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Cheraghi L, Niknam M, Masihay-Akbar H, Azizi F, Amiri P. How Do Active and Passive Cigarette Smokers in Iran Evaluate Their Health? A Sex-Specific Analysis on the Full-Spectrum of Quality of Life. Nicotine Tob Res 2024; 26:913-921. [PMID: 37651684 DOI: 10.1093/ntr/ntad157] [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: 03/16/2023] [Revised: 07/18/2023] [Accepted: 08/30/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION This study aimed to determine the sex-specific effects of active and passive cigarette smoking on the full spectrum of health-related quality of life (HRQoL) among a sizeable adult population. METHODS This study was conducted within the Tehran Lipid and Glucose Study (TLGS) framework. Participants included 7478 adults in the last examination of the TLGS. We used a quantile regression model to compare sex-specific HRQoL distributions among non-, current, and passive smokers. Two-step cluster analysis was used to consider the synergic effects of confounder variables. RESULTS In men, current smoking was negatively associated with only mental HRQoL in all percentiles of its distribution with a decrease in absolute estimation values from the lowest (5th: β = -6.59, p < .001) to the highest (90th: β=-0.93, p = .027). Also, passive smoking was negatively associated with men's physical HRQoL in the upper percentiles of its distribution (75th: β = -1.12, p = .010; 90th: β = -1.26, p = .016). In women, the current (β = -4.17 to -4.45 for 25th to 90th percentiles) and passive smokers (β = -2.05 to -4.25 for 10th to 90th percentiles) had lower mental HRQoL in the mentioned percentiles. Also, the current smoking had a negative association with the 5th percentile (β = -2.04, p = .008), and a positive association with the 50th (β = 1.94, p < .008) and 75th percentile of physical HRQoL (β = 2.25, p = .004). CONCLUSIONS The present study showed the harmful effect of smoking on mental HRQol in all participants. In contrast, the physical effect of smoking was only observed in female active smokers and at the extreme levels of the physical HRQoL spectrum. IMPLICATIONS According to the harmful effect of smoking on HRQoL, understanding active and passive smokers' perceptions of how smoking impacts their health is critical for tobacco control programs. Since most previous studies of smoking and HRQoL have mainly focused on the extreme parts or central values of the HRQoL distribution, the use of a multiple regression approach enables the evaluation of other parts of the conditional distribution of the outcome variable. This study demonstrated the prominent effect of smoking on the mental HRQoL as well as the more serious public health burden of passive smoking in women.
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Affiliation(s)
- Leila Cheraghi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdieh Niknam
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasti Masihay-Akbar
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Peier F, Mouthon M, De Pretto M, Chabwine JN. Response to experimental cold-induced pain discloses a resistant category among endurance athletes, with a distinct profile of pain-related behavior and GABAergic EEG markers: a case-control preliminary study. Front Neurosci 2024; 17:1287233. [PMID: 38287989 PMCID: PMC10822956 DOI: 10.3389/fnins.2023.1287233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Pain is a major public health problem worldwide, with a high rate of treatment failure. Among promising non-pharmacological therapies, physical exercise is an attractive, cheap, accessible and innocuous method; beyond other health benefits. However, its highly variable therapeutic effect and incompletely understood underlying mechanisms (plausibly involving the GABAergic neurotransmission) require further research. This case-control study aimed to investigate the impact of long-lasting intensive endurance sport practice (≥7 h/week for the last 6 months at the time of the experiment) on the response to experimental cold-induced pain (as a suitable chronic pain model), assuming that highly trained individual would better resist to pain, develop advantageous pain-copying strategies and enhance their GABAergic signaling. For this purpose, clinical pain-related data, response to a cold-pressor test and high-density EEG high (Hβ) and low beta (Lβ) oscillations were documented. Among 27 athletes and 27 age-adjusted non-trained controls (right-handed males), a category of highly pain-resistant participants (mostly athletes, 48.1%) was identified, displaying lower fear of pain, compared to non-resistant non-athletes. Furthermore, they tolerated longer cold-water immersion and perceived lower maximal sensory pain. However, while having similar Hβ and Lβ powers at baseline, they exhibited a reduction between cold and pain perceptions and between pain threshold and tolerance (respectively -60% and - 6.6%; -179.5% and - 5.9%; normalized differences), in contrast to the increase noticed in non-resistant non-athletes (+21% and + 14%; +23.3% and + 13.6% respectively). Our results suggest a beneficial effect of long-lasting physical exercise on resistance to pain and pain-related behaviors, and a modification in brain GABAergic signaling. In light of the current knowledge, we propose that the GABAergic neurotransmission could display multifaceted changes to be differently interpreted, depending on the training profile and on the homeostatic setting (e.g., in pain-free versus chronic pain conditions). Despite limitations related to the sample size and to absence of direct observations under acute physical exercise, this precursory study brings into light the unique profile of resistant individuals (probably favored by training) allowing highly informative observation on physical exercise-induced analgesia and paving the way for future clinical translation. Further characterizing pain-resistant individuals would open avenues for a targeted and physiologically informed pain management.
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Affiliation(s)
- Franziska Peier
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Michael Mouthon
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Michael De Pretto
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Joelle Nsimire Chabwine
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Neurology Division, Department of Internal Medicine, Fribourg-Cantonal Hospital, Fribourg, Switzerland
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Pereira TJ, Bouakkar J, Johnston H, Pakosh M, Drake JD, Edgell H. The effects of oral contraceptives on resting autonomic function and the autonomic response to physiological stressors: a systematic review. Clin Auton Res 2023; 33:859-892. [PMID: 37971640 DOI: 10.1007/s10286-023-00996-0] [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: 06/14/2023] [Accepted: 10/15/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE This systematic review aimed to summarize how oral contraceptives (OC) affect resting autonomic function and the autonomic response to a variety of physiological stressors. METHODS A search strategy was created to retrieve citations investigating physiological responses comparing OC users to non-users (NOC) in response to autonomic reflex activation. RESULTS A total of 6148 citations were identified across databases from inception to June 2, 2022, and 3870 citations were screened at the abstract level after deduplication. Then, 133 texts were assessed at full-text level, and only 40 studies met eligibility requirements. Included citations were grouped by the aspect of autonomic function assessed, including autonomic reflex (i.e., baroreflex, chemoreflex, mechanoreflex, metaboreflex, and venoarterial reflex), or indicators (i.e., heart rate variability, pulse wave velocity, and sympathetic electrodermal activity), and physiological stressors that may alter autonomic function (i.e., auditory, exercise, mental or orthostatic stress, altitude, cold pressor test, sweat test, and vasodilatory infusions). CONCLUSION OC influence the physiological responses to chemoreflex, mechanoreflex, and metaboreflex activation. In terms of autonomic indices and physiological stressors, there are more inconsistencies within the OC literature, which may be due to estrogen dosage within the OC formulation (i.e., heart rate variability) or the intensity of the stressor (exercise intensity/duration or orthostatic stress). Further research is required to elucidate the effects of OC on these aspects of autonomic function because of the relatively small amount of available research. Furthermore, researchers should more clearly define or stratify OC use by duration, dose, and/or hormone cycling to further elucidate the effects of OC.
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Affiliation(s)
- T J Pereira
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - J Bouakkar
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - H Johnston
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - M Pakosh
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - J D Drake
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
- Muscle Health Research Centre, York University, Toronto, ON, Canada
| | - H Edgell
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
- Library & Information Services, University Health Network, Toronto, ON, Canada.
- Muscle Health Research Centre, York University, Toronto, ON, Canada.
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Norbury R, Dickens L, Grant I, Emery A, Patterson SD. Remote ischaemic preconditioning increase tolerance to experimentally induced cold pain. Eur J Sport Sci 2023; 23:2435-2442. [PMID: 37746841 DOI: 10.1080/17461391.2023.2241831] [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] [Indexed: 09/26/2023]
Abstract
Ischaemic preconditioning (IPC) applied locally and remotely has been shown to reduce pain which may underpin its ergogenic effect on exercise performance, however, it is unclear how many IPC cycles are needed to induce hypoalgesia. Therefore the purpose of this study was to examine the number of cycles of IPC on experimental pain perception. Sixteen healthy participants underwent four, randomised, experimental sessions where they either underwent a sham protocol (1 × 5 min at 20 mmHg), and 1, 2 or 3 cycles × 5 min of remote IPC at 105% of limb occlusion pressure. Ten minutes post-intervention, participants underwent a cold-pressor test where pain threshold, pain tolerance and pain intensity were examined and compared between conditions with a one-way repeated measure analysis of variance. Pain threshold was not different between conditions (P = 0.065); but pain tolerance was increased by ∼30% in the 1 × 5 condition, 2 × 5 condition, and 3 × 5 condition compared to the sham condition. No differences in pain tolerance were seen between the different numbers of cycles (all P > 0.05). There was also no difference in the perception of pain 30 s into the cold pressor test (P = 0.279). Remote IPC appears to significantly improve tolerance to pain which may have significant implications for endurance performance and exercise rehabilitation, but this warrants further investigation.
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Affiliation(s)
- Ryan Norbury
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, UK
| | - Lieben Dickens
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, UK
| | - Ian Grant
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, UK
| | - Alison Emery
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, UK
| | - Stephen D Patterson
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, UK
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Raffaelli B, Do TP, Chaudhry BA, Ashina M, Amin FM, Ashina H. Menstrual migraine is caused by estrogen withdrawal: revisiting the evidence. J Headache Pain 2023; 24:131. [PMID: 37730536 PMCID: PMC10512516 DOI: 10.1186/s10194-023-01664-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To explore and critically appraise the evidence supporting the role of estrogen withdrawal in menstrual migraine. MAIN BODY Menstrual migraine, impacting about 6% of reproductive-age women, manifests as migraine attacks closely related to the menstrual cycle. The estrogen withdrawal hypothesis posits that the premenstrual drop in estrogen levels serves as a trigger of migraine attacks. Despite its wide acceptance, the current body of evidence supporting this hypothesis remains limited, warranting further validation. Estrogen is believed to exert a modulatory effect on pain, particularly within the trigeminovascular system - the anatomic and physiologic substrate of migraine pathogenesis. Nevertheless, existing studies are limited by methodologic inconsistencies, small sample sizes, and variable case definitions, precluding definitive conclusions. To improve our understanding of menstrual migraine, future research should concentrate on untangling the intricate interplay between estrogen, the trigeminovascular system, and migraine itself. This necessitates the use of robust methods, larger sample sizes, and standardized case definitions to surmount the limitations encountered in previous investigations. CONCLUSION Further research is thus needed to ascertain the involvement of estrogen withdrawal in menstrual migraine and advance the development of effective management strategies to address unmet treatment needs.
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Affiliation(s)
- Bianca Raffaelli
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Thien Phu Do
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Knowledge Center On Headache Disorders, Glostrup, Denmark
| | - Basit Ali Chaudhry
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Knowledge Center On Headache Disorders, Glostrup, Denmark
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Hijma H, Koopmans I, Klaassen E, Doll RJ, Zuiker R, Groeneveld GJ. A crossover study evaluating the sex-dependent and sensitizing effects of sleep deprivation using a nociceptive test battery in healthy subjects. Br J Clin Pharmacol 2023; 89:361-371. [PMID: 35997713 PMCID: PMC10086808 DOI: 10.1111/bcp.15505] [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: 04/25/2022] [Revised: 07/21/2022] [Accepted: 08/04/2022] [Indexed: 12/01/2022] Open
Abstract
AIM We assessed whether total sleep deprivation (TSD) in combination with pain tests yields a reliable method to assess altered pain thresholds, which subsequently may be used to investigate (novel) analgesics in healthy subjects. METHODS This was a two-part randomized crossover study in 24 healthy men and 24 women. Subjects were randomized 1:1 to first complete a day of nonsleep-deprived nociceptive threshold testing, followed directly by a TSD night and morning of sleep-deprived testing, or first complete the TSD night and morning sleep-deprived testing, returning 7 days later for a day of nonsleep-deprived testing. A validated pain test battery (heat, pressure, electrical burst and stair, cold pressor pain test and conditioned pain modulation [CPM] paradigm) and sleep questionnaires were performed. RESULTS Subjects were significantly sleepier after TSD as measured using sleepiness questionnaires. Cold pressor pain tolerance (PTT, estimate of difference [ED] -10.8%, 95% CI -17.5 to -3.6%), CPM PTT (ED -0.69 mA, 95% CI -1.36 to -0.03 mA), pressure PTT (ED -11.2%, 95% CI -17.5% to -4.3%) and heat pain detection thresholds (ED -0.74 °C, 95% CI -1.34 to -0.14 °C) were significantly decreased after TSD compared to the baseline morning assessment in the combined analysis (men + women). Heat hyperalgesia was primarily driven by an effect of TSD in men, whereas cold and pressure hyperalgesia was primarily driven by the effects of TSD observed in women. CONCLUSIONS TSD induced sex-dependent hyperalgesia on cold, heat and pressure pain, and CPM response. These results suggest that the TSD model may be suitable to evaluate (novel) analgesics in early-phase drug studies.
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Affiliation(s)
- Hemme Hijma
- Centre for Human Drug Research, CL, Leiden, The Netherlands.,Leiden University Medical Centre, ZA, Leiden, The Netherlands
| | - Ingrid Koopmans
- Centre for Human Drug Research, CL, Leiden, The Netherlands.,Leiden University Medical Centre, ZA, Leiden, The Netherlands
| | - Erica Klaassen
- Centre for Human Drug Research, CL, Leiden, The Netherlands
| | | | - Rob Zuiker
- Centre for Human Drug Research, CL, Leiden, The Netherlands
| | - Geert Jan Groeneveld
- Centre for Human Drug Research, CL, Leiden, The Netherlands.,Leiden University Medical Centre, ZA, Leiden, The Netherlands
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Plaza‐Cayón A, González‐Muñiz R, Martín‐Martínez M. Mutations of TRPM8 channels: Unraveling the molecular basis of activation by cold and ligands. Med Res Rev 2022; 42:2168-2203. [PMID: 35976012 PMCID: PMC9805079 DOI: 10.1002/med.21920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 01/09/2023]
Abstract
The cation nonselective channel TRPM8 is activated by multiple stimuli, including moderate cold and various chemical compounds (i.e., menthol and icilin [Fig. 1], among others). While research continues growing on the understanding of the physiological involvement of TRPM8 channels and their role in various pathological states, the information available on its activation mechanisms has also increased, supported by mutagenesis and structural studies. This review compiles known information on specific mutations of channel residues and their consequences on channel viability and function. Besides, the comparison of sequence of animals living in different environments, together with chimera and mutagenesis studies are helping to unravel the mechanism of adaptation to different temperatures. The results of mutagenesis studies, grouped by different channel regions, are compared with the current knowledge of TRPM8 structures obtained by cryo-electron microscopy. Trying to make this review self-explicative and highly informative, important residues for TRPM8 function are summarized in a figure, and mutants, deletions and chimeras are compiled in a table, including also the observed effects by different methods of activation and the corresponding references. The information provided by this review may also help in the design of new ligands for TRPM8, an interesting biological target for therapeutic intervention.
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8
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Kanbayashi Y, Ishikawa T, Kuriu Y, Otsuji E, Takayama K. Predictors for development of oxaliplatin-induced peripheral neuropathy in cancer patients as determined by ordered logistic regression analysis. PLoS One 2022; 17:e0275481. [PMID: 36174022 PMCID: PMC9521891 DOI: 10.1371/journal.pone.0275481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Oxaliplatin causes acute cold-induced neurotoxicity and chronic cumulative neuropathy, which can require dose modification and impacts quality of life. However, effective strategies for managing oxaliplatin-induced peripheral neuropathy (OIPN) among affected patients remain elusive. Objective This retrospective study aimed to identify predictors for the development of OIPN. Methods Participants comprised 322 cancer patients at our hospital who were receiving oxaliplatin between January 2017 and March 2021. For the regression analysis of factors associated with OIPN, variables were manually extracted from medical charts. The severity of OIPN was evaluated using the National Cancer Institute’s Common Terminology Criteria for Adverse Events, version 5. Multivariate ordered logistic regression analysis was performed to identify predictors for the development of OIPN. Optimal cut-off thresholds were determined using receiver operating characteristic analysis. Values of P <0.05 (2-tailed) were considered significant. Results Significant risk factors identified included higher body mass index (BMI) (odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.00–1.12; P = 0.043), female sex (OR = 1.67, 95%CI = 1.06–2.61; P = 0.026) and higher total dosage (OR = 2.39, 95%CI = 1.67–3.42; P = < 0.0001). Conclusion High BMI, female sex and high total dosage were identified as significant predictors for the development of OIPN.
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Affiliation(s)
- Yuko Kanbayashi
- Department of Outpatient Oncology Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Education and Research Center for Clinical Pharmacy, Faculty of Pharmacy, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- * E-mail:
| | - Takeshi Ishikawa
- Department of Outpatient Oncology Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiaki Kuriu
- Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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The Affective Dimension of Pain Appears to Be Determinant within a Pain-Insomnia-Anxiety Pathological Loop in Fibromyalgia: A Case-Control Study. J Clin Med 2022; 11:jcm11123296. [PMID: 35743367 PMCID: PMC9225613 DOI: 10.3390/jcm11123296] [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: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Fibromyalgia (FM) is a chronic pain disease characterized by multiple symptoms whose interactions and implications in the disease pathology are still unclear. This study aimed at investigating how pain, sleep, and mood disorders influence each other in FM, while discriminating between the sensory and affective pain dimensions. Methods: Sixteen female FM patients were evaluated regarding their pain, while they underwent—along with 11 healthy sex- and age-adjusted controls—assessment of mood and sleep disorders. Analysis of variance and correlations were performed in order to assess group differences and investigate the interactions between pain, mood, and sleep descriptors. Results: FM patients reported the typical widespread pain, with similar sensory and affective inputs. Contrary to controls, they displayed moderate anxiety, depression, and insomnia. Affective pain (but neither the sensory pain nor pain intensity) was the only pain indicator that tendentially correlated with anxiety and insomnia, which were mutually associated. An affective pain–insomnia–anxiety loop was thus completed. High ongoing pain strengthened this vicious circle, to which it included depression and sensory pain. Conclusions: Discriminating between the sensory and affective pain components in FM patients disclosed a pathological loop, with a key role of affective pain; high ongoing pain acted as an amplifier of symptoms interaction. This unraveled the interplay between three of most cardinal FM symptoms; these results contribute to better understand FM determinants and pathology and could help in orienting therapeutic strategies.
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Tan B, Philipp MC, Che Muhamed AM, Mundel T. Hypohydration but not Menstrual Phase Influences Pain Perception in Healthy Women. J Appl Physiol (1985) 2022; 132:611-621. [DOI: 10.1152/japplphysiol.00402.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic pain is a pervasive health problem and is associated with tremendous socioeconomic costs. However, current pain treatments are often ineffective due, in part, to the multi-factorial nature of pain. Mild hypohydration was shown to increase experimental pain sensitivity in men, but whether this also occurs in women has not been examined. Fluctuations in ovarian hormones (i.e., 17ß-oestradiol and progesterone) throughout the menstrual cycle may influence a woman's pain sensitivity, as well as hydration levels, suggesting possible interactions between hypohydration and menstrual phase on pain. We investigated the effects of mild hypohydration (HYPO, 24 hr of fluid restriction) on ischaemic pain sensitivity in 14 eumenorrheic women during the early follicular (EF) and mid-luteal (ML) phases of their menstrual cycle. We also examined whether acute water ingestion could reverse the negative effects of hypohydration. Elevated serum osmolality, plasma copeptin, and urine specific gravity indicated mild hypohydration. Compared to euhydration, HYPO reduced pain tolerance (by 34 ± 46 s; P = 0.02, ηp2 = 0.37) and increased ratings of pain intensity (by 0.7 ± 0.7 cm; P = 0.004; ηp2 = 0.55) and unpleasantness (by 0.7 ± 0.9 cm; P = 0.02; ηp2 = 0.40); these results were not influenced by menstrual phase. Water ingestion reduced thirst perception (Visual Analogue Scale, by 2.3 ± 0.9 cm; P < 0.001, ηp2 = 0.88) but did not reduce pain sensitivity. Therefore, hypohydration increases pain sensitivity in women with no influence of menstrual phase.
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Affiliation(s)
- Beverly Tan
- School of Sport Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | | | | | - Toby Mundel
- School of Sport Exercise and Nutrition, Massey University, Palmerston North, New Zealand
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11
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Hijma HJ, van Brummelen EMJ, Siebenga PS, Groeneveld GJ. A phase I, randomized, double-blind, placebo-controlled, single- and multiple dose escalation study evaluating the safety, pharmacokinetics and pharmacodynamics of VX-128, a highly selective Na v 1.8 inhibitor, in healthy adults. Clin Transl Sci 2021; 15:981-993. [PMID: 34958174 PMCID: PMC9010276 DOI: 10.1111/cts.13215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 01/14/2023] Open
Abstract
Selective inhibition of certain voltage‐gated sodium channels (Navs), such as Nav1.8, is of primary interest for pharmacological pain research and widely studied as a pharmacological target due to its contribution to repetitive firing, neuronal excitability, and pain chronification. VX‐128 is a highly potent and selective Nav1.8 inhibitor that was being developed as a treatment for pain. We evaluated the safety, tolerability, and pharmacokinetics of VX‐128 in healthy subjects in a single‐ and multiple‐ascending dose (MAD) first‐in‐human study. Pharmacodynamics were evaluated in the MAD part using a battery of evoked pain tests. Overall, single doses of VX‐128 up to 300 mg were well‐tolerated, although adverse effect (AE) incidence was higher in subjects receiving VX‐128 (41.7%) compared with placebo (25.0%). After multiple dosing of up to 10 days, skin rash events were observed at all dose levels (up to 100 mg once daily [q.d.]), in five of 26 (19.2%) subjects, including one subject receiving VX‐128 (100 mg q.d.) who had a serious AE of angioedema. A trend in pain tolerance were observed for cold pressor‐ and pressure pain, which was dose‐dependent for the latter. VX‐128 was rapidly absorbed (median time to maximum plasma concentration between 1 and 2 h) with a half‐life of ~80 h at 10 mg q.d., and approximately two‐fold accumulation ratio after 10 and 30 mg q.d. Although VX‐128, when given in a multiple dose fashion, resulted in early study termination due to tolerability issues, effects were observed on multiple pain tests that may support further investigation of Nav1.8 inhibitors as pain treatments.
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Affiliation(s)
- Hemme J Hijma
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Pieter S Siebenga
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
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12
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Niclou A, Ocobock C. Weather permitting: Increased seasonal efficiency of nonshivering thermogenesis through brown adipose tissue activation in the winter. Am J Hum Biol 2021; 34:e23716. [PMID: 34942026 DOI: 10.1002/ajhb.23716] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We investigated seasonal changes in brown adipose tissue (BAT) activation and metabolism in a temperate-climate Albany, NY population. METHODS Data were collected among 58 participants (21 males, 37 females, ages: 18-51) in the summer and 59 participants (23 males, 36 females, ages: 18-63) in the winter in Albany, New York. BAT activity was inferred by comparing metabolic rate, heat dissipation in the supraclavicular area, and respiratory quotient at room temperature and cold exposure. Seasonal variation in BAT was determined by comparing these measurements from summer and winter. RESULTS At mild cold exposure, heat dissipation of the supraclavicular area was significantly greater in the winter compared to summer (p < .001); however, no significant differences were found between seasons in metabolic rate measurements. This suggests BAT activation may be metabolically more efficient in the winter, due to prolonged lower seasonal temperatures relative to summer. Respiratory quotient significantly increased upon mild cold exposure in the winter compared to summer (p < .001). While carbohydrate utilization increased in the winter, fat remained the primary metabolic substrate for BAT activity across both seasons. CONCLUSION The seasonal variations in the effects of nonshivering thermogenesis on metabolic rate and substrate metabolism suggest a buffering of energy expenditure and an increased use of glucose as fuel by BAT as a result of acclimatization to cold in the winter. These findings point towards a potential role of BAT in human whole-body mediated glucose disposal and cold adaptation.
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Affiliation(s)
- Alexandra Niclou
- Department of Anthropology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Cara Ocobock
- Department of Anthropology, University of Notre Dame, Notre Dame, Indiana, USA
- Eck Institute for Global Health, Institute for Educational Initiatives, University of Notre Dame, Notre Dame, Indiana, USA
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13
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Hijma HJ, Siebenga PS, de Kam ML, Groeneveld GJ. A Phase 1, Randomized, Double-Blind, Placebo-Controlled, Crossover Study to Evaluate the Pharmacodynamic Effects of VX-150, a Highly Selective NaV1.8 Inhibitor, in Healthy Male Adults. PAIN MEDICINE 2021; 22:1814-1826. [PMID: 33543763 PMCID: PMC8346919 DOI: 10.1093/pm/pnab032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective To evaluate the analgesic potential, safety, tolerability, and pharmacokinetics of VX-150, a pro-drug of a highly selective NaV1.8 inhibitor, in healthy subjects. Design This was a randomized, double-blind, placebo-controlled, crossover study in healthy subjects. Subjects Twenty healthy male subjects with an age of 18–55 years, inclusive, were enrolled. Eligibility was based on general fitness, absence of current or previous medical conditions that could compromise subject safety, and a training assessment of pain tolerance across pain tests to exclude highly tolerant individuals whose tolerance could compromise the ability to detect analgesic responses. All dosed subjects completed the study. Methods Subjects were randomized 1:1 to one of two sequences receiving a single VX-150 dose and subsequently placebo, or vice versa, with at least 7 days between dosing. A battery of pain tests (pressure, electrical stair, [capsaicin-induced] heat, and cold pressor) was administered before dosing and repetitively up to 10 h after dosing, with blood sampling up to 24 h after dosing. Safety was monitored throughout the study. Data were analyzed with a repeated-measures mixed-effects model. Results VX-150 induced analgesia in a variety of evoked pain tests, without affecting subject safety. Significant effects were reported for the cold pressor and heat pain thresholds. Maximum median concentration for the active moiety was 4.30 µg/mL at 4 h after dosing. Conclusion Results of this proof-of-mechanism study are supportive of the potential of VX-150, a highly selective NaV1.8 channel inhibitor, to treat various pain indications.
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Affiliation(s)
- Hemme J Hijma
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter S Siebenga
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | | | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
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14
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Arout CA, Haney M, Herrmann ES, Bedi G, Cooper ZD. A placebo-controlled investigation of the analgesic effects, abuse liability, safety and tolerability of a range of oral cannabidiol doses in healthy humans. Br J Clin Pharmacol 2021; 88:347-355. [PMID: 34223660 DOI: 10.1111/bcp.14973] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Preclinical studies demonstrate that cannabidiol (CBD) elicits an antinociceptive response in animal models of neuropathic pain; in humans, limited data are available to support such analgesic effects. Few studies have examined CBD's analgesic effects when administered without other compounds, and little is known regarding dose-dependent effects in noncannabis users. METHODS This double-blind, placebo-controlled, within-subject outpatient clinical laboratory study sought to determine the analgesic effects, abuse liability, safety and tolerability of acute CBD (0, 200, 400 and 800 mg orally) in healthy noncannabis-using volunteers (n = 17; 8 men, 9 women). Outcomes included experimental pain threshold and pain tolerance using the cold pressor test (CPT), subjective ratings of CPT painfulness and bothersomeness, subjective ratings of abuse liability and mood, and cardiovascular measures, which were assessed at baseline and several time points after drug administration. Data analyses included repeated measures analysis of variance (ANOVA) with planned comparisons. RESULTS CBD failed to consistently affect pain threshold and tolerance in the CPT relative to placebo. All doses of CBD increased ratings of painfulness compared to placebo (P < .01). Further, CBD had dose-dependent, modest effects on mood and subjective drug effects associated with abuse liability. Oral CBD was safe and well tolerated, producing small decreases in blood pressure (P < .01). CONCLUSION CBD did not elicit consistent dose-dependent analgesia and in fact increased pain on some measures. Future studies exploring CBD-induced pain relief should consider using a more extensive pain assessment paradigm in different participant populations.
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Affiliation(s)
- Caroline A Arout
- Division on Substance Use Disorders, New York Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Margaret Haney
- Division on Substance Use Disorders, New York Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Evan S Herrmann
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, USA
| | - Gillinder Bedi
- Centre for Youth Mental Health, The University of Melbourne and Substance Use Research Group, Melbourne, Australia
| | - Ziva D Cooper
- University of California, Los Angeles Cannabis Research Initiative, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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15
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Matsuura Y, Akamine K, Murakami A, Wada T, Atsumi H, Kane E, Yano M, Yasui T. Associations between Sensitivity to Cold, Menstruation-Related Symptoms and Handgrip Strength in Female University Students in Japan. Health (London) 2021. [DOI: 10.4236/health.2021.135040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Physiological and subjective validation of a novel stress procedure: The Simple Singing Stress Procedure. Behav Res Methods 2020; 53:1478-1487. [DOI: 10.3758/s13428-020-01505-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 11/08/2022]
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17
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Lunde CE, Szabo E, Holmes SA, Borsook D, Sieberg CB. Commentary: Novel Use of Offset Analgesia to Assess Adolescents and Adults with Treatment Resistant Endometriosis-Associated Pain. J Pain Res 2020; 13:2775-2782. [PMID: 33204144 PMCID: PMC7660453 DOI: 10.2147/jpr.s276135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022] Open
Abstract
Background and Objective Endometriosis, affecting approximately 176 million adults and adolescents worldwide, is a debilitating condition in which uterine tissue grows outside the uterus. The condition costs the US economy approximately $78 billion annually in pain-related disability. By understanding the neural underpinnings of endometriosis-associated pain (EAP) and risk factors for chronification, translational research methods could lessen diagnostic delays and maximize successful pain remediation. This can be accomplished by the novel use of a known method, offset analgesia (OA), to better elucidate the neural mechanisms that may contribute to and maintain EAP. This commentary will provide justification and rationale for the use of OA in the study of EAP. Conclusion Utilizing an OA paradigm in patients with endometriosis, especially adolescents, may (1) provide insight into neural mechanisms contributing to pain maintenance, which could capture those at-risk for the transition to chronic pelvic pain, (2) provide a metric for the development of future centrally mediated treatment options for this population, and (3) elucidate the brain changes that result in resistance to treatment and pain chronification.
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Affiliation(s)
- Claire E Lunde
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA.,Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
| | - Edina Szabo
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Scott A Holmes
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Christine B Sieberg
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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18
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Tseng CH, Chong CK, Sheu JJ. Prevalence and Risk Factors of Sensory Symptoms in Diabetes Patients in Taiwan. Front Endocrinol (Lausanne) 2020; 11:580426. [PMID: 33488515 PMCID: PMC7821276 DOI: 10.3389/fendo.2020.580426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/26/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic sensory neuropathy has rarely been studied in the Asian populations. This study investigated the prevalence and risk factors of sensory symptoms (SS) in the Taiwanese diabetes patients. METHODS A total of 1,400 diabetes patients received a health examination together with a structured questionnaire interview for three categories of abnormal sensation of numbness or tingling pain, electric shock, and skin thickness sensation on seven anatomical sites on upper limbs and six sites on lower limbs. Prevalence of SS was defined using nine different criteria, with the least stringent criterion of "any positive symptom on at least 1 site" and the most stringent criterion of "any positive symptom on at least bilateral and symmetrical 2 sites involving the lower limb." Logistic regression was used to estimate the odds ratios and their 95% confidence interval for SS by the different definitions. Fasting plasma glucose and hemoglobin A1c were entered in separate models to avoid hypercollinearity. RESULTS The prevalence of SS was 14.4 and 54.0% when using the most stringent and least stringent criterion, respectively. Women consistently had a significantly higher prevalence than men did. Among the three categories of symptoms, numbness or tingling pain was the most common, and fingers and toes were the most commonly involved anatomical sites. For any symptoms, 37.1% of the patients had any symptoms on the upper limbs and 41.7% had any symptoms on the lower limbs. Female sex, diabetes duration, hemoglobin A1c, and hypertension were associated with SS in all models. CONCLUSIONS Taiwanese diabetes patients may have a high prevalence of SS if a structured questionnaire is used for screening. Female sex, diabetes duration, hemoglobin A1c, and hypertension are associated with SS.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Environmental Health and Occupational Medicine of the National Health Research Institutes, Zhunan, Taiwan
- *Correspondence: Chin-Hsiao Tseng,
| | - Choon-Khim Chong
- Chong’s Physical Medicine and Rehabilitation Center, Taipei, Taiwan
| | - Jau-Jiuan Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
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19
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Cooper ZD, Abrams DI. Considering abuse liability and neurocognitive effects of cannabis and cannabis-derived products when assessing analgesic efficacy: a comprehensive review of randomized-controlled studies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:580-595. [PMID: 31687845 DOI: 10.1080/00952990.2019.1669628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Pain is the most frequent indication for which medical cannabis treatment is sought.Objectives: The clinical potential of cannabis and cannabis-derived products (CDPs) relies on their efficacy to treat an indication and potential adverse effects that impact outcomes, including abuse liability and neurocognitive effects. To ascertain the extent to which these effects impact therapeutic utility, studies investigating cannabis and CDPs for pain were reviewed for analgesic efficacy and assessments of abuse liability and neurocognitive effects.Methods: A comprehensive review of placebo-controlled studies investigating cannabis and CDP analgesia was performed. Methods and findings related to adverse effects, abuse liability, and neurocognitive effects were extracted.Results: Thirty-eight studies were reviewed; 29 assessed cannabis and CDPs for chronic pain, 1 for acute pain, and 8 used experimental pain tests. Most studies ascertained adverse effects through self-report (N = 27). Fewer studies specifically probed abuse liability (N = 7) and cognitive and psychomotor effects (N = 12). Many studies related to chronic and experimental pain (N = 18 and N = 5, respectively) found cannabis and CDPs to reduce pain. Overall, adverse effects were mild to moderate, and dose-related. Studies investigating the impact of cannabis and CDPs on abuse liability and neurocognitive endpoints were mostly limited to inhaled administration and confirmed dose-related effects.Conclusion: Few studies investigating cannabis and CDP analgesia assess abuse liability and cognitive endpoints, adverse effects that impact the long-term clinical utility of these drugs. Future studies should include these measures to optimize research and clinical care related to cannabis-based therapeutics.
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Affiliation(s)
- Ziva D Cooper
- UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Science, University of California, Los Angeles, CA, USA.,Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Donald I Abrams
- Divison of Oncology, Department of Medicine, Zuckerberg San Francisco General, University of California San Francisco, San Francisco, CA, USA
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20
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Rogan S, Haehni M, Luijckx E, Dealer J, Reuteler S, Taeymans J. Effects of Hip Abductor Muscles Exercises on Pain and Function in Patients With Patellofemoral Pain: A Systematic Review and Meta-Analysis. J Strength Cond Res 2019; 33:3174-3187. [DOI: 10.1519/jsc.0000000000002658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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21
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Zebala JA, Searle SL, Webster LR, Johnson MS, Schuler AD, Maeda DY, Kahn SJ. Desmetramadol Has the Safety and Analgesic Profile of Tramadol Without Its Metabolic Liabilities: Consecutive Randomized, Double-Blind, Placebo- and Active Comparator-Controlled Trials. THE JOURNAL OF PAIN 2019; 20:1218-1235. [PMID: 31005596 PMCID: PMC6790288 DOI: 10.1016/j.jpain.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/25/2019] [Accepted: 04/15/2019] [Indexed: 01/16/2023]
Abstract
Desmetramadol is an investigational analgesic consisting of (+) and (-) enantiomers of the tramadol metabolite O-desmethyltramadol (M1). Tramadol is racemic and exerts analgesia by monoaminergic effects of (-)-tramadol and (-)-M1, and by the opioid (+)-M1. Tramadol labeling indicates cytochrome P450 (CYP) isozyme 2D6 ultrarapid metabolizer can produce dangerous (+)-M1 levels, and CYP2D6 poor metabolizers insufficient (+)-M1 for analgesia. We hypothesized that desmetramadol could provide the safety and analgesia of tramadol without its metabolic liabilities. We conducted consecutive double-blind, randomized, placebo-controlled, 3 segment cross-over trials A and B to investigate the steady-state pharmacokinetics and analgesia of 20 mg desmetramadol and 50 mg tramadol in 103 healthy participants without (n = 43) and with (n = 60) cotreatment with the CYP inhibitor paroxetine. In the absence of CYP inhibition (trial A), 20 mg desmetramadol and 50 mg tramadol dosed every 6 hours gave equivalent steady-state (+)-M1, similar adverse events, and analgesia significantly greater than placebo, but equal to each other. In trial B, CYP inhibition significantly depressed tramadol steady-state (+)-M1, reduced its adverse events, and led to insignificant analgesia comparable with placebo. In contrast, CYP inhibition in trial B had no deleterious effect on desmetramadol (+)-M1 or (-)-M1, which gave significant analgesia as in trial A and superior to tramadol (P = .003). Desmetramadol has the safety and efficacy of tramadol without its metabolic liabilities. CLINICALTRIALS.GOV REGISTRATIONS: NCT02205554, NCT03312777 PERSPECTIVE: To our knowledge, this is the first study of desmetramadol in humans and the first to show it provides the same safety and analgesia as tramadol, but without tramadol's metabolic liabilities and related drug-drug interactions. Desmetramadol could potentially offer expanded safety and usefulness to clinicians seeking an alternative to schedule II opioids.
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22
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Martinez D, Slifstein M, Matuskey D, Nabulsi N, Zheng MQ, Lin SF, Ropchan J, Urban N, Grassetti A, Chang D, Salling M, Foltin R, Carson RE, Huang Y. Kappa-opioid receptors, dynorphin, and cocaine addiction: a positron emission tomography study. Neuropsychopharmacology 2019; 44:1720-1727. [PMID: 31026862 PMCID: PMC6785004 DOI: 10.1038/s41386-019-0398-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 01/08/2023]
Abstract
Animal studies indicate that the kappa-opioid receptor/dynorphin system plays an important role in cocaine binges and stress-induced relapse. Our goal was to investigate changes in kappa-opioid receptor (KOR) availability in the human brain using positron emission tomography (PET), before and after a cocaine binge. We also investigated the correlation between KOR and stress-induced cocaine self-administration. PET imaging was performed with the KOR selective agonist [11C]GR103545. Subjects with cocaine-use disorder (CUD) underwent PET scans and performed two types of cocaine self-administration sessions in the laboratory as follows: (1) choice sessions following a cold pressor test, to induce stress, and (2) binge dosing of cocaine. This allowed us investigate the following: (1) the association between KOR binding and a laboratory model of stress-induced relapse and (2) the change in KOR binding following a 3-day cocaine binge, which is thought to represent a change in endogenous dynorphin. A group of matched healthy controls was included to investigate between group differences in KOR availability. A significant association between [11C]GR103545 binding and cocaine self-administration was seen: greater KOR availability was associated with more choices for cocaine. In addition, the 3-day cocaine binge significantly reduced [11C]GR103545 binding by 18% in the striatum and 14% across brain regions. No difference in [11C]GR103545 binding was found between the CUD subjects and matched controls. In the context of previous studies, these findings add to the growing evidence that pharmacotherapies targeting the KOR have the potential to significantly impact treatment development for cocaine-use disorder.
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Affiliation(s)
- Diana Martinez
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY, USA.
| | - Mark Slifstein
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY, USA
| | - David Matuskey
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Nabeel Nabulsi
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Ming-Qiang Zheng
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Shu-Fei Lin
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Jim Ropchan
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Nina Urban
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY, USA
| | - Alexander Grassetti
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY, USA
| | - Dinnisa Chang
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY, USA
| | - Michael Salling
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY, USA
| | - Richard Foltin
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY, USA
| | - Richard E Carson
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Yiyun Huang
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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Progesterone relates to enhanced incisional acute pain and pinprick hyperalgesia in the luteal phase of female volunteers. Pain 2019; 160:1781-1793. [DOI: 10.1097/j.pain.0000000000001561] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Mark J, Argentieri DM, Gutierrez CA, Morrell K, Eng K, Hutson AD, Mayor P, Szender JB, Starbuck K, Lynam S, Blum B, Akers S, Lele S, Paragh G, Odunsi K, de Leon-Casasola O, Frederick PJ, Zsiros E. Ultrarestrictive Opioid Prescription Protocol for Pain Management After Gynecologic and Abdominal Surgery. JAMA Netw Open 2018; 1:e185452. [PMID: 30646274 PMCID: PMC6324564 DOI: 10.1001/jamanetworkopen.2018.5452] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/09/2018] [Indexed: 01/19/2023] Open
Abstract
Importance Opioids are routinely prescribed for postoperative home pain management for most patients in the United States, with limited evidence of the amount needed to be dispensed. Opioid-based treatment often adversely affects recovery. Prescribed opioids increase the risk of chronic opioid use, abuse, and diversion and contribute to the current opioid epidemic. Objective To evaluate whether after hospital discharge, postsurgical acute pain can be effectively managed with a markedly reduced number of opioid doses. Design, Setting, and Participants In this case-control cohort study, an ultrarestrictive opioid prescription protocol (UROPP) was designed and implemented from June 26, 2017, through June 30, 2018, at a single tertiary-care comprehensive cancer center. All patients undergoing gynecologic oncology surgery were included. Patients undergoing ambulatory or minimally invasive surgery (laparoscopic or robotic approach) were not prescribed opioids at discharge unless they required more than 5 doses of oral or intravenous opioids while in the hospital. Patients who underwent a laparotomy were provided a 3-day opioid pain medication supply at discharge. Main Outcomes and Measures Total number of opioid pain medications prescribed in the 60-day perioperative period, requests for opioid prescription refills, and postoperative pain scores and complications were evaluated. Factors associated with increased postoperative pain, preoperative and postoperative pain scores, inpatient status, prior opioid use, and all opioid prescriptions within the 60-day perioperative window were monitored among the case patients and compared with those from consecutive control patients treated at the center in the 12 months before the UROPP was implemented. Results Patient demographics and procedure characteristics were not statistically different between the 2 cohorts of women (605 cases: mean [SD] age, 56.3 [14.5] years; 626 controls: mean [SD] age, 55.5 [13.9] years). The mean (SD) number of opioid tablets given at discharge after a laparotomy was 43.6 (17.0) before implementation of the UROPP and 12.1 (8.9) after implementation (P < .001). For patients who underwent laparoscopic or robotic surgery, the mean (SD) number of opioid tablets given at discharge was 38.4 (17.4) before implementation of the UROPP and 1.3 (3.7) after implementation (P < .001). After ambulatory surgery, the mean (SD) number of opioid tablets given at discharge was 13.9 (16.6) before implementation of the UROPP and 0.2 (2.1) after implementation (P < .001). The mean (SD) perioperative oral morphine equivalent dose was reduced to 64.3 (207.2) mg from 339.4 (674.4) mg the year prior for all opioid-naive patients (P < .001). The significant reduction in the number of dispensed opioids was not associated with an increase the number of refill requests (104 patients [16.6%] in the pre-UROPP group vs 100 patients [16.5%] in the post-UROPP group; P = .99), the mean (SD) postoperative visit pain scores (1.1 [2.2] for the post-UROPP group vs 1.4 [2.3] for pre-UROPP group; P = .06), or the number of complications (29 cases [4.8%] in the post-UROPP group vs 42 cases [6.7%] in the pre-UROPP group; P = .15). Conclusions and Relevance Implementation of a UROPP was associated with a significant decrease in the overall amount of opioids prescribed to patients after gynecologic and abdominal surgery at the time of discharge for all patients, and for the entire perioperative time for opioid-naive patients without changes in pain scores, complications, or medication refill requests.
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Affiliation(s)
- Jaron Mark
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Deanna M. Argentieri
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Camille A. Gutierrez
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Kayla Morrell
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kevin Eng
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Alan D. Hutson
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Paul Mayor
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - J. Brian Szender
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kristen Starbuck
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sarah Lynam
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Bonnie Blum
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Stacey Akers
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Shashikant Lele
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kunle Odunsi
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Peter J. Frederick
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Emese Zsiros
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Islamoglu E, Tas S, Karamik K, Yalcinkaya S, Tokgoz H, Savas M. Does extracorporeal shock wave lithotripsy-related pain get affected by menstrual cycle and menopause? Urolithiasis 2018; 47:575-581. [PMID: 30362030 DOI: 10.1007/s00240-018-1084-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/21/2018] [Indexed: 01/10/2023]
Abstract
The objective of the study was to investigate the effect of the menstrual cycle and menopause on extracorporeal shock wave lithotripsy (ESWL)-related pain outcome. Since March 2017, we evaluated a total of 145 women who underwent the first session of ESWL for renal or ureteral stones. Patients were divided into two groups, as menstruating and menopaused women. For menstruating women, the number of days between the last day of mens and ESWL was noted and women were separated as in the follicular phase (1-14 days) or in the luteal phase (15-30 days) of menstruation. To control these two female groups, 149 men of similar age were included in the study. After the procedure, the experienced pain was recorded on a ten-point visual analog scale (VAS) by the patient and they also rated the severity of pain as no, mild, tolerable, and intolerable on the pain questionnaire. The mean age of the patients was 43 ± 15 years for the female group and 42 ± 13 years for the male group. While stone burden was not different between the female and male groups (p = 0.459), VAS score was not statistically different between genders (p = 0.293). However, men reported a higher rate of mild pain, while women reported a higher rate of tolerable pain (p = 0.008) in the pain questionnaire. Mean VAS score was significantly lower for the menopaused women group than menstruating women, young and old men (p = 0.001). In a subgroup analysis, menopaused women group reported lower VAS score and better pain questionnaire result than menstruating women (p < 0.001). There was no statistically significant difference between the follicular and luteal phase of the menstrual cycle in terms of mean VAS score and pain questionnaire results (p = 0.891 and 0.441, respectively). When compared with the young men group, the only significant difference was pain questionnaire results between women in the luteal phase (p = 0.014). Multiple regression analysis showed that only menstruation (β = 0.639, p < 0.001) was an independent factor for VAS score. Menstrual cycle phase had no effect on pain perception during the ESWL session and menopaused women felt less pain than menstruating women during this procedure. The control male group showed that the reduction of ESWL-related pain in menopause was not related to aging.
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Affiliation(s)
- Ekrem Islamoglu
- University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Selim Tas
- University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Kaan Karamik
- University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Soner Yalcinkaya
- University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Husnu Tokgoz
- University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Murat Savas
- University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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Bier J. Bodily circulation and the measure of a life: Forensic identification and valuation after the Titanic disaster. SOCIAL STUDIES OF SCIENCE 2018; 48:635-662. [PMID: 30253686 PMCID: PMC6193206 DOI: 10.1177/0306312718801173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article analyzes the process of body recovery that took place after the sinking of the Titanic in 1912. Focusing on how identification was intertwined with valuation, I show how notions of economic class informed decisions about which human bodies were fit for preservation as human bodies. The RMS Titanic steamship was a microcosm of social circulation in the early 20th-century Atlantic, and life on board was systematically stratified according to economic class. During the recovery that following the sinking, 114 bodies, or one-third of the total recovered, were buried at sea, most of them crewmembers or immigrant passengers who had held third-class tickets. Sea burial exposed the bodies to rapid and inaccessible decomposition, thereby selectively excluding those bodies from the archival and forensic record even as those victims' names and personal artefacts were recorded for posterity. The recovery process thus demonstrates that the material existence of those passengers' remains was not a given, but instead emerged in varied ways through identification and recovery practices. Such practices drew on notions of economic value and identifiability to shape bodily materials, which were selectively preserved, transformed, and/or put out of reach. As such, I argue that identification and valuation are thoroughly enmeshed with what I call instantiation, or determinations of how and whether something exists.
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Affiliation(s)
- Jess Bier
- Jess Bier, Department of Public Administration and Sociology, Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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Cooper ZD, Bedi G, Ramesh D, Balter R, Comer SD, Haney M. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. Neuropsychopharmacology 2018; 43:2046-2055. [PMID: 29463913 PMCID: PMC6098090 DOI: 10.1038/s41386-018-0011-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 01/10/2023]
Abstract
Cannabinoids combined with opioids produce synergistic antinociceptive effects, decreasing the lowest effective antinociceptive opioid dose (i.e., opioid-sparing effects) in laboratory animals. Although pain patients report greater analgesia when cannabis is used with opioids, no placebo-controlled studies have assessed the direct effects of opioids combined with cannabis in humans or the impact of the combination on abuse liability. This double-blind, placebo-controlled, within-subject study determined if cannabis enhances the analgesic effects of low dose oxycodone using a validated experimental model of pain and its effects on abuse liability. Healthy cannabis smokers (N = 18) were administered oxycodone (0, 2.5, and 5.0 mg, PO) with smoked cannabis (0.0, 5.6% Δ9 tetrahydrocannabinol [THC]) and analgesia was assessed using the Cold-Pressor Test (CPT). Participants immersed their hand in cold water (4 °C); times to report pain (pain threshold) and withdraw the hand from the water (pain tolerance) were recorded. Abuse-related effects were measured and effects of oxycodone on cannabis self-administration were determined. Alone, 5.0 mg oxycodone increased pain threshold and tolerance (p ≤ 0.05). Although active cannabis and 2.5 mg oxycodone alone failed to elicit analgesia, combined they increased pain threshold and tolerance (p ≤ 0.05). Oxycodone did not increase subjective ratings associated with cannabis abuse, nor did it increase cannabis self-administration. However, the combination of 2.5 mg oxycodone and active cannabis produced small, yet significant, increases in oxycodone abuse liability (p ≤ 0.05). Cannabis enhances the analgesic effects of sub-threshold oxycodone, suggesting synergy, without increases in cannabis's abuse liability. These findings support future research into the therapeutic use of opioid-cannabinoid combinations for pain.
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Affiliation(s)
- Ziva D. Cooper
- 0000 0001 2285 2675grid.239585.0Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, NY 10032 USA
| | - Gillinder Bedi
- 0000 0001 2179 088Xgrid.1008.9Orygen National Centre of Excellence in Youth Mental Health, and Center for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Divya Ramesh
- 0000 0001 0860 4915grid.63054.34Center for Advancement in Managing Pain, University of Connecticut School of Nursing, Storrs, CT USA
| | - Rebecca Balter
- 0000 0001 2285 2675grid.239585.0Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, NY 10032 USA
| | - Sandra D. Comer
- 0000 0001 2285 2675grid.239585.0Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, NY 10032 USA
| | - Margaret Haney
- 0000 0001 2285 2675grid.239585.0Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, NY 10032 USA
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Alves B, Ibuki F, Gonçalves AS, Teixeira MJ, De Siqueira SRDT. Influence of Sexual Hormones on Neural Orofacial Perception. PAIN MEDICINE 2018; 18:1549-1556. [PMID: 28034986 DOI: 10.1093/pm/pnw272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To investigate the trigeminal somatosensory (thermal, pain, tactile, vibratory, and electric), gustative (salty, bitter, sweet, sour), and olfactory thresholds in healthy women during the menstrual cycle and investigate any association with estradiol and progesterone levels in saliva. Methods We examined/tested 39 women between age 19 and 47 years and with regular menstrual cycles and no comorbidities. All women were informed about the purposes of the study, and only those who signed the informed consent were included. The tests were performed at three stages within the cycle: menstrual phase, follicular phase, and luteal phase. The procedure consisted of saliva collection at the beginning of each session to measure hormone levels, salivary flow, somatosensory evaluation with quantitative sensory testing applied to the right trigeminal maxillary branch and right forearm, gustative (sweet [glucose], salt [sodium chloride], sour [citric acid], and bitter [urea]) and olfactory (isopropanol at different concentrations) thresholds. Results During the menstrual cycle, thresholds for sweet, salty, sour, cold, vibration, and deep pain decreased, but warmth, electrical, and superficial pain thresholds increased. The bitter threshold was high, and the olfactory threshold was low in the follicular phase. Low estrogen levels were correlated to high deep pain thresholds in the forearm ( P = 0.008) and face ( P = 0.041), high tactile thresholds ( P = 0.001), and high superficial pain ( P = 0.006) thresholds in the face. High levels of progesterone were associated with a high deep pain threshold in the face and a high salty threshold ( P < 0.001). Conclusion Estrogen and progesterone seem to be involved in sensory neuromodulation in women during the menstrual cycle.
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Affiliation(s)
- Bruna Alves
- Neurology Department, Interdisciplinary Pain Center, Medical School
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Brandal D, Keller MS, Lee C, Grogan T, Fujimoto Y, Gricourt Y, Yamada T, Rahman S, Hofer I, Kazanjian K, Sack J, Mahajan A, Lin A, Cannesson M. Impact of Enhanced Recovery After Surgery and Opioid-Free Anesthesia on Opioid Prescriptions at Discharge From the Hospital: A Historical-Prospective Study. Anesth Analg 2017; 125:1784-1792. [PMID: 29049123 DOI: 10.1213/ane.0000000000002510] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The United States is in the midst of an opioid epidemic, and opioid use disorder often begins with a prescription for acute pain. The perioperative period represents an important opportunity to prevent chronic opioid use, and recently there has been a paradigm shift toward implementation of enhanced recovery after surgery (ERAS) protocols that promote opioid-free and multimodal analgesia. The objective of this study was to assess the impact of an ERAS intervention for colorectal surgery on discharge opioid prescribing practices. METHODS We conducted a historical-prospective quality improvement study of an ERAS protocol implemented for patients undergoing colorectal surgery with a focus on the opioid-free and multimodal analgesia components of the pathway. We compared patients undergoing colorectal surgery 1 year before implementation (June 15, 2015, to June 14, 2016) and 1 year after implementation (June 15, 2016, to June 14, 2017). RESULTS Before the ERAS intervention, opioids at discharge were not significantly increasing (1% per month; 95% confidence interval [CI], -1% to 3%; P = .199). Immediately after the ERAS intervention, opioid prescriptions were not significantly lower (13%; 95% CI, -30% to 3%; P = .110). After the intervention, the rate of opioid prescriptions at discharge did not decrease significantly 1% (95% CI, -3% to 1%) compared to the pre-period rate (P = .399). Subgroup analysis showed that in patients with a combination of low discharge pain scores, no preoperative opioid use, and low morphine milligram equivalents consumption before discharge, the rate of discharge opioid prescription was 72% (95% CI, 61%-83%). CONCLUSIONS This study is the first to report discharge opioid prescribing practices in an ERAS setting. Although an ERAS intervention for colorectal surgery led to an increase in opioid-free anesthesia and multimodal analgesia, we did not observe an impact on discharge opioid prescribing practices. The majority of patients were discharged with an opioid prescription, including those with a combination of low discharge pain scores, no preoperative opioid use, and low morphine milligram equivalents consumption before discharge. This observation in the setting of an ERAS pathway that promotes multimodal analgesia suggests that our findings are very likely to also be observed in non-ERAS settings and offers an opportunity to modify opioid prescribing practices on discharge after surgery. For opioid-free anesthesia and multimodal analgesia to influence the opioid epidemic, the dose and quantity of the opioids prescribed should be modified based on the information gathered by in-hospital pain scores and opioid use as well as pain history before admission.
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Affiliation(s)
- Delara Brandal
- From the *Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California; †UCLA Fielding School of Public Health, Los Angles, California; ‡Department of Anesthesiology, Osaka City University, Osaka, Japan; §Department of Anesthesiology, Nimes University, Nimes, France; ∥Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan; and ¶Department of Surgery, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California
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Manikandan S, Nillni YI, Zvolensky MJ, Rohan KJ, Carkeek KR, Leyro TM. The role of emotion regulation in the experience of menstrual symptoms and perceived control over anxiety-related events across the menstrual cycle. Arch Womens Ment Health 2016; 19:1109-1117. [PMID: 27562823 PMCID: PMC6730650 DOI: 10.1007/s00737-016-0661-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/12/2016] [Indexed: 02/06/2023]
Abstract
Hormonal variation throughout the menstrual cycle is posited to impact various physical and mental health symptoms; however, this is not observed in all women and mechanisms are not well understood. Difficulty in emotion regulation may elucidate differences that women experience in physical and mental health functioning between menstrual phases. We examined the moderating role of difficulty in emotion regulation in the relation between menstrual phase and menstrual symptom severity and perceived control over anxiety-related events, in healthy, regularly menstruating women. The participants were 37 women (Mage = 26.5, SD = 9.6). A series of regression analyses were used to examine whether individual differences in emotion regulation difficulties moderate the relation between menstrual phase and our outcomes, severity of menstrual symptoms and perceived control over anxiety-related events, using a within-subjects design. The analyses revealed that difficulty in emotion regulation significantly moderated the relation between menstrual phase and perceived control over anxiety-related events (β = -0.42, p < .05), but not menstrual symptom severity. Women who reported higher emotion regulation difficulty experienced greater differences in perceived control over anxiety-related events between menstrual phases. Specifically, women with lower difficulty in emotion regulation report greater increase in control over anxiety during the late luteal phase compared to women with higher emotion regulation difficulty. Difficulty in emotion regulation may play an important role in understanding differences in menstrual phase-associated impairments, thereby informing the development of targeted interventions for vulnerable women.
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Affiliation(s)
| | - Yael I. Nillni
- National Center for PTSD Women’s Health Sciences Division at VA Boston Healthcare system, Boston, USA,Boston University School of Medicine, Boston, USA
| | | | | | | | - Teresa M. Leyro
- Rutgers, The State University of New Jersey, New Brunsick, USA
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Cankar K, Music M, Finderle Z. Cutaneous microvascular response during local cold exposure - the effect of female sex hormones and cold perception. Microvasc Res 2016; 108:34-40. [PMID: 27430896 DOI: 10.1016/j.mvr.2016.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 01/10/2023]
Abstract
It is generally known that differences exist between males and females with regard to sensitivity to cold. Similar differences even among females in different hormonal balance might influence microvascular response during cold provocation testing. The aim of the present study was to measure sex hormone levels, cold and cold pain perception thresholds and compare them to cutaneous laser-Doppler flux response during local cooling in both the follicular and luteal phases of the menstrual cycle. In the luteal phase a more pronounced decrease in laser-Doppler flux was observed compared to follicular phase during local cooling at 15°C (significant difference by Dunnett's test, p<0.05). In addition, statistically significant correlations between progesterone level and laser-Doppler flux response to local cooling were observed during the follicular (R=-0.552, p=0.0174) and during the luteal phases (R=0.520, p=0.0271). In contrast, the correlation between estradiol level and laser-Doppler flux response was observed only in the follicular phase (R=-0.506, p=0.0324). Our results show that individual sensitivity to cold influences cutaneous microvascular response to local cooling; that microvascular reactivity is more pronounced during the luteal phase of the menstrual cycle; and that reactivity correlates with hormone levels. The effect of specific sex hormone levels is related to the cold-provocation temperature.
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Affiliation(s)
- Ksenija Cankar
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Mark Music
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Zare Finderle
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Czerniak E, Biegon A, Ziv A, Karnieli-Miller O, Weiser M, Alon U, Citron A. Manipulating the Placebo Response in Experimental Pain by Altering Doctor's Performance Style. Front Psychol 2016; 7:874. [PMID: 27445878 PMCID: PMC4928147 DOI: 10.3389/fpsyg.2016.00874] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022] Open
Abstract
Background: Performance is paramount in traditional healing rituals. From a Western perspective, such performative behavior can be understood principally as inducing patients’ faith in the performer’s supernatural healing powers and effecting positive changes through the same mechanisms attributed to the placebo response, which is defined as improvement of clinical outcome in individuals receiving inactive treatment. Here we examined the possibility of using theatrical performance tools, including stage directions and scripting, to reproducibly manipulate the style and content of a simulated doctor–patient encounter and influence the placebo response in experimental pain. Methods: A total of 122 healthy volunteers (18–45 years, 76 men) exposed to experimental pain (the cold pressor test) were assessed for pain threshold and tolerance before and after receiving a placebo cream from a “doctor” impersonated by a trained actor. The actor alternated between two distinct scripts and stage directions, i.e., performance styles created by a theater director/playwright, one emulating a standard doctor–patient encounter (scenario A) and the other emphasizing attentiveness and strong suggestion, elements also present in ritual healing (scenario B). The placebo response size was calculated as the %difference in pain threshold and tolerance after exposure relative to baseline. In addition, subjects demonstrating a ≥30% increase in pain threshold or tolerance relative to baseline were defined as responders. Each encounter was videotaped in its entirety. Results: Inspection of the videotapes confirmed the reproducibility and consistency of the distinct scenarios enacted by the “doctor”-performer. Furthermore, scenario B resulted in a significant increase in pain threshold relative to scenario A. Interestingly, this increase derived from the placebo responder subgroup; as shown by two-way analysis of variance (performance style, F = 4.30; p = 0.040; η2 = 0.035; style × responder status interaction term, F = 5.21; p = 0.024) followed by post hoc analysis showing a ∼60% increase in pain threshold in responders exposed to scenario B (p = 0.020). Conclusion: These results support the hypothesis that structured manipulation of physician’s verbal and non-verbal performance, designed to build rapport and increase faith in treatment, is feasible and may have a significant beneficial effect on the size of the response to placebo analgesia. They also demonstrate that subjects, who are not susceptible to placebo, are also not susceptible to performance style.
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Affiliation(s)
- Efrat Czerniak
- Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel; The Joseph Sagol Neuroscience Center, Sheba Medical CenterTel Hashomer, Israel
| | - Anat Biegon
- Department of Neurology, State University of New York at Stony Brook, Stony Brook NY, USA
| | - Amitai Ziv
- Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel; Israel Center for Medical Simulation (MSR), Sheba Medical CenterTel Hashomer, Israel
| | | | - Mark Weiser
- Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel; Department of Psychiatry, Sheba Medical CenterTel Hashomer, Israel
| | - Uri Alon
- Department of Molecular and Cell Biology, Weizmann Institute of ScienceRehovot, Israel; The Theatre Laboratory, Weizmann Institute of ScienceRehovot, Israel
| | - Atay Citron
- Theatre Department, University of Haifa Haifa, Israel
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Abstract
OBJECTIVE Sex differences in pain are well established, with women reporting greater incidence of clinical pain and heightened responsivity to experimental pain stimuli relative to men. Sex hormones (ie, estrogens, progestins, androgens) could contribute to extant differences in pain sensitivity between men and women. Despite this, there has been limited experimental research assessing the relationship between pain and sex hormones. The purpose of this study was to extend previous research and examine the association between sex hormones and nociceptive processing in healthy women. MATERIALS AND METHODS A total of 40 healthy women were tested during the mid-follicular, ovulatory, and late-luteal phases of the menstrual cycle (testing order counterbalanced). Salivary estradiol, progesterone, and testosterone were collected at each testing session and pain was examined from electrocutaneous threshold/tolerance, ischemia threshold/tolerance, and McGill Pain Questionnaire-Short Form ratings of noxious stimuli. Nociceptive flexion reflex threshold was assessed as a measure of spinal nociception. RESULTS Overall, there were no significant menstrual phase-related differences in pain outcomes. Nonetheless, variability in testosterone (and to a lesser degree estradiol) was associated with pain; testosterone was antinociceptive, whereas estradiol was pronociceptive. No hormone was associated with nociceptive flexion reflex threshold. DISCUSSION Although future research is needed to replicate and extend these findings to clinical populations (ie, chronic pain, premenstrual dysphoric disorder), results from the present study indicate that menstrual phase-related changes in sex hormones have minimal influence on experimental pain. However, individual differences in testosterone may play a protective role against pain in healthy women.
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Allen AM, McRae-Clark AL, Carlson S, Saladin ME, Gray KM, Wetherington CL, McKee SA, Allen SS. Determining menstrual phase in human biobehavioral research: A review with recommendations. Exp Clin Psychopharmacol 2016; 24:1-11. [PMID: 26570992 PMCID: PMC4821777 DOI: 10.1037/pha0000057] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given the volume and importance of research focusing on menstrual phase, a review of the strategies being used to identify menstrual phase and recommendations that will promote methodological uniformity in the field is needed. We conducted a literature review via Ovid Medline and PsycINFO. Our goal was to review methods used to identify menstrual phase and subphases in biobehavioral research studies with women who had physiologically natural menstrual cycles. Therefore, we excluded articles that focused on any of the following: use of exogenous hormones, the postpartum period, menstrual-related problems (e.g., polycystic ovarian syndrome, endometriosis), and infertility/anovulation. We also excluded articles on either younger (<18 years old) or older (>45 years old) study samples. We initially identified a total of 1,809 articles. After our exclusionary criteria were applied, 146 articles remained, within which our review identified 6 different methods used to identify menstrual phase and subphases. The most common method used was self-report of onset of menses (145/146 articles) followed by urine luteinizing hormone testing (50/146 articles) and measurement of hormones (estradiol and/or progesterone) in blood samples (49/146 articles). Overall, we found a lack of consistency in the methodology used to determine menstrual phase and subphases. We provide several options to improve accuracy of phase identification, as well as to minimize costs and burden. Adoption of these recommendations will decrease misclassification within individual studies, facilitate cross-study comparisons, and enhance the reproducibility of results.
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Affiliation(s)
- Alicia M. Allen
- Department of Family Medicine & Community Health, Medical School, University of Minnesota; Mailing Address: 717 Delaware Street SE, Room 422, Minneapolis, Minnesota, USA 55414
| | - Aimee L. McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina; Mailing Address: 67 President Street, Charleston, SC, USA 29425
| | - Samantha Carlson
- Department of Family Medicine & Community Health, Medical School, University of Minnesota; Mailing Address: 717 Delaware Street SE, Room 400, Minneapolis, Minnesota, USA 55414
| | - Michael E. Saladin
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina; Mailing Address: 77 President St., Charleston, SC, USA 29425
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina; Mailing Address: 125 Doughty Street, Suite 190, MSC861, Charleston SC, USA 29425
| | - Cora Lee Wetherington
- National Institute on Drug Abuse, National Institutes of Health; Mailing Address: National Institute on Drug Abuse, 6001 Executive Blvd, Suite 3155, Bethesda, MD, USA 20892-9593
| | - Sherry A. McKee
- Department of Psychiatry, Yale University School of Medicine; Mailing Address: 2 Church St. South, #109, New Haven, CT, USA 06519
| | - Sharon S. Allen
- Department of Family Medicine & Community Health, Medical School, University of Minnesota; Mailing Address: 420 Delaware Street SE, MMC 381 Mayo, Minneapolis, Minnesota, USA 55455
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Bear T, Philipp M, Hill S, Mündel T. A preliminary study on how hypohydration affects pain perception. Psychophysiology 2016; 53:605-10. [DOI: 10.1111/psyp.12610] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/17/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Tracey Bear
- School of Sport and Exercise; Massey University; Palmerston North New Zealand
- School of Psychology; Massey University; Palmerston North New Zealand
- School of Food and Nutrition; Massey University; Palmerston North New Zealand
| | - Michael Philipp
- School of Psychology; Massey University; Palmerston North New Zealand
| | - Stephen Hill
- School of Psychology; Massey University; Palmerston North New Zealand
| | - Toby Mündel
- School of Sport and Exercise; Massey University; Palmerston North New Zealand
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Zheng B, Ren M, Lin F, Yao L. Prediction of pain in orthodontic patients based on preoperative pain assessment. Patient Prefer Adherence 2016; 10:251-6. [PMID: 27042019 PMCID: PMC4780399 DOI: 10.2147/ppa.s101391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate whether pretreatment assessment of experimental pain can predict the level of pain after archwire placement. METHODS One hundred and twenty-one general university students seeking orthodontic treatment were enrolled in this study. A cold pressor test was performed to estimate the pain tolerance of subjects before treatment. Self-reported pain intensity was calculated using a 10 cm visual analog scale during the 7 days after treatment. The relationship between pain tolerance and orthodontic pain was analyzed using Spearman's correlation analysis. RESULTS The maximum mean level of pain intensity occurred at 24 hours after bonding (53.31±16.13) and fell to normal levels at day 7. Spearman's correlation analysis found a moderate positive association between preoperative pain tolerance and self-reported pain after archwire placement (P<0.01). There was no significant difference in pain intensity between male and female patients at any time point (P>0.05). CONCLUSION A simple and noninvasive preoperative sensory test (the cold pressor test) was useful in predicting the risk of developing unbearable pain in patients after archwire placement. Self-reported pain after archwire placement decreased as individual pain tolerance increased.
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Affiliation(s)
- Baoyu Zheng
- Periodontic Department, School and Hospital of Stomatology, People’s Republic of China
| | - Manman Ren
- Oral and Maxillofacial Surgery Department, School and Hospital of Stomatology, People’s Republic of China
| | - Feiou Lin
- Orthodontic Department, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Linjie Yao
- Pedodontic Department, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
- Correspondence: Linjie Yao, Pedodontic Department, School and Hospital of Stomatology, Wenzhou Medical University, No 113 West Xueyuan Road, Wenzhou, Zhejiang, People’s Republic of China, Tel/fax +86 577 8806 3008, Email
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Hermans L, Van Oosterwijck J, Goubert D, Goudman L, Crombez G, Calders P, Meeus M. Inventory of Personal Factors Influencing Conditioned Pain Modulation in Healthy People: A Systematic Literature Review. Pain Pract 2015; 16:758-69. [DOI: 10.1111/papr.12305] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/09/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Linda Hermans
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
| | - Jessica Van Oosterwijck
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
| | - Dorien Goubert
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
| | - Lisa Goudman
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology; Ghent University; Ghent Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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Iacovides S, Avidon I, Baker F. Does pain vary across the menstrual cycle? A review. Eur J Pain 2015; 19:1389-405. [DOI: 10.1002/ejp.714] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 02/06/2023]
Affiliation(s)
- S. Iacovides
- Wits Dial-a-bed Sleep Laboratory; Brain Function Research Group; School of Physiology; Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
| | - I. Avidon
- Exercise Physiology Laboratory; School of Physiology; Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
| | - F.C. Baker
- Wits Dial-a-bed Sleep Laboratory; Brain Function Research Group; School of Physiology; Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
- Human Sleep Research Program; SRI International; San Francisco USA
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Lee J, Lee J, Ko S. The relationship between serum progesterone concentration and anesthetic and analgesic requirements: a prospective observational study of parturients undergoing cesarean delivery. Anesth Analg 2014; 119:901-905. [PMID: 25036373 DOI: 10.1213/ane.0000000000000366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In clinical practice, pregnant women have lower anesthetic requirements for general anesthesia than nonpregnant women. Although the hormonal changes such as progesterone associated with pregnancy may affect the minimum alveolar concentration of volatile anesthetics, the relationship between the anesthetic or analgesic requirements and progesterone level in full-term women has not been studied. In this study, we attempted to identify relationships between anesthetic or analgesic requirements and maternal serum concentrations of progesterone. METHODS We studied 100 parturients >36 weeks' gestation who were scheduled for planned cesarean delivery under general anesthesia. Venous blood was collected to measure the maternal progesterone concentration. Anesthesia was induced with 4 to 5 mg/kg thiopental and 0.8 mg/kg rocuronium. During anesthetic maintenance, sevoflurane 0.5% to 2.0% and nitrous oxide 50% in oxygen were titrated based on arterial blood pressure, heart rate, and bispectral index value. Vital signs, bispectral index, end-tidal sevoflurane concentration, and sevoflurane consumption per hour were recorded. Visual analog scale pain scores and cumulative analgesic consumption were recorded at 2, 24, and 48 hours postoperatively. RESULTS The mean serum progesterone concentration was 128.2 ± 83.0 ng/mL. There was a significant negative correlation between sevoflurane consumption per hour and serum progesterone concentration (Pearson correlation r = -0.26; 95% confidence interval, -0.44 to -0.05, P = 0.01). Cumulative analgesic consumption at postoperative hours 2 (r = -0.20, P = 0.05), 24 (r = -0.25, P = 0.02), and 48 (r = -0.28, P = 0.01) were correlated inversely with serum progesterone concentration. Women with high progesterone levels (higher than the median value) had lower sevoflurane consumption per hour (P = 0.02) and 48-hour postoperative cumulative analgesic consumption (P = 0.02) than women with low (below the median value) levels. CONCLUSIONS The decreased anesthetic and analgesic requirements of near full-term parturients might partially depend on serum progesterone concentration.
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Affiliation(s)
- Jeongwoo Lee
- From the Department of Anesthesiology and Pain Medicine, Chonbuk National University Hospital, Jeonju, Korea; and Department of Anesthesiology and Pain Medicine and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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The effect of repeated intramuscular alfentanil injections on experimental pain and abuse liability indices in healthy males. Clin J Pain 2014; 30:36-45. [PMID: 23446076 DOI: 10.1097/ajp.0b013e3182851758] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Opioid-induced hyperalgesia (OIH), increased sensitivity to noxious stimuli after repeated opioid exposures, has been demonstrated in preclinical studies. However, there is no accepted, prospective model of OIH after repeated opioid exposures currently available in humans. This study assessed a potential prospective OIH model. METHODS Double-blind intramuscular injections of a short-acting opioid (alfentanil 15 mcg/kg; N=8) were compared to active placebo (diphenhydramine 25 mg; N=3) on cold and pressure pain testing and standard abuse liability measures in eight 10-hour sessions (1 injection/session) over 4 to 5 weeks in healthy, pain-free males. Decreases from session baseline pain threshold (PThr) and tolerance (PTol) were calculated to represent hyperalgesia, and were assessed both within and across sessions. RESULTS Mean decreases in cold PTol were seen in the alfentanil group at 180 minutes (-3.8 s, ±26.5) and 480 minutes (-1.63 s, ±31.5) after drug administration. There was a trend for differences between conditions on cold PThr hyperalgesia but not for pressure PThr. Alfentanil participants had greater mean ratings on Liking and High visual analog scales at peak effects (30 min), but these scores did not change across sessions. DISCUSSION Repeated alfentanil exposures over 4 to 5 weeks resulted in within session decreases in cold pain tolerance from baseline but these differences were not substantially different from diphenhydramine controls. The results did not support the phenomenon of OIH in this model, although definitive conclusions regarding the existence of OIH in humans likely requires a larger sample size or an alternative model.
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Arendt-Nielsen L, Madsen H, Jarrell J, Gregersen H, Drewes AM. Pain evoked by distension of the uterine cervix in women with dysmenorrhea: evidence for central sensitization. Acta Obstet Gynecol Scand 2014; 93:741-8. [DOI: 10.1111/aogs.12403] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 04/10/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Lars Arendt-Nielsen
- Center for Sensory-Motor Interactions (SMI); Department of Health Science and Technology; School of Medicine; Aalborg University; Aalborg Denmark
| | - Hans Madsen
- Department of Obstetrics and Gynecology; Aalborg University Hospital; Aalborg Denmark
| | - John Jarrell
- Calgary Chronic Pain Centre and Department of Obstetrics and Gynecology; University of Calgary; Calgary Alberta Canada
| | - Hans Gregersen
- Mech-Sense; Department of Gastroenterology; Aalborg University Hospital; Aalborg Denmark
| | - Asbjørn M. Drewes
- Center for Sensory-Motor Interactions (SMI); Department of Health Science and Technology; School of Medicine; Aalborg University; Aalborg Denmark
- Mech-Sense; Department of Gastroenterology; Aalborg University Hospital; Aalborg Denmark
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Iacovides S, Baker FC, Avidon I, Bentley A. Women With Dysmenorrhea Are Hypersensitive to Experimental Deep Muscle Pain Across the Menstrual Cycle. THE JOURNAL OF PAIN 2013; 14:1066-76. [PMID: 23769507 DOI: 10.1016/j.jpain.2013.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/26/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
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Mechanical pain sensitivity and the severity of chronic neck pain and disability are not modulated across the menstrual cycle. THE JOURNAL OF PAIN 2013; 14:1450-9. [PMID: 24021578 DOI: 10.1016/j.jpain.2013.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/28/2013] [Accepted: 07/07/2013] [Indexed: 11/23/2022]
Abstract
UNLABELLED Despite the high prevalence of neck pain among women, menstrual effects on regional pain outcomes have not been investigated in this clinical population. This study evaluated menstrual effects on mechanical pain sensitivity (pressure pain threshold [PPT]), neck pain intensity (numeric pain rating scale [NPRS]), and neck-related disability (Neck Disability Index [NDI]) in 22 normally menstruating (NM) and 17 hormonal contraceptive users with chronic neck pain. Sex hormones, PPT, and NDI were measured during the early follicular (F1), late follicular (F2), and luteal (L) menstrual phases. Daily NPRS scores were recorded in an online symptom diary and averaged within each phase. Estradiol and progesterone increased only for NM women in F2 and L, respectively. Phase effects on PPT (η(2) = .003), NDI (η(2) = .003), and NPRS (η(2) = .016) for NM women were small and did not differ from those for the hormonal contraceptive users (P ≥ .386). Averaged across the menstrual cycle, PPT scores explained 29% of the variance in NPRS scores for NM women but were not associated with NDI scores in either group. Results indicate that the magnitude of menstrual effects on mechanical pain sensitivity and the severity of neck pain and disability do not exceed thresholds of clinically detectable change in women with chronic neck pain. PERSPECTIVE Fluctuations in evoked and clinical pain outcomes across the menstrual cycle do not appear to be of sufficient magnitude to impact clinical decision making for women with chronic neck pain.
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Comparison of the analgesic effects of dronabinol and smoked marijuana in daily marijuana smokers. Neuropsychopharmacology 2013; 38:1984-92. [PMID: 23609132 PMCID: PMC3746706 DOI: 10.1038/npp.2013.97] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/02/2013] [Accepted: 04/16/2013] [Indexed: 12/22/2022]
Abstract
Recent studies have demonstrated the therapeutic potential of cannabinoids to treat pain, yet none have compared the analgesic effectiveness of smoked marijuana to orally administered Δ(9)-tetrahydrocannabinol (THC; dronabinol). This randomized, placebo-controlled, double-dummy, double-blind study compared the magnitude and duration of analgesic effects of smoked marijuana and dronabinol under well-controlled conditions using a validated experimental model of pain. Healthy male (N=15) and female (N=15) daily marijuana smokers participated in this outpatient study comparing the analgesic, subjective, and physiological effects of marijuana (0.00, 1.98, or 3.56% THC) to dronabinol (0, 10, or 20 mg). Pain response was assessed using the cold-pressor test (CPT): participants immersed their left hand in cold water (4 °C), and the time to report pain (pain sensitivity) and withdraw the hand from the water (pain tolerance) were recorded. Subjective pain and drug effect ratings were also measured as well as cardiovascular effects. Compared with placebo, marijuana and dronabinol decreased pain sensitivity (3.56%; 20 mg), increased pain tolerance (1.98%; 20 mg), and decreased subjective ratings of pain intensity (1.98, 3.56%; 20 mg). The magnitude of peak change in pain sensitivity and tolerance did not differ between marijuana and dronabinol, although dronabinol produced analgesia that was of a longer duration. Marijuana (1.98, 3.56%) and dronabinol (20 mg) also increased abuse-related subjective ratings relative to placebo; these ratings were greater with marijuana. These data indicate that under controlled conditions, marijuana and dronabinol decreased pain, with dronabinol producing longer-lasting decreases in pain sensitivity and lower ratings of abuse-related subjective effects than marijuana.
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Honca M, Purtuloglu T, Honca T, Sizlan A, Deniz S, Kose A, Ogur R, Horasanlı E. Effects of the menstrual cycle on injection pain due to rocuronium. J Clin Anesth 2013; 25:399-402. [PMID: 23965205 DOI: 10.1016/j.jclinane.2013.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 02/11/2013] [Accepted: 02/15/2013] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To investigate the effect of the menstrual cycle on rocuronium injection pain. DESIGN Prospective, randomized, double-blinded study. SETTING Academic medical center. PATIENTS 80 ASA physical status 1 and 2 women scheduled for elective surgery with general anesthesia. MEASUREMENTS Patients were divided into two groups according to their time in the menstrual cycle. Forty patients at days 8 to 12 of the menstrual cycle were considered to be at the follicular phase (Group F), and 40 patients at days 20 to 24 of the menstrual cycle were considered to be at the luteal phase (Group L).Withdrawal movements were recorded. MAIN RESULTS Overall frequency of withdrawal movements was significantly higher in Group L than Group F (P < 0.001). The mean withdrawal movement score was 1.77 ± 0.76 in Group L and 0.52 ± 0.67 in Group F. CONCLUSION Menstrual cycle phases affect the severity of rocuronium injection pain. Women exhibit greater pain sensitivity from rocuronium injection in the luteal phase than the follicular phase.
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Affiliation(s)
- Mehtap Honca
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey.
| | - Tarık Purtuloglu
- Department of Anesthesiology and Reanimation, Gulhane Medical Faculty, Ankara, Turkey
| | - Tevfik Honca
- Department of Medical Biochemistry, Gulhane Medical Faculty, Ankara, Turkey
| | - Ali Sizlan
- Department of Anesthesiology and Reanimation, Gulhane Medical Faculty, Ankara, Turkey
| | - Suleyman Deniz
- Department of Anesthesiology and Reanimation, Gulhane Medical Faculty, Ankara, Turkey
| | - Arzu Kose
- Department of Anesthesiology and Reanimation, Kirikkale University School of Medicine, Kirikkale, Turkey
| | - Recai Ogur
- Department of Environmental Health, Gulhane Medical Faculty, Ankara, Turkey
| | - Eyup Horasanlı
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
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Comparing pain sensitivity and the nociceptive flexion reflex threshold across the mid-follicular and late-luteal menstrual phases in healthy women. Clin J Pain 2013; 29:154-61. [PMID: 22688607 DOI: 10.1097/ajp.0b013e31824c5edb] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Understanding the relationship between the menstrual cycle and pain can contribute significantly to our knowledge of pain processing in women. Many early studies suggested that pain sensitivity was enhanced during the luteal phase of the menstrual cycle relative to the follicular phase; however, these studies were often limited by small sample sizes, lack of ovulation verification, focus on a single pain modality, inadequate assessment of menstrual cycle regularity, and low-powered statistical methods. The current study was designed to address these limitations and examine the difference in pain processing between the mid-follicular (days 5 to 8) and late-luteal (days 1 to 6 preceding menses) phases. METHODS Forty-one healthy, regularly cycling women attended testing sessions that measured pain sensitivity from mechanical pain threshold, electrocutaneous pain threshold/tolerance, and ischemia pain threshold/tolerance, as well as McGill Pain Questionnaire qsensory and affective ratings of electric and ischemic stimuli. Electrocutaneous stimulation was also used to assess nociceptive flexion reflex threshold, a physiological measure of spinal nociception. RESULTS When analyses were limited to data collected only in the targeted menstrual phases (N=30), results indicated no menstrual phase effect on any pain outcome (all P's>0.05), with the exception of lower electrocutaneous pain thresholds during the late-luteal phase. No outcomes differed by menstrual phase in the full sample (N=41). This indicates nociceptive responding varies little between the mid-follicular and late-luteal phases. DISCUSSION The present study suggests that experimental pain processing does not significantly differ between the mid-follicular and late-luteal phases of the menstrual cycle in healthy women. This implies hormonal variation across these 2 phases (ie, progesterone) has a minimal effect on subjective and physiological responses to pain.
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Brain imaging reveals that engagement of descending inhibitory pain pathways in healthy women in a low endogenous estradiol state varies with testosterone. Pain 2013; 154:515-524. [DOI: 10.1016/j.pain.2012.11.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 09/12/2012] [Accepted: 11/30/2012] [Indexed: 11/23/2022]
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The influence of physical activity on pain thresholds in patients with depression and multiple somatoform symptoms. Clin J Pain 2013; 28:782-9. [PMID: 22699138 DOI: 10.1097/ajp.0b013e318243e2d1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Pain is a common symptom with high occurrence in somatoform syndromes and depressive disorders. Research in this area often focuses on experimental induction of pain and subsequent assessment of pain thresholds, ensuring repeatable stimuli of defined quality. Results on sensitivity to experimental pain in major depression are inconclusive, and data on pain thresholds in multiple somatoform symptoms are scarce. The goals of the present study were to differentiate between groups regarding the pressure pain thresholds, and to investigate the possible influence of physical activity on the pain thresholds in these groups. We postulate that physical fitness and physical activity influence pain thresholds in depression and persons with multiple somatoform symptoms. METHODS Thirty-eight persons with major depression, 26 persons with a minimum of 6 to 8 somatoform symptoms (somatoform symptom index 8, SSI-8), and 47 healthy participants participated in the study. Baseline values of pressure pain thresholds assessed at different sites of the body were compared with those after 1 week of increased and 1 week of reduced physical activity. RESULTS We used repeated measurement design (MANCOVA) and partial correlations for data analysis. Depressed participants reported lower pain thresholds compared with controls, and persons with SSI-8 showed intermediate thresholds. After 1 week of physical activity, participants reported higher pain thresholds. Men had higher pain thresholds following activity as compared with women. Participants who reported higher general fitness also showed higher pain thresholds. Sensitivity to pressure pain is associated with depression, but not with multiple somatoform symptoms. DISCUSSION Short low-graded exercise can have reducing effects on perception of pressure pain. Physical activity level is a relevant covariate when using pressure pain assessment. Reduced general fitness can partially account for lower pain thresholds in depression.
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Veldhuijzen DS, Keaser ML, Traub DS, Zhuo J, Gullapalli RP, Greenspan JD. The role of circulating sex hormones in menstrual cycle-dependent modulation of pain-related brain activation. Pain 2013; 154:548-559. [PMID: 23528204 DOI: 10.1016/j.pain.2012.12.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 11/09/2012] [Accepted: 12/19/2012] [Indexed: 12/26/2022]
Abstract
Sex differences in pain sensitivity have been consistently found, but the basis for these differences is incompletely understood. The present study assessed how pain-related neural processing varies across the menstrual cycle in normally cycling, healthy women, and whether menstrual cycle effects are based on fluctuating sex hormone levels. Fifteen subjects participated in 4 test sessions during their menstrual, midfollicular, ovulatory, and midluteal phases. Brain activity was measured while nonpainful and painful stimuli were applied with a pressure algometer. Serum hormone levels confirmed that scans were performed at appropriate cycle phases in 14 subjects. No significant cycle phase differences were found for pain intensity or unpleasantness ratings of stimuli applied during functional magnetic resonance imaging scans. However, lower pressure pain thresholds were found for follicular compared with other phases. Pain-specific brain activation was found in several regions traditionally associated with pain processing, including the medial thalamus, anterior and middle insula, midcingulate, primary and secondary somatosensory cortices, cerebellum, and frontal regions. The inferior parietal lobule, occipital gyrus, cerebellum, and several frontal regions showed interaction effects between stimulus level and cycle phase, indicating differential processing of pain-related responses across menstrual cycle phases. Correlational analyses indicated that cycle-related changes in pain sensitivity measures and brain activation were only partly explained by varying sex hormone levels. These results show that pain-related cerebral activation varies significantly across the menstrual cycle, even when perceived pain intensity and unpleasantness remain constant. The involved brain regions suggest that cognitive pain or more general bodily awareness systems are most susceptible to menstrual cycle effects.
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Affiliation(s)
- Dieuwke S Veldhuijzen
- Department of Neural and Pain Sciences, UMB Research Center for Neuroendocrine Influences on Pain, University of Maryland, Baltimore, MD, USA Pain Clinic, Division of Anesthesiology, Intensive Care and Emergency Medicine, Rudolf Magus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands Department of Diagnostic Radiology, University of Maryland, Baltimore, MD, USA
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Heddini U, Bohm-Starke N, Grönbladh A, Nyberg F, Nilsson KW, Johannesson U. GCH1-polymorphism and pain sensitivity among women with provoked vestibulodynia. Mol Pain 2012; 8:68. [PMID: 22971341 PMCID: PMC3489821 DOI: 10.1186/1744-8069-8-68] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 08/24/2012] [Indexed: 12/21/2022] Open
Abstract
Background Provoked vestibulodynia (PVD) is a pain disorder localized in the vestibular mucosa. It is the most common cause of dyspareunia among young women and it is associated with general pain hypersensitivity and other chronic pain conditions. Polymorphism in the guanosine triphosphate cyclohydrolase (GCH1) gene has been found to influence general pain sensitivity and the risk of developing a longstanding pain condition. The aim of this study was to investigate GCH1-polymorphism in women with PVD and healthy controls, in correlation to pain sensitivity. Results We found no correlation between the previously defined pain-protective GCH1-SNP combination and the diagnosis of PVD. Nor any correlation with pain sensitivity measured as pressure pain thresholds on the arm, leg and in the vestibule, coital pain scored on a visual analog scale and prevalence of other bodily pain conditions among women with PVD (n = 98) and healthy controls (n = 102). However, among patients with current treatment (n = 36), there was a significant interaction effect of GCH1-gene polymorphism and hormonal contraceptive (HC) therapy on coital pain (p = 0.04) as well as on pressure pain thresholds on the arm (p = 0.04). PVD patients carrying the specified SNP combination and using HCs had higher pain sensitivity compared to non-carriers. In non-HC-users, carriers had lower pain sensitivity. Conclusions The results of this study gave no support to the hypothesis that polymorphism in the GCH1-gene contributes to the etiology of PVD. However, among patients currently receiving treatment an interaction effect of the defined SNP combination and use of hormonal contraceptives on pain sensitivity was found. This finding offers a possible explanation to the clinically known fact that some PVD patients improve after cessation of hormonal contraceptives, indicating that PVD patients carrying the defined SNP combination of GCH1 would benefit from this intervention.
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Affiliation(s)
- Ulrika Heddini
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Division of Obstetrics and Gynecology, Stockholm, Sweden.
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