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De Schoenmacker I, Costa Marques D, Scheuren PS, Lütolf R, Gorrell LM, Mehli SC, Curt A, Rosner J, Hubli M. Novel neurophysiological evidence for preserved pain habituation across chronic pain conditions. Clin Neurophysiol 2024; 166:31-42. [PMID: 39094528 DOI: 10.1016/j.clinph.2024.07.007] [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: 09/01/2023] [Revised: 03/26/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The present study aimed to investigate whether subjective and objective measures of pain habituation can be used as potential markers for central sensitization across various chronic pain patients. METHODS Two blocks of contact-heat stimuli were applied to a non-painful area in 93 chronic pain patients (low back pain, neuropathic pain, and complex regional pain syndrome) and 60 healthy controls (HC). Habituation of pain ratings, contact-heat evoked potentials (CHEP), and sympathetic skin responses (SSR) was measured. RESULTS There was no significant difference in any measure of pain habituation between patients and HC. Even patients with apparent clinical signs of central sensitization showed no reduced pain habituation. However, prolonged baseline CHEP and SSR latencies (stimulation block 1) were found in patients compared to HC (CHEP: Δ-latency = 23 ms, p = 0.012; SSR: Δ-latency = 100 ms, p = 0.022). CONCLUSION Given the performed multimodal neurophysiological testing protocol, we provide evidence indicating that pain habituation may be preserved in patients with chronic pain and thereby be of limited use as a sensitive marker for central sensitization. These results are discussed within the framework of the complex interactions between pro- and antinociceptive mechanism as well as methodological issues. The prolonged latencies of CHEP and SSR after stimulation in non-painful areas may indicate subclinical changes in the integrity of thermo-nociceptive afferents, or a shift towards antinociceptive activity. This shift could potentially affect the relay of ascending signals. SIGNIFICANCE Our findings challenge the prevailing views in the literature and may encourage further investigations into the peripheral and central components of pain habituation, using advanced multimodal neurophysiological techniques.
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Affiliation(s)
- Iara De Schoenmacker
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.
| | - David Costa Marques
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Paulina S Scheuren
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Robin Lütolf
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lindsay M Gorrell
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Switzerland
| | - Sarah C Mehli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- 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; Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Allmendinger F, Scheuren PS, De Schoenmacker I, Brunner F, Rosner J, Curt A, Hubli M. Contact-Heat Evoked Potentials: Insights into Pain Processing in CRPS Type I. J Pain Res 2024; 17:989-1003. [PMID: 38505501 PMCID: PMC10949273 DOI: 10.2147/jpr.s436645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose The pathophysiological mechanisms underlying the development of chronic pain in complex regional pain syndrome (CRPS) are diverse and involve both peripheral and central changes in pain processing, such as sensitization of the nociceptive system. The aim of this study was to objectively distinguish the specific changes occurring at both peripheral and central levels in nociceptive processing in individuals with chronic CRPS type I. Patients and Methods Nineteen individuals with chronic CRPS type I and 16 age- and sex-matched healthy controls (HC) were recruited. All individuals underwent a clinical examination and pain assessment in the most painful limb, the contralateral limb, and a pain-free control area to distinguish between peripheral and central mechanisms. Contact-heat evoked potentials (CHEPs) were recorded after heat stimulation of the three different areas and amplitudes and latencies were analyzed. Additionally, quantitative sensory testing (QST) was performed in all three areas. Results Compared to HC, CHEP amplitudes in CRPS were only increased after stimulation of the painful area (p=0.025), while no increases were observed for the pain-free control area (p=0.14). None of the CHEP latencies were different between the two cohorts (all p>0.23). Furthermore, individuals with CRPS showed higher pain ratings after stimulation of the painful limb compared to their contralateral limb (p=0.013). Lastly, compared to HC, mechanical (p=0.012) and thermal (p=0.046) sensitivity was higher in the painful area of the CRPS cohort. Conclusion This study provides neurophysiological evidence supporting an intact thermo-nociceptive pathway with signs of peripheral sensitization, such as hyperexcitable primary afferent nociceptors, in individuals with CRPS type I. This is further supported by the observation of mechanical and thermal gain of sensation only in the painful limb. Additionally, the increased CHEP amplitudes might be related to fear-induced alterations of nociceptive processing.
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Affiliation(s)
- Florin Allmendinger
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Paulina Simonne Scheuren
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Iara De Schoenmacker
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, 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
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - 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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Rodríguez-Domínguez ÁJ, Rebollo-Salas M, Chillón-Martínez R, Rosales-Tristancho A, Jiménez-Rejano JJ. Clinical relevance of resistance training in women with fibromyalgia: A systematic review and meta-analysis. Eur J Pain 2024; 28:21-36. [PMID: 37458315 DOI: 10.1002/ejp.2161] [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: 11/15/2022] [Revised: 05/28/2023] [Accepted: 07/05/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND AND OBJECTIVE There has been an increase in the number of papers assessing the effects of resistance training (RT) in patients with fibromyalgia. Therefore, the objective of our study was to evaluate the clinical relevance and effectiveness of RT for pain intensity, functionality and severity of the disease specifically in women with fibromyalgia through a systematic review with meta-analysis. DATABASES AND DATA TREATMENT Seven databases were searched. Randomized controlled trials conducted in women over 18 years of age with fibromyalgia were included. Fifteen trials were included in the systematic review and 14 of these studies were included in the three meta-analyses performed. Study quality assessment was performed using the PEDro scale. In addition, the GRADE recommendations were used. RESULTS The global meta-analysis revealed statistically significant differences in the RT group versus the control group on pain intensity (SMD = -0.49; 95% CI [-0.74, -0.24], p = 0.0001), functionality (SMD = -0.23; 95% CI [0.01, 0.45], p = 0.04) and on severity of the disease (SMD = -0.58; 95% CI [-0.90, -0.26], p = 0.0005). Clinically relevant improvements in the overall outcome of the three variables studied in favour of RT were obtained. CONCLUSIONS RT is effective to improve pain intensity, functionality and severity of the disease in women with fibromyalgia. These improvements are clinically relevant. More clinical trials of RT are needed in women with fibromyalgia to support our results due to the low strength of evidence. SIGNIFICANCE This systematic review with meta-analysis provides evidence that RT produces clinically relevant improvements in women with fibromyalgia. The absence of immediate benefit is often a major barrier to adherence to treatment. Our findings will help clinicians to empower patients that if they continue treatment, they will achieve improvement in their disease.
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Devigili G, Di Stefano G, Donadio V, Frattale I, Mantovani E, Nolano M, Occhipinti G, Provitera V, Quitadamo S, Tamburin S, Toscano A, Tozza S, Truini A, Valeriani M, de Tommaso M. Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group. Neurol Sci 2023:10.1007/s10072-023-06836-3. [PMID: 37222872 DOI: 10.1007/s10072-023-06836-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/25/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia. AIM The aim of this position statement on behalf of the Neuropathic Pain Study Group of the Italian Society of Neurology is to give practical guidelines for the clinical and instrumental assessment of fibromyalgia (FM) in the neurological clinical practice, taking into consideration recent studies. METHODS Criteria for study selection and consideration were original studies, case-controls design, use of standardized methodologies for clinical practice, and FM diagnosis with ACR criteria (2010, 2011, 2016). RESULTS ACR criteria were revised. For diagnostic procedure of small-fiber pathology, 47 studies were totally considered. Recent diagnostic criteria should be applied (ACR, 2016). A rheumatologic visit seems mandatory. The involvement of small fibers should request at least 2 among HRV + SSR and/or laser-evoked responses and/or skin biopsy and/or corneal confocal microscopy, eventually followed by monitoring of metabolic and/or immunological/ and or/paraneoplastic basis, to be repeated at 1-year follow-up. CONCLUSIONS The correct diagnostic approach to FM could promote the exclusion of the known causes of small-fiber impairment. The research toward common genetic factors would be useful to promote a more specific therapeutic approach.
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Affiliation(s)
- G Devigili
- UOC Neurologia IIRCCS Carlo Besta, Milan, Italy
| | - G Di Stefano
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - V Donadio
- Clinica Neurologica Bellaria Hospital, Bologna, Italy
| | - I Frattale
- Child Neurology and Psychiatric Unit, Tor Vergata University, Rome, Italy
| | - E Mantovani
- Neurosciences, Biomedicine and Movement Sciences Department, Verona University, Verona, Italy
| | - M Nolano
- Skin Biopsy Laboratory, Department of Neurology, Instituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, 80100, Naples, Italy
| | - G Occhipinti
- UOC Neurologia E Malattie Neuromuscolari, AUO Martino Messina, Messina, Italy
| | - V Provitera
- Skin Biopsy Laboratory, Department of Neurology, Instituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
| | - S Quitadamo
- Neurophysiopathology Unit, DiBraiN Department, Policlinico General Hospital, Bari Aldo Moro University, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - S Tamburin
- Neurosciences, Biomedicine and Movement Sciences Department, Verona University, Verona, Italy
| | - A Toscano
- EURO-ERN NMD, AOU Martino University of Messina, Messina, Italy
| | - S Tozza
- UOC Neurologia E Malattie Neuromuscolari, AUO Martino Messina, Messina, Italy
| | - A Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - M Valeriani
- Developmental Neurology Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - M de Tommaso
- Neurophysiopathology Unit, DiBraiN Department, Policlinico General Hospital, Bari Aldo Moro University, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
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Holman A, Parikh N, Clauw DJ, Williams DA, Tapper EB. Contemporary management of pain in cirrhosis: Toward precision therapy for pain. Hepatology 2023; 77:290-304. [PMID: 35665522 PMCID: PMC9970025 DOI: 10.1002/hep.32598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/03/2023]
Abstract
Chronic pain is highly prevalent in patients with cirrhosis and is associated with poor health-related quality of life and poor functional status. However, there is limited guidance on appropriate pain management in this population, and pharmacologic treatment can be harmful, leading to adverse outcomes, such as gastrointestinal bleeding, renal injury, falls, and hepatic encephalopathy. Chronic pain can be categorized mechanistically into three pain types: nociceptive, neuropathic, and nociplastic, each responsive to different therapies. By discussing the identification, etiology, and treatment of these three mechanistic pain descriptors with a focus on specific challenges in patients with cirrhosis, we provide a framework for better tailoring treatments, including nonpharmacologic therapies, to patients' needs.
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Affiliation(s)
- Alexis Holman
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Neehar Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dan J. Clauw
- Chronic Pain and Fatigue Research Center, Anesthesiology Department, University of Michigan, Ann Arbor, Michigan, USA
| | - David A. Williams
- Chronic Pain and Fatigue Research Center, Anesthesiology Department, University of Michigan, Ann Arbor, Michigan, USA
| | - Elliot B. Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
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Barjola P, Peláez I, Ferrera D, González-Gutiérrez JL, Velasco L, Peñacoba-Puente C, López-López A, Fernandes-Magalhaes R, Mercado F. Electrophysiological indices of pain expectation abnormalities in fibromyalgia patients. Front Hum Neurosci 2022; 16:943976. [PMID: 36248693 PMCID: PMC9562711 DOI: 10.3389/fnhum.2022.943976] [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: 05/14/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Fibromyalgia is a chronic pain syndrome characterized by dysfunctional processing of nociceptive stimulation. Neuroimaging studies have pointed out that pain-related network functioning seems to be altered in these patients. It is thought that this clinical symptomatology may be maintained or even strengthened because of an enhanced expectancy for painful stimuli or its forthcoming appearance. However, neural electrophysiological correlates associated with such attentional mechanisms have been scarcely explored. In the current study, expectancy processes of upcoming laser stimulation (painful and non-painful) and its further processing were explored by event-related potentials (ERPs). Nineteen fibromyalgia patients and twenty healthy control volunteers took part in the experiment. Behavioral measures (reaction times and subjective pain perception) were also collected. We manipulated the pain/no pain expectancy through an S1–S2 paradigm (cue-target). S1 (image: triangle or square) predicted the S2 appearance (laser stimulation: warmth or pinprick sensation). Laser stimuli were delivered using a CO2 laser device. Temporal and spatial principal component analyses were employed to define and quantify the ERP component reliability. Statistical analyses revealed the existence of an abnormal pattern of pain expectancy in patients with fibromyalgia. Specifically, our results showed attenuated amplitudes at posterior lCNV component in anticipation of painful stimulation that was not found in healthy participants. In contrast, although larger P2 amplitudes to painful compared to innocuous events were shown, patients did not show any amplitude change in this laser-evoked response as a function of pain predictive cues (as occurred in the healthy control group). Additionally, analyses of the subjective perception of pain and reaction time indicated that laser stimuli preceded by pain cues were rated as more painful than those signaling non-pain expectancy and were associated with faster responses. Differences between groups were not found. The present findings suggest the presence of dysfunction in pain expectation mechanisms in fibromyalgia that eventually may make it difficult for patients to correctly interpret signs that prevent pain symptoms. Furthermore, the abnormal pattern in pain expectancy displayed by fibromyalgia patients could result in ineffective pain coping strategies. Understanding the neural correlates of pain processing and its modulatory factors is crucial to identify treatments for chronic pain syndromes.
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Lepping RJ, McMillan ML, Chadwick AL, Mansour ZM, Martin LE, Gustafson KM. Autonomic nervous system markers of music-elicited analgesia in people with fibromyalgia: A double-blind randomized pilot study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:953118. [PMID: 36185772 PMCID: PMC9521378 DOI: 10.3389/fpain.2022.953118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 01/02/2023]
Abstract
Purpose To investigate the feasibility of using music listening by adults with fibromyalgia (FM) as a potential tool for reducing pain sensitivity. Patients and methods We report results from a double-blind two-arm parallel randomized pilot study (NCT04059042) in nine participants with FM. Pain tolerance and threshold were measured objectively using quantitative sensory tests; autonomic nervous system (ANS) reactivity was measured with an electrocardiogram. Participants were randomized to listen to instrumental Western Classical music or a nature sound control to test whether music listening elicits greater analgesic effects over simple auditory distraction. Participants also completed separate control testing with no sound that was counterbalanced between participants. Results Participants were randomized 1:1 to music or nature sounds (four Music and five Nature). Although the groups were not different on FM scores, the Music group had marginally worse temporal pain summation (p = 0.06), and the Nature group had higher anxiety scores (p < 0.05). Outcome measures showed a significant difference between groups in the magnitude of change in temporal summation between sessions (p < 0.05), revealing that the Nature group had greater pain reduction during audio compared to silence mode, while the Music group had no difference between the sessions. No significant effects were observed for either mechanical pain tolerance or ANS testing. Within the Music group, there was a trend of vagal response increase from baseline to music listening, but it did not reach statistical significance; this pattern was not observed in the Nature group. Conclusion Auditory listening significantly altered pain responses. There may be a greater vagal response to music vs. nature sounds; however, results could be due to group differences in pain and anxiety. This line of study will help in determining whether music could be prophylactic for people with FM when acute pain is expected.
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Affiliation(s)
- Rebecca J. Lepping
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,*Correspondence: Rebecca J. Lepping
| | - Miranda L. McMillan
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Andrea L. Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Zaid M. Mansour
- Department of Physical and Occupational Therapy, The Hashemite University, Zarqa, Jordan
| | - Laura E. Martin
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States,Department for McMillan and Chadwick, Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, United States
| | - Kathleen M. Gustafson
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
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Galosi E, Truini A, Di Stefano G. A Systematic Review and Meta-Analysis of the Prevalence of Small Fibre Impairment in Patients with Fibromyalgia. Diagnostics (Basel) 2022; 12:diagnostics12051135. [PMID: 35626288 PMCID: PMC9139885 DOI: 10.3390/diagnostics12051135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 12/30/2022] Open
Abstract
Converging evidence shows that patients with fibromyalgia syndrome have signs of small fibre impairment, possibly leading to pain and autonomic symptoms, with a frequency that has not yet been systematically evaluated. To fill this gap, our review aims to define the frequency of somatic and autonomic small fibre damage in patients with fibromyalgia syndrome, as assessed by objective small fibre-related testing. We found 360 articles on somatic and autonomic small fibre assessment in patients with fibromyalgia. Out of the 88 articles assessed for eligibility, 20 were included in the meta-analysis, involving 903 patients with fibromyalgia. The estimated prevalence of somatic small fibre impairment, as assessed with skin biopsy, corneal confocal microscopy, and microneurography, was 49% (95% confidence interval (CI): 39–60%, I2 = 89%), whereas the estimated prevalence of autonomic small fibre impairment, as assessed with heart rate variability, sympathetic skin response, skin conductance, and tilt testing, was 45% (95% CI: 25–65%, I2 = 91%). Our study shows that a considerable proportion of patients with fibromyalgia have somatic and autonomic small fibre impairment, as assessed by extensive small fibre-related testing. Nevertheless, the heterogeneity and inconsistencies across studies challenge the exact role of small fibre impairment in fibromyalgia symptoms.
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The puzzle of fibromyalgia between central sensitization syndrome and small fiber neuropathy: a narrative review on neurophysiological and morphological evidence. Neurol Sci 2022; 43:1667-1684. [PMID: 35028777 DOI: 10.1007/s10072-021-05806-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/03/2021] [Indexed: 12/11/2022]
Abstract
Fibromyalgia (FM) is a condition characterized by chronic widespread pain whose pathogenesis is still not fully defined. Evidence based on structural and functional neuroimaging methods, electrophysiological, and morphological - skin biopsy - features demonstrated a central and peripheral nervous system involvement. A dysfunction in nociceptive inputs processing at the central level was highlighted as the primary cause of FM, but other data coming from different laboratories contributed to emphasize again the peripheral origin of FM. In fact, small fibers neuropathy (SFN) was observed in a large number of patients submitted to skin biopsy. The complex interaction between central and peripheral factors is opening a new scenario about the management of this neurological disorder. Whether proximal SFN is an initiating event leading to FM or is the consequence of stress-related insular hyper excitability remains unclear. Mild sufferance of peripheral afferents could function as a trigger for an exaggerated response of the so-called "salience matrix" in predisposed individuals. On the other side, the intriguing hypothesis rising from animal models could indicate that the cortical hyper function could cause peripheral small afferent damage. The research should go on the genetic origin of such peripheral and central abnormalities, the acquired facilitating factors, and the presence of different phenotypes in order to search for efficacious treatments, which are still lacking.
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Vecchio E, Giovanna Quitadamo S, Ricci K, Libro G, Delussi M, Lombardi R, Lauria G, de Tommaso M. Laser evoked potentials in fibromyalgia with peripheral small fiber involvement. Clin Neurophysiol 2022; 135:96-106. [DOI: 10.1016/j.clinph.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 12/16/2022]
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Castelo-Branco L, Cardenas-Rojas A, Pacheco-Barrios K, Teixeira PEP, Gonzalez-Mego P, Vasquez-Avila K, Cortez PC, Marduy A, Rebello-Sanchez I, Parente J, Marzouk S, Fregni F. Can neural markers be used for fibromyalgia clinical management? PRINCIPLES AND PRACTICE OF CLINICAL RESEARCH (2015) 2022; 8:28-33. [PMID: 35677778 PMCID: PMC9172964 DOI: 10.21801/ppcrj.2022.81.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru. La Fontana 550, La Molina – Peru 15024
| | - Paulo E. P. Teixeira
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
- MGH Institute of Health Professions, 36 1st Ave, Boston, MA 02129, USA
| | - Paola Gonzalez-Mego
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
| | - Karen Vasquez-Avila
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
| | - Pablo Costa Cortez
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
- Instituto de Ciencias Biologicas, Departamento de Imunologia Basica e Aplicada. Av. General Rodrigo Octavio Jordão Ramos, 1200 - Coroado I, Manaus - AM, Brazil- 69067-005
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
| | - Ingrid Rebello-Sanchez
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
| | - Joao Parente
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
| | | | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 79/96 13th Street, Charlestown – MA 02129
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Augière T, Desjardins A, Paquette Raynard E, Brun C, Pinard AM, Simoneau M, Mercier C. Tactile Detection in Fibromyalgia: A Systematic Review and a Meta-Analysis. FRONTIERS IN PAIN RESEARCH 2021; 2:740897. [PMID: 35295451 PMCID: PMC8915638 DOI: 10.3389/fpain.2021.740897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Fibromyalgia is a chronic pain syndrome characterized by sensorimotor deficits and distortions of body representation, that could both be caused by alterations in sensory processing. Several studies suggest a hypersensitivity to various sensory stimulations in fibromyalgia but results on detection of both noxious and non-noxious tactile stimulation, which are particularly relevant for body representation and motor control, remain conflicting. Therefore, the aim of this study is to systematically review and quantify the detection thresholds to noxious and non-noxious tactile stimuli in individuals with fibromyalgia compared to pain-free controls. A systematic review and a meta-analysis were performed in the MEDLINE, EMBASE, CINAHL, Cochrane, PsycInfo and Web of Science databases using keywords related to fibromyalgia, tactile pain detection threshold, tactile detection threshold and quantitative sensory testing. Nineteen studies were included in the review, with 12 in the meta-analysis. Despite the heterogeneity of the results, the data from both the review and from the meta-analysis suggest a trend toward hyperalgesia and no difference of sensitivity to non-noxious tactile stimuli in participants with fibromyalgia compared to healthy controls. This contradicts the hypothesis of a general increase in responsiveness of the central nervous system to noxious and non-noxious stimulations in fibromyalgia. This study shows no alteration of the sensitivity to non-noxious tactile stimulation in fibromyalgia, suggesting that an altered unimodal processing is not sufficient to explain symptoms such as sensorimotor impairments and body representation distortions. Future research should investigate whether alterations in multisensory integration could contribute to these symptoms.
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Affiliation(s)
- Tania Augière
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Audrey Desjardins
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Martin Simoneau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
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13
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Montoro CI, Winterholler C, Terrasa JL, Montoya P. Somatosensory Gating Is Modulated by Anodal Transcranial Direct Current Stimulation. Front Neurosci 2021; 15:651253. [PMID: 34557064 PMCID: PMC8452934 DOI: 10.3389/fnins.2021.651253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Anodal transcranial direct current stimulation (tDCS) of the somatosensory cortex causes cerebral hyperexcitability and a significant enhancement in pain thresholds and tactile spatial acuity. Sensory gating is a brain mechanism to suppress irrelevant incoming inputs, which is elicited by presenting pairs of identical stimuli (S1 and S2) within short time intervals between stimuli (e.g., 500 ms). Objectives/Hypothesis The present study addressed the question of whether tDCS could modulate the brain correlates of this inhibitory mechanism. Methods Forty-one healthy individuals aged 18–26 years participated in the study and were randomly assigned to tDCS (n = 21) or SHAM (n = 20). Somatosensory evoked potentials (SEP) elicited by S1 and S2 pneumatic stimuli (duration of 100 ms, ISI 550 ± 50 ms) and applied to the index finger of the dominant hand were recorded before and after tDCS. Results Before the intervention, the second tactile stimuli significantly attenuated the amplitudes of P50, N100, and the late positive complex (LPC, mean amplitude in the time window 150–350) compared to the first stimuli. This confirmed that sensory gating is a widespread brain inhibitory mechanism that can affect early- and middle-latency components of SEPs. Furthermore, our data revealed that this response attenuation or sensory gating (computed as S1 minus S2) was improved after tDCS for LPC, while no changes were found in participants who received SHAM. Conclusion All these findings suggested that anodal tDCS might modulate brain excitability leading to an enhancement of inhibitory mechanisms elicited in response to repetitive somatosensory stimuli during late stages of information processing.
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Affiliation(s)
- Casandra I Montoro
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Christine Winterholler
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS), Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
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14
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Lenoir D, Willaert W, Coppieters I, Malfliet A, Ickmans K, Nijs J, Vonck K, Meeus M, Cagnie B. Electroencephalography During Nociceptive Stimulation in Chronic Pain Patients: A Systematic Review. PAIN MEDICINE 2021; 21:3413-3427. [PMID: 32488229 DOI: 10.1093/pm/pnaa131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With its high temporal resolution, electroencephalography (EEG), a technique that records electrical activity of cortical neuronal cells, is a potentially suitable technique to investigate human somatosensory processing. By using EEG, the processing of (nociceptive) stimuli can be investigated, along with the functionality of the nociceptive pathway. Therefore, it can be applied in chronic pain patients to objectify whether changes have occurred in nociceptive processing. Typically, so-called event-related potential (ERP) recordings are used, where EEG signals are recorded in response to specific stimuli and characterized by latency and amplitude. OBJECTIVE To summarize whether differences in somatosensory processing occur between chronic pain patients and healthy controls, measured with ERPs, and determine whether this response is related to the subjective pain intensity. DESIGN Systematic review. SETTING AND METHODS PubMed, Web of Science, and Embase were consulted, and 18 case-control studies were finally included. SUBJECTS The chronic pain patients suffered from tension-type headache, back pain, migraine, fibromyalgia, carpal tunnel syndrome, prostatitis, or complex regional pain syndrome. RESULTS Chronic neuropathic pain patients showed increased latencies of the N2 and P2 components, along with a decreased amplitude of the N2-P2 complex, which was also obtained in FM patients with small fiber dysfunction. The latter also showed a decreased amplitude of the N2-P3 and N1-P1 complex. For the other chronic pain patients, the latencies and the amplitudes of the ERP components did not seem to differ from healthy controls. One paper indicated that the N2-P3 peak-to-peak amplitude correlates with the subjective experience of the stimulus. CONCLUSIONS Differences in ERPs with healthy controls can mostly be found in chronic pain populations that suffer from neuropathic pain or where fiber dysfunction is present. In chronic pain populations with other etiological mechanisms, limited differences were found or agreed upon across studies.
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Affiliation(s)
- Dorine Lenoir
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Ward Willaert
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Kelly Ickmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Kristl Vonck
- Department of Neurology, 4Brain, Ghent University Hospital, Ghent, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy - MOVANT Research Group, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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15
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Munk A, Reme SE, Jacobsen HB. What Does CATS Have to Do With Cancer? The Cognitive Activation Theory of Stress (CATS) Forms the SURGE Model of Chronic Post-surgical Pain in Women With Breast Cancer. Front Psychol 2021; 12:630422. [PMID: 33833718 PMCID: PMC8023326 DOI: 10.3389/fpsyg.2021.630422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/01/2021] [Indexed: 01/25/2023] Open
Abstract
Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery. While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of response outcome expectancies in the development of CPSP following breast cancer surgery. We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes. Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior - potentially driving and maintaining CPSP. Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer.
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Affiliation(s)
- Alice Munk
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Silje Endresen Reme
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Henrik Børsting Jacobsen
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
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16
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Rehm S, Sachau J, Hellriegel J, Forstenpointner J, Børsting Jacobsen H, Harten P, Gierthmühlen J, Baron R. Pain matters for central sensitization: sensory and psychological parameters in patients with fibromyalgia syndrome. Pain Rep 2021; 6:e901. [PMID: 33718743 PMCID: PMC7952123 DOI: 10.1097/pr9.0000000000000901] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/11/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022] Open
Abstract
Sensory abnormalities through quantitative sensory testing in fibromyalgia were not substantially influenced by psychological comorbidities. A significant subgroup showed signs of central sensitization, influenced by pain intensity. Introduction: Patients suffering from fibromyalgia syndrome (FMS) are heterogenous. They often present with sensory abnormalities and comorbidities. Objectives: We aimed to answer the following questions: (1) Is there a specific somatosensory profile in our patient cohort? (2) Can we detect subgroups characterized by a specific combination of sensory and psychological features? and (3) Do psychological parameters influence sensory signs? Methods: In 87 patients with FMS quantitative sensory testing was performed on the hand and evaluated in combination with questionnaire results regarding pain, psychological comorbidities, sleep, and functionality. Results: Patients presented different somatosensory patterns, but no specific subgroups regarding sensory signs and psychological features were detected. Hypersensitivity for noxious mechanical and thermal stimuli and hyposensitivity for nonnoxious mechanical stimuli were the most prominent features. Thirty-one percent of patients showed signs of central sensitization as indicated by abnormally increased pinprick hyperalgesia or dynamic mechanical allodynia. Central sensitization was associated with higher pain intensities (P < 0.001). Only a small influence of psychiatric comorbidities on mechanical pain sensitivity (P = 0.044) and vibration detection (P = 0.028) was found, which was partly associated with high pain intensities. A small subgroup of patients (11.4%) demonstrated thermal hyposensitivity (loss of small-fiber function). Conclusion: Patients with FMS showed various somatosensory abnormalities. These were not significantly influenced by psychological comorbidities. Signs for central sensitization were detected in about one-third of patients and associated with higher pain intensities. This supports the notion of central sensitization being a major pathophysiological mechanism in FMS, whereas small-fiber loss may be less important.
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Affiliation(s)
- Stefanie Rehm
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Jana Hellriegel
- Division of Psychiatry, Imland Klinik Rendsburg, Rendsburg, Germany
| | - Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.,Department of Anesthesia, Critical Care and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Mind-Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Janne Gierthmühlen
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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17
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Samartin-Veiga N, González-Villar AJ, Triñanes Y, Gómez-Perretta C, Carrillo-de-la-Peña MT. Effects of intensity, attention and medication on auditory-evoked potentials in patients with fibromyalgia. Sci Rep 2020; 10:21904. [PMID: 33318554 PMCID: PMC7736365 DOI: 10.1038/s41598-020-78377-0] [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: 05/06/2020] [Accepted: 11/12/2020] [Indexed: 11/09/2022] Open
Abstract
Fibromyalgia (FM) has been associated to an increased processing of somatosensory stimuli, but its generalization to other sensory modalities is under discussion. To clarify this, we studied auditory event-related potentials (AEPs) to stimuli of different intensity in patients with FM and healthy controls (HCs), considering the effects of attention mechanisms and medication. We performed two experiments: In study 1 (n = 50 FM, 60 HCs), the stimuli were presented randomly within the sequence; in study 2 (n = 28 FM, 30 HCs), they were presented in blocks of the same intensity. We analyzed intensity and group effects on N1-P2 amplitude and, only for the FM group, the effect of medication and the correlation between AEPs and clinical variables. Contrary to the expectation, the patients showed a trend of reduced AEPs to the loudest tones (study 1) or no significant differences with the HCs (study 2). Medication with central effects significantly reduced AEPs, while no significant relationships between the N1-P2 amplitude/intensity function and patients’ symptoms were observed. The findings do not provide evidence of augmented auditory processing in FM. Nevertheless, given the observed effect of medication, the role of sensory amplification as an underlying pathophysiological mechanism in fibromyalgia cannot be discarded.
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Affiliation(s)
- N Samartin-Veiga
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - A J González-Villar
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Psychological Neuroscience Lab, Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
| | - Y Triñanes
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - M T Carrillo-de-la-Peña
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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18
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Goudman L, Daenen L, Mouraux A, Nijs J, Cras P, Roussel N, Moens M, Coppieters I, Huysmans E, De Kooning M. Processing of Laser-Evoked Potentials in Patients with Chronic Whiplash-Associated Disorders, Chronic Fatigue Syndrome, and Healthy Controls: A Case-Control Study. PAIN MEDICINE 2020; 21:2553-2563. [PMID: 32289826 DOI: 10.1093/pm/pnaa068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to investigate patients with neuropathic pain, as they can provide an objective account of the functional status of thermo-nociceptive pathways. The goal of this study was to explore the functioning of the nociceptive afferent pathways by examining LEPs in patients with chronic whiplash-associated disorders (cWAD), patients with chronic fatigue syndrome (CFS), and healthy controls (HCs). DESIGN Case-control study. SETTING A single medical center in Belgium. SUBJECTS The LEPs of 21 patients with cWAD, 19 patients with CFS, and 18 HCs were analyzed in this study. METHODS All participants received brief nociceptive CO2 laser stimuli applied to the dorsum of the left hand and left foot while brain activity was recorded with a 32-channel electroencephalogram (EEG). LEP signals and transient power modulations were compared between patient groups and HCs. RESULTS No between-group differences were found for stimulus intensity, which was supraliminal for Aδ fibers. The amplitudes and latencies of LEP wave components N1, N2, and P2 in patients with cWAD and CFS were statistically similar to those of HCs. There were no significant differences between the time-frequency maps of EEG oscillation amplitude between HCs and both patient populations. CONCLUSIONS EEG responses of heat-sensitive Aδ fibers in patients with cWAD and CFS revealed no significant differences from the responses of HCs. These findings thus do not support a state of generalized central nervous system hyperexcitability in those patients.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Liesbeth Daenen
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Knowledge, Information and Research Center (KIR), Group Idewe, Louvain, Belgium
| | - Andre Mouraux
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Patrick Cras
- Laboratory of Neurology, Translational Neurosciences, University of Antwerp, Wilrijk, Belgium.,Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Campus, Drie Eiken, Wilrijk, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Margot De Kooning
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
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19
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González-Villar AJ, Triñanes Y, Gómez-Perretta C, Carrillo-de-la-Peña MT. Patients with fibromyalgia show increased beta connectivity across distant networks and microstates alterations in resting-state electroencephalogram. Neuroimage 2020; 223:117266. [PMID: 32853817 DOI: 10.1016/j.neuroimage.2020.117266] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 01/22/2023] Open
Abstract
Fibromyalgia (FM) is a chronic condition characterized by widespread pain of unknown etiology associated with alterations in the central nervous system. Although previous studies demonstrated altered patterns of brain activity during pain processing in patients with FM, alterations in spontaneous brain oscillations, in terms of functional connectivity or microstates, have been barely explored so far. Here we recorded the EEG from 43 patients with FM and 51 healthy controls during open-eyes resting-state. We analyzed the functional connectivity between different brain networks computing the phase lag index after group Independent Component Analysis, and also performed an EEG microstates analysis. Patients with FM showed increased beta band connectivity between different brain networks and alterations in some microstates parameters (specifically lower occurrence and coverage of microstate class C). We speculate that the observed alterations in spontaneous EEG may suggest the dominance of endogenous top-down influences; this could be related to limited processing of novel external events and the deterioration of flexible behavior and cognitive control frequently reported for FM. These findings provide the first evidence of alterations in long-distance phase connectivity and microstate indices at rest, and represent progress towards the understanding of the pathophysiology of fibromyalgia and the identification of novel biomarkers for its diagnosis.
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Affiliation(s)
- Alberto J González-Villar
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Psychological Neuroscience Lab, Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal.
| | - Yolanda Triñanes
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - María T Carrillo-de-la-Peña
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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20
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Mosch B, Hagena V, Diers M. Bildgebende Untersuchungen des neuronalen
Schmerznetzwerks. AKTUEL RHEUMATOL 2020. [DOI: 10.1055/a-1202-0766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
ZusammenfassungDer vorliegende Artikel soll eine Übersicht über bildgebende
Untersuchungen im Bereich chronischer Schmerzsyndrome bieten. Auf die
einleitenden Worte zur allgemeinen Phänomenologie des Schmerzes
folgt ein umfassender Einblick in die gegenwärtige Anwendung
funktioneller und struktureller Bildgebungstechniken am Beispiel
ausgewählter Schmerzsyndrome (Chronischer Rückenschmerz,
Fibromyalgiesyndrom (FMS), Phantomschmerz und Komplexes regionales
Schmerzsyndrom (CRPS)). In diesem Zusammenhang werden Gemeinsamkeiten und
Besonderheiten der spezifischen neurologischen Korrelate verschiedener
chronischer Schmerzerkrankungen diskutiert.
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Affiliation(s)
- Benjamin Mosch
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL
Universitätsklinikum Bochum der Ruhr-Universität Bochum,
Bochum
| | - Verena Hagena
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL
Universitätsklinikum Bochum der Ruhr-Universität Bochum,
Bochum
| | - Martin Diers
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL
Universitätsklinikum Bochum der Ruhr-Universität Bochum,
Bochum
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21
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Littlejohn G, Guymer E. Key Milestones Contributing to the Understanding of the Mechanisms Underlying Fibromyalgia. Biomedicines 2020; 8:biomedicines8070223. [PMID: 32709082 PMCID: PMC7400313 DOI: 10.3390/biomedicines8070223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 02/07/2023] Open
Abstract
The promulgation of the American College of Rheumatology (ACR) 1990 criteria for fibromyalgia (FM) classification has significantly contributed to an era of increased research into mechanisms that underlie the disorder. The previous emphasis on putative peripheral nociceptive mechanisms has advanced to identifying of changes in central neural networks that modulate pain and other sensory processes. The influences of psychosocial factors on the dynamic and complex neurobiological mechanisms involved in the fibromyalgia clinical phenotype are now better defined. This review highlights key milestones that have directed knowledge concerning the fundamental mechanisms contributing to fibromyalgia.
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Affiliation(s)
- Geoffrey Littlejohn
- Departments of Medicine, Monash University, Melbourne 3168, Australia;
- Departments of Rheumatology, Monash Health, Melbourne 3168, Australia
- Correspondence: ; Tel.: +61-3-95942575
| | - Emma Guymer
- Departments of Medicine, Monash University, Melbourne 3168, Australia;
- Departments of Rheumatology, Monash Health, Melbourne 3168, Australia
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Vecchio E, Lombardi R, Paolini M, Libro G, Delussi M, Ricci K, Quitadamo SG, Gentile E, Girolamo F, Iannone F, Lauria G, de Tommaso M. Peripheral and central nervous system correlates in fibromyalgia. Eur J Pain 2020; 24:1537-1547. [PMID: 32478943 DOI: 10.1002/ejp.1607] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fibromyalgia (FM) is a syndrome characterized by altered pain processing at central and peripheral level, whose pathophysiologic mechanisms remain obscure. We aimed at exploring the structural changes of peripheral nociceptor measured by skin biopsy, the functional changes of central nociceptive pathway assessed by laser-evoked potentials (LEP), and their correlation with clinical features and comorbidities. METHODS In all, 81 patients diagnosed with FM underwent skin biopsies with quantification of intraepidermal nerve fibre density (IENFD) at the thigh and distal leg, and LEP recording by stimulating hand, thigh and foot. Nerve conduction study (NCS), clinical features, comorbidity with migraine and mood disorders, and previous, non-active immune-mediated disorders were recorded. RESULTS Intraepidermal nerve fibre density was reduced in 85% of patients at the thigh and in 12.3% of patients at the distal leg, whereas it was normal in 14.8% of patients. N2P2 habituation index from laser stimulation at the thigh was altered in 97.5% of patients and correlated with reduced IENFD at the thigh. LEP latencies and amplitudes did not differ among groups. No association was found between IENFD, LEP, clinical features and comorbidities. CONCLUSIONS Fibromyalgia patients most commonly showed a mild loss of peripheral nociceptors at the thigh rather than distal small fibre neuropathy. This finding was associated with an altered habituation index and strengthened the hypothesis that central sensitization plays a key role in the pathogenesis of the disease. SIGNIFICANCE Central impairment of pain processing likely underlies FM, which in most patients is associated with mild proximal small fibre pathology.
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Affiliation(s)
- Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, Department of Basic Medical Sciences Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Raffaella Lombardi
- 3rd Neurology Unit and Skin Biopsy, Department of Clinical Neurosciences, Peripheral Neuropathy and Neuropathic Pain Laboratory, IRCCS Foundation, 'Carlo Besta' Neurological Institute, Milan, Italy
| | - Matilde Paolini
- 3rd Neurology Unit and Skin Biopsy, Department of Clinical Neurosciences, Peripheral Neuropathy and Neuropathic Pain Laboratory, IRCCS Foundation, 'Carlo Besta' Neurological Institute, Milan, Italy
| | - Giuseppe Libro
- Applied Neurophysiology and Pain Unit, Department of Basic Medical Sciences Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain Unit, Department of Basic Medical Sciences Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Katia Ricci
- Applied Neurophysiology and Pain Unit, Department of Basic Medical Sciences Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Silvia G Quitadamo
- Applied Neurophysiology and Pain Unit, Department of Basic Medical Sciences Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Eleonora Gentile
- Applied Neurophysiology and Pain Unit, Department of Basic Medical Sciences Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Girolamo
- Unit of Human Anatomy and Histology, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, School of Medicine, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Lauria
- 3rd Neurology Unit and Skin Biopsy, Department of Clinical Neurosciences, Peripheral Neuropathy and Neuropathic Pain Laboratory, IRCCS Foundation, 'Carlo Besta' Neurological Institute, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Department of Basic Medical Sciences Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
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23
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Achenbach J, Tran AT, Jaeger B, Kapitza K, Bernateck M, Karst M. Quantitative Sensory Testing in Patients with Multisomatoform Disorder with Chronic Pain as the Leading Bodily Symptom-a Matched Case-Control Study. PAIN MEDICINE 2020; 21:e54-e61. [PMID: 31578559 DOI: 10.1093/pm/pnz195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Chronic pain is a debilitating condition of multifactorial origin, often without physical findings to explain the presenting symptoms. Of the possible etiologies of persisting painful symptoms, somatoform disorders and functional somatic syndromes (FSS) are among the most challenging, with a prevalence of 8-20%. Many different somatoform disorders and FSS have overlapping symptoms, with pain being the most prevalent one. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We hypothesized that the concept of MSD will be reflected in a distinct sensory profile of patients compared with healthy controls and possibly provide insight into the type and pathophysiology of the pain commonly experienced by patients. DESIGN We performed comprehensive quantitative sensory testing (QST) in 151 patients and 149 matched controls. RESULTS There were significant differences in the sensory profiles of patients compared with controls. Patients with MSD showed a combination of tactile and thermal hypesthesia combined with mechanical and cold hyperalgesia. This was true for measurements at test and control sites, with the exception of vibration detection threshold and mechanical pain threshold. Among the observed changes, a marked sensory loss of function, as evidenced by an increase in cold detection threshold, and a marked gain of function, as evidenced by a decrease of pressure pain threshold, were most notable. There was no evidence of concurrent medication influencing QST results. CONCLUSIONS The observed somatosensory profile of patients with MSD resembles that of patients suffering from neuropathic pain with evidence of central sensitization.
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Affiliation(s)
- Johannes Achenbach
- Department of Anesthesiology and Intensive Care Medicine.,Department of Anesthesiology and Intensive Care Medicine, Pain Clinic
| | | | - Burkhardt Jaeger
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Karl Kapitza
- Asklepios Klinik Nord, Betriebsteil Heidberg, Zentrale Notaufnahme, Hamburg, Germany
| | | | - Matthias Karst
- Department of Anesthesiology and Intensive Care Medicine
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Van Assche DCF, Plaghki L, Masquelier E, Hatem SM. Fibromyalgia syndrome—A laser‐evoked potentials study unsupportive of small nerve fibre involvement. Eur J Pain 2019; 24:448-456. [DOI: 10.1002/ejp.1501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 02/02/2023]
Affiliation(s)
| | - Leon Plaghki
- Institute of Neuroscience Université catholique de Louvain Brussels Belgium
| | - Etienne Masquelier
- Institute of Neuroscience Université catholique de Louvain Brussels Belgium
- Multidisciplinary Pain Center CHU UCL Namur, site Godinne Yvoir Belgium
| | - Samar M. Hatem
- Physical Medicine and Rehabilitation Brugmann University Hospital Brussels Belgium
- Institute of Neuroscience Université catholique de Louvain Brussels Belgium
- Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium
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25
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Castelo-Branco L, Uygur Kucukseymen E, Duarte D, El-Hagrassy MM, Bonin Pinto C, Gunduz ME, Cardenas-Rojas A, Pacheco-Barrios K, Yang Y, Gonzalez-Mego P, Estudillo-Guerra A, Candido-Santos L, Mesia-Toledo I, Rafferty H, Caumo W, Fregni F. Optimised transcranial direct current stimulation (tDCS) for fibromyalgia-targeting the endogenous pain control system: a randomised, double-blind, factorial clinical trial protocol. BMJ Open 2019; 9:e032710. [PMID: 31672712 PMCID: PMC6830717 DOI: 10.1136/bmjopen-2019-032710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Fibromyalgia (FM) is a common debilitating condition with limited therapeutic options. Medications have low efficacy and are often associated with adverse effects. Given that FM is associated with a defective endogenous pain control system and central sensitisation, combining interventions such as transcranial direct current stimulation (tDCS) and aerobic exercise (AE) to modulate pain-processing circuits may enhance pain control. METHODS AND ANALYSIS A prospective, randomised (1:1:1:1), placebo-controlled, double-blind, factorial clinical trial will test the hypothesis that optimised tDCS (16 anodal tDCS sessions combined with AE) can restore of the pain endogenous control system. Participants with FM (n=148) will undergo a conditioning exercise period and be randomly allocated to one of four groups: (1) active tDCS and AE, (2) sham tDCS and AE, (3) active tDCS and non-aerobic exercise (nAE) or (4) sham tDCS and nAE. Pain inhibitory activity will be assessed using conditioned pain modulation (CPM) and temporal slow pain summation (TSPS)-primary outcomes. Secondary outcomes will include the following assessments: Transcranial magnetic stimulation and electroencephalography as cortical markers of pain inhibitory control and thalamocortical circuits; secondary clinical outcomes on pain, FM, quality of life, sleep and depression. Finally, the relationship between the two main mechanistic targets in this study-CPM and TSPS-and changes in secondary clinical outcomes will be tested. The change in the primary efficacy endpoint, CPM and TSPS, from baseline to week 4 of stimulation will be tested with a mixed linear model and adjusted for important demographic variables. ETHICS AND DISSEMINATION This study obeys the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of Partners Healthcare under the protocol number 2017P002524. Informed consent will be obtained from participants. Study findings will be reported in conferences and peer-reviewed journal publications. TRIAL REGISTRATION NUMBER NCT03371225.
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Affiliation(s)
- Luis Castelo-Branco
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Uygur Kucukseymen
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dante Duarte
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mirret M El-Hagrassy
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Camila Bonin Pinto
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammed Enes Gunduz
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yiling Yang
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paola Gonzalez-Mego
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anayali Estudillo-Guerra
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ludmilla Candido-Santos
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ines Mesia-Toledo
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Haley Rafferty
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wolnei Caumo
- Laboratory of Pain & Neuromodulation, Hospital de Clinicas de Porto Alegre da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Fregni
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Bar-Shalita T, Granovsky Y, Parush S, Weissman-Fogel I. Sensory Modulation Disorder (SMD) and Pain: A New Perspective. Front Integr Neurosci 2019; 13:27. [PMID: 31379526 PMCID: PMC6659392 DOI: 10.3389/fnint.2019.00027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/01/2019] [Indexed: 01/17/2023] Open
Abstract
Sensory modulation disorder (SMD) affects sensory processing across single or multiple sensory systems. The sensory over-responsivity (SOR) subtype of SMD is manifested clinically as a condition in which non-painful stimuli are perceived as abnormally irritating, unpleasant, or even painful. Moreover, SOR interferes with participation in daily routines and activities (Dunn, 2007; Bar-Shalita et al., 2008; Chien et al., 2016), co-occurs with daily pain hyper-sensitivity, and reduces quality of life due to bodily pain. Laboratory behavioral studies have confirmed abnormal pain perception, as demonstrated by hyperalgesia and an enhanced lingering painful sensation, in children and adults with SMD. Advanced quantitative sensory testing (QST) has revealed the mechanisms of altered pain processing in SOR whereby despite the existence of normal peripheral sensory processing, there is enhanced facilitation of pain-transmitting pathways along with preserved but delayed inhibitory pain modulation. These findings point to central nervous system (CNS) involvement as the underlying mechanism of pain hypersensitivity in SOR. Based on the mutual central processing of both non-painful and painful sensory stimuli, we suggest shared mechanisms such as cortical hyper-excitation, an excitatory-inhibitory neuronal imbalance, and sensory modulation alterations. This is supported by novel findings indicating that SOR is a risk factor and comorbidity of chronic non-neuropathic pain disorders. This is the first review to summarize current empirical knowledge investigating SMD and pain, a sensory modality not yet part of the official SMD realm. We propose a neurophysiological mechanism-based model for the interrelation between pain and SMD. Embracing the pain domain could significantly contribute to the understanding of this condition’s pathogenesis and how it manifests in daily life, as well as suggesting the basis for future potential mechanism-based therapies.
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Affiliation(s)
- Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yelena Granovsky
- Laboratory of Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Technion-Israel Institute of Technology, Rambam Health Care Campus, Haifa, Israel
| | - Shula Parush
- School of Occupational Therapy, Faculty of Medicine of Hadassah, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Irit Weissman-Fogel
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Abstract
In this chapter, we provide an overview of neuroimaging studies in chronic pain. We start with an introduction about the phenomenology of pain. In the following section, the application of functional and structural imaging techniques is shown in selected chronic pain syndromes (chronic back pain, fibromyalgia syndrome (FMS), phantom limb pain, and complex regional pain syndrome (CRPS)), and commonalities and peculiarities of imaging correlates across different types of chronic pain are discussed. We conclude this chapter with implications for treatments, with focus on behavioral interventions, sensory and motor trainings, and mirror and motor imagery trainings.
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Affiliation(s)
- Martin Diers
- Clinical and Experimental Behavioral Medicine, Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Alexandrinenstrasse 1-3, 44791, Bochum, Germany.
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28
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Cutaneous silent periods – Part 2: Update on pathophysiology and clinical utility. Clin Neurophysiol 2019; 130:604-615. [DOI: 10.1016/j.clinph.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 02/08/2023]
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29
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Brietzke AP, Antunes LC, Carvalho F, Elkifury J, Gasparin A, Sanches PRS, da Silva Junior DP, Dussán-Sarria JA, Souza A, da Silva Torres IL, Fregni F, Md WC. Potency of descending pain modulatory system is linked with peripheral sensory dysfunction in fibromyalgia: An exploratory study. Medicine (Baltimore) 2019; 98:e13477. [PMID: 30653087 PMCID: PMC6370006 DOI: 10.1097/md.0000000000013477] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fibromyalgia (FM) is characterized by chronic widespread pain whose pathophysiological mechanism is related to central and peripheral nervous system dysfunction. Neuropathy of small nerve fibers has been implicated due to related pain descriptors, psychophysical pain, and neurophysiological testing, as well as skin biopsy studies. Nevertheless, this alteration alone has not been previously associated to the dysfunction in the descending pain modulatory system (DPMS) that is observed in FM. We hypothesize that they associated, thus, we conducted a cross-sectional exploratory study.To explore small fiber dysfunction using quantitative sensory testing (QST) is associated with the DPMS and other surrogates of nociceptive pathways alterations in FM.We run a cross-sectional study and recruited 41 women with FM, and 28 healthy female volunteers. We used the QST to measure the thermal heat threshold (HTT), heat pain threshold (HPT), heat pain tolerance (HPT), heat pain tolerance (HPTo), and conditional pain modulation task (CPM-task). Algometry was used to determine the pain pressure threshold (PPT). Scales to assess catastrophizing, anxiety, depression, and sleep disturbances were also applied. Serum brain-derived neurotrophic factor (BDNF) was measured as a marker of neuroplasticity. We run multivariate linear regression models by group to study their relationships.Samples differed in their psychophysical profile, where FM presented lower sensitivity and pain thresholds. In FM but not in the healthy subjects, regression models revealed that serum BDNF was related to HTT and CPM-Task (Hotelling Trace = 1.80, P < .001, power = 0.94, R = 0.64). HTT was directly related to CPM-Task (B = 0.98, P = .004, partial-η = 0.25), and to HPT (B = 1.61, P = .008, partial η = 0.21), but not to PPT. Meanwhile, BDNF relationship to CPM-Task was inverse (B = -0.04, P = .043, partial-η = 0.12), and to HPT was direct (B = -0.08, P = .03, partial-η = 0.14).These findings high spot that in FM the disinhibition of the DPMS is positively correlated with the dysfunction in peripheral sensory neurons assessed by QST and conversely with serum BDNF.
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Affiliation(s)
- Aline Patrícia Brietzke
- Post-Graduate Program in Medical Sciences, Medical Engineering Service
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre
| | - Luciana Conceição Antunes
- Post-Graduate Program in Medical Sciences, Medical Engineering Service
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre
| | - Fabiana Carvalho
- Post-Graduate Program in Medical Sciences, Medical Engineering Service
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre
| | - Jessica Elkifury
- Post-Graduate Program in Medical Sciences, Medical Engineering Service
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre
| | - Assunta Gasparin
- Post-Graduate Program in Medical Sciences, Medical Engineering Service
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre
| | | | | | | | - Andressa Souza
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre
| | | | - Felipe Fregni
- Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown
| | - Wolnei Caumo Md
- Post-Graduate Program in Medical Sciences, Medical Engineering Service
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre
- Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre, Porto Alegre
- Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil
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30
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Affiliation(s)
- Steven E. Harte
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Richard E. Harris
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Daniel J. Clauw
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
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31
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de Tommaso M, Ricci K, Libro G, Vecchio E, Delussi M, Montemurno A, Lopalco G, Iannone F. Pain Processing and Vegetative Dysfunction in Fibromyalgia: A Study by Sympathetic Skin Response and Laser Evoked Potentials. PAIN RESEARCH AND TREATMENT 2017; 2017:9747148. [PMID: 29093972 PMCID: PMC5637844 DOI: 10.1155/2017/9747148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND A dysfunction of pain processing at central and peripheral levels was reported in fibromyalgia (FM). We aimed to correlate laser evoked potentials (LEPs), Sympathetic Skin Response (SSR), and clinical features in FM patients. METHODS Fifty FM patients and 30 age-matched controls underwent LEPs and SSR by the right hand and foot. The clinical evaluation included FM disability (FIQ) and severity scores (WPI), anxiety (SAS) and depression (SDS) scales, and questionnaires for neuropathic pain (DN4). RESULTS The LEP P2 latency and amplitude and the SSR latency were increased in FM group. This latter feature was more evident in anxious patients. The LEPs habituation was reduced in FM patients and correlated to pain severity scores. In a significant number of patients (32%) with higher DN4 and FIQ scores, SSR or LEP responses were absent. CONCLUSIONS LEPs and SSR might contribute to clarifying the peripheral and central nervous system involvement in FM patients.
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Affiliation(s)
- Marina de Tommaso
- Neurophysiopathology of Pain Laboratory, Basic Medical Science, Neuroscience and Sensory System Department, Bari Aldo Moro University, Bari, Italy
| | - Katia Ricci
- Neurophysiopathology of Pain Laboratory, Basic Medical Science, Neuroscience and Sensory System Department, Bari Aldo Moro University, Bari, Italy
| | - Giuseppe Libro
- Neurophysiopathology of Pain Laboratory, Basic Medical Science, Neuroscience and Sensory System Department, Bari Aldo Moro University, Bari, Italy
| | - Eleonora Vecchio
- Neurophysiopathology of Pain Laboratory, Basic Medical Science, Neuroscience and Sensory System Department, Bari Aldo Moro University, Bari, Italy
| | - Marianna Delussi
- Neurophysiopathology of Pain Laboratory, Basic Medical Science, Neuroscience and Sensory System Department, Bari Aldo Moro University, Bari, Italy
| | - Anna Montemurno
- Neurophysiopathology of Pain Laboratory, Basic Medical Science, Neuroscience and Sensory System Department, Bari Aldo Moro University, Bari, Italy
| | - Giuseppe Lopalco
- Department of Emergency and Organ Transplantation, Bari Aldo Moro University, Bari, Italy
| | - Florenzo Iannone
- Department of Emergency and Organ Transplantation, Bari Aldo Moro University, Bari, Italy
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Abstract
This review includes a summary of contemporary theories of pain processing and advocates a multimodal analgesia approach for providing perioperative care. A summary of various medication classes and anesthetic techniques is provided that highlights evidence emerging from neurosurgical literature. This summary covers opioid management, acetaminophen, nonsteroidal antiinflammatories, ketamine, lidocaine, dexmedetomidine, corticosteroids, gabapentin, and regional anesthesia for neurosurgery. At present, there is not enough investigation into these areas to describe best practices for treating or preventing chronic pain in neurosurgery; but providers can identify a wider range of options available to personalize perioperative care strategies.
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Affiliation(s)
- Samuel Grodofsky
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street 5th Floor Dulles, Philadelphia, PA 19104, USA.
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33
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Abstract
Many chronic pain syndromes are characterized by enhanced perception of painful stimuli as well as alterations in cortical processing in sensory and motor regions. In this review article the alterations in muscle pain and neuropathic pain are described. Alterations in patients with fibromyalgia and chronic back pain are described as examples for musculoskeletal pain and also in patients with phantom limb pain after amputation and complex regional pain syndrome as examples for neuropathic pain. In addition to altered pain perception, cumulative evidence on alterations in the processing of reward and the underlying mechanisms in chronic pain has been described. A description is given of what is known on how pain and reward interact and affect each other. The relevance of such interactions for chronic pain is discussed. The implications of these findings for therapeutic approaches are delineated with respect to sensorimotor training and behavioral therapy, focusing on the effectiveness of these approaches, mechanisms and future developments. In particular, we discuss operant behavioral therapy in patients with chronic back pain and fibromyalgia as well as prosthesis training in patients with phantom limb pain and discrimination, mirror and imaginary training in patients with phantom limb pain and complex regional pain syndrome. With respect to the processing of reward, the focus of the discussion is on the role of reward and associated learning in pain therapy.
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Affiliation(s)
- S Becker
- Institut für Neuropsychologie und Klinische Psychologie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - M Diers
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum, Ruhr-Universität Bochum, Alexandrinenstr. 1-3, 44791, Bochum, Deutschland.
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Abstract
Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.
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Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
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Caumo W, Deitos A, Carvalho S, Leite J, Carvalho F, Dussán-Sarria JA, Lopes Tarragó MDG, Souza A, Torres ILDS, Fregni F. Motor Cortex Excitability and BDNF Levels in Chronic Musculoskeletal Pain According to Structural Pathology. Front Hum Neurosci 2016; 10:357. [PMID: 27471458 PMCID: PMC4946131 DOI: 10.3389/fnhum.2016.00357] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/30/2016] [Indexed: 12/26/2022] Open
Abstract
The central sensitization syndrome (CSS) encompasses disorders with overlapping symptoms in a structural pathology spectrum ranging from persistent nociception [e.g., osteoarthritis (OA)] to an absence of tissue injuries such as the one presented in fibromyalgia (FM) and myofascial pain syndrome (MPS). First, we hypothesized that these syndromes present differences in their cortical excitability parameters assessed by transcranial magnetic stimulation (TMS), namely motor evoked potential (MEP), cortical silent period (CSP), short intracortical inhibition (SICI) and short intracortical facilitation (SICF). Second, considering that the presence of tissue injury could be detected by serum neurotrophins, we hypothesized that the spectrum of structural pathology (i.e., from persistent nociception like in OA, to the absence of tissue injury like in FM and MPS), could be detected by differential efficiency of their descending pain inhibitory system, as assessed by the conditioned pain modulation (CPM) paradigm. Third, we explored whether brain-derived neurotrophic factor (BDNF) had an influence on the relationship between motor cortex excitability and structural pathology. This cross-sectional study pooled baseline data from three randomized clinical trials. We included females (n = 114), aged 19-65 years old with disability by chronic pain syndromes (CPS): FM (n = 19), MPS (n = 54), OA (n = 27) and healthy subjects (n = 14). We assessed the serum BDNF, the motor cortex excitability by parameters the TMS measures and the change on numerical pain scale [NPS (0-10)] during CPM-task. The adjusted mean (SD) on the SICI observed in the absence of tissue injury was 56.36% lower than with persistent nociceptive input [0.31(0.18) vs. 0.55 (0.32)], respectively. The BDNF was inversely correlated with the SICI and with the change on NPS (0-10)during CPM-task. These findings suggest greater disinhibition in the motor cortex and the descending pain inhibitory system in FM and MPS than in OA and healthy subjects. Likewise, the inter-hemispheric disinhibition as well as the dysfunction in the descending pain modulatory system is higher in chronic pain without tissue injury compared to a structural lesion. In addition, they suggest that a greater level of serum BDNF may be involved in the processes that mediate the disinhibition of motor cortex excitability, as well as the function of descending inhibitory pain modulation system, independently of the physiopathology mechanism of musculoskeletal pain syndromes.
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Affiliation(s)
- Wolnei Caumo
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at UFRGSPorto Alegre, Brazil; Anesthesiologist, Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA)Porto Alegre, Brazil; Pain and Anesthesia in Surgery Department, School of Medicine, UFRGSPorto Alegre, Brazil
| | - Alícia Deitos
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at UFRGSPorto Alegre, Brazil
| | - Sandra Carvalho
- Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Campus de Gualtar Braga, Portugal
| | - Jorge Leite
- Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Campus de Gualtar Braga, Portugal
| | - Fabiana Carvalho
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at UFRGSPorto Alegre, Brazil
| | - Jairo Alberto Dussán-Sarria
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at UFRGSPorto Alegre, Brazil
| | - Maria da Graça Lopes Tarragó
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at UFRGSPorto Alegre, Brazil
| | - Andressa Souza
- Post-graduate Program in Health and Human Development, La Salle University Center Canoas, Brazil
| | - Iraci Lucena da Silva Torres
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)Porto Alegre, Brazil; Department of Pharmacology, Instituto de Ciências Básicas da Saúde, UFRGSPorto Alegre, Brazil
| | - Felipe Fregni
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
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Littlejohn GO, Guymer EK, Ngian GS. Is there a role for opioids in the treatment of fibromyalgia? Pain Manag 2016; 6:347-55. [PMID: 27296831 DOI: 10.2217/pmt-2016-0012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The use of opioids for chronic pain has increased significantly due to a combination of the high patient burden of pain and the more widespread availability of a range of long-acting opioid preparations. This increased opioid use has translated into the care of many patients with fibromyalgia. The pain mechanism in fibromyalgia is complex but does not seem to involve disturbance of opioid analgesic functions. Hence, there is general concern about the harms in the absence of benefits of opioids in this setting. There is no evidence that pure opioids are effective in fibromyalgia but there is some evidence that opioids with additional actions on the norepinephrine-related pain modulatory pathways, such as tramadol, can be clinically useful in some patients. Novel actions of low-dose opioid antagonists may lead to better understanding of the role of opioid function in fibromyalgia.
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Affiliation(s)
- Geoffrey O Littlejohn
- Departments of Medicine & Rheumatology, Monash University & Monash Health, Melbourne, Australia
| | - Emma K Guymer
- Departments of Medicine & Rheumatology, Monash University & Monash Health, Melbourne, Australia
| | - Gene-Siew Ngian
- Departments of Medicine & Rheumatology, Monash University & Monash Health, Melbourne, Australia
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Okifuji A, Gao J, Bokat C, Hare BD. Management of fibromyalgia syndrome in 2016. Pain Manag 2016; 6:383-400. [PMID: 27306300 PMCID: PMC5066139 DOI: 10.2217/pmt-2016-0006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/02/2016] [Indexed: 12/18/2022] Open
Abstract
Fibromyalgia syndrome is a chronic pain disorder and defies definitively efficacious therapy. In this review, we summarize the results from the early treatment research as well as recent research evaluating the pharmacological, interventional and nonpharmacological therapies. We further discuss future directions of fibromyalgia syndrome management; we specifically focus on the issues that are associated with currently available treatments, such as the need for personalized approach, new technologically oriented and interventional treatments, the importance of understanding and harnessing placebo effects and enhancement of patient engagement in therapy.
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Affiliation(s)
- Akiko Okifuji
- Department of Anaesthesiology, Pain Management & Research Center, University of Utah, 615 Arapeen Drive, Suite 200, Salt Lake City, UT 84108, USA
| | - Jeff Gao
- Department of Anaesthesiology, Pain Management & Research Center, University of Utah, 615 Arapeen Drive, Suite 200, Salt Lake City, UT 84108, USA
| | - Christina Bokat
- Department of Anaesthesiology, Pain Management & Research Center, University of Utah, 615 Arapeen Drive, Suite 200, Salt Lake City, UT 84108, USA
| | - Bradford D Hare
- Department of Anaesthesiology, Pain Management & Research Center, University of Utah, 615 Arapeen Drive, Suite 200, Salt Lake City, UT 84108, USA
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Attentional focus on subjective interoceptive experience in patients with fibromyalgia. Brain Cogn 2015; 101:35-43. [DOI: 10.1016/j.bandc.2015.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/12/2015] [Accepted: 10/16/2015] [Indexed: 11/20/2022]
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Clauw DJ. Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s). Best Pract Res Clin Rheumatol 2015; 29:6-19. [PMID: 26266995 DOI: 10.1016/j.berh.2015.04.024] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Until recently, most clinicians considered chronic pain to be typically due to ongoing peripheral nociceptive input (i.e., damage or inflammation) in the region of the body where the individual is experiencing pain. Clinicians are generally aware of a few types of pain (e.g., headache and phantom limb pain) where chronic pain is not due to such causes, but most do not realize there is not a single chronic pain state where any radiographic, surgical, or pathological description of peripheral nociceptive damage has been reproducibly shown to be related to the presence or severity of pain. The primary reason for this appears to be that both the peripheral and central nervous systems play a critical role in determining which nociceptive input being detected by sensory nerves in the peripheral tissues will lead to the perception of pain in humans. This manuscript reviews some of the latest findings regarding the neural processing of pain, with a special focus on how clinicians can use information gleaned from the history and physical examination to assess which mechanisms are most likely to be responsible for pain in a given individual, and tailors therapy appropriately. A critical construct is that, within any specific diagnostic category (e.g., fibromyalgia (FM), osteoarthritis (OA), and chronic low back pain (CLBP) are specifically reviewed), individual patients may have markedly different peripheral/nociceptive and neural contributions to their pain. Thus, just as low back pain has long been acknowledged to have multiple potential mechanisms, so also is this true of all chronic pain states, wherein some individuals will have pain primarily due to peripheral nociceptive input, whereas in others peripheral (e.g., peripheral sensitization) or central nervous system factors ("central sensitization" or "centralization" of pain via augmented pain processing in spinal and brain) may be playing an equally or even more prominent role in their pain and other symptoms.
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Affiliation(s)
- Daniel J Clauw
- Chronic Pain and Fatigue Research Center, The University of Michigan, 24 Frank Lloyd Wright Dr PO Box 385, Ann Arbor, MI 48106, USA.
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Plazier M, Ost J, Snijders E, Gilbers M, Vancamp T, De Ridder D, Vanneste S. Laser-Evoked Potentials in Fibromyalgia: The Influence of Greater Occipital Nerve Stimulation on Cerebral Pain Processing. Neuromodulation 2015; 18:376-83. [PMID: 25996805 DOI: 10.1111/ner.12310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 02/02/2015] [Accepted: 03/04/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Fibromyalgia causes widespread musculo-skeletal pain in the four quadrants of the body. Greater occipital nerve stimulation has recently shown beneficial effects in fibromyalgia patients on pain, fatigue, and mood disorders. Laser-evoked potentials (LEPs) are used for research to understand the pathophysiological mechanisms of pain and to evaluate the effects of pain treatment. In fibromyalgia patients, LEPs tend to have a higher N2 amplitude, a tendency to shorter latencies, and patients have a lower pain threshold. Greater occipital nerve stimulation might exert a modulation of the medial pain pathways processing the affective motivational components of pain (unpleasantness) as well as the descending pain inhibitory pathways (reducing pain), both of which are contributing to the N2P2 peak. MATERIALS AND METHODS To test this hypothesis, the authors performed LEPs in a group of fibromyalgia patients with and without greater occipital nerve stimulation. RESULTS Occipital nerve stimulation does not alter the amplitudes of the LEP recordings, although a significant difference in latencies can be seen. More specifically, latencies of the N2P2 increased in the condition after stimulation, and especially at the Pz electrode. CONCLUSION Our results suggest Occipital Nerve Stimulation (ONS) induces a modification of the balance between antinociceptive pain inhibitory pathways and pain-provoking pathways.
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Affiliation(s)
- Mark Plazier
- Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium
| | - Jan Ost
- BRAI2N, Sint Augustinus Hospital Antwerp, Edegem, Belgium
| | - Erwin Snijders
- Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium
| | - Martijn Gilbers
- Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium
| | - Tim Vancamp
- Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium
| | - Dirk De Ridder
- BRAI2N, Sint Augustinus Hospital Antwerp, Edegem, Belgium.,BRAI2N, Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas, Dallas, TX, USA
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Vossen CJ, Vossen HGM, Joosten EA, van Os J, Lousberg R. Does habituation differ in chronic low back pain subjects compared to pain-free controls? A cross-sectional pain rating ERP study reanalyzed with the ERFIA multilevel method. Medicine (Baltimore) 2015; 94:e865. [PMID: 25984683 PMCID: PMC4602586 DOI: 10.1097/md.0000000000000865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The objective of the present study was to investigate cortical differences between chronic low back pain (CLBP) subjects and pain-free controls with respect to habituation and processing of stimulus intensity. The use of a novel event-related fixed-interval areas (ERFIA) multilevel technique enables the analysis of event-related electroencephalogram (EEG) of the whole post stimulus range at a single trial level. This technique makes it possible to disentangle the cortical processes of habituation and stimulus intensity.In a cross-sectional study, 78 individuals with CLBP and 85 pain-free controls underwent a rating paradigm of 150 nonpainful and painful somatosensory electrical stimuli. For each trial, the entire epoch was partitioned into 20-ms ERFIAs, which acted as dependent variables in a multilevel analysis. The variability of each consecutive ERFIA period was modeled with a set of predictor variables, including 3 forms of habituation and stimulus intensity.Seventy-six pain-free controls and 65 CLBP subjects were eligible for analysis. CLBP subjects showed a significantly decreased linear habituation at 340 to 460 ms in the midline electrodes and C3 (Ps < .05) and had a significantly more pronounced dishabituation for the regions of 400 to 460 ms and 800 to 820 ms for all electrodes, except for T3 and T4 (Ps < .05). No significant group differences for stimulus intensity processing were observed.In this study, group differences with respect to linear habituation and dishabituation were demonstrated. By means of the ERFIA multilevel technique, habituation effects were found in a broad post stimulus range and were not solely limited to peaks. This study suggests that habituation may be a key mechanism involved in the transition process to chronic pain. Future studies with a longitudinal design are required to solve this issue.
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Affiliation(s)
- Catherine J Vossen
- From the Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands (CJV, EAJ); Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands (HGMV); Department of Psychiatry & Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands (JVO, RL); King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom (JVO)
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López-Solà M, Pujol J, Wager TD, Garcia-Fontanals A, Blanco-Hinojo L, Garcia-Blanco S, Poca-Dias V, Harrison BJ, Contreras-Rodríguez O, Monfort J, Garcia-Fructuoso F, Deus J. Altered functional magnetic resonance imaging responses to nonpainful sensory stimulation in fibromyalgia patients. Arthritis Rheumatol 2015; 66:3200-9. [PMID: 25220783 DOI: 10.1002/art.38781] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 07/08/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Fibromyalgia (FM) is a disorder characterized by chronic pain and enhanced responses to acute noxious events. However, the sensory systems affected in FM may extend beyond pain itself, as FM patients show reduced tolerance to non-nociceptive sensory stimulation. Characterizing the neural substrates of multisensory hypersensitivity in FM may thus provide important clues about the underlying pathophysiology of the disorder. The aim of this study was to characterize brain responses to non-nociceptive sensory stimulation in FM patients and their relationship to subjective sensory sensitivity and clinical pain severity. METHODS Functional magnetic resonance imaging (MRI) was used to assess brain response to auditory, visual, and tactile motor stimulation in 35 women with FM and 25 matched controls. Correlation and mediation analyses were performed to establish the relationship between brain responses and 3 types of outcomes: subjective hypersensitivity to daily sensory stimulation, spontaneous pain, and functional disability. RESULTS Patients reported increased subjective sensitivity (increased unpleasantness) in response to multisensory stimulation in daily life. Functional MRI revealed that patients showed reduced task-evoked activation in primary/secondary visual and auditory areas and augmented responses in the insula and anterior lingual gyrus. Reduced responses in visual and auditory areas were correlated with subjective sensory hypersensitivity and clinical severity measures. CONCLUSION FM patients showed strong attenuation of brain responses to nonpainful events in early sensory cortices, accompanied by an amplified response at later stages of sensory integration in the insula. These abnormalities are associated with core FM symptoms, suggesting that they may be part of the pathophysiology of the disease.
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Affiliation(s)
- Marina López-Solà
- University of Colorado Boulder, and Hospital del Mar, Barcelona, Spain
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Do fibromyalgia patients benefit from cognitive restructuring and acceptance? An experimental study. J Behav Ther Exp Psychiatry 2014; 45:467-74. [PMID: 25020122 DOI: 10.1016/j.jbtep.2014.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 05/06/2014] [Accepted: 06/06/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to clarify mechanisms of psychological fibromyalgia treatment by experimentally examining the effectiveness of its core elements. We assessed the effects of cognitive restructuring and acceptance on experimentally-induced heat and cold pain tolerance and pain intensity in fibromyalgia patients. METHODS Cold and heat pain were induced in a sample of 60 fibromyalgia patients using a thermode. We conducted ANCOVAs to examine group differences in posttest scores, co-varying for pretest scores. The between-groups factor was the type of instruction provided (acceptance, cognitive restructuring, and a control condition). In addition, we controlled for pain sensitivity, age, and depression. RESULTS We found that acceptance and cognitive restructuring were superior to the control condition in increasing heat pain tolerance, but did not differ from one another. With respect to cold pain tolerance, cognitive restructuring was associated with increases in cold pain tolerance compared to the control condition, while acceptance did not differ either from the control condition or from cognitive restructuring. LIMITATIONS Further experimental research on chronic pain treatment mechanisms is needed, particularly research on individually tailoring treatment strategies according to patients characteristics. CONCLUSION Results show that both, cognitive restructuring and acceptance instructions, enhance pain tolerance in fibromyalgia patients.
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Carrillo-de-la-Peña M, Triñanes Y, González-Villar A, Gómez-Perretta C, García-Larrea L. Filtering out repetitive auditory stimuli in fibromyalgia: A study of P50 sensory gating. Eur J Pain 2014; 19:576-84. [DOI: 10.1002/ejp.627] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 01/22/2023]
Affiliation(s)
- M.T. Carrillo-de-la-Peña
- Department of Clinical Psychology and Psychobiology; University of Santiago de Compostela; Spain
| | - Y. Triñanes
- Department of Clinical Psychology and Psychobiology; University of Santiago de Compostela; Spain
| | - A. González-Villar
- Department of Clinical Psychology and Psychobiology; University of Santiago de Compostela; Spain
| | | | - L. García-Larrea
- Central Integration of Pain Unit; U879 INSERM and University Claude Bernard Lyon 1; Neurological Hospital; Lyon France
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Diers M. The impact of the stimulation method on differences in pain thresholds and brain responses between chronic pain patients and healthy controls. Eur J Pain 2014; 18:1365-6. [PMID: 25303612 DOI: 10.1002/ejp.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Martin Diers
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health/Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Reduction of pain thresholds in fibromyalgia after very low-intensity magnetic stimulation: a double-blinded, randomized placebo-controlled clinical trial. Pain Res Manag 2014; 18:e101-6. [PMID: 24308025 DOI: 10.1155/2013/270183] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exposure to electromagnetic fields has been reported to have analgesic and antinociceptive effects in several organisms. OBJECTIVE To test the effect of very low-intensity transcranial magnetic stimulation on symptoms associated with fibromyalgia syndrome. METHODS A double-blinded, placebo-controlled clinical trial was performed in the Sagrado Corazón Hospital, Seville, Spain. Female fibromyalgia patients (22 to 50 years of age) were randomly assigned to either a stimulation group or a sham group. The stimulation group (n=28) was stimulated using 8 Hz pulsed magnetic fields of very low intensity, while the sham group (n=26) underwent the same protocol without stimulation. Pressure pain thresholds before and after stimulation were determined using an algometer during the eight consecutive weekly sessions of the trial. In addition, blood serotonin levels were measured and patients completed questionnaires to monitor symptom evolution. RESULTS A repeated-measures ANOVA indicated statistically significant improvement in the stimulation group compared with the control group with respect to somatosensory pain thresholds, ability to perform daily activities, perceived chronic pain and sleep quality. While improvement in pain thresholds was apparent after the first stimulation session, improvement in the other three measures occurred after the sixth week. No significant between-group differences were observed in scores of depression, fatigue, severity of headaches or serotonin levels. No adverse side effects were reported in any of the patients. CONCLUSIONS Very low-intensity magnetic stimulation may represent a safe and effective treatment for chronic pain and other symptoms associated with fibromyalgia.
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Role of the primary motor cortex in the maintenance and treatment of pain in fibromyalgia. Med Hypotheses 2014; 83:332-6. [PMID: 24992875 DOI: 10.1016/j.mehy.2014.06.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/20/2014] [Accepted: 06/09/2014] [Indexed: 11/23/2022]
Abstract
Fibromyalgia is a highly prevalent, debilitating disease, characterized by chronic widespread pain. The mechanisms underlying pain are not completely understood, but it is believed to be associated with important neuroplastic changes in pain-related neural circuits. Although the involvement of the pain matrix in fibromyalgia is well established, another area that has been found to play a role in the maintenance and treatment of chronic pain is the primary motor cortex (M1). Maladaptive plasticity of M1 is a common finding in patients with chronic pain and many studies in animal models and in human subjects have shown that modulation of the activity of this cortical area induces significant analgesic effects. Furthermore, studies in other chronic pain syndromes have found alterations in baseline characteristics of M1, including an increase in cortical excitability and an abnormally enhanced response to incoming sensory stimuli. Given these findings, we hypothesize that M1 is a major modulator of pain in fibromyalgia and therefore its baseline activity reflects this strong feedback between M1 and pain-related neural areas. However, the feedback loop between M1 and the pain matrix is not enough to decrease pain in fibromyalgia per se, thus increasing its modulatory effect by engaging this network through different behavioral and modulatory techniques is a potentially beneficial treatment for pain in fibromyalgia.
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Triñanes Y, González-Villar A, Gómez-Perretta C, Carrillo-de-la-Peña MT. Profiles in fibromyalgia: algometry, auditory evoked potentials and clinical characterization of different subtypes. Rheumatol Int 2014; 34:1571-80. [PMID: 24723098 DOI: 10.1007/s00296-014-3007-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 03/27/2014] [Indexed: 12/28/2022]
Abstract
The heterogeneity found in fibromyalgia (FM) patients has led to the investigation of disease subgroups, mainly based on clinical features. The aim of this study was to test the hypothesis that clinical FM subgroups are associated with different underlying pathophysiological mechanisms. Sixty-three FM patients were classified in type I or type II, according to the Fibromyalgia Impact Questionnaire (FIQ), and in mild/moderate versus severe FM, according to the severity of three cardinal symptoms considered in the American College of Rheumatology (ACR) 2010 criteria (unrefreshed sleep, cognitive problems and fatigue). To validate the subgroups obtained by these two classifications, we calculated the area under the receiver operating characteristic curves for various clinical variables and for two potential biomarkers of FM: Response to experimental pressure pain (algometry) and the amplitude/intensity slopes of the auditory evoked potentials (AEPs) obtained to stimuli of increasing intensity. The variables that best discriminated type I versus type II were those related to depression, while the indices of clinical or experimental pain (threshold or tolerance) did not significantly differ between them. The variables that best discriminated the mild/moderate versus severe subgroups were those related to the algometry. The AEPs did not allow discrimination among the generated subsets. The FIQ-based classification allows the identification of subgroups that differ in psychological distress, while the index based on the ACR 2010 criteria seems to be useful to characterize the severity of FM mainly based on hyperalgesia. The incorporation of potential biomarkers to generate or validate classification criteria is crucial to advance in the knowledge of FM and in the understanding of pathophysiological pathways.
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Affiliation(s)
- Yolanda Triñanes
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Calle Xosé María Suárez Nuñez, s/n. Campus Vida, 15782, Santiago de Compostela, Spain,
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Alterations in excitatory and inhibitory brainstem interneuronal circuits in fibromyalgia: Evidence of brainstem dysfunction. Clin Neurophysiol 2014; 125:593-601. [DOI: 10.1016/j.clinph.2013.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 08/02/2013] [Accepted: 08/21/2013] [Indexed: 12/11/2022]
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