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Stoyanova-Piroth G, Milanov I, Stambolieva K. Association between pain threshold and manifested pain assessed using a PD-specific pain scale in Parkinson's disease. Front Neurol 2024; 15:1420696. [PMID: 39131046 PMCID: PMC11312374 DOI: 10.3389/fneur.2024.1420696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/28/2024] [Indexed: 08/13/2024] Open
Abstract
Background The neurodegenerative process in Parkinson's disease (PD) affects both dopaminergic and non-dopaminergic structures, which determine the wide range of motor and non-motor symptoms (NMS), including different types of pain. Diverse mechanisms contribute to pain in PD. Abnormal nociceptive processing is considered a distinctive feature of the disease. Objective In the present study, we used a validated PD-specific pain assessment tool to investigate self-reported pain in PD patients and to analyze the association with the objective pain threshold. Methods The RIII component of the nociceptive flexor reflex was assessed in 35 patients with PD and was compared to 40 healthy controls. Self-reported pain was measured using the Bulgarian version of the King's Parkinson's Disease Pain Scale (KPPS-BG). A correlation analysis was used to investigate the relationship between the objective nociceptive threshold and PD pain as assessed by KPPS-BG. Results PD patients had a significantly lower RIII threshold than control individuals (the mean SD value was 6.24 ± 1.39 vs. 10.33 ± 1.64) when assessed in the "off" state. A statistically significant (p < 0.05) fairly negative Spearman's correlation was observed between the decreased spinal nociceptive threshold and fluctuation-related pain (-0.31). Domain 4, "nocturnal pain" (-0.21), and the KPPS-BG total score (-0.21) showed a weak negative correlation. An insignificant positive correlation was found between domain 6-"discoloration, edema/swelling"-and the RIII threshold. A higher Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score and modified Hoehn and Yahr (H&Y) scale are associated with a decreased nociceptive flexor reflex threshold. Conclusion The results of the present study demonstrate the important role of increased spinal nociception in the occurrence of pain, which is associated with fluctuations and, to a lesser extent, nocturnal pain.
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Affiliation(s)
- Galina Stoyanova-Piroth
- St. Naum Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria
- ZURZACH Care, Neurorehabilitation, Rehaklinik Baden Dättwil, Baden, Switzerland
| | - Ivan Milanov
- St. Naum Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria
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Asci F, Di Stefano G, Di Santo A, Bianchini E, Leone C, La Cesa S, Zampogna A, Cruccu G, Suppa A. Pain-motor integration in chronic pain: A neurophysiological study. Clin Neurophysiol 2023; 154:107-115. [PMID: 37595480 DOI: 10.1016/j.clinph.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE Chronic pain may lead to functional changes in several brain regions, including the primary motor cortex (M1). Our neurophysiological study aimed to probe M1 plasticity, through a non-invasive transcranial magnetic stimulation protocol, in a cohort of patients with chronic pain. METHODS Twenty patients with chronic pain (age ± SD: 62.9 ± 9.9) and 20 age- and sex-matched healthy controls (age ± SD: 59.6 ± 15.8) were recruited. Standardized scales were used for the evaluation of pain severity. Neurophysiological measures included laser-evoked potentials (LEPs) and motor-evoked potentials (MEPs) collected at baseline and over 60 minutes following a standardized Laser-paired associative stimulation (Laser-PAS) protocol. RESULTS LEPs and MEPs were comparable in patients with chronic pain and controls. The pain threshold was lower in patients than in controls. Laser-PAS elicited decreased responses in patients with chronic pain. The response to Laser-PAS was similar in subgroups of patients with different chronic pain phenotypes. CONCLUSIONS M1 plasticity, as tested by Laser-PAS, is altered in patients with chronic pain, possibly reflecting abnormal pain-motor integration processes. SIGNIFICANCE Chronic pain is associated with a disorder of M1 plasticity raising from abnormal pain-motor integration.
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Affiliation(s)
- Francesco Asci
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy; IRCCS Neuromed Institute, Via Atinense, 18, 86077 Pozzilli, IS, Italy.
| | - Giulia Di Stefano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy.
| | - Alessandro Di Santo
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
| | - Caterina Leone
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy.
| | - Silvia La Cesa
- Unit of Neurology, S. Camillo-Forlanini Hospital, Rome, Italy.
| | - Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy.
| | - Giorgio Cruccu
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy.
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185 Rome, Italy; IRCCS Neuromed Institute, Via Atinense, 18, 86077 Pozzilli, IS, Italy.
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Cruccu G, Suppa A. Improving drug-resistant chronic neuropathic pain with Non-invasive brain stimulation. Clin Neurophysiol 2021; 132:2673-2674. [PMID: 34470726 DOI: 10.1016/j.clinph.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Affiliation(s)
- G Cruccu
- Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - A Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli IS, Italy
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Guidali G, Roncoroni C, Bolognini N. Paired associative stimulations: Novel tools for interacting with sensory and motor cortical plasticity. Behav Brain Res 2021; 414:113484. [PMID: 34302877 DOI: 10.1016/j.bbr.2021.113484] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 12/26/2022]
Abstract
In the early 2000s, a novel non-invasive brain stimulation protocol, the paired associative stimulation (PAS), was introduced, allowing to induce and investigate Hebbian associative plasticity within the humans' motor system, with patterns resembling spike-timing-dependent plasticity properties found in cellular models. Since this evidence, PAS efficacy has been proved in healthy, and to a lesser extent, in clinical populations. Recently, novel 'modified' protocols targeting sensorimotor and crossmodal networks appeared in the literature. In the present work, we have reviewed recent advances using these 'modified' PAS protocols targeting sensory and motor cortical networks. To better categorize them, we propose a novel classification according to the nature of the peripheral and cortical stimulations (i.e., within-system, cross-systems, and cortico-cortical PAS). For each protocol of the categories mentioned above, we describe and discuss their main features, how they have been used to study and promote brain plasticity, and their advantages and disadvantages. Overall, current evidence suggests that these novel non-invasive brain stimulation protocols represent very promising tools to study the plastic properties of humans' sensorimotor and crossmodal networks, both in the healthy and in the damaged central nervous system.
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Affiliation(s)
- Giacomo Guidali
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy.
| | - Camilla Roncoroni
- Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy; Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Sympathetic and sensory nerve fiber function in multiple system atrophy and idiopathic Parkinson's disease. J Neurol 2021; 268:3435-3443. [PMID: 33715046 PMCID: PMC8357748 DOI: 10.1007/s00415-021-10514-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore small fiber somatosensory and sympathetic function in PD and MSA. METHODS We recruited 20 PD patients (7 women, median age 65.5 years; IQR 54.75-70.0), 10 MSA patients (4 women; median age 68 years; IQR 66.25-74.0), and 10 healthy subjects (HC; 4 women, median age 68; IQR 59.0-71.0 years). Autonomic testing included forehead cooling, intradermal microdialysis of norepinephrine (NE; 10-5; 10-6; 10-7; and 10-8), and orthostatic hypotension (OH); somatosensory testing included quantitative sensory testing (QST) according to the protocol of the German Research Network on Neuropathic Pain (DFNS). RESULTS OH occurred more frequently in PD (p = 0.018) and MSA (p = 0.002) compared to HC. Vasoconstriction responses were stronger in PD compared to MSA during forehead cooling (p = 0.044) and microdialysis of physiologically concentrated NE solutions (10-7; 10-8; p = 0.017). PD and MSA had impaired cold (PD: p < 0.01; MSA: p < 0.05) and warm detection thresholds (PD and MSA, both p < 0.05). The mechanical detection threshold was higher in PD (p < 0.01). Conversely, mechanical pain thresholds were decreased in PD and MSA (both p < 0.001), indicating mechanical hyperalgesia. CONCLUSION In contrast to MSA, we found evidence of peripheral adrenoreceptor hypersensitivity in PD, probably caused by peripheral sympathetic denervation. Sensory testing revealed peripheral neuropathy and central pain sensitization in PD and MSA. Jointly, our data demonstrate autonomic and somatosensory dysfunction in PD and MSA.
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Tai YC, Lin CH. An overview of pain in Parkinson's disease. Clin Park Relat Disord 2019; 2:1-8. [PMID: 34316612 PMCID: PMC8302194 DOI: 10.1016/j.prdoa.2019.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/20/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022] Open
Abstract
Pain is a common non-motor symptom of Parkinson's disease (PD) and the prevalence of pain among PD patients varies because of the disease stage, co-morbidities, and evaluating tools. Risk factors for pain in PD include an early age of onset, long disease duration, motor complications, concomitant depressive symptoms, female gender, and associated medical conditions. In patients with PD, pain can be classified as musculoskeletal pain, chronic body pain (central or visceral), fluctuation-related pain, nocturnal pain, orofacial pain, pain with discolouration/oedema/swelling, and radicular/neuropathic pain; musculoskeletal pain as the most common type. Potential underlying mechanisms include a disruption of peripheral nociception and alterations in central pain threshold/processing. Genetic polymorphisms in genes that confer pain susceptibility might also play a role in the occurrence of pain in PD. In advanced stage of patients with PD, polyneuropathy could occur in patients using high dosage of levodopa. Pain often correlates to other non-motor symptoms of PD, including depression, sleep, and autonomic symptoms. Dopaminergic drugs, non-dopaminergic medications, botulinum toxin, deep brain stimulation, and physiotherapy have shown some benefits for certain types of PD-related pain. An increased awareness of pain as a common non-motor symptom of PD provides further insights into sensory system dysregulation in this disease. In this review, we aim to summarizes the clinical features of pain in patients with PD and emphasize the latest evidence of pain related to levodopa treatment.
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Affiliation(s)
- Yi-Cheng Tai
- Department of Neurology, E-DA Hospital, Kaohsiung, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University, College of Medicine, Taipei, Taiwan
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Parkinsonism is associated with altered primary motor cortex plasticity in frontotemporal dementia–primary progressive aphasia variant. Neurobiol Aging 2018; 69:230-238. [DOI: 10.1016/j.neurobiolaging.2018.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 12/12/2022]
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Affiliation(s)
- A Di Santo
- Neurology Unit, Campus Bio-Medico University, Rome, Italy
| | - F Asci
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - A Suppa
- Department of Human Neuroscience, Sapienza University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli, IS, Italy.
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Suppa A, Quartarone A, Siebner H, Chen R, Di Lazzaro V, Del Giudice P, Paulus W, Rothwell J, Ziemann U, Classen J. The associative brain at work: Evidence from paired associative stimulation studies in humans. Clin Neurophysiol 2017; 128:2140-2164. [DOI: 10.1016/j.clinph.2017.08.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 12/25/2022]
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