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Kaplan CM, Kelleher E, Irani A, Schrepf A, Clauw DJ, Harte SE. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nat Rev Neurol 2024; 20:347-363. [PMID: 38755449 DOI: 10.1038/s41582-024-00966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Nociplastic pain is a mechanistic term used to describe pain that arises or is sustained by altered nociception, despite the absence of tissue damage. Although nociplastic pain has distinct pathophysiology from nociceptive and neuropathic pain, these pain mechanisms often coincide within individuals, which contributes to the intractability of chronic pain. Key symptoms of nociplastic pain include pain in multiple body regions, fatigue, sleep disturbances, cognitive dysfunction, depression and anxiety. Individuals with nociplastic pain are often diffusely tender - indicative of hyperalgesia and/or allodynia - and are often more sensitive than others to non-painful sensory stimuli such as lights, odours and noises. This Review summarizes the risk factors, clinical presentation and treatment of nociplastic pain, and describes how alterations in brain function and structure, immune processing and peripheral factors might contribute to the nociplastic pain phenotype. This article concludes with a discussion of two proposed subtypes of nociplastic pain that reflect distinct neurobiological features and treatment responsivity.
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Affiliation(s)
- Chelsea M Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Eoin Kelleher
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anushka Irani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Division of Rheumatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
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Rafferty C, Ward J. Fibromyalgia is linked to increased subjective sensory sensitivity across multiple senses. Perception 2024; 53:276-286. [PMID: 38410035 PMCID: PMC10960319 DOI: 10.1177/03010066241234037] [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: 04/27/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024]
Abstract
Changes in subjective sensory sensitivity - reporting sensory stimuli as being atypically intense or weak - are a transdiagnostic symptom of several disorders. The present study documents for the first time the sensory sensitivity profile of fibromyalgia, taking a questionnaire measure that asks about different sensory modalities and both hyper- and hyposensitivity (the Glasgow Sensory Questionnaire, GSQ). The fibromyalgia group had higher overall scores on this measure. This was linked more strongly to sensory hypersensitivity and was pervasive across all senses that were surveyed. Although differences in hyposensitivity were found, these were sporadic (perhaps linked to the symptoms of fibromyalgia itself) and did not resemble the pattern documented for autism (e.g., self-stimulating and repetitive behaviours were not a feature of fibromyalgia). We suggest that individual differences in subjective sensory hypersensitivity may be a multisensory dispositional trait linked to fibromyalgia which ultimately becomes most pronounced for pain.
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Leon M, Woo CC. Olfactory loss is a predisposing factor for depression, while olfactory enrichment is an effective treatment for depression. Front Neurosci 2022; 16:1013363. [PMID: 36248633 PMCID: PMC9558899 DOI: 10.3389/fnins.2022.1013363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
The loss of olfactory stimulation correlates well with at least 68 widely differing neurological disorders, including depression, and we raise the possibility that this relationship may be causal. That is, it seems possible that olfactory loss makes the brain vulnerable to expressing the symptoms of these neurological disorders, while daily olfactory enrichment may decrease the risk of expressing these symptoms. This situation resembles the cognitive reserve that is thought to protect people with Alzheimer’s neuropathology from expressing the functional deficit in memory through the cumulative effect of intellectual stimulation. These relationships also resemble the functional response of animal models of human neurological disorders to environmental enrichment, wherein the animals continue to have the induced neuropathology, but do not express the symptoms as they do in a standard environment with restricted sensorimotor stimulation.
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Affiliation(s)
- Michael Leon
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
- Center for the Neurobiology of Learning and Memory, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Michael Leon,
| | - Cynthia C. Woo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
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Caretta A, Mucignat-Caretta C. Not Only COVID-19: Involvement of Multiple Chemosensory Systems in Human Diseases. Front Neural Circuits 2022; 16:862005. [PMID: 35547642 PMCID: PMC9081982 DOI: 10.3389/fncir.2022.862005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Chemosensory systems are deemed marginal in human pathology. In appraising their role, we aim at suggesting a paradigm shift based on the available clinical and experimental data that will be discussed. Taste and olfaction are polymodal sensory systems, providing inputs to many brain structures that regulate crucial visceral functions, including metabolism but also endocrine, cardiovascular, respiratory, and immune systems. Moreover, other visceral chemosensory systems monitor different essential chemical parameters of “milieu intérieur,” transmitting their data to the brain areas receiving taste and olfactory inputs; hence, they participate in regulating the same vital functions. These chemosensory cells share many molecular features with olfactory or taste receptor cells, thus they may be affected by the same pathological events. In most COVID-19 patients, taste and olfaction are disturbed. This may represent only a small portion of a broadly diffuse chemosensory incapacitation. Indeed, many COVID-19 peculiar symptoms may be explained by the impairment of visceral chemosensory systems, for example, silent hypoxia, diarrhea, and the “cytokine storm”. Dysregulation of chemosensory systems may underlie the much higher mortality rate of COVID-19 Acute Respiratory Distress Syndrome (ARDS) compared to ARDSs of different origins. In chronic non-infectious diseases like hypertension, diabetes, or cancer, the impairment of taste and/or olfaction has been consistently reported. This may signal diffuse chemosensory failure, possibly worsening the prognosis of these patients. Incapacitation of one or few chemosensory systems has negligible effects on survival under ordinary life conditions but, under stress, like metabolic imbalance or COVID-19 pneumonia, the impairment of multiple chemosensory systems may lead to dire consequences during the course of the disease.
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Affiliation(s)
- Antonio Caretta
- National Institute for Biostructures and Biosystems (NIBB), Rome, Italy
- Department of Food and Drug Science, University of Parma, Parma, Italy
| | - Carla Mucignat-Caretta
- National Institute for Biostructures and Biosystems (NIBB), Rome, Italy
- Department of Molecular Medicine, University of Padova, Padua, Italy
- *Correspondence: Carla Mucignat-Caretta,
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5
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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Halpert G, Shoenfeld Y. SARS-CoV-2, the autoimmune virus. Autoimmun Rev 2020; 19:102695. [PMID: 33130000 PMCID: PMC7598743 DOI: 10.1016/j.autrev.2020.102695] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Gilad Halpert
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel; Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg 199034, Russian Federation.
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel; Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg 199034, Russian Federation.
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Masala C, Firinu D, Piras R, Deidda M, Cinetto F, Del Giacco S. Olfactory Function Is Impaired in Patients with Mastocytosis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1359-1364. [PMID: 33059098 DOI: 10.1016/j.jaip.2020.09.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mastocytosis is a clinically heterogeneous disorder associated with abnormal mast cell accumulation in different organs. No data are available as regards the assessment of olfactory function and its association with mastocytosis. OBJECTIVE The aim of the study was first to investigate odor threshold, discrimination, and identification in patients with mastocytosis compared with age-matched healthy controls (HC), and furthermore, to correlate olfactory function with the other clinical symptoms of mastocytosis. METHODS Eighty-one participants were enrolled: 41 patients with mastocytosis (23 males and 18 females; mean age, 47.95 years; standard deviation [SD], 14.7 years) were compared with 40 HC (23 males and 17 females; mean age, 47.88 years; SD, 14.6 years). Olfactory function among participants was evaluated using the "Sniffin' Sticks" test for odor detection threshold (OT), odor discrimination (OD), and odor identification (OI). RESULTS Patients with systemic mastocytosis showed a significant decrease in the total olfactory function (Threshold-Discrimination-Identification [TDI] score), OT, OD, and OI compared with HC. A significant negative correlation was observed only between TDI score and serum tryptase concentration (μg/L). No correlation was observed between disease duration versus OT, OD, OI, and TDI score. CONCLUSIONS Our results suggest that the olfactory function is impaired in patients compared with HC; a significant negative correlation was found between TDI score and the level of serum tryptase. Olfactory dysfunction in mastocytosis may be considered among the clinical manifestations contributing to the burden of this disease.
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Affiliation(s)
- Carla Masala
- Department of Biomedical Sciences, Physiology Section, University of Cagliari, Monserrato, Cagliari, Italy
| | - Davide Firinu
- Allergy and Clinical Immunology Unit, Department of Medical Sciences and Public Health, University Hospital "Duilio Casula," Monserrato, Cagliari, Italy
| | - Raffaella Piras
- Department of Biomedical Sciences, Physiology Section, University of Cagliari, Monserrato, Cagliari, Italy
| | - Margherita Deidda
- Allergy and Clinical Immunology Unit, Department of Medical Sciences and Public Health, University Hospital "Duilio Casula," Monserrato, Cagliari, Italy
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padova, Italy; Internal Medicine I, Ca' Foncello Hospital, Treviso, Italy
| | - Stefano Del Giacco
- Allergy and Clinical Immunology Unit, Department of Medical Sciences and Public Health, University Hospital "Duilio Casula," Monserrato, Cagliari, Italy.
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Ryabkova VA, Churilov LP, Shoenfeld Y. Neuroimmunology: What Role for Autoimmunity, Neuroinflammation, and Small Fiber Neuropathy in Fibromyalgia, Chronic Fatigue Syndrome, and Adverse Events after Human Papillomavirus Vaccination? Int J Mol Sci 2019; 20:E5164. [PMID: 31635218 PMCID: PMC6834318 DOI: 10.3390/ijms20205164] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/26/2019] [Accepted: 10/16/2019] [Indexed: 02/06/2023] Open
Abstract
Fibromyalgia is a disorder characterized by chronic widespread pain and non-pain symptoms, such as fatigue, dysautonomia, and cognitive and sleep disturbances. Its pathogenesis and treatment continue to be the subject of debate. We highlight the role of three mechanisms-autoimmunity, neuroinflammation, and small fiber neuropathy-in the pathogenesis of the disease. These mechanisms are shown to be closely interlinked (also on a molecular level), and the review considers the implementation of this relationship in the search for therapeutic options. We also pay attention to chronic fatigue syndrome, which overlaps with fibromyalgia, and propose a concept of "autoimmune hypothalamopathy" for its pathogenesis. Finally, we analyze the molecular mechanisms underlying the neuroinflammatory background in the development of adverse events following HPV vaccination and suggesting neuroinflammation, which could exacerbate the development of symptoms following HPV vaccination (though this is hotly debated), as a model for fibromyalgia pathogenesis.
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Affiliation(s)
- Varvara A Ryabkova
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg 199034, Russian Federation.
| | - Leonid P Churilov
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg 199034, Russian Federation.
- Saint Petersburg Research Institute of Phthisiopulmonology; Saint-Petersburg 191036, Russian Federation.
| | - Yehuda Shoenfeld
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg 199034, Russian Federation.
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, affiliated to Tel-Aviv University School of Medicine, Tel-Hashomer 52621, Israel.
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Abstract
Alterations in the ability to smell or taste are of considerable consequence, impacting quality of life, safety, nutrition, and dietary activities. These primary senses are influenced by a wide range of systemic diseases and disorders that commonly involve the entire body. These include viral, bacterial, fungal, protozoal, cestode, and nematode infections that can spread throughout the gastric, lymphatic, neural, or circulatory systems as well as classic autoimmune disorders, collagen diseases, diabetes, and hypertension, and others. Although a considerable literature has evolved in which the function of both taste and smell has been assessed in a number of such disorders, quantitative chemosensory testing is still relatively rare with many disorders not receiving empirical assessment. Incongruent findings are not uncommon. This chapter reviews what is known about the influences of a wide spectrum of systemic diseases and disorders on the abilities to taste and smell.
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Affiliation(s)
- Richard L Doty
- Smell and Taste Center and Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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10
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Hulens M, Rasschaert R, Vansant G, Stalmans I, Bruyninckx F, Dankaerts W. The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology. J Pain Res 2018; 11:3129-3140. [PMID: 30573989 PMCID: PMC6292399 DOI: 10.2147/jpr.s186878] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Idiopathic intracranial hypertension (IICH) is a condition characterized by raised intracranial pressure (ICP), and its diagnosis is established when the opening pressure measured during a lumbar puncture is elevated >20 cm H2O in nonobese patients or >25 cm H2O in obese patients. Papilledema is caused by forced filling of the optic nerve sheath with cerebrospinal fluid (CSF). Other common but underappreciated symptoms of IICH are neck pain, back pain, and radicular pain in the arms and legs resulting from associated increased spinal pressure and forced filling of the spinal nerves with CSF. Widespread pain and also several other characteristics of IICH share notable similarities with characteristics of fibromyalgia (FM) and chronic fatigue syndrome (CFS), two overlapping chronic pain conditions. The aim of this review was to compare literature data regarding the characteristics of IICH, FM, and CFS and to link the shared data to an apparent underlying physiopathology, that is, increased ICP. METHODS Data in the literature regarding these three conditions were compared and linked to the hypothesis of the shared underlying physiopathology of increased cerebrospinal pressure. RESULTS The shared characteristics of IICH, FM, and CFS that can be caused by increased ICP include headaches, fatigue, cognitive impairment, loss of gray matter, involvement of cranial nerves, and overload of the lymphatic olfactory pathway. Increased pressure in the spinal canal and in peripheral nerve root sheaths causes widespread pain, weakness in the arms and legs, walking difficulties (ataxia), and bladder, bowel, and sphincter symptoms. Additionally, IICH, FM, and CFS are frequently associated with sympathetic overactivity symptoms and obesity. These conditions share a strong female predominance and are frequently associated with Ehlers-Danlos syndrome. CONCLUSION IICH, FM, and CFS share a large variety of symptoms that might all be explained by the same pathophysiology of increased cerebrospinal pressure.
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Affiliation(s)
- Mieke Hulens
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, University of Leuven, Leuven, Belgium,
| | - Ricky Rasschaert
- Department of Neurosurgery, Sint-Jozefziekenhuis, Bornem, Belgium
| | - Greet Vansant
- Department of Social and Primary Health Care, Public Health Nutrition, University of Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Department of Neurosciences, Ophthalmology Research Group, University of Leuven KU Leuven, Leuven, Belgium
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Frans Bruyninckx
- Clinical Electromyography Laboratory, Department of Academic Consultants, Faculty of Medicine, University Hospitals UZ Leuven, Leuven, Belgium
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, University of Leuven, Leuven, Belgium,
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11
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Blanco S, Sanromán L, Pérez-Calvo S, Velasco L, Peñacoba C. Olfactory and cognitive functioning in patients with fibromyalgia. PSYCHOL HEALTH MED 2018; 24:530-541. [PMID: 30453770 DOI: 10.1080/13548506.2018.1549741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Fibromyalgia is a complex syndrome characterized by chronic musculoskeletal pain. Previous research has found impaired olfactory function and cognitive deficits in patients with fibromyalgia. In non-clinical population (middle-aged and elderly populations) an association has been found between olfactory function and cognitive impairment. Therefore, olfactory impairment identification could be considered as a reliable and early marker predicting the decline of cognitive function in mild cognitive impairment, Alzheimer's disease and Parkinson's disease. Nevertheless, the relationship between cognitive and olfactory functioning has not been studied in fibromyalgia patients. The aims of the study have been to analyze the cognitive and olfactory functioning and their association in a sample of women with fibromyalgia in comparison to women without a chronic pain disease. A transversal study was conducted with fibromyalgia patients (n = 146) and women without a chronic pain disease (n = 122). Data were collected using the WAIS-III (cognitive functioning) and the CCCRC test (olfactory functioning). Descriptive analysis, Student's t test and chi-square tests were conducted. There were significant differences in perceptive organization and processing speed, and in odour identification, odour threshold and total CCCRC score; the lower scores were for fibromyalgia patients. Among the fibromyalgia patients there were significant differences in the verbal scale, the manipulative scale, the total scale and processing speed between normosmic and hyposmic patients, the lowest scores were for hyposmic patients. Although previous literature has shown that self-reports by fibromyalgia patients inform about an enhanced olfactory acuity, the current study suggests that there are deficits in olfactory functioning in these patients. Also, the relationship between olfactory and cognitive functioning in fibromyalgia patients, due to the lack of previous studies, suggests a new line of research. Taken together, these results suggest that olfactory functioning could be included in a bio-psycho-social approach of fibromyalgia patients, because of the association with cognitive functioning.
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Affiliation(s)
- Sheila Blanco
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
| | - Lucía Sanromán
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
| | - Soledad Pérez-Calvo
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
| | - Lilian Velasco
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
| | - Cecilia Peñacoba
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
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Bombini MF, Peres FA, Lapa AT, Sinicato NA, Quental BR, Pincelli ÁDSM, Amaral TN, Gomes CC, Del Rio AP, Marques-Neto JF, Costallat LTL, Fernandes PT, Cendes F, Rittner L, Appenzeller S. Olfactory function in systemic lupus erythematosus and systemic sclerosis. A longitudinal study and review of the literature. Autoimmun Rev 2018; 17:405-412. [PMID: 29444467 DOI: 10.1016/j.autrev.2018.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE To evaluate olfactory function in systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and healthy controls over a 2-year period, and to determine the association of olfactory dysfunction with age, disease activity, disease damage, treatment, anxiety and depression symptoms and limbic structures volumes. METHODS Consecutive SLE and SSc patients were enrolled in this study. Clinical, laboratory disease activity and damage were assessed according to diseases specific guidelines. Olfactory functions were evaluated using the Sniffin' Sticks test (TDI). Volumetric magnetic resonance imaging (MRI) was obtained in a 3T Phillips scanner. Amygdalae and hippocampi volumes were analyzed using FreeSurfer® software. RESULTS We included 143 SLE, 57 SSc and 166 healthy volunteers. Olfactory dysfunction was observed in 78 (54.5%) SLE, 35 (59.3%) SSc patients and in 24 (14.45%) controls (p<0.001) at study entry. SLE and SSc patients had significantly lower mean in all three phases (TDI) of the olfactory assessment when compared with healthy volunteers. In SLE, the presence of olfactory dysfunction was associated with older age, disease activity, higher anxiety and depression symptoms score, smaller left hippocampus volume, smaller left and right amygdalae volume and the presence of anti-ribosomal P (anti-P) antibodies. In SSc the presence of olfactory impairment was associated with older age, disease activity, smaller left and right hippocampi volumes and smaller right amygdala volume. Olfactory function was repeated after a 2-year period in 90 SLE, 35 SSc and 62 controls and was stable in all three groups. CONCLUSION Both SLE and SSc patients with longstanding disease had significant reduction in all stages of TDI that maintained stable over a 2-year period. Olfactory dysfunction was associated with age, inflammation and hippocampi and amygdalae volumes. In SLE, additional association with anti-P, anxiety and depression symptoms was observed.
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Affiliation(s)
- Mariana Freschi Bombini
- Physiopathology Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil
| | - Fernando Augusto Peres
- Medicine Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil
| | - Aline Tamires Lapa
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Child and Adolescent Health Graduate Program, School of Medical Sciences, University of Campinas, Brazil
| | - Nailú Angélica Sinicato
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Child and Adolescent Health Graduate Program, School of Medical Sciences, University of Campinas, Brazil
| | - Beatriz Ricato Quental
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil
| | - Ágatha de Souza Melo Pincelli
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil
| | - Tiago Nardi Amaral
- Medicine Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil
| | | | - Ana Paula Del Rio
- Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil
| | | | - Lilian T L Costallat
- Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil
| | | | - Fernando Cendes
- Medical Imaging Computing Laboratory, School of Electrical and Computer Engineering, University of Campinas, Brazil
| | - Leticia Rittner
- Department of Neurology, School of Medical Sciences, University of Campinas, Brazil
| | - Simone Appenzeller
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil.
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Decreased olfactory bulb volumes in patients with fibromyalgia syndrome. Clin Rheumatol 2017; 36:2821-2824. [PMID: 28744789 DOI: 10.1007/s10067-017-3772-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/11/2017] [Accepted: 07/18/2017] [Indexed: 12/29/2022]
Abstract
Among the other symptoms, impaired olfactory function such as odor identification, threshold, and discrimination have been reported in patients with fibromyalgia syndrome (FMS). To investigate olfactory bulb (OB) volumes in FMS, by using magnetic resonance imaging (MRI), and to make reasonable suggestions are the goals of the present study. The study included 62 individuals as the FMS group (n = 30) and the control group (n = 32). MRI examinations were performed by a 1.5-T scanner and a standard head coil was used for the images. The coronal T2-weighted images were used for to measure OB volumes. Right, left, and total OB volumes were calculated with the aid of these images. The mean age of the FMS group was 44.2 ± 8.3 years and the control group was 41.7 ± 3.53 years. The mean volume of the right OB was 74.9 ± 12.4 mm3 in the FMS group and was 92.6 ± 12.9 mm3 in the control group. The mean value of the left OB volume was 74.3 ± 10.8 mm3 in the FMS group and 92.8 ± 12.6 mm3 in the control group. The mean of the total OB volume was 146.6 ± 20.81 mm3 in the FMS group and 186.5 ± 23.5 mm3 in the control group. Left, right, and total OB volumes were significantly lower in the FMS group than in the control group (all p < 0.05). Female patients with FMS are under the risk of the decreased olfactory bulb volumes. This situation should be kept in mind for proper and reasonable management of this tough syndrome.
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Rosenthal E, Versini M, Jeandel PY, Shoenfeld Y. Introduction to the special issue on the 9th International Congress on Autoimmunity. Immunol Res 2015; 60:153-5. [PMID: 25420963 DOI: 10.1007/s12026-014-8605-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Eric Rosenthal
- Department of Internal Medicine, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia Antipolis, 06200, Nice, France,
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