificity. The index was also characterized by a 1-s lag in both anticipation and perception of pain, implying top-down innervation of the periphery. Our findings suggest that the SNS responds to pain in an emotion-specific and sensation-unbiased manner, thus enabling an early assessment of individual pain perception using this index. This study integrates peripheral and cerebral hemodynamic responses toward a comprehensive understanding of bodily responses to pain.
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Affiliation(s)
- Ziqiang Xu
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Zu Soh
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan.
| | - Yuta Kurota
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Yuya Kimura
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Harutoyo Hirano
- Department of Medical Equipment Engineering, Clinical Collaboration Unit, School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takafumi Sasaoka
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan.
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Wegeberg AM, Sejersgaard-Jacobsen TH, Brock C, Drewes AM. Prediction of pain using electrocardiographic-derived autonomic measures: A systematic review. Eur J Pain 2024; 28:199-213. [PMID: 37655709 DOI: 10.1002/ejp.2175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Pain is a major clinical challenge, and understanding the pathophysiology is critical for optimal management. The autonomic nervous system reacts to pain stimuli, and autonomic dysfunction may predict pain sensation. The most used assessment of autonomic function is based on electrocardiographic measures, and the ability of such measures to predict pain was investigated. DATABASES AND DATA TREATMENT English articles indexed in PubMed and EMBASE were reviewed for eligibility and included when they reported electrocardiographic-derived measures' ability to predict pain response. The quality in prognostic studies (QUIPS) tool was used to assess the quality of the included articles. RESULTS The search revealed 15 publications, five on experimental pain, five on postoperative pain, and five on longitudinal clinical pain changes, investigating a total of 1069 patients. All studies used electrocardiographically derived parameters to predict pain assessed with pain thresholds using quantitative sensory testing or different scales. Across all study modalities, electrocardiographic measures were able to predict pain. Higher parasympathetic activity predicted decreased experimental, postoperative, and long-term pain in most cases while changes in sympathetic activity did not consistently predict pain. CONCLUSIONS Most studies demonstrated that parasympathetic activity could predict acute and chronic pain intensity. In the clinic, this may be used to identify which patients need more intensive care to prevent, for example postoperative pain and develop personalized chronic pain management. SIGNIFICANCE Pain is a debilitating problem, and the ability to predict occurrence and severity would be a useful clinical tool. Basal autonomic tone has been suggested to influence pain perception. This systematic review investigated electrocardiographic-derived autonomic tone and found that increased parasympathetic tone could predict pain reduction in different types of pain.
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Affiliation(s)
- Anne-Marie Wegeberg
- Thisted Research Unit, Aalborg University Hospital Thisted, Thisted, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Thisted Research Unit, Aalborg University Hospital Thisted, Thisted, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
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Iolascon G, Snichelotto F, Moretti A. An update on the pharmacotherapeutic options for complex regional pain syndrome. Expert Rev Neurother 2024; 24:177-190. [PMID: 38241139 DOI: 10.1080/14737175.2024.2307490] [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: 11/01/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Complex regional pain syndrome (CRPS) is a rare and painful condition that has a wide range of triggering factors, often traumatic, and can present various clinical manifestations. The lack of knowledge about the underlying mechanisms has led to numerous treatment approaches, both conservative and surgical, which work through different mechanisms of action. AREAS COVERED In this review, the authors explore the key aspects of CRPS, including definition, diagnostic criteria, pitfalls, pathogenic hypotheses, and treatment strategies with a focus on pharmacotherapy. The review was based on a comprehensive search of the literature using PubMed, while also considering international guidelines for managing CRPS. EXPERT OPINION Based on the available evidence, pharmacological interventions appear to be effective in treating CRPS, especially when they target peripheral mechanisms, specifically nociceptive inflammatory pain, and when administered early in the course of the disease. However, there is still a lack of reliable evidence regarding the effects of drugs on central mechanisms of chronic pain in CRPS. In our expert opinion, drug therapy should be initiated as soon as possible, particularly in warm CRPS patient clusters, to prevent significant functional limitations, psychological distress, and negative impacts on individuals' social and economic well-being.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Snichelotto
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Nocheva H, Stoynev N, Vodenicharov V, Krastev D, Krastev N, Mileva M. Cannabinoid and Serotonergic Systems: Unraveling the Pathogenetic Mechanisms of Stress-Induced Analgesia. Biomedicines 2024; 12:235. [PMID: 38275406 PMCID: PMC10813752 DOI: 10.3390/biomedicines12010235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
The perception of "stress" triggers many physiological and behavioral responses, collectively called the stress response. Such a complex process allows for coping with stress and also triggers severe pathology. Because of the multidirectional effect of stress on the body, multiple systems participate in its pathogenesis, with the endogenous cannabinoid and the serotoninergic ones among them. These two systems also take part in the pain perception decrease, known as stress-induced analgesia (SIA), which can then be taken as an indirect indicator of the stress response. The aim of our study was to study the changes in cold SIA (c-SIA) resulting from the exogenous activation of cannabinoid receptor type 1 (CB1) and 5-hydroxytryptamine (5-HT, serotonin) receptor type 1A (5-HT1A). Various combinations of agonists and/or antagonists of CB1 and 5-HT1A, before or after 1 h of cold exposure, were applied, since we presumed that the exogenous activation of the receptors before the cold exposure would influence the pathogenesis of the stress response, while their activation after the stressful trigger would influence the later development. Our results show that the serotonergic system "maintained" c-SIA in the pre-stress treatment, while the cannabinoids' modulative effect was more prominent in the post-stress treatment. Here, we show the interactions of the two systems in the stress response. The interpretation and understanding of the mechanisms of interaction between CB1 and 5-HT1A may provide information for the prevention and control of adverse stress effects, as well as suggest interesting directions for the development of targeted interventions for the control of specific body responses.
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Affiliation(s)
- Hristina Nocheva
- Department of Physiology and Pathophysiology, Medical Faculty, Medical University, 2 Zdrave Str., 1431 Sofia, Bulgaria; (H.N.); (N.S.)
| | - Nikolay Stoynev
- Department of Physiology and Pathophysiology, Medical Faculty, Medical University, 2 Zdrave Str., 1431 Sofia, Bulgaria; (H.N.); (N.S.)
| | - Vlayko Vodenicharov
- Department of Epidemiology and Hygiene, Medical Faculty, Medical University, 2 Zdrave Str., 1431 Sofia, Bulgaria;
| | - Dimo Krastev
- Department of Anatomy and Physiology, South-West University “Neofit Rilski”, Blagoevgrad, 66, Ivan Mihaylov Str., 2700 Blagoevgrad, Bulgaria;
| | - Nikolay Krastev
- Department of Anatomy, Faculty of Medicine, Medical University, 2, Zdrave Str., 1431 Sofia, Bulgaria;
| | - Milka Mileva
- Institute of Microbiology “Stephan Angeloff”, Bulgarian Academy of Sciences, 26, Acad. Georgi Bonchev Str., 1113 Sofia, Bulgaria
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Jeon H, Lee S, Kim SA, Lee U, Lee S. Effect of Korean Medicine Treatment on Patients with Postherpetic Neuralgia: A Retrospective Chart Review. Healthcare (Basel) 2024; 12:256. [PMID: 38275536 PMCID: PMC10815056 DOI: 10.3390/healthcare12020256] [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: 12/10/2023] [Revised: 01/05/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Evidence regarding Korean medicine treatment (KMT) for neuropathic pain is lacking. We aimed to identify the effects of integrative KMT in patients with postherpetic neuralgia (PHN). We retrospectively analyzed the electronic medical records of patients with PHN who received KMT at Kyung Hee University Korean Medicine Hospital between August 2021 and July 2022. We evaluated the effects of KMT-comprising acupuncture, pharmacopuncture, herbal medicine, cupping, and moxibustion-on pain intensity using the numerical rating scale (NRS), Short-Form McGill Pain Questionnaire (SF-MPQ), Hospital Anxiety and Depression Scale-Anxiety (HADS-A), Hospital Anxiety and Depression Scale-Depression (HADS-D), Daily Sleep Interference Scale (DSIS), Fatigue Severity Scale (FSS), and EuroQol-5D. Among 53 patients with PHN, 13 were included. The NRS score for worst pain over 1 week decreased from 6.54 ± 0.64 at baseline to 3.85 ± 0.63 at 8 weeks (41% reduction, p < 0.01), while that for average pain over 1 week decreased from 4.93 ± 0.67 at baseline to 3.08 ± 0.46 at 8 weeks (37% reduction, p < 0.01). From baseline to 8 weeks, there were significant reductions in the SF-MPQ, HADS-A, FSS, and EuroQol-5D scores. No adverse events were reported after KMT. Therefore, KMT may be an effective treatment option for patients with PHN.
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Affiliation(s)
- Hyoseung Jeon
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Suji Lee
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Sung-A Kim
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Unhyung Lee
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Seunghoon Lee
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul 02453, Republic of Korea
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11
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Dilrukshi EAC, Nishiyama Y, Ito K, Nomura S. Alleviation of acute stress response by black pepper aroma administration. J Physiol Anthropol 2024; 43:3. [PMID: 38167228 PMCID: PMC10759736 DOI: 10.1186/s40101-023-00352-1] [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: 08/26/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Black pepper is one of the most popular spices globally. As black pepper essential oil has not yet been used in the context of aromatherapy, this study examined the effect of black pepper aroma on cardiac and peripheral autonomic nervous system (ANS) activity under stressful conditions using an olfactometer to administer aroma in a precise and controlled manner to ensure reproducibility. METHODS A within-participant design experiment was conducted with 20 male university students who performed a 30-min calculation task as a short-term stressor under three aroma conditions: black pepper, ginger, and dipropylene glycol (DPG) (scentless air as a control). Each aroma was sporadically delivered (first 20 s of each 1-min interval) with the olfactometer during the task. Electrocardiograms and skin conductance level (SCL) were measured to evaluate ANS's physiological acute stress response. Subjective evaluations for the given stressful task and impressions on the types of aromas were assessed. RESULTS The physiological acute stress response induced by the short-term stressor, which is characterized by the enhancement of the heart rate (HR) and SCL and decreases in the heart rate variability (HRV), was suppressed with black pepper: the increase in HR and reduction in HRV from the baseline were 38.9% (p = 0.048 when compared with DPG) and 32.9% smaller (p = 0.002 for multiple comparisons) than those in DPG, respectively, and the increase of SCL was 15.5% smaller (p = 0.005 for multiple comparisons) than that in ginger. However, there was no significant difference in subjective scores among the conditions. CONCLUSION Although black pepper is a stimulative agent, the study findings showed that black pepper aroma alleviated the physiological acute stress response, which can be beneficial in aromatherapy under stressful conditions.
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Affiliation(s)
- E A Chayani Dilrukshi
- Graduate School of Engineering, Nagaoka University of Technology, Nagaoka, Niigata, 940-2188, Japan
- Department of Industrial Management, Faculty of Applied Sciences, Wayamba University of Sri Lanka, Kuliyapitiya, 60200, Sri Lanka
| | - Yuta Nishiyama
- Graduate School of Engineering, Nagaoka University of Technology, Nagaoka, Niigata, 940-2188, Japan
| | - Kanetoshi Ito
- Corporate Research & Development, Takasago International Corporation, Hiratsuka, Kanagawa, 254-0073, Japan
| | - Shusaku Nomura
- Graduate School of Engineering, Nagaoka University of Technology, Nagaoka, Niigata, 940-2188, Japan.
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12
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Seton B, Pandey R, Piscura MK, Pearson WG. Autonomic Recalibration: A Promising Approach for Alleviating Myofascial Pain Explored in a Retrospective Case Series. Cureus 2024; 16:e52450. [PMID: 38371140 PMCID: PMC10871156 DOI: 10.7759/cureus.52450] [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: 08/04/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
This retrospective case series introduces autonomic recalibration (AR) as a novel approach for alleviating chronic myofascial pain. The manuscript explores the rationale, theory, and practice of AR, which targets the autonomic nervous system (ANS) to restore homeostasis and reduce pain. The involvement of the ANS in pain modulation and the role of autonomic imbalance in chronic pain are discussed, emphasizing the potential benefits of addressing autonomic dysregulation through AR. The technique combines manual interventions and patient education, relying on neuroplastic adaptations. Three diverse case reports are presented to illustrate the effectiveness of AR in patients with different sources of pain. Each case presents a unique clinical scenario, including a nine-year-old male diagnosed with spondylolisthesis, a 68-year-old male with a history of abdominal surgeries, and a 56-year-old male with chronic low back pain following lumbar fusion surgery. In all cases, AR resulted in pain relief, improved sleep, and restoration of functional abilities. These findings support the potential of AR as an effective alternative approach for myofascial pain. Further research is warranted to validate these outcomes and investigate the underlying mechanisms of AR.
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Affiliation(s)
- Bob Seton
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Rishika Pandey
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Mary K Piscura
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - William G Pearson
- Department of Biomedical Research and Affairs, Edward Via College of Osteopathic Medicine, Auburn, USA
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13
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Suarez-Roca H, Mamoun N, Watkins LL, Bortsov AV, Mathew JP. Higher Cardiovagal Baroreflex Sensitivity Predicts Increased Pain Outcomes After Cardiothoracic Surgery. THE JOURNAL OF PAIN 2024; 25:187-201. [PMID: 37567546 PMCID: PMC10841280 DOI: 10.1016/j.jpain.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/05/2023] [Accepted: 08/06/2023] [Indexed: 08/13/2023]
Abstract
Excessive postoperative pain can lead to extended hospitalization and increased expenses, but factors that predict its severity are still unclear. Baroreceptor function could influence postoperative pain by modulating nociceptive processing and vagal-mediated anti-inflammatory reflexes. To investigate this relationship, we conducted a study with 55 patients undergoing minimally invasive cardiothoracic surgery to evaluate whether cardiovagal baroreflex sensitivity (BRS) can predict postoperative pain. We assessed the spontaneous cardiovagal BRS under resting pain-free conditions before surgery. We estimated postoperative pain outcomes with the Pain, Enjoyment, and General Activity scale and pressure pain thresholds on the first (POD1) and second (POD2) postoperative days and persistent pain 3 and 6 months after hospital discharge. We also measured circulating levels of relevant inflammatory biomarkers (C-reactive protein, albumin, cytokines) at baseline, POD1, and POD2 to assess the contribution of inflammation to the relationship between BRS and postoperative pain. Our mixed-effects model analysis showed a significant main effect of preoperative BRS on postoperative pain (P = .013). Linear regression analysis revealed a significant positive association between preoperative BRS and postoperative pain on POD2, even after adjusting for demographic, surgical, analgesic treatment, and psychological factors. Moreover, preoperative BRS was linked to pain interfering with general activity and enjoyment but not with other pain parameters (pain intensity and pressure pain thresholds). Preoperative BRS had modest associations with postoperative C-reactive protein and IL-10 levels, but they did not mediate its relationship with postoperative pain. These findings indicate that preoperative BRS can independently predict postoperative pain, which could serve as a modifiable criterion for optimizing postoperative pain management. PERSPECTIVE: This article shows that preoperative BRS predicts postoperative pain outcomes independently of the inflammatory response and pain sensitivity to noxious pressure stimulation. These results provide valuable insights into the role of baroreceptors in pain and suggest a helpful tool for improving postoperative pain management.
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Affiliation(s)
- Heberto Suarez-Roca
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, North Carolina
| | - Negmeldeen Mamoun
- Division of Cardiothoracic Anesthesia and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Lana L Watkins
- Psychiatry and Behavioral Sciences Department, Duke University Medical Center, Durham, North Carolina
| | - Andrey V Bortsov
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Division of Cardiothoracic Anesthesia and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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14
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Modarresi S, Pearson N, Madden K, Bennell KL, Fahnestock M, Neogi T, Carlesso LC. Pain Informed Movement for people with knee osteoarthritis: Protocol for a pilot randomized controlled trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100402. [PMID: 37664870 PMCID: PMC10469070 DOI: 10.1016/j.ocarto.2023.100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Objective Conservative pain management strategies for knee osteoarthritis (KOA) have limited effectiveness and do not employ a pain-mechanism informed approach. Pain Informed Movement is a novel intervention combining mind-body techniques with neuromuscular exercise and pain neuroscience education (PNE), aimed at improving endogenous pain modulation. While the feasibility and acceptability of this program has been previously established, it now requires further evaluation in comparison to standard KOA care. Design This protocol describes the design of a pilot two-arm randomized controlled trial (RCT) with an embedded qualitative component. The primary outcome is complete follow-up rate. With an allocation ratio of 1:1, 66 participants (33/arm) (age ≥40 years, KOA diagnosis or meeting KOA NICE criteria, and pain intensity ≥3/10), will be randomly allocated to two groups that will both receive 8 weeks of twice weekly in-person exercise sessions. Those randomized to Pain Informed Movement will receive PNE and mind-body technique instruction provided initially as videos and integrated into exercise sessions. The control arm will receive neuromuscular exercise and standard OA education. Assessment will include clinical questionnaires, physical and psychophysical tests, and blood draws at baseline and program completion. Secondary outcomes are program acceptability, burden, rate of recruitment, compliance and adherence, and adverse events. Participants will be invited to an online focus group at program completion. Conclusion The results of this pilot RCT will serve as the basis for a larger multi-site RCT aimed at determining the program's effectiveness with the primary outcome of assessing the mediating effects of descending modulation on changes in pain.
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Affiliation(s)
- Shirin Modarresi
- Michael DeGroote Institute for Pain Research and Care (IPRC), McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Neil Pearson
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Kim Madden
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joe's, Hamilton, ON, Canada
| | - Kim L. Bennell
- Centre for Health Exercise and Sports Medicine | Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Margaret Fahnestock
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Lisa C. Carlesso
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joe's, Hamilton, ON, Canada
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15
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Luebke L, Gouverneur P, Szikszay TM, Adamczyk WM, Luedtke K, Grzegorzek M. Objective Measurement of Subjective Pain Perception with Autonomic Body Reactions in Healthy Subjects and Chronic Back Pain Patients: An Experimental Heat Pain Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:8231. [PMID: 37837061 PMCID: PMC10575054 DOI: 10.3390/s23198231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
Multiple attempts to quantify pain objectively using single measures of physiological body responses have been performed in the past, but the variability across participants reduces the usefulness of such methods. Therefore, this study aims to evaluate whether combining multiple autonomic parameters is more appropriate to quantify the perceived pain intensity of healthy subjects (HSs) and chronic back pain patients (CBPPs) during experimental heat pain stimulation. HS and CBPP received different heat pain stimuli adjusted for individual pain tolerance via a CE-certified thermode. Different sensors measured physiological responses. Machine learning models were trained to evaluate performance in distinguishing pain levels and identify key sensors and features for the classification task. The results show that distinguishing between no and severe pain is significantly easier than discriminating lower pain levels. Electrodermal activity is the best marker for distinguishing between low and high pain levels. However, recursive feature elimination showed that an optimal subset of features for all modalities includes characteristics retrieved from several modalities. Moreover, the study's findings indicate that differences in physiological responses to pain in HS and CBPP remain small.
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Affiliation(s)
- Luisa Luebke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, 23562 Lübeck, Germany; (L.L.); (T.M.S.); (K.L.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, 23562 Lübeck, Germany
| | - Philip Gouverneur
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany;
| | - Tibor M. Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, 23562 Lübeck, Germany; (L.L.); (T.M.S.); (K.L.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, 23562 Lübeck, Germany
| | - Wacław M. Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland;
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3026, USA
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, 23562 Lübeck, Germany; (L.L.); (T.M.S.); (K.L.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, 23562 Lübeck, Germany
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany;
- Department of Knowledge Engineering, University of Economics in Katowice, 40-287 Katowice, Poland
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16
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Borutta MC, Koehn J, de Oliveira DS, Del Vecchio A, Engelhorn T, Schwab S, Buchfelder M, Kinfe TM. The Impact of Burst Motor Cortex Stimulation on Cardiovascular Autonomic Modulation in Chronic Pain: A Feasibility Study for a New Approach to Objectively Monitor Therapeutic Effects. Pain Ther 2023; 12:1235-1251. [PMID: 37532960 PMCID: PMC10444743 DOI: 10.1007/s40122-023-00541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Chronic refractory pain of various origin occurs in 30-45% of pain patients, and a considerable proportion remains resistant to pharmacological and behavioral therapies, requiring adjunctive neurostimulation therapies. Chronic pain is known to stimulate sympathetic outflow, yet the impact of burst motor cortex stimulation (burstMCS) on objectifiable autonomic cardiovascular parameters in chronic pain remains largely unknown. METHODS In three patients with chronic pain (2 facial pain/1 post-stroke pain), we compared pain intensity using a visual analog scale (VAS 1-10) and parameters of autonomic cardiovascular modulation at supine rest, during parasympathetic challenge with six cycles per minute of metronomic deep breathing, and during sympathetic challenge (active standing) at baseline and after 4 months of burstMCS compared to age-/gender-matched healthy controls. RESULTS While two out of three patients were responsive after 4 months of adjunctive burstMCS (defined as pain reduction of > 30%), no differences were found in any of the three patients regarding the R-R intervals of adjacent QRS complexes (RRI, 642 vs. 676 ms) and blood pressure (BP, 139/88 vs. 141/90 mmHg). Under resting conditions, parameters of parasympathetic tone [normalized units of high-frequency oscillations of RRI (RRI-HFnu power) 0.24 vs. 0.38, root-mean-square differences of successive RRI (RRI-RMSSD) 7.7 vs. 14.7 ms], total autonomic cardiac modulation [RRI total power 129.3 vs. 406.2 ms2, standard deviation of RRI (RRI-SD) 11.6 vs. 18.5 ms, coefficient of variation of RRI (RRI-CV) 1.9 vs. 3.7%], and baroreceptor reflex sensitivity (BRS, 1.9 vs. 2.3 ms/mmHg) increased, and parameters of sympathetic tone [normalized units of low-frequency oscillations of RRI (RRI-LFnu power) 0.76 vs. 0.62] and sympatho-vagal balance [ratio of RR-LF to RRI-HF power (RRI-LF/HF ratio) 3.4 vs. 1.9] decreased after 4 months of burstMCS. Low-frequency oscillations of systolic blood pressure (SBP-LF power), a parameter of sympathetic cardiovascular modulation, increased slightly (17.6 vs. 20.4 mmHg2). During parasympathetic stimulation, the expiratory-inspiratory ratio (E/I ratio) increased slightly, while upon sympathetic stimulation, the ratio between the shortest RRI around the 15th heartbeat and the longest RRI around the 30th heartbeat after standing up (RRI 30/15 ratio) remained unchanged. CONCLUSION Four months of adjunctive burstMCS was associated with an increase in parameters reflecting both total and parasympathetic autonomic modulation and baroreceptor reflex sensitivity. In contrast, sympathetic tone declined in our three patients, suggesting stimulation-associated improvement not only in subjectively perceived VAS pain scores, but also in objectifiable parameters of autonomic cardiovascular modulation.
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Affiliation(s)
- Matthias C Borutta
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Koehn
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Daniela Souza de Oliveira
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alessandro Del Vecchio
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas M Kinfe
- Division of Functional Neurosurgery and Stereotaxy, Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Schwabach Anlage 6, 91054, Erlangen, Germany.
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17
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Forte G, Troisi G, Favieri F, De Pascalis V, Langher V, Casagrande M. Inhibition and Heart Rate Variability in Experimentally Induced Pain. J Pain Res 2023; 16:3239-3249. [PMID: 37790193 PMCID: PMC10542212 DOI: 10.2147/jpr.s418238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/03/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Pain is a complex experience that requires executive functions (EFs) to be processed. The autonomic outcome of the neural networks involved in the cognitive evaluation of pain is reflected by heart rate variability (HRV), an index of self-regulation abilities. Although some results suggest a relationship between HRV, EFs, and pain, studies focusing on this three-way relationship are still scarce. Objective This study aims to investigate the relationship between pain, cognitive, and autonomic mechanisms, hypothesizing an association between resting HRV and both cognitive and motor inhibition as indices of executive functioning. This relationship was investigated after an experimental-induced pain. Methods Seventy-six young adults were exposed to the Cold Pressure Arm Warp to induce experimental pain. HRV was collected, and cognitive tasks were administered to assess executive performance. Results The results showed that (1) HRV indices significantly increased during pain stimulation, (2) cognitive inhibition was positively correlated with vagal indices and with pain parameters, (3) both inhibition tasks significantly predicted pain threshold while the performance on the Stroop Task predicted pain tolerance. Conclusion Results suggest a three-way relationship. Further research would focus on the role of HRV and cognitive strategies in pain management in chronic pain conditions.
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Affiliation(s)
- Giuseppe Forte
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, 00185, Italy
| | - Giovanna Troisi
- Department of Psychology, Sapienza University of Rome, Roma, 00185, Italy
| | - Francesca Favieri
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, 00185, Italy
| | | | - Viviana Langher
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, 00185, Italy
| | - Maria Casagrande
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, 00185, Italy
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Penha LMB, Pontes-Silva A, Santos-de-Araújo AD, Camargo PF, Pires FDO, Fidelis-de-Paula-Gomes CA, Mostarda CT, Bassi-Dibai D, Dibai-Filho AV. Reliability of the Heart Rate Variability Registered Through Polar Cardio Frequency Meter in Individuals With Chronic Low Back Pain. J Chiropr Med 2023; 22:180-188. [PMID: 37644996 PMCID: PMC10461136 DOI: 10.1016/j.jcm.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 08/31/2023] Open
Abstract
Objective The purpose of this study was to analyze the intra- and inter-examiner reliability of the analysis of heart rate variability (HRV) captured by a Polar cardio frequency meter in individuals with chronic nonspecific low back pain. Methods The study included 35 individuals with nonspecific low back pain, both sexes, aged 18 to 45. We used a Polar V800 cardio frequency meter to capture HRV in individuals in different positions, and we calculated the reliability through the intraclass correlation coefficient (ICC). Results Regarding intra-examiner reliability, we found excellent reliability of HRV analysis in the supine position (ICC ranging from 0.89 to 1.00) and in the standing position (ICC ranging from 0.95 to 0.99). In addition, for inter-examiner reliability, we found substantial to excellent reliability of the HRV analysis in the supine position (ICC ranging from 0.76 to 0.98) and moderate to excellent reliability in the standing position (ICC ranging from 0.73 to 0.99). Conclusion The HRV analysis captured by a Polar cardio frequency meter presented adequate reliability when considering different times and different examiners.
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Affiliation(s)
| | - André Pontes-Silva
- Postgraduate Program in Adult Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | - Patrícia Faria Camargo
- Postgraduate Program in Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | | | | | - Daniela Bassi-Dibai
- Postgraduate Program in Programs Management and Health Services, Ceuma University, São Luís, Maranhão, Brazil
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Adult Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
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Andersson MLE, Thorén E, Sylwander C, Bergman S. Associations between chronic widespread pain, pressure pain thresholds, leptin, and metabolic factors in individuals with knee pain. BMC Musculoskelet Disord 2023; 24:639. [PMID: 37559026 PMCID: PMC10410998 DOI: 10.1186/s12891-023-06773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE The aim was to study associations between chronic widespread pain, widespread pain sensitivity, leptin, and metabolic factors in individuals with knee pain. A secondary aim was to study these associations in a subgroup of individuals with normal BMI. METHOD This cross-sectional study included 265 individuals. The participants were categorised into three different pain groups: Chronic widespread pain (CWP), chronic regional pain (ChRP), or no chronic pain (NCP). The pressure pain thresholds (PPTs) were assessed using computerised pressure algometry. Low PPTs were defined as having PPTs in the lowest third of all tender points. Leptin and metabolic factors such as BMI, visceral fat area (VFA), lipids, and glucose were also assessed. RESULT Sixteen per cent reported CWP, 15% had low PPTs, and 4% fulfilled both criteria. Those who fulfilled the criteria for CWP were more often women, more obese, and had increased leptin levels. In logistic regression, adjusted for age and gender, leptin was associated with fulfilling criteria for CWP, OR 1.015 (95% CI 1.004-1.027, p = 0.008). In logistic regression, adjusted for age and gender, leptin was associated with low PPTs, OR 1.016 (95% CI 1.004-1.029, p = 0.012). Leptin was also associated with fulfilling both criteria, adjusted for age, sex, and visceral fat area (VFA), OR 1.030 (95% CI 1.001-1.060), p = 0.040. CONCLUSION Leptin was associated with fulfilling the combined criteria for chronic widespread pain and low PPTs, even after adjusting for the visceral fat area (VFA). Longitudinal studies are needed to study the causal relationships between leptin and the development of widespread pain. TRIAL REGISTRATION clinicalTrials.gov Identifier: NCT04928170.
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Affiliation(s)
- Maria L E Andersson
- Spenshult Research and Development Centre, Halmstad, Sweden.
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
- School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden.
| | - Emelie Thorén
- Spenshult Research and Development Centre, Halmstad, Sweden
| | - Charlotte Sylwander
- Spenshult Research and Development Centre, Halmstad, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Stefan Bergman
- Spenshult Research and Development Centre, Halmstad, Sweden
- Primary Health Care Unit, Department of Public Health and Community Medicine, Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Tanaka K, Kuzumaki N, Hamada Y, Suda Y, Mori T, Nagumo Y, Narita M. Elucidation of the mechanisms of exercise-induced hypoalgesia and pain prolongation due to physical stress and the restriction of movement. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 14:100133. [PMID: 37274841 PMCID: PMC10239008 DOI: 10.1016/j.ynpai.2023.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023]
Abstract
Persistent pain signals cause brain dysfunction and can further prolong pain. In addition, the physical restriction of movement (e.g., by a cast) can cause stress and prolong pain. Recently, it has been recognized that exercise therapy including rehabilitation is effective for alleviating chronic pain. On the other hand, physical stress and the restriction of movement can prolong pain. In this review, we discuss the neural circuits involved in the control of pain prolongation and the mechanisms of exercise-induced hypoalgesia (EIH). We also discuss the importance of the mesolimbic dopaminergic network in these phenomena.
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Affiliation(s)
- Kenichi Tanaka
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Naoko Kuzumaki
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yusuke Hamada
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yukari Suda
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Tomohisa Mori
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Yasuyuki Nagumo
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Minoru Narita
- Department of Pharmacology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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21
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Favretti M, Iannuccelli C, Di Franco M. Pain Biomarkers in Fibromyalgia Syndrome: Current Understanding and Future Directions. Int J Mol Sci 2023; 24:10443. [PMID: 37445618 DOI: 10.3390/ijms241310443] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
Fibromyalgia is a complex and heterogeneous clinical syndrome, mainly characterized by the presence of widespread pain, possibly associated with a variety of other symptoms. Fibromyalgia can have an extremely negative impact on the psychological, physical and social lives of people affected, sometimes causing patients to experience dramatically impaired quality of life. Nowadays, the diagnosis of fibromyalgia is still clinical, thus favoring diagnostic uncertainties and making its clear identification challenging to establish, especially in primary care centers. These difficulties lead patients to undergo innumerable clinical visits, investigations and specialist consultations, thus increasing their stress, frustration and even dissatisfaction. Unfortunately, research over the last 25 years regarding a specific biomarker for the diagnosis of fibromyalgia has been fruitless. The discovery of a reliable biomarker for fibromyalgia syndrome would be a critical step towards the early identification of this condition, not only reducing patient healthcare utilization and diagnostic test execution but also providing early intervention with guideline-based treatments. This narrative article reviews different metabolite alterations proposed as possible biomarkers for fibromyalgia, focusing on their associations with clinical evidence of pain, and highlights some new, promising areas of research in this context. Nevertheless, none of the analyzed metabolites emerge as sufficiently reliable to be validated as a diagnostic biomarker. Given the complexity of this syndrome, in the future, a panel of biomarkers, including subtype-specific biomarkers, could be considered as an interesting alternative research area.
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Affiliation(s)
- Martina Favretti
- Rheumatology Unit, Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristina Iannuccelli
- Rheumatology Unit, Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Manuela Di Franco
- Rheumatology Unit, Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
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22
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Sasso JM, Ammar RM, Tenchov R, Lemmel S, Kelber O, Grieswelle M, Zhou QA. Gut Microbiome-Brain Alliance: A Landscape View into Mental and Gastrointestinal Health and Disorders. ACS Chem Neurosci 2023; 14:1717-1763. [PMID: 37156006 DOI: 10.1021/acschemneuro.3c00127] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Gut microbiota includes a vast collection of microorganisms residing within the gastrointestinal tract. It is broadly recognized that the gut and brain are in constant bidirectional communication, of which gut microbiota and its metabolic production are a major component, and form the so-called gut microbiome-brain axis. Disturbances of microbiota homeostasis caused by imbalance in their functional composition and metabolic activities, known as dysbiosis, cause dysregulation of these pathways and trigger changes in the blood-brain barrier permeability, thereby causing pathological malfunctions, including neurological and functional gastrointestinal disorders. In turn, the brain can affect the structure and function of gut microbiota through the autonomic nervous system by regulating gut motility, intestinal transit and secretion, and gut permeability. Here, we examine data from the CAS Content Collection, the largest collection of published scientific information, and analyze the publication landscape of recent research. We review the advances in knowledge related to the human gut microbiome, its complexity and functionality, its communication with the central nervous system, and the effect of the gut microbiome-brain axis on mental and gut health. We discuss correlations between gut microbiota composition and various diseases, specifically gastrointestinal and mental disorders. We also explore gut microbiota metabolites with regard to their impact on the brain and gut function and associated diseases. Finally, we assess clinical applications of gut-microbiota-related substances and metabolites with their development pipelines. We hope this review can serve as a useful resource in understanding the current knowledge on this emerging field in an effort to further solving of the remaining challenges and fulfilling its potential.
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Affiliation(s)
- Janet M Sasso
- CAS, a division of the American Chemical Society, 2540 Olentangy River Rd, Columbus, Ohio 43202, United States
| | - Ramy M Ammar
- Bayer Consumer Health, R&D Digestive Health, Darmstadt 64295, Germany
| | - Rumiana Tenchov
- CAS, a division of the American Chemical Society, 2540 Olentangy River Rd, Columbus, Ohio 43202, United States
| | - Steven Lemmel
- CAS, a division of the American Chemical Society, 2540 Olentangy River Rd, Columbus, Ohio 43202, United States
| | - Olaf Kelber
- Bayer Consumer Health, R&D Digestive Health, Darmstadt 64295, Germany
| | - Malte Grieswelle
- Bayer Consumer Health, R&D Digestive Health, Darmstadt 64295, Germany
| | - Qiongqiong Angela Zhou
- CAS, a division of the American Chemical Society, 2540 Olentangy River Rd, Columbus, Ohio 43202, United States
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Kim TH, Park SK, Cho IY, Lee JH, Jang HY, Yoon YS. Substantiating the Therapeutic Effects of Simultaneous Heat Massage Combined with Conventional Physical Therapy for Treatment of Lower Back Pain: A Randomized Controlled Feasibility Trial. Healthcare (Basel) 2023; 11:healthcare11070991. [PMID: 37046917 PMCID: PMC10093909 DOI: 10.3390/healthcare11070991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background: There are various therapeutic options for the conservative management of lower back pain (LBP). A combination of two or more treatment options may be more effective in the clinical management of non-specific LBP. In this study, we compared the effects of simultaneous heat massage with conventional physical therapy in patients with subacute LBP. Methods: A single-center randomized controlled trial in which 40 participants with LBP were allocated to one of two groups: a heat massage group (HMG) and physical therapy group (PTG). The HMG received simultaneous heat massage therapy using a mechanical device (CGM MB-1401, Ceragem, Republic of Korea). The PTG received conventional physical therapy. Both groups received 40 min of therapy once daily, five times a week, for a total of four weeks. Changes in serum cortisol, epinephrine (EP), and norepinephrine (NE) were assessed. The outcomes were measured using the pain numeric rating scale (PNRS), the Oswestry disability index (ODI), the Roland–Morris disability questionnaire (RMDQ), the short-form McGill pain questionnaire (SF-MPQ), the multidimensional fatigue inventory (MFI-20), the Beck depression inventory (BDI), surface EMG (sEMG), and sympathetic skin response (SSR) at baseline (PRE), at 2 (2 W) and 4 weeks (4 W) following the intervention. Results: The serum EP and NE levels in the HMG decreased after treatment. The PNRS, ODI, RMDQ, and SF-MPQ scores improved without significance in both groups. The BDI score showed improvement in the HMG before the PTG. The MFI-20 score improved in both groups, but the results were better in the HMG than in the PTG at 4 W. All the activities of sEMG were significantly decreased in both groups. However, the improvement of the %MVIC in the HMG was better than that in the PTG at 4 W. The SSR latency on sEMG decreased while the amplitude increased in the HMG at 2 W and 4 W, respectively. Conclusions: Following 4 weeks of combined therapies, heat massage was not superior to conventional physical therapy alone. Both treatments were shown to be effective in improving LBP and pain-related disability. However, heat massage was shown to have a better effect on the control of autonomic nerve function and underlying moods.
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Mourad F, Giudice A, Maritati G, Maselli F, Kranenburg R, Taylor A, Kerry R, Hutting N. A guide to identify cervical autonomic dysfunctions (and associated conditions) in patients with musculoskeletal disorders in physical therapy practice. Braz J Phys Ther 2023; 27:100495. [PMID: 37075598 DOI: 10.1016/j.bjpt.2023.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 09/24/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Differential diagnosis is a hot topic in physical therapy, especially for those working in a direct access setting dealing with neck pain and its associated disorders. All international guidelines agree in recommending to first rule out non-musculoskeletal pathologies as the cause of signs and symptoms in the patient. Although the autonomic nervous system (ANS) has a crucial role and is also involved in pain conditions, coverage of it in neuroscience textbooks and educational programmes is limited and most healthcare professionals are unfamiliar with it. Although autonomic conditions are benign in nature, they are clinically of great importance as they may be a 'red flag' warning of an injury along the sympathetic pathway. Therefore, sound knowledge of the ANS system is essential for clinicians. OBJECTIVE To develop physical therapists' knowledge of and confidence in understanding cervical ANS function and dysfunction, thus enhancing clinical reasoning skills and the pattern recognition process, and performing and interpreting objective examinations. METHODS This master class provides an introductory guide and essential knowledge to facilitate clinicians to understand cervical autonomic dysfunctions and their clinical evaluation. The optimal referral method is also handled. CONCLUSIONS Gaining knowledge and understanding of the ANS, its function, its dysfunction, and the related clinical manifestations is likely to lead to a decision-making process driven by 'science and conscience'. This will empower physical therapists to be aware of subtle clues that may be offered by patients during the interview and history intake leading to the appropriate physical examination and triage.
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Affiliation(s)
- Firas Mourad
- Department of Physical Therapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg; Luxembourg Health & Sport Sciences Research Institute A.s.b.l., Differdange, Luxembourg
| | - Andrea Giudice
- Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy
| | - Giorgio Maritati
- Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy
| | - Rik Kranenburg
- Healthy Ageing, Allied Health Care and Nursing Research Group, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Alan Taylor
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, UK
| | - Roger Kerry
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, UK
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands.
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25
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Warner SM, Tannenbaum SL, Pathan S, Lozada JS. Weighted Blankets for Pain and Anxiety Relief in Acutely Injured Trauma Patients. J Pain Palliat Care Pharmacother 2023:1-10. [PMID: 36749646 DOI: 10.1080/15360288.2023.2174634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/28/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
To determine the impact of a weighted blanket on acute pain and anxiety in trauma patients, a preliminary prospective/retrospective study at a level-one trauma center (n = 24 patients) was conducted. In this study, 12 patients using weighted blankets for five consecutive days were compared to a matched retrospective cohort of 12 patients not using a blanket. The change in morphine milligram equivalents (MME) and alprazolam milligram equivalents (AME) over five days were compared. There was a significant difference of MME per day between the intervention group (mean MME change = -22.9) and matched controls (mean MME change = 6.2; p = 0.0072) by blanket use. Total MMEs in the intervention group decreased by 275.5 and in the control group increased by 75 between day 1 and day 5. There was no significant difference in AME change between groups (p = 0.3227). The majority of patients who took a post-intervention questionnaire reported less pain and less anxiety with blanket use compared to those without blanket use (78% and 56% of patients, respectively). To summarize, trauma patients in acute pain had less opioid use and reported less pain and anxiety when using a weighted blanket for five consecutive days compared to a control group who did not use a blanket.
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26
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Cleary DR, Tan H, Ciacci J. Intradermal and Intramuscular Bupivacaine Reduces Opioid Use Following Noninstrumented Spine Surgery. World Neurosurg 2023; 170:e716-e723. [PMID: 36442775 DOI: 10.1016/j.wneu.2022.11.099] [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: 10/06/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of intraoperative bupivacaine hydrochloride wound infiltration as an adjunct means of pain relief following noninstrumented posterior spine surgery. METHODS A retrospective cohort analysis was performed of all patients who underwent posterior spinal decompression surgery at the University of California, San Diego, and at the San Diego VA Medical Center between June 2020 and July 2021, following a change in practice to including bupivacaine infiltration at the end of the surgery. Patients were stratified into groups based on whether they received intrawound bupivacaine during surgery. Demographic and clinical data were extracted from the electronic health record. Postoperative opioid use, visual analog pain scores, heart rate, and blood pressure were compared. RESULTS The analysis included 43 patients; 21 received bupivacaine infiltration, and 22 did not. No complications were encountered in the perioperative period. Patients who received bupivacaine consumed significantly less opioids over the 72 hours following surgery, had slightly lower pain scores, and experienced slightly lower heart rates. No significant difference was found between groups with respect to systolic blood pressure, operative time, or length of hospital stay. CONCLUSIONS Intraoperative infiltration of the exposed paraspinous musculature and peri-incisional subdermal layer with bupivacaine significantly reduced postoperative opioid consumption for 72 hours after surgery and slightly reduced pain ratings and conferred superior heart rate control. This low-cost intervention produced significant patient benefit with minimal risk and no significant increase in surgical time or hospital stay.
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Affiliation(s)
- Daniel R Cleary
- Department of Neurosurgery, University of California, San Diego, San Diego, California, USA.
| | - Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph Ciacci
- Department of Neurosurgery, University of California, San Diego, San Diego, California, USA
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27
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Ford E, Bozin M, Shedda S, McCormick J, Skandarajah A, Cade T. Risk factors for acute colonic pseudo-obstruction after caesarean section: A retrospective case-control study. Aust N Z J Obstet Gynaecol 2023; 63:86-92. [PMID: 35815382 DOI: 10.1111/ajo.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pregnancy and caesarean section are known to predispose to the development of acute colonic pseudo-obstruction (ACPO), a rare form of functional ileus of the distal large bowel. Pathogenesis of ACPO is likely influenced by pregnancy and childbirth and subsequent changes to hormonal, autonomic and metabolic physiology. Identifying pregnancy risk factors will assist with early identification, as the insidious onset postpartum often leads to delayed diagnosis and bowel ischaemia, perforation and sepsis. AIMS To establish pregnancy risk factors associated with the development of ACPO after caesarean section. MATERIALS AND METHODS A retrospective case-control study included 19 121 women undergoing caesarean between 1 January 2008 and 31 December 2016 at a tertiary referral hospital. Twenty-three cases of computerised tomography (CT)-diagnosed ACPO post-caesarean were identified from hospital medical records and imaging databases. Controls were matched for gestational and maternal age within one week of delivery with a ratio of 1:3. RESULTS The incidence of ACPO was one in 800 caesarean sections. ACPO was significantly more likely to occur in women who had been administered opioid analgesia in labour (odds ratio (OR) 4.67, P = 0.04), and a trend for increased estimated blood loss (OR 1.01, P = 0.01). There was no increased risk associated with emergency or elective caesarean classification, previous abdominal surgery, type of anaesthesia, duration of labour, oxytocin augmentation, intrapartum fever, hypertensive disorders, diabetes in pregnancy, antepartum haemorrhage, multiple gestation, fetal presentation or birthweight. CONCLUSIONS Risk factors for developing ACPO post-caesarean include opioid analgesia in labour and a trend for increased blood loss.
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Affiliation(s)
- Elisa Ford
- The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Michael Bozin
- Department of Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Susan Shedda
- Department of Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jacob McCormick
- Department of Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Cade
- Department of Maternity Services, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Wank I, Niedermair T, Kronenberg D, Stange R, Brochhausen C, Hess A, Grässel S. Influence of the Peripheral Nervous System on Murine Osteoporotic Fracture Healing and Fracture-Induced Hyperalgesia. Int J Mol Sci 2022; 24:510. [PMID: 36613952 PMCID: PMC9820334 DOI: 10.3390/ijms24010510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Osteoporotic fractures are often linked to persisting chronic pain and poor healing outcomes. Substance P (SP), α-calcitonin gene-related peptide (α-CGRP) and sympathetic neurotransmitters are involved in bone remodeling after trauma and nociceptive processes, e.g., fracture-induced hyperalgesia. We aimed to link sensory and sympathetic signaling to fracture healing and fracture-induced hyperalgesia under osteoporotic conditions. Externally stabilized femoral fractures were set 28 days after OVX in wild type (WT), α-CGRP- deficient (α-CGRP -/-), SP-deficient (Tac1-/-) and sympathectomized (SYX) mice. Functional MRI (fMRI) was performed two days before and five and 21 days post fracture, followed by µCT and biomechanical tests. Sympathectomy affected structural bone properties in the fracture callus whereas loss of sensory neurotransmitters affected trabecular structures in contralateral, non-fractured bones. Biomechanical properties were mostly similar in all groups. Both nociceptive and resting-state (RS) fMRI revealed significant baseline differences in functional connectivity (FC) between WT and neurotransmitter-deficient mice. The fracture-induced hyperalgesia modulated central nociception and had robust impact on RS FC in all groups. The changes demonstrated in RS FC in fMRI might potentially be used as a bone traumata-induced biomarker regarding fracture healing under pathophysiological musculoskeletal conditions. The findings are of clinical importance and relevance as they advance our understanding of pain during osteoporotic fracture healing and provide a potential imaging biomarker for fracture-related hyperalgesia and its temporal development. Overall, this may help to reduce the development of chronic pain after fracture thereby improving the treatment of osteoporotic fractures.
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Affiliation(s)
- Isabel Wank
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Tanja Niedermair
- Institute of Pathology, University of Regensburg, 93053 Regensburg, Germany
| | - Daniel Kronenberg
- Department of Regenerative Musculoskeletal Medicine, Institute of Musculoskeletal Medicine (IMM), University Hospital Münster, 48149 Münster, Germany
| | - Richard Stange
- Department of Regenerative Musculoskeletal Medicine, Institute of Musculoskeletal Medicine (IMM), University Hospital Münster, 48149 Münster, Germany
| | | | - Andreas Hess
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Susanne Grässel
- Centre for Medical Biotechnology (ZMB), Department of Orthopedic Surgery, Experimental Orthopedics, University of Regensburg, 93053 Regensburg, Germany
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Polymorphisms in COMT and OPRM1 Collectively Contribute to Chronic Shoulder Pain and Disability in South African Breast Cancer Survivors'. Genes (Basel) 2022; 14:genes14010009. [PMID: 36672750 PMCID: PMC9858584 DOI: 10.3390/genes14010009] [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: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic shoulder pain and disability is a common adverse effect experienced by >40% of breast cancer survivors (BCS). Pain management protocols for acute and chronic pain include the use of opioids and opioid derivatives. Furthermore, pain-modulating genes, such as COMT and OPRM1, have been linked to the aetiology of chronic pain. This study aimed to investigate the association between genetic variants of major pain modulator genes and chronic pain/disability in BCS. Assessment of pain, disability and combined (pain and disability) symptoms were determined using the Shoulder Pain and Disability Index (SPADI). Participants were grouped according to their scores such as no-low (<30%) and moderate-high (≥30%) groups of pain, disability and combined (pain and disability). Genotyping of the COMT rs6269 (A > G), rs4633 (C > T), rs4818 (C > G) and the functional rs4680(G > A) SNPs within the BCS (N = 252) cohort were conducted using TaqMan® SNP assays. Genotype, allele, haplotype, and allele-allele combination frequencies were evaluated. Statistical analysis was applied, with significance accepted at p < 0.05. The COMT rs4680:A/A genotype was significantly associated with moderate-high pain (p = 0.024, OR: 3.23, 95% CI: 1.33-7.81) and combined (pain and disability) (p = 0.015, OR: 3.81, 95% CI: 1.47-9.85). The rs4680:A allele was also significantly associated with moderate-high pain (p = 0.035, OR: 1.58, 95% CI: 1.03-2.43) and combined (pain and disability) (p = 0.017, OR: 1.71, 95% CI: 1.07-2.71). For the inferred COMT (rs6269 A > G-rs4680 G > A) haplotype analyses, the G-G (p = 0.026, OR: 0.67, 95% CI: 0.38-1.18) and A-A (p = 0.007, OR: 2.09, 95% CI: 0.89-4.88) haplotypes were significantly associated with reduced and increased likelihoods of reporting moderate-high pain, respectively. The inferred A-A (p = 0.003, OR: 2.18, 95% CI: 0.92-5.17) haplotype was also significantly associated with combined (pain and disability). Gene-gene interaction analyses further showed allele-allele combinations for COMT (rs4680 G > A)-OPRM1 (rs1799971 A > G) and COMT (rs4680 G > A)-OPRM1(rs540825 T > A) were associated with reporting pain and combined (pain and disability) symptoms, p < 0.05. The findings of this study suggest that COMT and OPRM1 SNPs play a role in the development of chronic shoulder pain/disability in BCS in a unique South African cohort from the Western Cape.
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Dourado A, Gomes A, Teixeira P, Lobo L, Azevedo JT, Dias IR, Pinelas R. Antinociceptive Effect of a Sacro-Coccygeal Epidural of Morphine and Lidocaine in Cats Undergoing Ovariohysterectomy. Vet Sci 2022; 9:623. [PMID: 36356100 PMCID: PMC9698262 DOI: 10.3390/vetsci9110623] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND A commonly described analgesic protocol for ovariohysterectomy (OHE) combines systemic opioids, sedatives, and non-steroidal anti-inflammatory drugs. However, systemic analgesia does not fully prevent perioperative visceral and somatic pain triggered by the surgical stimulus. OBJECTIVES To compare the analgesic effects and quality of recovery of systemic analgesia with those of a sacrococcygeal epidural injection of lidocaine and morphine in cats undergoing elective OHE. Methods: Twenty domestic female cats were premedicated with dexmedetomidine (0.01 mg kg-1 IM) and alfaxalone (1.5 mg kg-1 IM) and randomly assigned to one of two analgesic protocols: methadone (0.2 mg kg-1 IM) in the control group CTR (n = 10) and methadone (0.1 mg kg-1 IM) + epidural (lidocaine 2% (0.3 mL kg-1) + morphine 1% (0.1 mg kg-1) diluted with NaCl 0.9% to a total volume of 1.5 mL in the SCC-E group (n = 10). General anaesthesia was induced with alfaxalone (1 mg kg-1 IV) and maintained with sevoflurane in 100% oxygen. Non-invasive blood arterial pressure and cardiorespiratory variables were recorded. The quality of recovery was assessed using a simple descriptive scale. Before surgery and 1, 2, 3, 4, 6, and 8 h post-op pain was assessed using the UNESP-Botucatu multidimensional composite pain scale (MCPS) and mechanical nociception thresholds (MNT). The repeated measures analysis of variance (ANOVA) was used to compare groups over time. Comparison between groups was performed using independent samples t-test if the assumption of normality was verified, or the Mann-Whitney test. The chi-square test of independence and exact Fisher's test were used to compare groups according to recovery quality. RESULTS Heart rate and systolic arterial pressure increased significantly from baseline values in the CTR group and did not change in the SCC-E group. In the CTR group, MNT and UNESP-Botucatu-MCPS scores increased significantly from baseline for all assessment points and the first 3 h, respectively, whereas this did not occur in the SCC-E group. CONCLUSIONS AND CLINICAL RELEVANCE Based on our results, the SCC-E administration of lidocaine 2% with morphine 1% is a reasonable option to provide perioperative analgesia in cats submitted to OHE, compared to a systemic protocol alone.
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Affiliation(s)
- Amândio Dourado
- Veterinary Hospital of Porto, 4250-475 Porto, Portugal
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | - Anabela Gomes
- Veterinary Hospital of Porto, 4250-475 Porto, Portugal
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | | | - Luís Lobo
- Veterinary Hospital of Porto, 4250-475 Porto, Portugal
- CECA—Center for Animal Science Studies, University of Porto, 4485-661 Vila do Conde, Portugal
- Faculty of Veterinary Medicine, Lusophone University of Humanities and Technology, 1749-024 Lisbon, Portugal
| | - Jorge T. Azevedo
- Department of Animal Science, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- CECAV—Center for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- AL4AnimalS—Associate Laboratory for Animal and Veterinary Sciences, 5000-801 Vila Real, Portugal
| | - Isabel R. Dias
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- CECAV—Center for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- AL4AnimalS—Associate Laboratory for Animal and Veterinary Sciences, 5000-801 Vila Real, Portugal
| | - Rui Pinelas
- North Downs Specialist Referrals, Bletchingley RH1 4QP, UK
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Accuracy of infrared thermography in detecting tendinopathy: A systematic review with meta-analysis. Phys Ther Sport 2022; 58:117-125. [DOI: 10.1016/j.ptsp.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/18/2022]
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Sun K, Jiang J, Wang Y, Sun X, Zhu J, Xu X, Sun J, Shi J. The role of nerve fibers and their neurotransmitters in regulating intervertebral disc degeneration. Ageing Res Rev 2022; 81:101733. [PMID: 36113765 DOI: 10.1016/j.arr.2022.101733] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/11/2022] [Accepted: 09/11/2022] [Indexed: 01/31/2023]
Abstract
Intervertebral disc degeneration (IVDD) has been the major contributor to chronic lower back pain (LBP). Abnormal apoptosis, senescence, and pyroptosis of IVD cells, extracellular matrix (ECM) degradation, and infiltration of immune cells are the major molecular alternations during IVDD. Changes at tissue level frequently occur at advanced IVD tissue. Ectopic ingrowth of nerves within inner annulus fibrosus (AF) and nucleus pulposus (NP) tissue has been considered as the primary cause for LBP. Innervation at IVD tissue mainly included sensory and sympathetic nerves, and many markers for these two types of nerves have been detected since 1940. In fact, in osteoarthritis (OA), beyond pain transmission, the direct regulation of neuropeptides on functions of chondrocytes have attracted researchers' great attention recently. Many physical and pathological similarities between joint and IVD have shed us the light on the neurogenic mechanism involved in IVDD. Here, an overview of the advances in the nervous system within IVD tissue will be performed, with a discussion on in the role of nerve fibers and their neurotransmitters in regulating IVDD. We hope this review can attract more research interest to address neuromodulation and IVDD itself, which will enhance our understanding of the contribution of neuromodulation to the structural changes within IVD tissue and inflammatory responses and will help identify novel therapeutic targets and enable the effective treatment of IVDD disease.
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Affiliation(s)
- Kaiqiang Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China; Department of Orthopedics, Naval Medical Center of PLA, China
| | - Jialin Jiang
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Yuan Wang
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Xiaofei Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Jian Zhu
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Ximing Xu
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China.
| | - Jiangang Shi
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China.
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Jones RJF, Littzen COR. An Analysis of Theoretical Perspectives in Research on Nature-Based Interventions and Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12740. [PMID: 36232042 PMCID: PMC9566272 DOI: 10.3390/ijerph191912740] [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: 08/15/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Chronic pain results from a complex series of biomechanical, inflammatory, neurological, psychological, social, and environmental mechanisms. Pain and pain-related diseases are the leading causes of disability and disease burden globally. Employing nature-based interventions for the treatment of pain is an emerging field. Current theory driving the suggested mechanism(s) linking the pain reducing effects of nature-based interventions is lacking. A two-step approach was taken to complete a theoretical review and analysis. First, a literature review was completed to gather a substantive amount of research related to theoretical frameworks on the topic of nature-based interventions and pain. Secondly, a theoretical analysis as proposed by Walker and Avant was completed to explore current theoretical frameworks accepted in the literature on nature-based interventions and pain. Stress reduction theory and attention restoration theory were the most common theoretical frameworks identified. Neither theoretical framework explicitly identifies, describes, or intends to adequately measure the concept of pain, revealing a limitation for their application in research with nature-based interventions and pain. Theoretical development is needed, as it pertains to nature-based interventions and pain. Without this development, research on nature-based interventions and pain will continue to use proxy concepts for measurement and may result in misrepresented findings.
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Affiliation(s)
- Reo J. F. Jones
- School of Nursing, Oregon Health & Science University, Portland, OR 97239, USA
- School of Nursing and Health Innovations, The University of Portland, Portland, OR 97203, USA
| | - Chloé O. R. Littzen
- School of Nursing and Health Innovations, The University of Portland, Portland, OR 97203, USA
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Sonkodi B. Should We Void Lactate in the Pathophysiology of Delayed Onset Muscle Soreness? Not So Fast! Let's See a Neurocentric View! Metabolites 2022; 12:857. [PMID: 36144262 PMCID: PMC9505902 DOI: 10.3390/metabo12090857] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 01/01/2023] Open
Abstract
The pathophysiology of delayed onset muscle soreness is not entirely known. It seems to be a simple, exercise-induced delayed pain condition, but has remained a mystery for over 120 years. The buildup of lactic acid used to be blamed for muscle fatigue and delayed onset muscle soreness; however, studies in the 1980s largely refuted the role of lactate in delayed onset muscle soreness. Regardless, this belief is widely held even today, not only in the general public, but within the medical and scientific community as well. Current opinion is highlighting lactate's role in delayed onset muscle soreness, if neural dimension and neuro-energetics are not overlooked. By doing so, lactate seems to have an essential role in the initiation of the primary damage phase of delayed onset muscle soreness within the intrafusal space. Unaccustomed or strenuous eccentric contractions are suggested to facilitate lactate nourishment of proprioceptive sensory neurons in the muscle spindle under hyperexcitation. However, excessive acidosis and lactate could eventually contribute to impaired proprioception and increased nociception under pathological condition. Furthermore, lactate could also contribute to the secondary damage phase of delayed onset muscle soreness in the extrafusal space, primarily by potentiating the role of bradykinin. After all, neural interpretation may help us to dispel a 40-year-old controversy about lactate's role in the pathophysiology of delayed onset muscle soreness.
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Affiliation(s)
- Balázs Sonkodi
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Science, 1123 Budapest, Hungary
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Tapiainen AA, Zaproudina N, Lipponen JA, Tarvainen MP, Vierola A, Rissanen SM, Karjalainen PA, Närhi M. Autonomic responses to tooth clenching and handgrip test. Acta Odontol Scand 2022; 80:389-395. [PMID: 35062852 DOI: 10.1080/00016357.2022.2027514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim was to study the differences in autonomic nervous system activation between maximal tooth clenching task and handgrip test during and after the tasks. Also, the possible activation of trigeminocardiac reflex during the clenching task was explored. MATERIAL AND METHODS We compared autonomic responses to maximal tooth clenching and handgrip in 28 participants. Responses in heart rate variability, heart rate, and blood pressure were evaluated before, during, and after tests. Although all study participants were considered healthy during recruitment, 14 of them showed painful temporomandibular disorders in the clinical examination, which was taken into account in the analyses. RESULTS Handgrip and tooth clenching caused similar autonomic responses. However, tooth clenching seemed to activate the trigeminocardiac reflex shown as clenching-related vagal activation. The painful signs of temporomandibular disorders may interfere with the heart rate variability both at the baseline and during both tests causing significant variation in them. CONCLUSIONS Both handgrip and tooth clenching affect the autonomic nervous system function. Tooth clenching differs from the handgrip due to trigeminocardiac reflex. Painful signs of temporomandibular disorders are interfering with the results of the tests and maybe underestimated in the studies of autonomic responses to both tasks.
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Affiliation(s)
- Atte A. Tapiainen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Nina Zaproudina
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka A. Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mika P. Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, KUH, Kuopio, Finland
| | - Anu Vierola
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Saara M. Rissanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Pasi A. Karjalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Matti Närhi
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
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Celenlioglu AE, Sir E. Predictive factors affecting treatment success in ganglion impar block applied in chronic coccygodynia. Reg Anesth Pain Med 2022; 47:rapm-2022-103582. [PMID: 35738667 DOI: 10.1136/rapm-2022-103582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study aimed to determine the predictive factors affecting the success of ganglion impar block applied in chronic coccygodynia. METHODS Patients who received ganglion impar block to treat coccygodynia between January 1, 2018 and January 1, 2021 were retrospectively screened. Of the 195 patients, 102 met the final analysis criteria and were included in the study. Demographic data, coccygodynia etiology, coccygodynia symptom duration, history of coccyx fracture, regular opioid use, and presence of other musculoskeletal chronic pain conditions accompanying coccygodynia were obtained from patient records. In addition, coccyx radiography was examined, and coccyx curvature type, permanent subluxation, and posterior spicule presence were evaluated. The criterion for treatment success was set as ≥50% reduction in Numerical Rating Scale pain scores in the third month after treatment. RESULTS Treatment was successful of the patients in 69.6% (95% CI 60.4% to 78.7%). A significant cut-off value (24.5 months) was determined for coccygodynia symptom duration using receiver operating characteristic analysis. Symptom duration above the cut-off value was defined as prolonged symptom duration. Multivariable logistic regression analysis was performed to determine the predictive factors affecting treatment success in the third month after injection. In the final model, the presence of permanent subluxation (yes vs no), and the prolonged symptom duration (yes vs no) were found to have significant effects on treatment success (OR 9.56, 95% CI 1.44 to 63.40, p=0.02; OR 137.00, 95% CI 19.59 to 958.03, p<0.001). CONCLUSION Treatment success of ganglion impar block for coccygodynia is high. However, longer preprocedure symptom duration and the presence of permanent subluxation were associated with a decrease likelihood of treatment success.
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Affiliation(s)
- Alp Eren Celenlioglu
- Department of Pain Medicine, University of Health Sciences Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ender Sir
- Department of Pain Medicine, University of Health Sciences Gulhane Training and Research Hospital, Ankara, Turkey
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Romantic partner embraces reduce cortisol release after acute stress induction in women but not in men. PLoS One 2022; 17:e0266887. [PMID: 35584124 PMCID: PMC9116618 DOI: 10.1371/journal.pone.0266887] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/30/2022] [Indexed: 12/11/2022] Open
Abstract
Stress is omnipresent in our everyday lives. It is therefore critical to identify potential stress-buffering behaviors that can help to prevent the negative effects of acute stress in daily life. Massages, a form of social touch, are an effective buffer against both the endocrinological and sympathetic stress response in women. However, for other forms of social touch, potential stress-buffering effects have not been investigated in detail. Furthermore, the possible stress-buffering effects of social touch on men have not been researched so far. The present study focused on embracing, one of the most common forms of social touch across many cultures. We used a short-term embrace between romantic partners as a social touch intervention prior to the induction of acute stress via the Socially Evaluated Cold Pressor Test. Women who embraced their partner prior to being stressed showed a reduced cortisol response compared to a control group in which no embrace occurred. No stress-buffering effect could be observed in men. No differences between the embrace and control group were observed regarding sympathetic nervous system activation measured via blood pressure or subjective affect ratings. These findings suggest that in women, short-term embraces prior to stressful social situations such as examinations or stressful interviews can reduce the cortisol response in that situation.
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Morais CA, DeMonte LC, Bartley EJ. Regulatory Emotional Self-Efficacy Buffers the Effect of Heart Rate Variability on Functional Capacity in Older Adults With Chronic Low Back Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:818408. [PMID: 35669039 PMCID: PMC9163301 DOI: 10.3389/fpain.2022.818408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Chronic low back pain is one of the leading causes of disability globally among older adults. Prevailing research suggests that autonomic dysregulation places individuals at increased risk for chronic pain. This study examines the moderating role of emotional self-efficacy (ESE) on the relationship between heart rate variability (HRV) and pain related-outcomes, including movement-evoked pain (MEP) and physical functioning. Methods In a secondary analysis of the Adaptability and Resilience in Aging Adults (ARIAA) study, a total of 58 adults (aged 60 and older) with chronic low back pain (cLBP) completed the PROMIS self-efficacy for managing emotions questionnaire and the 6-minute walk test (6 MWT) to assess functional capacity and MEP. Heart rate variability, indexed by the frequency domain, was assessed for 5 min during rest. Results For pain-related outcomes, having a lower body mass index (p = 0.03) was associated with better functional capacity on the 6MWT, while higher education level (p = 0.01) and less pain duration (p = 0.00) were correlated with lower MEP. After controlling for sex, age, and body mass index, an increase in low-frequency HRV (LF-HRV) was associated with poorer physical functioning among individuals low in ESE (b = −0.12 p = 0.03). No significant moderation effects were observed for MEP. Conclusion Our results bring attention to the degree to which ESE influences the relationship between LF-HRV and physical functioning. Interventions that enhance adaptive psychological processes such as ESE may dampen ANS dysregulation and mitigate risk for adverse pain outcomes among older adults with cLBP.
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Affiliation(s)
- Calia A. Morais
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Calia A. Morais
| | - Lucas C. DeMonte
- Department of Counseling and Higher Education, Northern Illinois University, DeKalb, IL, United States
| | - Emily J. Bartley
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
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Desjardins M, Apfelbach C, Rubino M, Verdolini Abbott K. Integrative Review and Framework of Suggested Mechanisms in Primary Muscle Tension Dysphonia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1867-1893. [PMID: 35446683 PMCID: PMC9559660 DOI: 10.1044/2022_jslhr-21-00575] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE Despite the high prevalence of primary muscle tension dysphonia (MTD-1), its underlying mechanisms and their interrelationships have yet to be fully identified. The objectives of this integrative review were (a) to describe and classify the suggested underlying mechanisms for MTD-1, (b) to appraise the empirical evidence supporting each of the proposed mechanisms, and (c) to summarize the information in an integrative model. METHOD PubMed, Scopus, and CINAHL were searched for all publications pertaining to muscle tension dysphonia. Papers were retained if they included theoretical or empirical data pertaining to underlying mechanisms of MTD-1. A total of 921 papers initially qualified for screening, of which 100 remained for consideration in this review. Underlying mechanisms of MTD-1 were extracted using a consensus approach. RESULTS Seven broad categories of putative mechanisms involved in MTD-1 were identified: psychosocial, autonomic, sensorimotor, respiratory, postural, inflammatory, and neuromuscular. These categories were further divided into 19 subcategories detailed in the body of this review article. Based on the reviewed evidence, our proposed integrative model presents MTD-1 as an idiosyncratic motor adaptation to physiological perturbation or perceived threat. Under this model, physiologically or psychologically aversive stimuli can instigate a series of motor adaptations at multiple levels of the nervous system, ultimately disturbing muscle activation patterns and their biomechanical outcomes. Importantly, these adaptations appear to have the potential to become chronic even after threatening stimuli are withdrawn. CONCLUSIONS The proposed model highlights the importance of personalized rehabilitation in MTD-1 treatment. Limitations of the literature are discussed to provide guidance for future research aimed at improving our understanding of MTD-1. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19586065.
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Affiliation(s)
- Maude Desjardins
- Department of Communication Sciences & Disorders, University of Delaware, Newark
| | | | - Marianna Rubino
- Department of Communication Sciences & Disorders, University of Delaware, Newark
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Quantifying virtual reality pain modulation in healthy volunteers: A randomized, crossover study. J Clin Anesth 2022; 80:110876. [PMID: 35525050 DOI: 10.1016/j.jclinane.2022.110876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE Virtual reality (VR) is an emerging tool to reduce pain and anxiety during procedures. Although VR's clinical benefits are reported, biometric data quantifying VR's effect on pain tolerance is lacking. We used time-lapse, subjective, and biometric data to evaluate VR's effect on modulating pain. DESIGN Randomized, controlled crossover within-subject clinical trial. SETTING This study was conducted in the Chariot Lab at Lucile Packard Children's Hospital and outdoors at Stanford University School of Medicine. PATIENTS 156 healthy volunteers were included. INTERVENTIONS Participants underwent pain-inducing ice immersions while connected to biometric sensors. Participants were randomized to immerse their dominant or non-dominant hand with VR or control (no VR) for one immersion, and then crossed-over to the other hand for the second immersion. We instructed participants to submerge their hand until they reached their pain tolerance or until four minutes elapsed. MEASUREMENTS Outcomes included ice immersion duration, perceived pain scores, and skin conductance response density (SCRD), a marker of sympathetic arousal. We used survival analysis and mixed effects models to compare measurements with and without VR. MAIN RESULTS 153 participants were included in the analysis. Participants with VR were 64% less likely to remove their hands from the ice bath throughout the immersion's duration compared to control (P < 0.001). Participants with VR reported significantly lower pain scores after controlling for dominant hand treatment assignment, VR vs. no VR treatment order, and gender (P < 0.001). SCRD increased as time progressed for both VR and control groups (P = 0.047 combined), with no significant mean group differences. CONCLUSIONS Participants with VR were more likely to survive the 4-min ice bath challenge longer and with lower levels of pain perception, supporting VR's effectiveness as a distraction tool during painful procedures. We observed no differences in sympathetic response when comparing VR to no VR.
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Yang W, Yang X, Cai X, Zhou Z, Yao H, Song X, Zhao T, Xiong P. The Prevalence of Irritable Bowel Syndrome Among Chinese University Students: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:864721. [PMID: 35493361 PMCID: PMC9051230 DOI: 10.3389/fpubh.2022.864721] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background Irritable bowel syndrome (IBS) has become a common public health issue among university students, impairing their physical and mental health. This meta-analysis aimed to examine the pooled prevalence of IBS and its associated factors among Chinese university students. Methods Databases of PubMed, EMBASE, MEDLINE (via EBSCO), CINAHL (via EBSCO), Wan Fang, CNKI and Weipu (via VIP) were systematically searched from inception date to May 31, 2021. Meta-analysis was performed using random-effects models. Meta-regression and subgroup analysis were used to detect the potential source of heterogeneity. Key Results A total of 22 cross-sectional studies (14 were in Chinese and 8 were in English) with 33,166 Chinese university students were included. The pooled prevalence of IBS was estimated as 11.89% (95% CI = 8.06%, 16.35%). The prevalence was 10.50% (95% CI = 6.80%, 15.87%) in Rome II criteria, 12.00% (95% CI = 8.23%, 17.17%) in Rome III criteria, and 3.66% (95% CI = 2.01%, 6.60%) in Rome IV criteria. The highest prevalence of IBS was 17.66% (95% CI = 7.37%, 36.64%) in North China, and the lowest was 3.18% (95% CI = 1.28%, 7.68%) in South China. Subgroup analyses indicated that gender, major, anxiety and depression symptoms, drinking and smoking behaviors were significantly associated with the prevalence of IBS. Meta-regression analyses suggested that region influenced prevalence estimates for IBS. Conclusions and Inferences This meta-analysis illustrated that IBS is very common in Chinese university students. Regular screening, effective prevention, and appropriate treatments should be implemented to reduce the risk of IBS in this population. More future studies should be conducted in Northeastern and Southwestern parts of China.
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Affiliation(s)
- Weixin Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xiao Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xianghao Cai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhuoren Zhou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Huan Yao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xingrong Song
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tianyun Zhao
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Tianyun Zhao
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- Peng Xiong ;
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Jenei-Lanzl Z, Pongratz G. Posttraumatic osteoarthritis as potential modulator of autonomic nervous system function. Osteoarthritis Cartilage 2022; 30:498-500. [PMID: 35017059 DOI: 10.1016/j.joca.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Z Jenei-Lanzl
- Dr Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60528 Frankfurt/Main, Germany.
| | - G Pongratz
- Department of Rheumatology and Hiller Research Center for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany.
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Abstract
The idea that perioperative outcomes may be improved through the implementation of measures that modify the surgical stress response has been around for several decades. Many techniques have been trialled with varying success. In addition, how the response to modification is measured, what constitutes a positive result and how this translates into clinical practice is the subject of debate. Modification of the stress response is the principal tenet behind the enhanced recovery after surgery (ERAS) movement which has seen the development of guidelines for perioperative care across a variety of surgical specialties bringing with them significant improvements in outcomes.
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Affiliation(s)
- Leigh J S Kelliher
- Department of Anaesthetics, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7AS, UK.
| | - Michael Scott
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Surgical Outcomes Research Centre, University College London, London, UK
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45
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Kwon OS, Kwon BK, Kim JH, Kim BH. Effects of heating therapy on pain, anxiety, physiologic measures, and satisfaction in patients undergoing cystoscopy. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:73-79. [DOI: 10.1016/j.anr.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/02/2022] Open
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Assessment of salivary alpha-amylase and cortisol as a pain related stress biomarker in dogs pre-and post-operation. BMC Vet Res 2022; 18:31. [PMID: 35027050 PMCID: PMC8756664 DOI: 10.1186/s12917-021-03114-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The use of salivary biomarkers has garnered attention because the composition of saliva reflects the body’s physiological state. Saliva contains a wide range of components, including peptides, nucleic acids, electrolytes, enzymes, and hormones. It has been reported that salivary alpha-amylase and cortisol are biomarkers of stress related biomarker in diseased dogs; however, evaluation of salivary alpha-amylase and cortisol pre- and post- operation has not been studied yet. The aim of this study was to evaluate salivary alpha-amylase and cortisol levels in dogs before and after they underwent surgery and investigate the association between the salivary alpha-amylase and cortisol activity and pain intensity. For this purpose, a total of 35 dogs with disease-related pain undergoing orthopedic and soft tissue surgeries were recruited. Alpha-amylase and cortisol levels in the dogs’ saliva and serum were measured for each using a commercially available canine-specific enzyme-linked immunosorbent assay kit, and physical examinations (measurement of heart rate and blood pressure) were performed. In addition, the dogs’ pre- and post-operative pain scores determined using the short form of the Glasgow Composite Measure Pain Scale (CMPS-SF) were evaluated.
Results
After surgery, there was a significant decrease in the dogs’ pain scores (0.4-fold for the CMPS-SF, p < 0.001) and serum cortisol levels (0.73-fold, p < 0.01). Based on their pre-operative CMPS-SF scores, the dogs were included in either a high-pain-score group or a low-pain-score group. After the dogs in the high-pain-score group underwent surgical intervention, there was a significant decrease in their CMPS-SF scores and levels of salivary alpha-amylase, serum alpha-amylase, and serum cortisol. Additionally, there was a positive correlation between salivary alpha-amylase levels and CMPS-SF scores in both the high- and low-pain-score groups.
Conclusions
The measurement of salivary alpha amylase can be considered an important non-invasive tool for the evaluation of pain-related stress in dogs.
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47
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OUP accepted manuscript. Brain 2022; 145:3225-3235. [DOI: 10.1093/brain/awac147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/14/2022] Open
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48
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Somani SN, Yu KM, Chiu AG, Sykes KJ, Villwock JA. Consumer Wearables for Patient Monitoring in Otolaryngology: A State of the Art Review. Otolaryngol Head Neck Surg 2021; 167:620-631. [PMID: 34813407 DOI: 10.1177/01945998211061681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Consumer wearables, such as the Apple Watch or Fitbit devices, have become increasingly commonplace over the past decade. The application of these devices to health care remains an area of significant yet ill-defined promise. This review aims to identify the potential role of consumer wearables for the monitoring of otolaryngology patients. DATA SOURCES PubMed. REVIEW METHODS A PubMed search was conducted to identify the use of consumer wearables for the assessment of clinical outcomes relevant to otolaryngology. Articles were included if they described the use of wearables that were designed for continuous wear and were available for consumer purchase in the United States. Articles meeting inclusion criteria were synthesized into a final narrative review. CONCLUSIONS In the perioperative setting, consumer wearables could facilitate prehabilitation before major surgery and prediction of clinical outcomes. The use of consumer wearables in the inpatient setting could allow for early recognition of parameters suggestive of poor or declining health. The real-time feedback provided by these devices in the remote setting could be incorporated into behavioral interventions to promote patients' engagement with healthy behaviors. Various concerns surrounding the privacy, ownership, and validity of wearable-derived data must be addressed before their widespread adoption in health care. IMPLICATIONS FOR PRACTICE Understanding how to leverage the wealth of biometric data collected by consumer wearables to improve health outcomes will become a high-impact area of research and clinical care. Well-designed comparative studies that elucidate the value and clinical applicability of these data are needed.
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Affiliation(s)
- Shaan N Somani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Katherine M Yu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer A Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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49
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Lütolf R, Rosner J, Curt A, Hubli M. Identifying Discomplete Spinal Lesions: New Evidence from Pain-Autonomic Interaction in Spinal Cord Injury. J Neurotrauma 2021; 38:3456-3466. [PMID: 34806429 DOI: 10.1089/neu.2021.0280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The clinical evaluation of spinal afferents is an important diagnostic and prognostic marker for neurological and functional recovery after spinal cord injury (SCI). Particularly important regarding neuropathic pain following SCI is the function of the spinothalamic tract (STT) conveying nociceptive and temperature information. Here, we investigated the added value of neurophysiological methods revealing discomplete STT lesions; that is, residual axonal sparing in clinically complete STT lesions. Specifically, clinical pinprick testing and thermal thresholds were compared with objective contact heat-evoked potentials (CHEPs) and a novel measure of pain-autonomic interaction employing heat-induced sympathetic skin responses (SSR). The test stimuli (i.e., contact heat, pinprick) were applied below the lesion level in 32 subjects with thoracic SCI while corresponding heat-evoked responses (i.e., CHEPs and SSR) were recorded above the lesion (i.e., scalp and hand, respectively). Readouts of STT function were related to neuropathic pain characteristics. In subjects with abolished pinprick sensation, measures of thermosensation (10%), CHEPs (33%), and SSR (48%) revealed residual STT function. Importantly, SSRs can be used as an objective readout and when abolished, no other proxy indicated residual STT function. No relationship was found between STT function readouts and spontaneous neuropathic pain intensity and extent. However, subjects with clinically preserved STT function presented more often with allodynia (54%) than subjects with discomplete (13%) or complete STT lesions (18%). In individuals with absent pinprick sensation, discomplete STT lesions can be revealed employing pain-autonomic measures. The improved sensitivity to discerning STT lesion completeness might support the investigation of its association with neuropathic pain following SCI.
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Affiliation(s)
- Robin Lütolf
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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50
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Marco-Ariño N, Vide S, Agustí M, Chen A, Jaramillo S, Irurzun-Arana I, Pacheco A, Gonzalez C, Jensen EW, Capsi-Morales P, Valencia JF, Troconiz IF, Gambus PL, Larson MD. Semimechanistic models to relate noxious stimulation, movement, and pupillary dilation responses in the presence of opioids. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 11:581-593. [PMID: 34716984 PMCID: PMC9124350 DOI: 10.1002/psp4.12729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/26/2021] [Accepted: 09/13/2021] [Indexed: 01/03/2023]
Abstract
Intraoperative targeting of the analgesic effect still lacks an optimal solution. Opioids are currently the main drug used to achieve antinociception, and although underdosing can lead to an increased stress response, overdose can also lead to undesirable adverse effects. To better understand how to achieve the optimal analgesic effect of opioids, we studied the influence of remifentanil on the pupillary reflex dilation (PRD) and its relationship with the reflex movement response to a standardized noxious stimulus. The main objective was to generate population pharmacodynamic models relating remifentanil predicted concentrations to movement and to pupillary dilation during general anesthesia. A total of 78 patients undergoing gynecological surgery under general anesthesia were recruited for the study. PRD and movement response to a tetanic stimulus were measured multiple times before and after surgery. We used nonlinear mixed effects modeling to generate a population pharmacodynamic model to describe both the time profiles of PRD and movement responses to noxious stimulation. Our model demonstrated that movement and PRD are equally depressed by remifentanil. Using the developed model, we changed the intensity of stimulation and simulated remifentanil predicted concentrations maximizing the probability of absence of movement response. An estimated effect site concentration of 2 ng/ml of remifentanil was found to inhibit movement to a tetanic stimulation with a probability of 81%.
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Affiliation(s)
- Nicolás Marco-Ariño
- Pharmacometrics & Systems Pharmacology, Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Sergio Vide
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain.,Center for Clinical Research in Anesthesia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Mercè Agustí
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Andrew Chen
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Sebastián Jaramillo
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Itziar Irurzun-Arana
- Pharmacometrics & Systems Pharmacology, Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Adrià Pacheco
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Carmen Gonzalez
- Department of Research and Development, Quantium Medical, Mataró, Barcelona, Spain
| | - Erik W Jensen
- Department of Research and Development, Quantium Medical, Mataró, Barcelona, Spain
| | - Patricia Capsi-Morales
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - José F Valencia
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain.,Electronic Engineering Program, School of Engineering, Universidad de San Buenaventura, Cali, Colombia
| | - Iñaki F Troconiz
- Pharmacometrics & Systems Pharmacology, Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Pedro L Gambus
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain.,NeuroImmunology Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Merlin D Larson
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain.,Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
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