1
|
Sakurai S, Matsui K, Narukawa M. Comparison of the Incidence of Adverse Events Between Japanese and Non-Japanese Healthy Subjects in Phase I Studies: A Systematic Review and Meta-Analysis. Clin Drug Investig 2024; 44:11-19. [PMID: 38041786 DOI: 10.1007/s40261-023-01327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Ethnic and racial differences are key factors affecting the results of clinical studies. However, the influence of these factors on the efficacy and safety of medicinal products remains unclear. Race-dependent nature is considered to be one of the factors causing differences in clinical findings, and we investigated its influence on the safety evaluation of drugs. METHODS We searched PubMed and a Japan drug approval list to find relevant studies, and extracted phase I studies conducted with Japanese and non-Japanese participants using the same protocol and at the same study site. Pooled estimates of odds ratios (ORs) for the incidence of major adverse events in Japanese and non-Japanese participants were calculated, using a DerSimonian-Laird method with a random-effects model. RESULTS Odds ratios for some adverse events in the active drug arm were significantly lower in Japanese participants: headaches [OR 0.65 (95% confidence interval [CI] 0.52-0.82), p = 0.0003], neurological disorders NEC [OR 0.70 (95% CI 0.53-0.93), p = 0.0135] in a High-Level Group Term, nervous system disorders [OR 0.64 (95% CI 0.49-0.82), p = 0.0004], infections and infestations [OR 0.71 (95% CI 0.53-0.95), p = 0.0202], and musculoskeletal and connective tissue disorders [OR 0.66 (95% CI 0.48-0.91, p = 0.0107] in the System Organ Class. CONCLUSIONS Our research suggested that racial factors such as race-dependent nature influence a drug safety assessment. With knowledge of these differences, it is expected that Japan will actively conduct multi-regional clinical trials, in which more diverse populations are included.
Collapse
Affiliation(s)
- Satomi Sakurai
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan.
| | - Kazuhiro Matsui
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
| |
Collapse
|
2
|
He Q, Zhou M, Yin P, Jiang B, Qi J, Liu Y, Liu J, You J, Zhou Y, Long Z, Xing X, Cheng Q, Chen Y, Wang H, Liu Z. Can global or national disability weights represent provincial level? BMC Public Health 2023; 23:461. [PMID: 36899365 PMCID: PMC9999537 DOI: 10.1186/s12889-022-14347-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/11/2022] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND A universal set of disability weights(DWs) is mainly based on the survey of North America, Australia and Europe, whereas the participants in Asia was limited. The debate hasn't yet settled whether a universal DW is desirable or useful.The focus of the debate is its representativenes-s.After all, the DWs come from people's subjective evaluation of pain, and they may vary according to cultural background.The differences of the DWs could have implications for the magnitude or ranking of disease burdens.The DWs of Anhui Province has not been completely presented.This paper aims to obtain the DWs suitable for the general population of Anhui Province of China, and attempts to explore the differences between different DWs by comparing the DWs with the similar-cultural background and the DWs with cross-cultural background. METHODS A web-based survey was conducted to estimate the DWs for 206 health states of Anhui province in 2020. Paired comparison (PC) data were analyzed and anchored by probit regression and fitting loess model. We compared the DWs in Anhui with other provinces in China and those in Global burden of disease (GBD) and Japan. RESULTS Compared with Anhui province, the proportion of health states which showed 2 times or more differences ranged from 1.94% (Henan) to 11.17% (Sichuan) in China and domestic provinces. It was 19.88% in Japan and 21.51% in GBD 2013 respectively. In Asian countries or regions, most of the health states with top 15 DWs belonged to the category of mental, behavioral, and substance use disorders. But in GBD, most were infectious diseases and cancer. The differences of DWs in neighboring provinces were smaller than other geographically distant provinces or countries. CONCLUSION PC responses were largely consistent across very distinct settings,but the exceptions do need to be faced squarely.The differences of DWs among similar-cultural regions were smaller than cross-cultural regions. There is an urgent need for relevant gold standards.
Collapse
Affiliation(s)
- Qin He
- Anhui Provincial Center for Disease Control and Prevention, Shushan District, Hefei, 230601, China
| | - Maigeng Zhou
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, 100050, China
| | - Peng Yin
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, 100050, China
| | - Bo Jiang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, 100050, China
| | - Jinlei Qi
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, 100050, China
| | - Yunning Liu
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, 100050, China
| | - Jiangmei Liu
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, 100050, China
| | - Jinling You
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, 100050, China
| | - Yuchang Zhou
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, 100050, China
| | - Zheng Long
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, 100050, China
| | - Xiuya Xing
- Anhui Provincial Center for Disease Control and Prevention, Shushan District, Hefei, 230601, China
| | - Qianyao Cheng
- Anhui Provincial Center for Disease Control and Prevention, Shushan District, Hefei, 230601, China
| | - Yeji Chen
- Anhui Provincial Center for Disease Control and Prevention, Shushan District, Hefei, 230601, China
| | - Huadong Wang
- Anhui Provincial Center for Disease Control and Prevention, Shushan District, Hefei, 230601, China
| | - Zhirong Liu
- Anhui Provincial Center for Disease Control and Prevention, Shushan District, Hefei, 230601, China.
| |
Collapse
|
3
|
The Inflammation Level and a Microbiological Analysis of the Anophthalmic Cavities of Unilateral Ocular Prosthesis Users: A Blind, Randomized Observational Study. Antibiotics (Basel) 2022; 11:antibiotics11111486. [PMID: 36358141 PMCID: PMC9686759 DOI: 10.3390/antibiotics11111486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Irritation and biofilm adhesion are complaints associated with ocular prosthesis use. This study aimed to evaluate the effects of prosthesis repolishing on several conditions of anophthalmic volunteers. Participants were divided into two groups: intervention (IG, n = 10) and nonintervention (NIG, n = 6) groups. The anophthalmic cavity, contralateral eye, and prosthesis surface were evaluated at initial, day 15, and day 30 after repolishing. Microbiological analysis (colony-forming units), exfoliative cytology (conjunctiva inflammatory cells), sensory analysis (quantitative mechanical sensory test), tear production (Schirmer’s test), and conjunctival inflammation (clinical evaluation) were performed. Nonparametric tests were used to compare groups in the initial period and to analyze periods for the IG (p < 0.05). More microorganisms were formed in the anophthalmic socket and prosthesis than in the contralateral eye in the initial period. For IG, the anophthalmic cavity exhibited more microorganisms and inflammatory clinical signs in the initial period than at 15 and 30 after repolishing. The prosthesis showed greater accumulations of total bacteria and Candida albicans in the initial period than at 15 and 30 days after repolishing. The anophthalmic cavity had more palpebral inflammation than the contralateral eye. In conclusion, repolishing reduced the number of microorganisms and inflammatory signs over time.
Collapse
|
4
|
Liu X, Wang F, Yu C, Zhou M, Yu Y, Qi J, Yin P, Yu S, Zhou Y, Lin L, Liu Y, Wang Q, Zhong W, Huang S, Li Y, Liu L, Liu Y, Ma F, Zhang Y, Tian Y, Yu Q, Zeng J, Pan J, Zhou M, Kang W, Zhou JY, Yu H, Liu Y, Li S, Yu H, Wang C, Xia T, Xi J, Ren X, Xing X, Cheng Q, Fei F, Wang D, Zhang S, He Y, Wen H, Liu Y, Shi F, Wang Y, Sun P, Bai J, Wang X, Shen H, Ma Y, Yang D, Mubarik S, Cao J, Meng R, Zhang Y, Guo Y, Yan Y, Zhang W, Ke S, Zhang R, Wang D, Zhang T, Nomura S, Hay SI, Salomon JA, Haagsma JA, Murray CJ, Vos T. Eliciting national and subnational sets of disability weights in mainland China: Findings from the Chinese disability weight measurement study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100520. [PMID: 35910433 PMCID: PMC9335373 DOI: 10.1016/j.lanwpc.2022.100520] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND The disability weight (DW) quantifies the severity of health states from disease sequela and is a pivotal parameter for disease burden calculation. We conducted a national and subnational DW measurement in China. METHODS In 2020-2021, we conducted a web-based survey to assess DWs for 206 health states in 31 Chinese provinces targeting health workers via professional networks. We fielded questions of paired comparison (PC) and population health equivalence (PHE). The PC data were analysed by probit regression analysis, and the regression results were anchored by results from the PHE responses on the DW scale between 0 (no loss of health) and 1 (health loss equivalent to death). FINDINGS We used PC responses from 468,541 respondents to estimate DWs of health states. Eight of 11 domains of health had significantly negative coefficients in the regression of the difference between Chinese and Global Burden of Disease (GBD) DWs, suggesting lower DW values for health states with mention of these domains in their lay description. We noted considerable heterogeneity within domains, however. After applying these Chinese DWs to the 2019 GBD estimates for China, total years lived with disability (YLDs) increased by 14·9% to 177 million despite lower estimates for musculoskeletal disorders, cardiovascular diseases, mental disorders, diabetes and chronic kidney disease. The lower estimates of YLDs for these conditions were more than offset by higher estimates of common, low-severity conditions. INTERPRETATION The differences between the GBD and Chinese DWs suggest that there might be some contextual factors influencing the valuation of health states. While the reduced estimates for mental disorders, alcohol use disorder, and dementia could hint at a culturally different valuation of these conditions in China, the much greater shifts in YLDs from low-severity conditions more likely reflects methodological difficulty to distinguish between health states that vary a little in absolute DW value but a lot in relative terms. FUNDING This work was supported by the National Natural Science Foundation of China [grant number 82173626], the National Key Research and Development Program of China [grant numbers 2018YFC1315302], Wuhan Medical Research Program of Joint Fund of Hubei Health Committee [grant number WJ2019H304], and Ningxia Natural Science Foundation Project [grant number 2020AAC03436].
Collapse
Affiliation(s)
- Xiaoxue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Fang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou 221004, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
- Global Health Institute, Wuhan University, Wuhan 430072, China
- Corresponding authors.
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
- Corresponding authors.
| | - Yong Yu
- School of Public Health and Management, Hubei University of Medicine, Shiyan 442000, Hubei, China
| | - Jinlei Qi
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Peng Yin
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Shicheng Yu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuchang Zhou
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Lin Lin
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Yunning Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Qiqi Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenling Zhong
- Fujian Provincial Center for Disease Control and Prevention, No. 78 Jintai Road, Gulou District, Fuzhou City 350001, Fujian province, China
| | - Shaofen Huang
- Fujian Provincial Center for Disease Control and Prevention, No. 78 Jintai Road, Gulou District, Fuzhou City 350001, Fujian province, China
| | - Yanxia Li
- Liaoning Provincial Center for Disease Control and Prevention, No. 79 Jixian Street, Heping District, Shenyang City 110005, China
| | - Li Liu
- Liaoning Provincial Center for Disease Control and Prevention, No. 79 Jixian Street, Heping District, Shenyang City 110005, China
| | - Yuan Liu
- Hunan Provincial Center for Disease Control and Prevention, No. 450 first section of Middle Furong Road, Changsha City 410005, Hunan Province, China
| | - Fang Ma
- Ningxia Center for Disease Control and Prevention, No. 528 Shengli Street, Xingqing District, Yinchuan City 750004, Ningxia, China
| | - Yine Zhang
- Ningxia Center for Disease Control and Prevention, No. 528 Shengli Street, Xingqing District, Yinchuan City 750004, Ningxia, China
| | - Yuan Tian
- Ningxia Center for Disease Control and Prevention, No. 528 Shengli Street, Xingqing District, Yinchuan City 750004, Ningxia, China
| | - Qiuli Yu
- Yunnan Center for Disease Control and Prevention, No. 158 Dongsi Street, Xishan District, Kunming City 650022, Yunnan Province, China
| | - Jing Zeng
- Sichuan Center for Disease Control and Prevention, No. 6 Middle School Road, Wuhou District, Chengdu City 610041, Sichuan Province, China
| | - Jingju Pan
- Hubei Provincial Center for Disease Control and Prevention, No. 6 Zhuodaoquan North Road, Hongshan District, Wuhan City 430079, Hubei Province, China
| | - Mengge Zhou
- Hubei Provincial Center for Disease Control and Prevention, No. 6 Zhuodaoquan North Road, Hongshan District, Wuhan City 430079, Hubei Province, China
| | - Weiwei Kang
- Inner Mongolia Integrative Center for Disease Control and Prevention, No. 50 Ordos Street, Hohhot 010031, China
| | - Jin-Yi Zhou
- Jiangsu Provincial Center for disease Control and Prevention, Public Health Research Institute of Jiangsu Province, Jiangsu Road No. 172, Gulou District, Nanjing city 210009, Jiangsu Province, China
| | - Hao Yu
- Jiangsu Provincial Center for disease Control and Prevention, Public Health Research Institute of Jiangsu Province, Jiangsu Road No. 172, Gulou District, Nanjing city 210009, Jiangsu Province, China
| | - Yuehua Liu
- Heilongjiang Provincial Center for Disease Control and Prevention, No. 40 Youfang Street, Xiangfang District, Harbin City 150030, China
| | - Shaofang Li
- Henan Provincial Center for Disease Control and Prevention, No. 105 Nongye South Street, Zhengdong New District, Zhengzhou City 450016, China
| | - Huiting Yu
- Shanghai Municipal Center for Disease Control and Prevention, No. 1380 Zhongshan West Street, Changning District, Shanghai City 200051, China
| | - Chunfang Wang
- Shanghai Municipal Center for Disease Control and Prevention, No. 1380 Zhongshan West Street, Changning District, Shanghai City 200051, China
| | - Tian Xia
- Shanghai Municipal Center for Disease Control and Prevention, No. 1380 Zhongshan West Street, Changning District, Shanghai City 200051, China
| | - Jinen Xi
- Gansu Provincial Center for Disease Control and Prevention, No. 230 Donggang West Street, Chengguan District, Lanzhou City 73000, China
| | - Xiaolan Ren
- Gansu Provincial Center for Disease Control and Prevention, No. 230 Donggang West Street, Chengguan District, Lanzhou City 73000, China
| | - Xiuya Xing
- Anhui Provincial Center for Disease Control and Prevention, No. 12560 Fanhua Avenue, Economic and Technological Development District, Hefei City 230601, China
| | - Qianyao Cheng
- Anhui Provincial Center for Disease Control and Prevention, No. 12560 Fanhua Avenue, Economic and Technological Development District, Hefei City 230601, China
| | - Fangrong Fei
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Street, Binjiang District, Hangzhou City 310051, China
| | - Dezheng Wang
- Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Street, Hedong District, Tianjin City 300011, China
| | - Shuang Zhang
- Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Street, Hedong District, Tianjin City 300011, China
| | - Yuling He
- Shanxi Center for Disease Control and Prevention, No. 6 Xiaonanguan Shuangta West Street, Yingze District, Taiyuan City 030012, China
| | - Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Panglin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Xuyan Wang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hui Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Yudiyang Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Donghui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Jinhong Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Runtang Meng
- Department of Preventive Medicine, School of Medicine, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Yunquan Zhang
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yan Guo
- Wuhan Centers for Disease Control and Prevention, Wuhan 430024, Hubei, China
| | - Yaqiong Yan
- Wuhan Centers for Disease Control and Prevention, Wuhan 430024, Hubei, China
| | - Wei Zhang
- Wuhan Centers for Disease Control and Prevention, Wuhan 430024, Hubei, China
| | - Sisi Ke
- Wuhan Centers for Disease Control and Prevention, Wuhan 430024, Hubei, China
| | - Runhua Zhang
- Beijing Tiantan Hospital, Capital Medical University Beijing, China
| | - Dingyi Wang
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital; National Center for Respiratory Medicine, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Tingting Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100083, China
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Japan
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Joshua A. Salomon
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| |
Collapse
|
5
|
Nomura S, Yamamoto Y, Yoneoka D, Haagsma JA, Salomon JA, Ueda P, Mori R, Santomauro D, Vos T, Shibuya K. How do Japanese rate the severity of different diseases and injuries?-an assessment of disability weights for 231 health states by 37,318 Japanese respondents. Popul Health Metr 2021; 19:21. [PMID: 33892742 PMCID: PMC8063365 DOI: 10.1186/s12963-021-00253-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Disability weights (DWs) are weight factors that reflect the severity of health states for estimates of disability-adjusted life years. A new set of global DWs was published for the Global Burden of Diseases and Injuries (GBD) 2013 study, which relied on sampling from various world regions, but included little data for countries in East Asia. This study aimed to measure DWs in Japan using comparable methods, and compare the results with previous estimates from the GBD 2013 DW study. Methods We conducted a web-based survey in 2019 to estimate DWs for 231 health states for the Japanese population. The survey included five new health states but otherwise followed the method of the GBD DW measurement study. The survey consisted of 15 paired comparison (PC) questions and 3 population health equivalence questions (PHE) per respondent. We analyzed PC data using probit regression and rescaled results to DW units between 0 (equivalent to full health) and 1 (equivalent to death). Findings We considered 37,318 nationally representative respondents. The values of the resulting DWs ranged from 0.707 (95% uncertainty interval (UI) 0.527–0.842) for spinal cord injury at neck level (untreated) to 0.004 (UI 0.001–0.009) for mild anemia. High correlation between Japanese DW and GBD 2013 DW was observed, but there was considerable disagreement. Out of 226 comparable health states, 55 (24.3%) showed more than a factor-of-two difference, of which 41 (74.6%) had a higher value in Japanese DW. Many of the health states with higher DW in the Japan study were injuries, including amputation and fracture, and hearing and vision loss, while mental, behavioral, and substance use disorders generally tended to be lower. Conclusions This study has created an empirical basis for assessment of Japanese DWs of health status. The findings from this study based on the Japanese population suggest that there might be contextual differences in rating the severity of health states compared to previous surveys conducted elsewhere. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00253-4.
Collapse
Affiliation(s)
- Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan. .,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | | | - Daisuke Yoneoka
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Joshua A Salomon
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, California, USA
| | - Peter Ueda
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Rintaro Mori
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Damian Santomauro
- School of Public Health, The University of Queensland, Queensland, Australia.,Queensland Centre for Mental Health Research, Queensland, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Kenji Shibuya
- Institute for Population Health, King's College London, London, UK
| |
Collapse
|
6
|
Tuck NL, Khuvtsagaan B, Rashid U, Aamir T, Goucke R, Regjii B, Dorjbal EA, Lundeg G, Bean DJ. The Adaptation of Pain Assessment Tools from High-Income to Low- and Middle-Income Countries: Psychometric Properties of a Set of Chronic Pain Questionnaires in Mongolian and New Zealand Patient Samples. PAIN MEDICINE 2021; 22:948-960. [PMID: 33001213 DOI: 10.1093/pm/pnaa267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chronic pain is a leading cause of disability in low- and middle-income countries; however, pain assessment tools have generally been developed and validated in high-income countries. This study examines the psychometric properties of a set of translated pain (and distress) questionnaires in Mongolia and documents the characteristics of people seeking treatment for chronic pain in Mongolia, compared with those in New Zealand, which is representative of high-income countries. DESIGN Cross-sectional, observational. SETTING Hospital-based pain treatment centers in New Zealand and Mongolia. SUBJECTS People seeking treatment for chronic pain in Mongolia (N = 142) and New Zealand (N = 159). METHODS The Brief Pain Inventory, the Depression Anxiety Stress Scale-21, the Pain Catastrophizing Scale, and the Pain Self-Efficacy Questionnaire were translated into Mongolian and administered to patients attending a hospital-based pain service. Questionnaires that were completed by patients in New Zealand were used for comparisons. Internal reliability, convergent validity, and factor structure were assessed in both groups. RESULTS Patients in Mongolia were older and reported lower pain intensity, interference, and distress and higher pain self-efficacy than those in New Zealand. The translated questionnaires had good internal consistencies, and the relationships between pain variables were similar across both groups. The factor structure for the Pain Catastrophizing Scale was consistent across both groups, but this was not the case for the Brief Pain Inventory or the Depression Anxiety Stress Scale-21. CONCLUSIONS Findings indicate that some pain outcome measures may be appropriate for use in Mongolia and should be investigated in other low- and middle-income countries.
Collapse
Affiliation(s)
- Natalie L Tuck
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand.,The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,The Waitematā District Health Board (WDHB) Chronic Pain Service, Department of Anesthesiology and Perioperative Medicine, Auckland, New Zealand
| | | | - Usman Rashid
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Tipu Aamir
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Roger Goucke
- Medical School University of Western Australia, Nedlands, Western Australia, Australia
| | | | | | - Ganbold Lundeg
- The Mongolian National University of Medical Sciences, Ulaanbatar, Mongolia
| | - Debbie J Bean
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,The Waitematā District Health Board (WDHB) Chronic Pain Service, Department of Anesthesiology and Perioperative Medicine, Auckland, New Zealand
| |
Collapse
|
7
|
Ahn H, Jackson N, An K, Fillingim RB, Miao H, Lee M, Ko J, Galle K, Lee MA. Relationship between Acculturative Stress and Pain Catastrophizing in Korean Americans. J Immigr Minor Health 2020; 23:741-746. [PMID: 32915374 DOI: 10.1007/s10903-020-01083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 11/30/2022]
Abstract
Acculturative stress is speculated to be a sociocultural factor contributing to pain since cultural beliefs and practices can influence the way patients perceive and respond to pain. However, the relationship between acculturative stress and pain catastrophizing remains poorly understood. Therefore, we examined the relationship between acculturative stress and pain catastrophizing in Korean Americans. We collected survey data from Korean American in Texas (N = 374). Acculturative stress was measured with the Acculturative Stress Scale, and pain catastrophizing was measured with the Pain Catastrophizing Scale. Participants' mean age was 46.89 years, and 63% were women. Bivariate and multivariate statistical analyses indicated that higher acculturative stress may contribute to higher pain catastrophizing (regression coefficient = 1.02, P = 0.04). These findings advance our understanding of sociocultural factors associated with pain in Korean Americans; additional research with a larger sample is warranted for cross-validation.
Collapse
Affiliation(s)
- Hyochol Ahn
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center At Houston, 6901 Bertner Avenue, Ste. 567A, Houston, TX, 77030, USA.
| | - Natalie Jackson
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center At Houston, 6901 Bertner Avenue, Ste. 567A, Houston, TX, 77030, USA
| | - Kyungeh An
- Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Hongyu Miao
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center At Houston, Houston, TX, USA
| | - Moonju Lee
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jisook Ko
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kelli Galle
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center At Houston, 6901 Bertner Avenue, Ste. 567A, Houston, TX, 77030, USA
| | - Mikyoung A Lee
- College of Nursing, Texas Woman's University, Denton, TX, USA
| |
Collapse
|
8
|
Abstract
Blinking sustains the corneal tear film generated by sexually dimorphic lacrimal and meibomian glands. Our study examines whether trigeminal control of blinking is also sexually dimorphic by investigating trigeminal reflex blinking, associative blink modification, and spontaneous blinking in male and female rats before and after unilateral dry eye caused by exorbital gland removal. Before gland removal, female rats exhibited a lower threshold for evoking trigeminal reflex blinks, a weaker effect of associative blink modification, and longer-duration spontaneous blinks than males. Spontaneous blink rate, reflex blink excitability, and occurrence of blink oscillations did not differ between the sexes. Reanalysis of previous data showed that humans showed the same blink sexual dimorphisms as rats. During the first 2 wk of dry eye, trigeminal blink circuit excitability and blink oscillations steadily rose in male rats, whereas excitability and blink oscillations did not change in females. Following dry eye, spontaneous blink duration increased for both males and females, whereas spontaneous blink rate remained constant for males but decreased for females. The associative modification treatment to depress trigeminal blink amplitude initially produced blink depression in males that converted to blink potentiation as trigeminal excitability rose, whereas females exhibited progressively more blink depression. These data indicated that dry eye increased excitability in male trigeminal reflex blink circuits at the expense of circuit modifiability, whereas trigeminal modifiability increased in females. This increased modifiability of female trigeminal blink circuits with dry eye may contribute to the preponderance of females developing the focal dystonia, benign essential blepharospasm.NEW & NOTEWORTHY All the elements controlling the corneal tear film are sexually dimorphic. Blinking, which smooths and maintains the tear film, also exhibits sex differences. Dry eye increases the sexual dimorphisms of blinking, including increased exaggeration of excitability in males and enhanced modifiability of the female trigeminal complex. This increased modifiability may explain female predominance in the development of the focal dystonia, benign essential blepharospasm.
Collapse
Affiliation(s)
- Ashley Culoso
- Department of Neurobiology & Behavior, Stony Brook University, Stony Brook, New York
| | - Cynthia Lowe
- Department of Neurobiology & Behavior, Stony Brook University, Stony Brook, New York
| | - Craig Evinger
- Department of Neurobiology & Behavior, Stony Brook University, Stony Brook, New York
| |
Collapse
|
9
|
Nakatani-Enomoto S, Yamazaki M, Kamimura Y, Abe M, Asano K, Enomoto H, Wake K, Watanabe S, Ugawa Y. Frequency-dependent current perception threshold in healthy Japanese adults. Bioelectromagnetics 2019; 40:150-159. [PMID: 30920674 DOI: 10.1002/bem.22175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 02/10/2019] [Indexed: 01/31/2023]
Abstract
The purpose of the study involves measuring the threshold for electric currents (i.e., current perception threshold or CPT) under several stimulating current frequencies. Specifically, current perception threshold (CPT) was measured in 53 healthy volunteers between the ages of 21 and 67. The stimulation currents were applied on the right index finger with stimulus frequencies in the range of 50 Hz - 300 kHz. The method of limits and method of constant stimuli were combined to measure the CPT. In a manner consistent with the findings obtained by previous studies, the results indicated that CPT was higher in men than in women and in older individuals than in young subjects. Bioelectromagnetics. 9999:XX-XX, 2019. © 2019 Bioelectromagnetics Society.
Collapse
Affiliation(s)
- Setsu Nakatani-Enomoto
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Madoka Yamazaki
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Health Science, Daito Bunka University, Saitama, Japan
| | - Yoshitsugu Kamimura
- Department of Information Science, Graduate School of Engineering, Utsunomiya University, Tochigi, Japan
| | - Mitsunari Abe
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kohei Asano
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Enomoto
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kanako Wake
- Electromagnetic Compatibility Laboratory, Applied Electromagnetic Research Institute, National Institute of Information and Communications Technology, Tokyo, Japan
| | - Soichi Watanabe
- Electromagnetic Compatibility Laboratory, Applied Electromagnetic Research Institute, National Institute of Information and Communications Technology, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan.,Fukushima Global Medical Science Center, Advanced Clinical Research Center, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
10
|
The Relationship between Acculturation and Experimental Pain Sensitivity in Asian Americans with Knee Osteoarthritis. Pain Res Manag 2019; 2018:9128015. [PMID: 30607217 PMCID: PMC6304828 DOI: 10.1155/2018/9128015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/18/2018] [Indexed: 01/03/2023]
Abstract
Multiple studies in healthy populations and clinical samples have shown that ethnic minorities have greater pain sensitivity than their majority counterparts. Acculturation is speculated to be one of the sociocultural factors contributing to pain sensitivity since cultural beliefs and practices can influence the way patients perceive and respond to pain. However, the relationship of acculturation to pain sensitivity in minority populations remains poorly understood. Therefore, in this cross-sectional study, we examined the relationship between acculturation and experimental pain sensitivity in 50 Asian Americans residing in North Central Florida with knee osteoarthritis pain. The Suinn-Lew Asian Self Identity Acculturation Scale was used to assess acculturation, and multimodal quantitative sensory testing was performed to measure experimental sensitivity, including heat pain tolerance, pressure pain threshold, and punctate mechanical pain. Descriptive and regression analyses were performed. Participants' mean age was 55.7 years, and about half of this sample were Korean American (56%). The participants had lived in the United States for 21 years on average. Regression analyses indicated that lower acculturation to American culture may contribute to greater experimental pain sensitivity. Asian Americans who were more acculturated to the American culture had higher heat pain tolerance (beta = 0.61, P=0.01), higher pressure pain threshold (beta = 0.59, P=0.02), and lower ratings of punctate mechanical pain (beta = -0.70, P < 0.01). These findings add to the literature regarding sociocultural factors associated with pain in Asian Americans; additional research with a larger and more diverse sample of Asian Americans is warranted for cross-validation.
Collapse
|
11
|
Ahn H, Weaver M, Lyon D, Choi E, Fillingim RB. Depression and Pain in Asian and White Americans With Knee Osteoarthritis. THE JOURNAL OF PAIN 2017; 18:1229-1236. [PMID: 28619697 PMCID: PMC5661986 DOI: 10.1016/j.jpain.2017.05.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/05/2017] [Accepted: 05/25/2017] [Indexed: 11/25/2022]
Abstract
Few studies have examined the underlying psychosocial mechanisms of pain in Asian Americans. Using the biopsychosocial model, we sought to determine whether variations in depression contribute to racial group differences in symptomatic knee osteoarthritis pain between Asian Americans and non-Hispanic white Americans. The sample consisted of 100 participants, including 50 Asian Americans (28 Korean Americans, 9 Chinese Americans, 7 Japanese Americans, 5 Filipino Americans, and 1 Indian American) and 50 age- and sex-matched non-Hispanic white Americans with symptomatic knee osteoarthritis pain. The Centers for Epidemiologic Studies Depression Scale was used to assess symptoms of depression, and the Western Ontario and McMaster Universities Osteoarthritis Index and the Graded Chronic Pain Scale were used to measure clinical pain. In addition, quantitative sensory testing was used to measure experimental sensitivity to heat- and mechanically-induced pain. The results indicated that higher levels of depression in Asian Americans may contribute to greater clinical pain and experimental pain sensitivity. These findings add to the growing literature regarding ethnic and racial differences in pain and its associated psychological conditions, and additional research is warranted to strengthen these findings. PERSPECTIVE This article shows the contribution of depression to clinical pain and experimental pain sensitivity in Asian Americans with knee osteoarthritis. Our results suggest that Asian Americans have higher levels of depressive symptoms and that depression plays a relevant role in greater clinical pain and experimental pain sensitivity in Asian Americans.
Collapse
Affiliation(s)
- Hyochol Ahn
- The University of Texas Health Science Center at Houston, School of Nursing, Department of Nursing Systems, Houston, Texas.
| | - Michael Weaver
- University of Florida College of Nursing, Department of Behavioral Nursing Science, Gainesville, Florida
| | - Debra Lyon
- University of Florida College of Nursing, Department of Behavioral Nursing Science, Gainesville, Florida
| | - Eunyoung Choi
- The University of Texas Health Science Center at Houston, School of Nursing, Department of Nursing Systems, Houston, Texas
| | - Roger B Fillingim
- University of Florida Pain Research and Intervention Center of Excellence, Gainesville, Florida
| |
Collapse
|
12
|
Rahavard BB, Candido KD, Knezevic NN. Different pain responses to chronic and acute pain in various ethnic/racial groups. Pain Manag 2017; 7:427-453. [PMID: 28937312 DOI: 10.2217/pmt-2017-0056] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIM Our goal in this study was to review the similarities and differences among ethnic groups and their respective responses to acute and chronic clinically related and experimentally induced pain. METHOD In this review, the PUBMED and Google-Scholar databases were searched to analyze articles that have assessed the variations in both acute and chronic pain responses among different ethnic/racial groups. RESULTS According to the results from 42 reviewed articles, significant differences exist among ethnic-racial groups for pain prevalence as well as responses to acute and chronic pain. Compared with Caucasians, other ethnic groups are more susceptible to acute pain responses to nociceptive stimulation and to the development of long-term chronic pain. CONCLUSION These differences need to be addressed and assessed more extensively in the future in order to minimize the pain management disparities among various ethnic-racial groups and also to improve the relationship between pain management providers and their patients.
Collapse
Affiliation(s)
- Behnoosh B Rahavard
- Department of Anesthesiology & Pain Management of Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Kenneth D Candido
- Department of Anesthesiology & Pain Management of Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Department of Anesthesiology of University of Illinois at Chicago, Chicago, IL 60612, USA.,Department of Surgery of University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology & Pain Management of Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Department of Anesthesiology of University of Illinois at Chicago, Chicago, IL 60612, USA.,Department of Surgery of University of Illinois at Chicago, Chicago, IL 60612, USA
| |
Collapse
|
13
|
Feng Y, Herdman M, van Nooten F, Cleeland C, Parkin D, Ikeda S, Igarashi A, Devlin NJ. An exploration of differences between Japan and two European countries in the self-reporting and valuation of pain and discomfort on the EQ-5D. Qual Life Res 2017; 26:2067-2078. [PMID: 28343350 PMCID: PMC5509839 DOI: 10.1007/s11136-017-1541-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the systematic differences in the self-reporting and valuation of overall health and, in particular, pain/discomfort between three countries (England/UK, Japan, and Spain) on the EQ-5D. METHODS Existing datasets were used to explore differences in responses on the EQ-5D descriptive system between Japan (3L and 5L), the UK (3L), England (5L), and Spain (5L), particularly on the dimension of pain/discomfort. The role of different EQ dimensions in determining self-reported overall health scores for the EuroQol visual analog scale (EQ-VAS) was investigated using ordinary least squares regression. Time trade-off (TTO) results from Japanese and UK respondents for the EQ-5D-3L as well as Japanese and English respondents for the EQ-5D-5L were compared using t tests. RESULTS For the EQ-5D-3L, a higher percentage of respondents in Japan than in the UK reported 'no pain/discomfort' (81.6 vs 67.0%, respectively); for the EQ-5D-5L, the proportions were 79.2% in Spain, 73.2% in Japan, and 63-64% in England, after adjusting for age differences in samples. The 'pain/discomfort' dimension had the largest impact on respondents' self-reported EQ-VAS only for EQ-5D-3L in Japan. Using the EQ-5D-3L, Japanese respondents were considerably less willing to trade off time to avoid pain/discomfort than the UK respondents; for example, moving from health state, 11121 (some problems with pain/discomfort) to 11131 (extreme pain/discomfort) represented a decrement of 0.65 on the observed TTO value in the UK compared with 0.15 in Japan. Using the EQ-5D-5L, Japanese respondents were also less willing to trade off time to avoid pain/discomfort than respondents in England; however, the difference in values was much smaller than that observed using EQ-5D-3L data. CONCLUSIONS This study provides evidence of between-country differences in the self-reporting and valuation of health, including pain/discomfort, when using EQ-5D in general population samples. The results suggest a need for caution when comparing or aggregating EQ-5D self-reported data in multi-country studies.
Collapse
Affiliation(s)
- Yan Feng
- Office of Health Economics, London, UK.
| | | | | | | | | | - Shunya Ikeda
- International University of Health and Welfare, Otawara, Japan
| | | | | |
Collapse
|
14
|
Ahn H, Weaver M, Lyon D, Kim J, Choi E, Staud R, Fillingim RB. Differences in Clinical Pain and Experimental Pain Sensitivity Between Asian Americans and Whites With Knee Osteoarthritis. Clin J Pain 2017; 33:174-180. [PMID: 28060784 PMCID: PMC5218521 DOI: 10.1097/ajp.0000000000000378] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Ethnicity has been associated with clinical and experimental pain responses. Whereas ethnic disparities in pain in other minority groups compared with whites are well described, pain in Asian Americans remains poorly understood. The purpose of this study was to characterize differences in clinical pain intensity and experimental pain sensitivity among older Asian American and non-Hispanic white (NHW) participants with knee osteoarthritis (OA). METHODS Data were collected from 50 Asian Americans ages 45 to 85 (28 Korean, 9 Chinese, 7 Japanese, 5 Filipino, and 1 Indian) and compared with 50 age-matched and sex-matched NHW individuals with symptomatic knee OA pain. The Western Ontario and McMaster Universities Osteoarthritis Index and Graded Chronic Pain Scale were used to assess the intensity of clinical knee pain. In addition, quantitative sensory testing was used to measure experimental sensitivity to heat-induced and mechanically induced pain. RESULTS Asian American participants had significantly higher levels of clinical pain intensity than NHW participants with knee OA. In addition, Asian American participants had significantly higher experimental pain sensitivity than NHW participants with knee OA. DISCUSSION These findings add to the growing literature regarding ethnic and racial differences in clinical pain intensity and experimental pain sensitivity. Asian Americans in particular may be at risk for clinical pain and heightened experimental pain sensitivity. Further investigation is needed to identify the mechanisms underlying ethnic group differences in pain between Asian Americans and NHWs, and to ensure that ethnic group disparities in pain are ameliorated.
Collapse
Affiliation(s)
- Hyochol Ahn
- University of Florida College of Nursing, Gainesville, Florida
| | - Michael Weaver
- University of Florida College of Nursing, Gainesville, Florida
| | - Debra Lyon
- University of Florida College of Nursing, Gainesville, Florida
| | - Junglyun Kim
- University of Florida College of Nursing, Gainesville, Florida
| | - Eunyoung Choi
- University of Florida College of Nursing, Gainesville, Florida
| | - Roland Staud
- University of Florida College of Medicine, Gainesville, Florida
| | - Roger B. Fillingim
- University of Florida Pain Research and Intervention Center of Excellence, Gainesville, Florida
| |
Collapse
|
15
|
Racial and ethnic differences in experimental pain sensitivity: systematic review and meta-analysis. Pain 2016; 158:194-211. [DOI: 10.1097/j.pain.0000000000000731] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
16
|
González-Duarte A, Lem-Carrillo M, Guerrero-Torres L. Normative values of quantitative sensory testing in Hispanic Latino population. Brain Behav 2016; 6:e00466. [PMID: 27458540 PMCID: PMC4951613 DOI: 10.1002/brb3.466] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Quantitative Sensory Testing (QST) is more often used because of the increasing recognition of small fiber neuropathy. METHODS We studied QST in a systematic way in an age-stratified cohort of 83 neurological-free Hispanic Latinamerican patients. Predefined standardized stimuli were applied using the method of limits. RESULTS WDT range from 2.2 to 3.3°C in hands, and from 4.0°C up to 6.6°C in feet. Cold detection threshold range from 2.2 to 3.6°C in hands, and from 2.6°C to 4.5°C in feet. Heat-induced pain (HP) was induced at lower temperatures than previously reported, with a range from 41.8°C to 44.5°C in hands and from 43.2 to 45.7°C in feet. Similar to HP, cold pain was also induced at much higher temperatures, between 21.4-17.3°C in hands and 21.5-16.5°C in feet. Vibratory stimuli ranged from 0.8 to 1.7 μ/sec in hands and from 1.4 to 3.5 μ/sec in feet. CONCLUSION Temperature and vibration thresholds were similar to those previously reported in other populations except for pain thresholds that were lower in this population than in the Caucasian population.
Collapse
Affiliation(s)
- Alejandra González-Duarte
- Department of Neurology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán México City México
| | - Mónica Lem-Carrillo
- Department of Neurology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán México City México
| | - Lorena Guerrero-Torres
- Department of Neurology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán México City México
| |
Collapse
|
17
|
Al-Harthy M, Ohrbach R, Michelotti A, List T. The effect of culture on pain sensitivity. J Oral Rehabil 2015; 43:81-8. [DOI: 10.1111/joor.12346] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Affiliation(s)
- M. Al-Harthy
- Department of Oral Basic and Clinical Sciences; Faculty of Dentistry; Umm Al-Qura University; Makkah Saudi Arabia
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
| | - R. Ohrbach
- Department of Oral Diagnostic Sciences; School of Dental Medicine; University at Buffalo; Buffalo NY USA
| | - A. Michelotti
- Department of Orthodontics and Temporomandibular Disorders; School of Dentistry; University of Naples Federico II; Naples Italy
| | - T. List
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
- Department of Rehabilitation Medicine; Skane University Hospital; Lund Sweden
| |
Collapse
|
18
|
|
19
|
Sipilä K, Tolvanen M, Mitrirattanakul S, Sitthisomwong P, Järvelin MR, Taanila A, Anttonen V, Lahti S. Orofacial pain and symptoms of temporomandibular disorders in Finnish and Thai populations. Acta Odontol Scand 2015; 73:330-5. [PMID: 25613141 DOI: 10.3109/00016357.2014.949842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cultural or ethnic factors may play an important role in subjects' pain reports. The aim of the study was to compare the prevalence of orofacial pain symptoms between Finnish and Thai populations. MATERIALS AND METHODS The Finnish study population comprised the Northern Finland Birth Cohort 1966, of which 5696 subjects participated in the present study. The Thai sample consisted of 1501 randomly selected people living in 10 different districts in Bangkok. Data on orofacial pain was collected based on questionnaires. RESULTS After adjusting for age, gender and education, the logistic regression analysis showed that Thai subjects had an increased risk for reporting oral pain (OR = 4.5, 95% CI = 3.7-5.4), tooth pain (OR = 2.0, 95% CI = 1.8-2.4) and pain in the face (OR = 1.5, 95% CI = 1.2-1.7). CONCLUSIONS It can be concluded that Thai people report more orofacial pain symptoms than Finnish subjects. Cross-cultural factors exist in the background of reporting pain symptoms in the oral and facial area.
Collapse
Affiliation(s)
- Kirsi Sipilä
- Institute of Dentistry, University of Eastern Finland , Finland
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Gordeev SA, Turbina LG, Shtang OM. Study of exteroceptive suppression of voluntary muscular activity in healthy volunteers and patients with paroxysmal neuropathic pain. Bull Exp Biol Med 2014; 157:380-2. [PMID: 25065319 DOI: 10.1007/s10517-014-2571-4] [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: 03/11/2013] [Indexed: 11/26/2022]
Abstract
The exteroceptive suppression of voluntary electromyographic activity of the masseter and temporal muscles was studied in healthy volunteers and patients with paroxysmal neuropathic pain (trigeminal neuralgia). The latent period of the exteroceptive suppression was prolonged and the duration of its late fragment was shortened in the patients in comparison with normal subjects. A short exteroceptive suppression period in patients with trigeminal neuralgia reflected deficient activity of inhibitory interneurons of the reflector loop and excessive activity of the antinociceptive system of the brain stem, while prolongation of the latent period reflected prolongation of inhibitory interneurons activation. A direct correlation between the degree of changes in the exteroceptive suppression parameters and pain intensity, evaluated by the patients by the visual analog scale, was detected.
Collapse
Affiliation(s)
- S A Gordeev
- Department of Brain Studies, Research Center of Neurology, Russian Academy of Medical Sciences, Moscow, Russia,
| | | | | |
Collapse
|
21
|
Liu HC, Tao WK, Zeng RF, ShangGuang WN, Li J, Huang WG, Dong ZL, Wang X, Lian QQ. Dose requirements of remifentanil for intubation in nonparalyzed Chinese children. Paediatr Anaesth 2014; 24:505-9. [PMID: 24708453 DOI: 10.1111/pan.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this study was to determine ED50 and ED95 of remifentanil for intubation combined with propofol in nonparalyzed Chinese children. METHODS Forty-seven American Society of Anesthesiologists Class I children aged 4-11 years weighing 14-33.5 kg underwent general anesthesia with 2.5 mg·kg(-1) of intravenous propofol followed by remifentanil in Wenzhou, China. The initial dose of remifentanil was 2.5 μg·kg(-1) injected over 60 s. Intubation was attempted 30 s after the completion of remifentanil injection. Level of difficulty to intubate was graded on a scoring system. If the initial intubation condition was deemed satisfactory, subsequent remifentanil doses were decreased by 0.25 μg·kg(-1). If the intubating condition was deemed unsatisfactory, subsequent remifentanil doses were increased by 0.25 μg·kg(-1). Mean arterial pressure, heart rate, and pulse oximetry were documented before and after induction, immediately after intubation, and 1 min after intubation. RESULTS The ED50 of remifentanil used to render a satisfactory intubating condition used in combination with 2.5 mg·kg(-1) of propofol in nonparalyzed Chinese children was 2.30 μg·kg(-1) (95% confidence interval: 2.28-2.31 μg·kg(-1)), and the ED95 is 2.75 μg·kg(-1) (95% confidence interval: 2.59-3.35 μg·kg(-1)). These doses were lower than previously reported. CONCLUSION When used in combination with 2.5 mg·kg(-1) of intravenous propofol, ED50 and ED95 of remifentanil for adequate intubation in nonparalyzed children were lower than previously reported, at 2.30 and 2.75 μg·kg(-1), respectively.
Collapse
Affiliation(s)
- Hua-Cheng Liu
- Department of Anesthesiology, the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Pickering ME, Bunna P, Rat P, Madeline G, Lebost C, Serrie A, Pereira B. Acute Pain Evaluation with Algoplus®Scale in Cambodian Patients. PAIN MEDICINE 2013; 14:1971-6. [DOI: 10.1111/pme.12174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Abstract
The prevalence of itch is higher in individuals with darker skin types. In this paper, we review the systems involved in the physiology of itch and how they may differ across the races. Current data point out that the differences may be explained by barrier function, mast cell physiology, and itch receptor polymorphisms.
Collapse
Affiliation(s)
- Enes Hajdarbegovic
- Department of Dermatology and Venereology, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | | |
Collapse
|
24
|
Alabas OA, Tashani OA, Johnson MI. Effects of ethnicity and gender role expectations of pain on experimental pain: a cross-cultural study. Eur J Pain 2012; 17:776-86. [PMID: 23070971 DOI: 10.1002/j.1532-2149.2012.00229.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Gender role expectations of pain (GREP) have been shown to mediate sex differences in experimental pain. Few studies have investigated the role of ethnicity in shaping GREP. The aim of this study was to examine interactions between ethnicity and GREP on experimentally induced pressure and ischaemic pain in Libyan and white British students in their respective countries. METHODS Libyan (n = 124) and white British (n = 51) students completed a GREP questionnaire and their response to experimental pain was measured. Blunt pressure pain threshold (PPT) was measured over the 1st interosseous muscle using algometry. Pain intensity and pain unpleasantness (100 mm visual analogue scale) were measured at 1-min intervals during a submaximal effort tourniquet test on the forearm. RESULTS Multivariate analysis of variance detected significant effects for Sex and Ethnicity on pain measurements. Men had higher PPTs than women (p < 0.001). Libyans had higher PPTs than white British participants (p < 0.001). There were significant effects for Sex and Ethnicity for pain intensity ratings (p < 0.01) but no significant differences between the sexes in pain unpleasantness (p > 0.05). Libyan participants had higher pain intensity (p < 0.01) and pain unpleasantness (p < 0.05) ratings compared with white British participants. There were effects for Sex and Ethnicity for all GREP dimensions. Libyan participants exhibited stronger stereotypical views in GREP than white British participants (p < 0.001). CONCLUSIONS GREP was the mediator of sex but not ethnic differences in pain report, suggesting that gender stereotypical attitudes to pain account for differences in pain expression between men and women.
Collapse
Affiliation(s)
- O A Alabas
- Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, UK.
| | | | | |
Collapse
|
25
|
Rahim-Williams B, Riley JL, Williams AKK, Fillingim RB. A quantitative review of ethnic group differences in experimental pain response: do biology, psychology, and culture matter? PAIN MEDICINE 2012; 13:522-40. [PMID: 22390201 DOI: 10.1111/j.1526-4637.2012.01336.x] [Citation(s) in RCA: 222] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Pain is a subjectively complex and universal experience. We examine research investigating ethnic group differences in experimental pain response and factors contributing to group differences. METHOD We conducted a systematic literature review and analysis of studies using experimental pain stimuli to assess pain sensitivity across multiple ethnic groups. Our search covered the period from 1944 to 2011, and used the PubMed bibliographic database; a reference source containing over 17 million citations. We calculated effect sizes; identified ethnic/racial group categories, pain stimuli, and measures; and examined findings regarding biopsychosociocultural factors contributing to ethnic/racial group differences. RESULTS We found 472 studies investigating ethnic group differences and pain. Twenty-six of these met our review inclusion criteria of investigating ethnic group differences in experimental pain. The majority of studies included comparisons between African Americans (AA) and non-Hispanic Whites (NHW). There were consistently moderate to large effect sizes for pain tolerance across multiple stimulus modalities; AA demonstrated lower pain tolerance. For pain threshold, findings were generally in the same direction, but effect sizes were small to moderate across ethnic groups. Limited data were available for suprathreshold pain ratings. A subset of studies comparing NHW and other ethnic groups showed a variable range of effect sizes for pain threshold and tolerance. CONCLUSION There are potentially important ethnic/racial group differences in experimental pain perception. Elucidating ethnic group differences has translational merit for culturally competent clinical care and for addressing and reducing pain treatment disparities among ethnically/racially diverse groups.
Collapse
Affiliation(s)
- Bridgett Rahim-Williams
- Department of Behavioral Science and Community Health, University of Florida, College of Public Health and Health Professions, Gainesville, Florida 32610, USA.
| | | | | | | |
Collapse
|
26
|
Lodetti G, Mapelli A, Musto F, Rosati R, Sforza C. EMG spectral characteristics of masticatory muscles and upper trapezius during maximum voluntary teeth clenching. J Electromyogr Kinesiol 2011; 22:103-9. [PMID: 22100151 DOI: 10.1016/j.jelekin.2011.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/21/2011] [Accepted: 10/21/2011] [Indexed: 02/03/2023] Open
Abstract
To assess the surface electromyographic spectral characteristics of masticatory and neck muscles during the performance of maximum voluntary clench (MVC) tasks, 29 healthy young adults (15 men, 14 women, mean age 22years) were examined. Electromyography of masseter, temporalis and upper trapezius muscles was performed during 5-s MVCs either on cotton rolls or in intercuspal position. Using a fast Fourier transform, the median power frequency (MPF) was obtained for the first and last seconds of clench, and compared between sexes, muscles, sides, tests and time intervals using ANOVAs. On average, the MPFs did not differ between sexes or sides (p>0.05), but significant effects of muscle (MPF temporalis larger than masseter, larger than trapezius muscles), test (larger MPFs when clenching in intercuspal position than when clenching on cotton rolls) and time (larger MPFs in the first than in the fifth second of clench) were found. In conclusion, a set of data to characterize the sEMG spectral characteristics of jaw and neck muscles in young adult subjects performing MVC tasks currently in use within the dental field was obtained. Reference values may assist in the assessment of patients with alterations in the cranio-cervical-mandibular system.
Collapse
Affiliation(s)
- Gianluigi Lodetti
- Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Dipartimento di Morfologia Umana e Scienze Biomediche Città Studi, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy
| | | | | | | | | |
Collapse
|
27
|
Asians differ from non-Hispanic Whites in experimental pain sensitivity. Eur J Pain 2011; 15:764-71. [PMID: 21561793 DOI: 10.1016/j.ejpain.2010.11.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 11/01/2010] [Accepted: 11/29/2010] [Indexed: 11/21/2022]
Abstract
This study examined differences between Asians and non-Hispanic Whites (Whites) in pain sensitivity, and its relationship to mean arterial pressure (MAP) and heart rate (HR). In 30 Whites (50% female) and 30 Asians (50% female), experimental pain sensitivity was assessed with a hand cold pressor task, yielding measures of pain threshold, tolerance, intensity, and unpleasantness. Mean arterial pressure and HR measurements taken at rest and in response to speech stress were assessed. Perceived stress, anxiety, perfectionism, parental criticism, parental expectations and depressive symptoms were also measured. The results indicated that for the cold pain test, Asians demonstrated significantly lower pain threshold and tolerance levels than Whites. Although no ethnic differences were seen for MAP or HR responses to stress, for Whites higher stress MAP levels were correlated with reduced pain sensitivity, while for Asians higher baseline and stress HR levels were correlated with reduced pain sensitivity. Asians reported higher parental expectations and greater parental criticism than Whites. For Asians only, higher levels of perfectionism were related to more depressive symptoms, anxiety and perceived stress. These results indicate that Asian Americans are more sensitive to experimental pain than Whites and suggest ethnic differences in endogenous pain regulatory mechanisms (e.g. MAP and HR). The results may also have implications for understanding ethnic differences in clinical pain.
Collapse
|
28
|
Toyosato A, Begum M, Sugiyama K, Someya G. Modulation of exteroceptive suppression periods in human jaw-closing muscles by subanaesthetic dose of propofol. J Oral Rehabil 2011; 38:79-85. [PMID: 21198772 DOI: 10.1111/j.1365-2842.2010.02150.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Exteroceptive suppression (ES) periods in human jaw-closing muscles can be conditioned by a wide range of somatosensory stimuli and cognitive states. The aim of this study was to examine the effects of subanaesthetic doses of midazolam, ketamine and propofol on the short latency (ES1) and long latency (ES2) reflex in the jaw-closing muscles. First, we tried to evaluate the various methodological criteria for ES recording. We then examined the effect of subanaesthetic doses of midazolam (0·035 mg kg(-1)), ketamine (0·30 mg kg(-1)) and propofol (0·35 mg kg(-1)) on these reflexes of recording left masseter and temporalis muscle. ES duration did not differ greatly in the present study, recorded with the correct adjustment of stimulating and recording conditions. None of the subanaesthetic doses of the agents influenced ES1, and no significant effects on ES2 were observed with midazolam and ketamine. However, significant inhibitory change was observed in ES2 with propofol. ES2 is thought to be mediated by afferents, which descend in the spinal trigeminal tract and connect with a polysynaptic chain of excitatory interneurones located in the lateral reticular formation. Our observations indicate that propofol is uniquely effective not only through involvement of the gamma-aminobutyric acid type A receptor, but also through a range of other effects.
Collapse
Affiliation(s)
- A Toyosato
- Department of Dental Anesthesiology, Kagoshima University of Medical and Dental Hospital, Kagoshima, Japan.
| | | | | | | |
Collapse
|
29
|
Komiyama O, Wang K, Svensson P, Arendt-Nielsen L, De Laat A, Kawara M. Magnetic and electric stimulation to elicit the masseteric exteroceptive suppression period. Clin Neurophysiol 2010; 121:793-9. [DOI: 10.1016/j.clinph.2010.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 01/08/2010] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
|
30
|
Dzheldubayeva ÉR, Chuyan EN, Bogdanova OV, Strizhak LA. Electroneuromyographic studies of pain sensitivity. NEUROPHYSIOLOGY+ 2009. [DOI: 10.1007/s11062-009-9091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
31
|
Ritter C, Bingel U. Neuroimaging the genomics of pain processing--a perspective. Neuroscience 2009; 164:141-55. [PMID: 19467296 DOI: 10.1016/j.neuroscience.2009.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 05/11/2009] [Accepted: 05/18/2009] [Indexed: 11/19/2022]
Abstract
The significant inter-individual variability in pain behavior and its contributing factors remains a pervasive clinical challenge and has generated intense scientific investigations in this field. Recent studies indicate that our genes considerably influence nociceptive information processes, how our nociceptive system copes with peripheral injury, and the individual response to analgesic treatments. Neuroimaging studies of pain are beginning to link such genetic influences with physiological processes in the human brain. This review presents the pioneering endeavors of the hybrid approach of neuroimaging pain genes in humans and identifies potential future directions.
Collapse
Affiliation(s)
- C Ritter
- Department of Neurology, Christian-Albrechts-University Kiel, Germany
| | | |
Collapse
|