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Kaplan CM, Kelleher E, Irani A, Schrepf A, Clauw DJ, Harte SE. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nat Rev Neurol 2024; 20:347-363. [PMID: 38755449 DOI: 10.1038/s41582-024-00966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Nociplastic pain is a mechanistic term used to describe pain that arises or is sustained by altered nociception, despite the absence of tissue damage. Although nociplastic pain has distinct pathophysiology from nociceptive and neuropathic pain, these pain mechanisms often coincide within individuals, which contributes to the intractability of chronic pain. Key symptoms of nociplastic pain include pain in multiple body regions, fatigue, sleep disturbances, cognitive dysfunction, depression and anxiety. Individuals with nociplastic pain are often diffusely tender - indicative of hyperalgesia and/or allodynia - and are often more sensitive than others to non-painful sensory stimuli such as lights, odours and noises. This Review summarizes the risk factors, clinical presentation and treatment of nociplastic pain, and describes how alterations in brain function and structure, immune processing and peripheral factors might contribute to the nociplastic pain phenotype. This article concludes with a discussion of two proposed subtypes of nociplastic pain that reflect distinct neurobiological features and treatment responsivity.
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Affiliation(s)
- Chelsea M Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Eoin Kelleher
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anushka Irani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Division of Rheumatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
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2
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Rafferty C, Ward J. Fibromyalgia is linked to increased subjective sensory sensitivity across multiple senses. Perception 2024; 53:276-286. [PMID: 38410035 PMCID: PMC10960319 DOI: 10.1177/03010066241234037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024]
Abstract
Changes in subjective sensory sensitivity - reporting sensory stimuli as being atypically intense or weak - are a transdiagnostic symptom of several disorders. The present study documents for the first time the sensory sensitivity profile of fibromyalgia, taking a questionnaire measure that asks about different sensory modalities and both hyper- and hyposensitivity (the Glasgow Sensory Questionnaire, GSQ). The fibromyalgia group had higher overall scores on this measure. This was linked more strongly to sensory hypersensitivity and was pervasive across all senses that were surveyed. Although differences in hyposensitivity were found, these were sporadic (perhaps linked to the symptoms of fibromyalgia itself) and did not resemble the pattern documented for autism (e.g., self-stimulating and repetitive behaviours were not a feature of fibromyalgia). We suggest that individual differences in subjective sensory hypersensitivity may be a multisensory dispositional trait linked to fibromyalgia which ultimately becomes most pronounced for pain.
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Cardoso S, Fernandes C, Barbosa F. Attentional deficits in fibromyalgia: an ERP study with the oddball dual task and emotional stroop task. BMC Psychol 2024; 12:104. [PMID: 38424648 PMCID: PMC10902965 DOI: 10.1186/s40359-024-01601-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
The present study investigated the neural correlates of attentional deficits in fibromyalgia through an Oddball Dual Task and an Emotional Stroop Task, both performed during EEG recordings. Thirty female participants were recruited, being divided into two groups: a group of patients with fibromyalgia (FM, n = 15, Mage = 51.87, SDage = 7.12) and a healthy control group (HC, n = 15, Mage = 46.13, SDage = 8.41). In the Emotional Stroop Task, the behavioural results showed that patients with FM had less hits and longer times reactions than healthy controls. These results were consistent with those obtained with our Event-related Potential (ERP) methodology, which evidenced that patients with FM had higher frontal latencies in the P200 time-window compared to healthy controls. Regarding the Oddball Dual Task, we found that patients with FM had lower P300 amplitudes than healthy participants. Moreover, we found that rare stimuli elicited higher P300 amplitudes than frequent stimuli for healthy controls, but this comparison was non-significant for patients with FM. Taken together, our results suggest that fibromyalgia may be associated to a reduced processing speed, along to reduced neural resources to process stimuli, mainly in distinguishing relevant (rare) and irrelevant (frequent) stimuli according to the goals of the task. Altogether, our results seem to support the hypothesis of generalized attentional deficits in FM.
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Affiliation(s)
- Susana Cardoso
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Avenida Carlos de Oliveira Campos-Castêlo da Maia, 4475-690, Maia, Portugal.
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.
| | - Carina Fernandes
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Faculty of Human and Social Sciences, University Fernando Pessoa, Porto, Portugal
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) & RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Tsai ST, Yang CC, Liao HY, Lin YW. Electroacupuncture Reduces Fibromyalgia Pain via Neuronal/Microglial Inactivation and Toll-like Receptor 4 in the Mouse Brain: Precise Interpretation of Chemogenetics. Biomedicines 2024; 12:387. [PMID: 38397989 PMCID: PMC10886830 DOI: 10.3390/biomedicines12020387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Fibromyalgia (FM) is a complex, chronic, widespread pain syndrome that can cause significant health and economic burden. Emerging evidence has shown that neuroinflammation is an underlying pathological mechanism in FM. Toll-like receptors (TLRs) are key mediators of the immune system. TLR4 is expressed primarily in microglia and regulates downstream signaling pathways, such as MyD88/NF-κB and TRIF/IRF3. It remains unknown whether electroacupuncture (EA) has therapeutic benefit in attenuating FM pain and what role the TLR4 pathway may play in this effect. We compared EA with sham EA to eliminate the placebo effect due to acupuncture. We demonstrated that intermittent cold stress significantly induced an increase in mechanical and thermal FM pain in mice (mechanical: 2.48 ± 0.53 g; thermal: 5.64 ± 0.32 s). EA but not sham EA has an analgesic effect on FM mice. TLR4 and inflammatory mediator-related molecules were increased in the thalamus, medial prefrontal cortex, somatosensory cortex (SSC), and amygdala of FM mice, indicating neuroinflammation and microglial activation. These molecules were reduced by EA but not sham EA. Furthermore, a new chemogenetics method was used to precisely inhibit SSC activity that displayed an anti-nociceptive effect through the TLR4 pathway. Our results imply that the analgesic effect of EA is associated with TLR4 downregulation. We provide novel evidence that EA modulates the TLR4 signaling pathway, revealing potential therapeutic targets for FM pain.
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Affiliation(s)
- Sheng-Ta Tsai
- Department of Neurology, China Medical University Hospital, Taichung 404332, Taiwan;
- School of Medicine, China Medical University, Taichung 404328, Taiwan
| | - Chia-Chun Yang
- Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan 330035, Taiwan;
| | - Hsien-Yin Liao
- School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404328, Taiwan
- Department of Acupuncture, China Medical University Hospital, Taichung 404328, Taiwan
| | - Yi-Wen Lin
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 404328, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung 404328, Taiwan
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Tilbor E, Hadar A, Portnoy V, Ganor O, Braw Y, Amital H, Ablin J, Dror C, Bloch Y, Nitzan U. TMS in combination with a pain directed intervention for the treatment of fibromyalgia - A randomized, double-blind, sham-controlled trial. J Psychiatr Res 2024; 170:167-173. [PMID: 38150768 DOI: 10.1016/j.jpsychires.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/03/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Fibromyalgia Syndrome (FMS) is a highly prevalent condition, that causes chronic pain and severe reduction in quality of life and productivity, as well as social isolation. Despite the significant morbidity and economic burden of FMS, current treatments are scarce. OBJECTIVE To investigate whether stimulation of ACC -mPFC activity by dTMS enhances a pain-directed psychotherapeutic intervention. METHODS 19 FMS patients were randomised to receive either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. With the H7 HAC coil or sham stimulation, we targeted the ACC -mPFC; specific brain areas that play a central role in pain processing. Clinical response to treatment was assessed with the McGill Pain Questionnaire Short Form (SF-MPQ), the Visual Analogue Fibromyalgia Impact Questionnaire, the Brief Pain Inventory questionnaire, and the Hamilton Depression Rating Scale. RESULTS DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the combined sensory and affective pain dimensions was specifically demonstrated in the dTMS cohort, as measured by the SF-MPQ (Significant group × time interaction [F(2, 32) = 3.51, p < .05,ηp2 = 0.18]; No significant changes were found in depressive symptoms in both the dTMS and sham groups. CONCLUSION Our results suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not dTMS alone, but rather dTMS-induced plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions.
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Affiliation(s)
- Einat Tilbor
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Aviad Hadar
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Victor Portnoy
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel.
| | - Ori Ganor
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Yoram Braw
- Ariel University, Department of Psychology, 65 Ramat HaGolan Street, Ari'el, Israel.
| | - Howard Amital
- Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel; Sheba Medical Center Hospital, Tel Hashomer, 52621, Ramat Gan, Israel.
| | - Jacob Ablin
- Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel; Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
| | - Chen Dror
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Yuval Bloch
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Uri Nitzan
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
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6
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Gupta A, Schikler K. Prevalence of tinnitus in juvenile fibromyalgia patients visiting a pediatric rheumatology clinic. Int J Pediatr Otorhinolaryngol 2024; 176:111837. [PMID: 38168650 DOI: 10.1016/j.ijporl.2023.111837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
Juvenile fibromyalgia (JFMS) is a common disorder in the adolescent population with a prevalence of 1-6%. Our study looked at the prevalence of tinnitus in JFMS patients seen at a pediatric rheumatology clinic between 2016 and 2021. The objective of this study was to retrospectively assess prevalence of tinnitus and compare that with prevalence in non- JFMS patients presenting to the clinic. We also assessed prevalence of other sensory and pain symptoms, Widespread pain index >6 and abdominal pain in these two groups. Of the 290 forms evaluated, tinnitus was present in 31.1 % of JFMS subjects, versus only 3.5 % in non-JFMS subjects. There was a significant association between tinnitus and tingling and numbness among subjects with JFM (p = 0.005). On logistic regression analysis, the odds of having JFMS were 5.2 times higher among tinnitus patients compared to non-tinnitus (p = 0.003, 95 % CI 1.77-15.55). Tingling/numbness were also associated with 21.78 times increased odds for diagnosis of JFMS (p = 0.0003, 95 % CI 4.05-117.21). The odds of having JFMS were 22.6 times higher among patients with Widespread Pain Index >6 (p < 0.0001, 95 % CI 7.88-64.71). Tinnitus is a commonly prevalent condition in patients with JFMS. In patients with JFMS, there is a significant association between tinnitus and tingling/numbness. Further studies are needed to explore the underlying pathogenesis of these symptoms.
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Affiliation(s)
- Ayush Gupta
- Division of Child Neurology, Department of Neurology, University of Louisville, United States
| | - Kenneth Schikler
- Division of Rheumatology, Department of Pediatrics, University of Louisville, United States.
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Pierce J, Harte SE, Afari N, Bradley CS, Griffith JW, Kim J, Lutgendorf S, Naliboff BD, Rodriguez LV, Taple BJ, Williams D, Harris RE, Schrepf A. Mediators of the association between childhood trauma and pain sensitivity in adulthood: a Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network analysis. Pain 2023; 164:1995-2008. [PMID: 37144687 PMCID: PMC10440258 DOI: 10.1097/j.pain.0000000000002895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/13/2023] [Indexed: 05/06/2023]
Abstract
ABSTRACT Urologic chronic pelvic pain syndrome (UCPPS) is a complex, debilitating condition in which patients often report nonpelvic pain in addition to localized pelvic pain. Understanding differential predictors of pelvic pain only vs widespread pain may provide novel pathways for intervention. This study leveraged baseline data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network's Symptom Pattern Study to investigate the impact of childhood sexual and nonsexual violent trauma on pelvic and nonpelvic pain sensitivity among adult patients with UCPPS, as well as potential mediators of this association. Study participants who met inclusion criteria for UCPPS completed questionnaires assessing childhood and recent trauma, affective distress, cognitive dysfunction, and generalized sensory sensitivity. Experimental pain sensitivity was also evaluated using standardized pressure pain applied to the pubic region and the arm. Bivariate analyses showed that childhood violent trauma was associated with more nonviolent childhood trauma, more recent trauma, poorer adult functioning, and greater pain sensitivity at the pubic region, but not pain sensitivity at the arm. Path analysis suggested that childhood violent trauma was indirectly associated with pain sensitivity at both sites and that this indirect association was primarily mediated by generalized sensory sensitivity. More experiences of recent trauma also contributed to these indirect effects. The findings suggest that, among participants with UCPPS, childhood violent trauma may be associated with heightened pain sensitivity to the extent that trauma history is associated with a subsequent increase in generalized sensory sensitivity.
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Affiliation(s)
- Jennifer Pierce
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Niloofar Afari
- VA Center for Excellence for Stress & Mental Health and Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Catherine S Bradley
- Departments of Obstetrics and Gynecology and Urology, Carver College of Medicine, and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jayoung Kim
- Departments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Susan Lutgendorf
- Department of Psychological and Brain Sciences, Department of Urology, and Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, United States
| | - Bruce D Naliboff
- Department of Medicine, Oppenheimer Center for Neurobiology of Stress and Resilience and Division of Digestive Diseases, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, United States
| | - Larissa V Rodriguez
- Institute of Urology, University of Southern California, Beverly Hills, CA, United States
| | - Bayley J Taple
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Richard E Harris
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
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Kmiecik MJ, Tu FF, Clauw DJ, Hellman KM. Multimodal hypersensitivity derived from quantitative sensory testing predicts pelvic pain outcome: an observational cohort study. Pain 2023; 164:2070-2083. [PMID: 37226937 PMCID: PMC10440257 DOI: 10.1097/j.pain.0000000000002909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/09/2023] [Indexed: 05/26/2023]
Abstract
ABSTRACT Multimodal hypersensitivity (MMH)-greater sensitivity across multiple sensory modalities (eg, light, sound, temperature, pressure)-is associated with the development of chronic pain. However, previous MMH studies are restricted given their reliance on self-reported questionnaires, narrow use of multimodal sensory testing, or limited follow-up. We conducted multimodal sensory testing on an observational cohort of 200 reproductive-aged women, including those at elevated risk for chronic pelvic pain conditions and pain-free controls. Multimodal sensory testing included visual, auditory, and bodily pressure, pelvic pressure, thermal, and bladder pain testing. Self-reported pelvic pain was examined over 4 years. A principal component analysis of sensory testing measures resulted in 3 orthogonal factors that explained 43% of the variance: MMH, pressure pain stimulus response, and bladder hypersensitivity. The MMH and bladder hypersensitivity factors correlated with baseline self-reported menstrual pain, genitourinary symptoms, depression, anxiety, and health. Over time, MMH increasingly predicted pelvic pain and was the only component to predict outcome 4 years later, even when adjusted for baseline pelvic pain. Multimodal hypersensitivity was a better predictor of pelvic pain outcome than a questionnaire-based assessment of generalized sensory sensitivity. These results suggest that MMHs overarching neural mechanisms convey more substantial long-term risk for pelvic pain than variation in individual sensory modalities. Further research on the modifiability of MMH could inform future treatment developments in chronic pain.
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Affiliation(s)
- Matthew J. Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F. Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Daniel J. Clauw
- Departments of Anesthesiology, Medicine, and Psychiatry, Chronic Pain and Fatigue Research Center, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kevin M. Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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9
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Marinkovic K, Woodruff D, White DR, Caudle MM, Cronan T. Neural indices of multimodal sensory and autonomic hyperexcitability in fibromyalgia. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 14:100140. [PMID: 38033709 PMCID: PMC10687342 DOI: 10.1016/j.ynpai.2023.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 12/02/2023]
Abstract
Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain and psychological distress. Research suggests people with FM experience increased somatosensory sensitization which generalizes to other sensory modalities and may indicate neural hyperexcitability. However, the available evidence is limited, and studies including measures of neural responsivity across sensory domains and both central and peripheral aspects of the neuraxis are lacking. Thirty-nine participants (51.5 ± 13.6 years of age) with no history of neurological disorders, psychosis, visual, auditory, or learning deficits, were recruited for this study. People with FM (N = 19) and control participants (CNT, N = 20) did not differ on demographic variables and cognitive capacity. Participants completed a task that combined innocuous auditory stimuli with electrocutaneous stimulation (ECS), delivered at individually-selected levels that were uncomfortable but not painful. Event-related potentials (ERPs) and electrodermal activity were analyzed to examine the central and sympathetic indices of neural responsivity. FM participants reported greater sensitivity to ECS and auditory stimulation, as well as higher levels of depression, anxiety, ADHD, and an array of pain-related experiences than CNT. In response to ECS, the P50 deflection was greater in FM than CNT participants, reflecting early somatosensory hyperexcitability. The P50 amplitude was positively correlated with the FM profile factor obtained with a principal component analysis. The N100 to innocuous tones and sympathetic reactivity to ECS were greater in FM participants, except in the subgroup treated with gabapentinoids, which aligns with previous evidence of symptomatic improvement with GABA-mimetic medications. These results support the principal tenet of generalized neural hyperexcitability in FM and provide preliminary mechanistic insight into the impact of GABA-mimetic pharmacological therapy on ameliorating the neural excitation dominance.
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Affiliation(s)
- Ksenija Marinkovic
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr., San Diego, CA 92182, USA
- Department of Radiology, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Denali Woodruff
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
| | - David R. White
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
| | - Morgan M. Caudle
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr., San Diego, CA 92182, USA
| | - Terry Cronan
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr., San Diego, CA 92182, USA
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10
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Pinto AM, Luís M, Geenen R, Palavra F, Lumley MA, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, Häuser W, Kosek E, López-Solà M, Mease P, Marques TR, Jacobs JWG, Castilho P, da Silva JAP. Neurophysiological and Psychosocial Mechanisms of Fibromyalgia: A Comprehensive Review and Call for An Integrative Model. Neurosci Biobehav Rev 2023:105235. [PMID: 37207842 DOI: 10.1016/j.neubiorev.2023.105235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023]
Abstract
Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fibromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the understanding, assessment, and intervention for fibromyalgia.
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Affiliation(s)
- Ana Margarida Pinto
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal; University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal.
| | - Mariana Luís
- Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal.
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Martinus J. Langeveldgebouw, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, the Netherlands.
| | - Filipe Palavra
- Centre for Child Development, Neuropediatric Unit. Pediatric Hospital, Coimbra Hospital and University Centre, Avenida Afonso Romão, 3000-602 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7908, Detroit, MI 48202, USA.
| | - Jacob N Ablin
- Internal Medicine H, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
| | - Kirstine Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Jaime Branco
- Rheumatology Department, Egas Moniz Hospital - Lisboa Ocidental Hospital Centre (CHLO-EPE), R. da Junqueira 126, 1349-019 Lisbon, Portugal; Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal.
| | - Dan Buskila
- Ben Gurion University of the Negev Beer-Sheba, Israel.
| | - João Castelhano
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, Department of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec, Canada, H3G 1A4.
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm 171 77, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA.
| | - Tiago Reis Marques
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, South Kensington, London SW7 2BU, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London WC2R 2LS, UK.
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
| | - Paula Castilho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal.
| | - José A P da Silva
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
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11
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Molot J, Sears M, Anisman H. Multiple Chemical Sensitivity: It's time to catch up to the science. Neurosci Biobehav Rev 2023; 151:105227. [PMID: 37172924 DOI: 10.1016/j.neubiorev.2023.105227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
Multiple chemical sensitivity (MCS) is a complex medical condition associated with low dose chemical exposures. MCS is characterized by diverse features and common comorbidities, including fibromyalgia, cough hypersensitivity, asthma, and migraine, and stress/anxiety, with which the syndrome shares numerous neurobiological processes and altered functioning within diverse brain regions. Predictive factors linked to MCS comprise genetic influences, gene-environment interactions, oxidative stress, systemic inflammation, cell dysfunction, and psychosocial influences. The development of MCS may be attributed to the sensitization of transient receptor potential (TRP) receptors, notably TRPV1 and TRPA1. Capsaicin inhalation challenge studies demonstrated that TRPV1 sensitization is manifested in MCS, and functional brain imaging studies revealed that TRPV1 and TRPA1 agonists promote brain-region specific neuronal variations. Unfortunately, MCS has often been inappropriately viewed as stemming exclusively from psychological disturbances, which has fostered patients being stigmatized and ostracized, and often being denied accommodation for their disability. Evidence-based education is essential to provide appropriate support and advocacy. Greater recognition of receptor-mediated biological mechanisms should be incorporated in laws, and regulation of environmental exposures.
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Affiliation(s)
- John Molot
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Margaret Sears
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Hymie Anisman
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
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12
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Rodebaugh TL, Piccirillo ML, Frumkin MR, Kallogjeri D, Gerull KM, Piccirillo JF. Investigating Individual Variation Using Dynamic Structural Equation Modeling: A Tutorial with Tinnitus. Clin Psychol Sci 2023; 11:574-591. [PMID: 37408827 PMCID: PMC10321503 DOI: 10.1177/21677026221129279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
A growing body of research suggests that standard group-based models might provide little insight regarding individuals. In the current study, we sought to compare group-based and individual predictors of bothersome tinnitus, illustrating how researchers can use dynamic structural equation modeling (DSEM) for intensive longitudinal data to examine whether findings from analyses of the group apply to individuals. A total of 43 subjects with bothersome tinnitus responded to up to 200 surveys each. In multi-level DSEM models, survey items loaded on three factors (tinnitus bother, cognitive symptoms, and anxiety) and results indicated a reciprocal relationship between tinnitus bother and anxiety. In fully idiographic models, the three-factor model fit poorly for two individuals, and the multilevel model did not generalize to most individuals, possibly due to limited power. Research examining heterogeneous conditions such as tinnitus bother may benefit from methods such as DSEM that allow researchers to model dynamic relationships.
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Affiliation(s)
- Thomas L Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St Louis
| | - Marilyn L Piccirillo
- Department of Psychological and Brain Sciences, Washington University in St Louis
| | - Madelyn R Frumkin
- Department of Psychological and Brain Sciences, Washington University in St Louis
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University School of Medicine in St Louis
| | - Katherine M Gerull
- Department of Otolaryngology, Washington University School of Medicine in St Louis
| | - Jay F Piccirillo
- Department of Otolaryngology, Washington University School of Medicine in St Louis
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13
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Drummond PD, Finch PM. Auditory disturbances in patients with complex regional pain syndrome. Pain 2023; 164:804-810. [PMID: 36036917 DOI: 10.1097/j.pain.0000000000002766] [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: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Complex regional pain syndrome (CRPS) is often associated with reduced sound tolerance (hyperacusis) on the affected side, but the mechanism of this symptom is unclear. As compensatory increases in central auditory activity after cochlear injury may trigger hyperacusis, hearing and discomfort thresholds to pure tones (250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz) were assessed in 34 patients with CRPS and 26 pain-free controls. In addition, in 31 patients and 17 controls, auditory-evoked potentials to click stimuli (0.08 ms duration, 6 Hz, 60 dB above the hearing threshold) were averaged across 2000 trials for each ear. Auditory discomfort thresholds were lower at several pitches on the CRPS-affected than contralateral side and lower at all pitches on the affected side than in controls. However, ipsilateral hyperacusis was not associated with psychophysical or physiological signs of cochlear damage. Instead, neural activity in the ipsilateral brainstem and midbrain was greater when repetitive click stimuli were presented on the affected than contralateral side and greater bilaterally than in controls. In addition, click-evoked potentials, reflecting thalamo-cortical signal transfer and early cortical processing, were greater contralaterally in patients than controls. Together, these findings suggest that hyperacusis originates in the ipsilateral brainstem and midbrain rather than the peripheral auditory apparatus of patients with CRPS. Failure of processes that jointly modulate afferent auditory signalling and pain (eg, inhibitory influences stemming from the locus coeruleus) could contribute to ipsilateral hyperacusis in CRPS.
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Affiliation(s)
- Peter D Drummond
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
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14
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Verspyck E, Attal N. Diagnosing nociplastic pain in cancer survivors: a major step forward. Br J Anaesth 2023; 130:515-518. [PMID: 36890060 DOI: 10.1016/j.bja.2023.02.006] [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: 01/27/2023] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Nociplastic pain syndromes include particular fibromyalgia, irritable bowel syndrome, headache, complex regional pain syndrome, and idiopathic orofacial pain. Several mechanisms have been proposed to account for nociplastic pain including central sensitisation, alterations of pain modulatory controls, epigenetic changes, and peripheral mechanisms. Importantly, nociplastic pain might also be present in patients with cancer pain, particularly those with pain related to complications of cancer treatment. Increased awareness of nociplastic pain associated with cancer should have important implications for monitoring and managing such patients.
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Affiliation(s)
| | - Nadine Attal
- CETD, Ambroise Pare Hospital, APHP, Boulogne-Billancourt, France; Inserm U987, UVSQ-Paris-Saclay University, Ambroise Pare Hospital, APHP, Boulogne-Billancourt, France.
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15
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Harper DE, Gopinath K, Smith JL, Gregory M, Ichesco E, Aronovich S, Harris RE, Harte SE, Clauw DJ, Fleischer CC. Characterization of visual processing in temporomandibular disorders using functional magnetic resonance imaging. Brain Behav 2023; 13:e2916. [PMID: 36793184 PMCID: PMC10013945 DOI: 10.1002/brb3.2916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/20/2022] [Accepted: 01/15/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND AND PURPOSE Many patients with chronic pain report hypersensitivity not only to noxious stimuli, but also to other modalities including innocuous touch, sound, and light, possibly due to differences in the processing of these stimuli. The goal of this study was to characterize functional connectivity (FC) differences between subjects with temporomandibular disorders (TMD) and pain-free controls during a visual functional magnetic resonance imaging (fMRI) task that included an unpleasant, strobing visual stimulus. We hypothesized the TMD cohort would exhibit maladaptations in brain networks consistent with multisensory hypersensitivities observed in TMD patients. METHODS This pilot study included 16 subjects, 10 with TMD and 6 pain-free controls. Clinical pain was characterized using self-reported questionnaires. Visual task-based fMRI data were collected on a 3T MR scanner and used to determine differences in FC via group independent component analysis. RESULTS Compared to controls, subjects with TMD exhibited abnormally increased FC between the default mode network and lateral prefrontal areas involved in attention and executive function, and impaired FC between the frontoparietal network and higher order visual processing areas. CONCLUSIONS The results indicate maladaptation of brain functional networks, likely due to deficits in multisensory integration, default mode network function, and visual attention and engendered by chronic pain mechanisms.
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Affiliation(s)
- Daniel E Harper
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kaundinya Gopinath
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mia Gregory
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Eric Ichesco
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery and Hospital Dentistry, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Candace C Fleischer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, Georgia, USA
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16
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Hyperacusis: Loudness Intolerance, Fear, Annoyance and Pain. Hear Res 2022; 426:108648. [DOI: 10.1016/j.heares.2022.108648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
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17
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Salaffi F, Farah S, Mariani C, Sarzi‐Puttini P, Di Carlo M. Validity of the Central Sensitization Inventory compared with traditional measures of disease severity in fibromyalgia. Pain Pract 2022; 22:702-710. [PMID: 36097821 PMCID: PMC9826291 DOI: 10.1111/papr.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/01/2022] [Accepted: 08/29/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The goal of this study was to explore additional evidence of convergent and discriminant validity of the Central Sensitization Inventory (CSI) in a large sample of subjects with fibromyalgia (FM). METHODS Patients were consecutively enrolled for a cross-sectional assessment comprehensive of three FM-specific measures (the revised Fibromyalgia Impact Questionnaire [FIQR], the modified Fibromyalgia Assessment Status [modFAS], and the Polysymptomatic Distress Scale [PDS]) and of CSI. To test the convergent validity, the Spearman's rho was used to measure the degree of correlation between the variables CSI and the FM-specific measures. To assess discriminant validity, CSI scores were grouped according to FIQR disease severity states, and differences between these groups studied with the Kruskal-Wallis test. Interpretative cutoffs were established with the interquartile reconciliation approach. RESULTS The study included 562 FM patients, 199 (35.4%) were classified as having central sensitization syndrome (CSI ≥40). CSI was largely correlated with modFAS (ρ = 0.580; p < 0.0001), FIQR (ρ = 0.542; p < 0.0001), and PDS (ρ = 0.518; p < 0.0001). The differences between the CSI scores in accordance with the FIQR were significant (p < 0.000001). CSI cutoffs proposed for FM: 21 between remission and mild severity, 30 between mild and moderate severity, 37 between moderate and severe disease, and 51 between severe and very severe disease. CONCLUSION The current study successfully showed additional evidence of the convergent and discriminant validity of the CSI in FM patients.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Ospedale “Carlo Urbani”Università Politecnica delle MarcheAnconaItaly
| | - Sonia Farah
- Rheumatology Clinic, Ospedale “Carlo Urbani”Università Politecnica delle MarcheAnconaItaly
| | - Claudia Mariani
- Rheumatology Clinic, Ospedale “Carlo Urbani”Università Politecnica delle MarcheAnconaItaly
| | - Piercarlo Sarzi‐Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli‐SaccoMilan University School of MedicineMilanItaly
| | - Marco Di Carlo
- Rheumatology Clinic, Ospedale “Carlo Urbani”Università Politecnica delle MarcheAnconaItaly
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18
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Alorfi NM. Pharmacological treatments of fibromyalgia in adults; overview of phase IV clinical trials. Front Pharmacol 2022; 13:1017129. [PMID: 36210856 PMCID: PMC9537626 DOI: 10.3389/fphar.2022.1017129] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Fibromyalgia is a chronic neurological condition characterized by widespread pain. The effectiveness of current pharmacological treatments is limited. However, several medications have been approved for phase IV trials in order to evaluate them. Aim: To identify and provide details of drugs that have been tested in completed phase IV clinical trials for fibromyalgia management in adults, including the primary endpoints and treatment outcomes. This article was submitted to Neuropharmacology, a section of the journal Frontiers in Pharmacology. Method: Publicly available and relevant phase IV trials registered at ClinicalTrials.gov were analyzed. The uses of the trialed drugs for fibromyalgia were reviewed. Results: As of 8 August 2022, a total of 1,263 phase IV clinical trials were identified, of which 121 were related to fibromyalgia. From these, 10 clinical trials met the inclusion criteria for the current study. The drugs used in phase IV trials are milnacipran, duloxetine, pregabalin, a combination of tramadol and acetaminophen, and armodafinil. The effectiveness of the current pharmacological treatments is apparently limited. Conclusion: Due to its complexity and association with other functional pain syndromes, treatment options for fibromyalgia only are limited and they are designed to alleviate the symptoms rather than to alter the pathological pathway of the condition itself. Pain management specialists have numerous pharmacologic options available for the management of fibromyalgia.
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19
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Balba NM, McBride AA, Callahan ML, Mist SD, Jones KD, Butler MP, Lim MM, Heinricher MM. Photosensitivity Is Associated with Chronic Pain following Traumatic Brain Injury. J Neurotrauma 2022; 39:1183-1194. [PMID: 35373595 PMCID: PMC9422792 DOI: 10.1089/neu.2022.0019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Individuals with a history of traumatic brain injury (TBI) report increased rates of chronic pain. Photosensitivity is also a common chronic symptom following TBI and is prevalent among other types of chronic pain. The aim of this study was to better understand the relationship between chronic pain, pain-related disability, and photosensitivity in a TBI population. We quantified participants' visual photosensitivity thresholds (VPT) using an Ocular Photosensitivity Analyzer and measured pressure-pain sensitivity using pressure algometry. Participants also completed a battery of self-report measures related to chronic pain, TBI history, and mental health. A total of 395 participants completed testing, with 233 reporting a history of TBI. The TBI group was divided into 120 symptomatic TBI participants (s-TBI), and 113 asymptomatic TBI participants (a-TBI) based on their Neurobehavioral Symptom Inventory (NSI) scores. Participants in the s-TBI group scored significantly higher on self-reported chronic pain measures compared with a-TBI and no-TBI participants, including the Symptom Impact Questionnaire Revised (SIQR; p < 0.001) and the Michigan Body Map (MBM; p < 0.001). Despite differences in chronic pain complaints, groups displayed similar pressure-pain thresholds (p = 0.270). Additionally, s-TBI participants were more sensitive to light (lower VPT, p < 0.001), and VPT was correlated with SIQR scores across all participants (R = -0.452, p < 0.001). These data demonstrate that photosensitivity is associated with self-reported chronic pain and disability in individuals with chronic TBI symptomatology. Photosensitivity could therefore serve as a simple, more highly quantitative marker of high-impact chronic pain after TBI.
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Affiliation(s)
- Nadir M. Balba
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon, USA
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | | | | | - Scott D. Mist
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Kim D. Jones
- School of Nursing, Linfield University, Portland, Oregon, USA
| | - Matthew P. Butler
- Department of Behavioral Neuroscience, Oregon Health & Science University (OHSU), Portland, Oregon, USA
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Miranda M. Lim
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon, USA
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University (OHSU), Portland, Oregon, USA
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, Oregon, USA
- Department of Medicine, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Mary M. Heinricher
- Department of Behavioral Neuroscience, Oregon Health & Science University (OHSU), Portland, Oregon, USA
- Department of Neurological Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
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20
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Schrepf A, Gallop R, Naliboff B, Harte SE, Afari N, Lai HH, Pontari M, McKernan LC, Strachan E, Kreder KJ, As-Sanie SA, Rodriguez LV, Griffith JW, Williams DA. Clinical Phenotyping for Pain Mechanisms in Urologic Chronic Pelvic Pain Syndromes: A MAPP Research Network Study. THE JOURNAL OF PAIN 2022; 23:1594-1603. [PMID: 35472518 PMCID: PMC10547025 DOI: 10.1016/j.jpain.2022.03.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
Three categories of pain mechanisms are recognized as contributing to pain perception: nociceptive, neuropathic, and nociplastic (ie, central nervous system augmented pain processing). We use validated questionnaires to identify pain mechanisms in Urologic Chronic Pelvic Pain Syndrome (UCCPS) patients (n = 568, female = 378, male = 190) taking part in the Symptom Patterns Study of the Multidisciplinary Approach to the study of chronic Pelvic Pain Research Network. A cutoff score of 12 on the painDETECT questionnaire (-1 to 38) was used to classify patients into the neuropathic category while the median score of 7 on the fibromyalgia survey criteria (0-31) was used to classify patients into the nociplastic category. Categories were compared on demographic, clinical, psychosocial, psychophysical and medication variables. At baseline, 43% of UCPPS patients were classified as nociceptive-only, 8% as neuropathic only, 27% as nociceptive+nociplastic, and 22% as neuropathic+nociplastic. Across outcomes nociceptive-only patients had the least severe symptoms and neuropathic+nociplastic patients the most severe. Neuropathic pain was associated with genital pain and/or sensitivity on pelvic exam, while nociplastic pain was associated with comorbid pain conditions, psychosocial difficulties, and increased pressure pain sensitivity outside the pelvis. A self-report method classifying individuals on pain mechanisms reveals clinical differences that could inform clinical trials and novel targets for treatment. PERSPECTIVE: This article presents differences in clinical characteristics based on a simple self-report method of classifying pain mechanisms for Urologic Chronic Pelvic Pain Syndrome patients. This method can be easily applied to other chronic pain conditions and may be useful for exploring pathophysiology in pain subtypes.
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Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Robert Gallop
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Niloofar Afari
- Department of Psychiatry, UC San Diego & VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - H Henry Lai
- Department of Surgery (Urology) and Anesthesiology, Washington University School of Medicine, St Louis, Missouri
| | - Michel Pontari
- Department of Urology, Temple University, Philadelphia, Pennsylvania
| | - Lindsey C McKernan
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Karl J Kreder
- Departments of Urology and Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa
| | - Sawsan A As-Sanie
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Larissa V Rodriguez
- Departments of Urology and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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21
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical mechanisms of visual hypersensitivity in women at risk for chronic pelvic pain. Pain 2022; 163:1035-1048. [PMID: 34510138 PMCID: PMC8882209 DOI: 10.1097/j.pain.0000000000002469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Increased sensory sensitivity across non-nociceptive modalities is a common symptom of chronic pain conditions and is associated with chronic pain development. Providing a better understanding of the brain-behavior relationships that underlie multimodal hypersensitivity (MMH) may clarify the role of MMH in the development of chronic pain. We studied sensory hypersensitivity in a cohort of women (n = 147) who had diary confirmation of menstrual status and were enriched with risk factors for chronic pelvic pain, such as dysmenorrhea and increased bladder sensitivity. We administered 2 experimental tasks to evaluate the cross-modal relationship between visual and visceral sensitivity. Visual sensitivity was probed by presenting participants with a periodic pattern-reversal checkerboard stimulus presented across 5 brightness intensities during electroencephalography recording. Self-reported visual unpleasantness ratings for each brightness intensity were simultaneously assessed. Visceral sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visually evoked cortical activity increased with brightness intensity across the entire scalp, especially at occipital electrode sites. Visual stimulation-induced unpleasantness was associated with provoked bladder pain and evoked primary visual cortex activity. However, the relationship between unpleasantness and cortical activity was moderated by provoked bladder pain. These results demonstrate that activity in the primary visual cortex is not greater in individuals with greater visceral sensitivity. We hypothesize that downstream interpretation or integration of this signal is amplified in individuals with visceral hypersensitivity. Future studies aimed at reducing MMH in chronic pain conditions should prioritize targeting of cortical mechanisms responsible for aberrant downstream sensory integration.
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Affiliation(s)
- Matthew J. Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F. Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L. Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E. Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E. Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M. Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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22
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Yang M, Baser RE, Li SQ, Hou YN, Chong K, Zhang YL, Hoque I, Bao T, Mao JJ. Tibetan Herbal Pain-Relieving Plaster for Chronic Musculoskeletal Pain Among Cancer Survivors: Study Protocol of a Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol 2022; 13:878371. [PMID: 35600872 PMCID: PMC9114465 DOI: 10.3389/fphar.2022.878371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic pain is common and debilitating in cancer survivors. Tibetan herbal pain-relieving plaster is used as an external analgesic to treat musculoskeletal pain in China; however, its safety and efficacy have not been evaluated via clinical trials in cancer survivors. We designed this Phase II randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT04916249) to assess the efficacy and safety of the pain-relieving plaster for temporary pain relief among cancer survivors with chronic musculoskeletal pain. Under ethical approval from the Institutional Review Board at the Memorial Sloan Kettering Cancer Center, we will enroll eligible cancer survivors who have a clinical diagnosis of moderate to severe chronic musculoskeletal pain in this study. We use a central randomization system to allocate the eligible participants to either the treatment or the control group in a 1:1 ratio, with stratification by baseline opioid use. We will instruct the participants to apply the herbal patch (Tibetree Pain-Relieving Plaster, Tibet Cheezheng Tibetan Medicine Co. Ltd., Tibet, China) or placebo patch daily at the focal area with worst pain for 14 consecutive days. Study physician, participant, outcome assessor, and biostatistician are blinded to the group allocation. The primary outcome is pain severity measured by the Brief Pain Inventory on Days 2–7. Secondary outcomes include changes in insomnia, anxiety, depression, fatigue, pressure pain threshold, pain medication use, and global impression of change. We will also monitor the adverse events throughout the study period. Statistical analysis will follow the intention-to-treat principle and linear mixed modeling will be used. With rigorous design and implementation, this randomized, placebo-controlled trial will provide the initial evidence on the efficacy and safety of the pain-relieving plaster for pain relief among cancer survivors with chronic musculoskeletal pain.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY, United States
| | - Susan Q. Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yen-Nien Hou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Kamyar Chong
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yi Lily Zhang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Irfan Hoque
- Investigational Drug Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
- *Correspondence: Jun J. Mao,
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23
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Staud R. Advances in the management of fibromyalgia: what is the state of the art? Expert Opin Pharmacother 2022; 23:979-989. [PMID: 35509228 DOI: 10.1080/14656566.2022.2071606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Fibromyalgia (FM) is a chronic pain syndrome associated with fatigue, insomnia, dyscognition, and emotional distress. Critical illness mechanisms include central sensitization to nociceptive and non-nociceptive stimuli often resulting in hypersensitivity to all sensory input. AREAS COVERED The clinical presentation of FM can vary widely and therefore requires therapies tailored to each patient's set of symptoms. This manuscript examines currently prescribed therapeutic approaches supported by empirical evidence as well as promising novel treatments. Although pharmacological therapy until now has been only moderately effective for FM symptoms, it represents a critical component of every treatment plan. EXPERT OPINION Currently approved pharmacological therapies for FM symptoms have limited but proven effectiveness. Novel therapies with cannabinoids and naltrexone appear promising. Recent functional imaging studies of FM have discovered multiple brain network abnormalities that may provide novel targets for mechanism-based therapies. Future treatment approaches, however, need to improve more than clinical pain but also other FM domains like fatigue, insomnia, and distress.
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Affiliation(s)
- Roland Staud
- Division of Rheumatology and Clinical Immunology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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24
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Hamed R, Mizrachi L, Granovsky Y, Issachar G, Yuval-Greenberg S, Bar-Shalita T. Neurofeedback Therapy for Sensory Over-Responsiveness-A Feasibility Study. SENSORS 2022; 22:s22051845. [PMID: 35270991 PMCID: PMC8914621 DOI: 10.3390/s22051845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/22/2022]
Abstract
Background: Difficulty in modulating multisensory input, specifically the sensory over-responsive (SOR) type, is linked to pain hypersensitivity and anxiety, impacting daily function and quality of life in children and adults. Reduced cortical activity recorded under resting state has been reported, suggestive of neuromodulation as a potential therapeutic modality. This feasibility study aimed to explore neurofeedback intervention in SOR. Methods: Healthy women with SOR (n = 10) underwent an experimental feasibility study comprising four measurement time points (T1—baseline; T2—preintervention; T3—postintervention; T4—follow-up). Outcome measures included resting-state EEG recording, in addition to behavioral assessments of life satisfaction, attaining functional goals, pain sensitivity, and anxiety. Intervention targeted the upregulation of alpha oscillatory power over ten sessions. Results: No changes were detected in all measures between T1 and T2. Exploring the changes in brain activity between T2 and T4 revealed power enhancement in delta, theta, beta, and gamma oscillatory bands, detected in the frontal region (p = 0.03−<0.001; Cohen’s d = 0.637−1.126) but not in alpha oscillations. Furthermore, a large effect was found in enhancing life satisfaction and goal attainment (Cohen’s d = 1.18; 1.04, respectively), and reduced pain sensitivity and anxiety trait (Cohen’s d = 0.70). Conclusion: This is the first study demonstrating the feasibility of neurofeedback intervention in SOR.
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Affiliation(s)
- Ruba Hamed
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
| | - Limor Mizrachi
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
| | - Yelena Granovsky
- Laboratory of Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Rambam Health Care Campus, Technion, Haifa 3109601, Israel;
| | - Gil Issachar
- Biomedical Engineering Department, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Shlomit Yuval-Greenberg
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 6997801, Israel;
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-525437631
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25
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Fernandes-Magalhaes R, Ferrera D, Peláez I, Martín-Buro MC, Carpio A, De Lahoz ME, Barjola P, Mercado F. Neural correlates of the attentional bias towards pain-related faces in fibromyalgia patients: An ERP study using a dot-probe task. Neuropsychologia 2022; 166:108141. [PMID: 34995568 DOI: 10.1016/j.neuropsychologia.2021.108141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND One of the major cognitive deficits in fibromyalgia has been linked to the hypervigilance phenomenon. It is mainly reflected as a negative bias for allocating attentional resources towards both threatening and pain-related information. Although the interest in its study has recently grown, the neural temporal dynamics of the attentional bias in fibromyalgia still remains an open question. METHOD Fifty participants (25 fibromyalgia patients and 25 healthy control subjects) performed a dot-probe task. Two types of facial expressions (pain-related and neutral) were employed as signal stimuli. Then, as a target stimulus, a single dot replaced the location of one of these two faces. Event-related potentials (ERP) in response to facial expressions and target stimulation (i.e., dot) were recorded. Reaction time (RT) and accuracy measures in the experimental task were collected as behavioural outcomes. RESULTS Temporal dynamics of brain electrical activity were analysed on two ERP components (P2 and N2a) sensitive to the facial expressions meaning. Pain-related faces elicited higher frontal P2 amplitudes than neutral faces for the whole sample. Interestingly, an interaction effect between group and facial expressions was also found showing that pain-related faces elicited enhanced P2 amplitudes (at fronto-central regions, in this case) compared to neutral faces only when the group of patients was considered. Furthermore, higher P2 amplitudes were observed in response to pain-related faces in patients with fibromyalgia compared to healthy control participants. Additionally, a shorter latency of P2 (at centro-parietal regions) was also detected for pain-related facial expressions compared to neutral faces. Regarding the amplitude of N2a, it was lower for patients as compared to the control group. Non-relevant effects of the target stimulation on the ERPs were found. However, patients with fibromyalgia exhibited slower RT to locate the single dot for incongruent trials as compared to congruent and neutral trials. CONCLUSIONS Data suggest the presence of an attentional bias in fibromyalgia that it would be followed by a deficit in the allocation of attentional resources to further process pain-related information. Altogether the current results suggest that attentional biases in fibromyalgia might be explained by automatic attentional mechanisms, which seem to be accompanied by an alteration of more strategic or controlled attentional components.
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Affiliation(s)
- Roberto Fernandes-Magalhaes
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain; Clinical Foundation of the Rey Juan Carlos University, Madrid, Spain
| | - David Ferrera
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Irene Peláez
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | | | - Alberto Carpio
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - María Eugenia De Lahoz
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Paloma Barjola
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Francisco Mercado
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
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26
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Augière T, Desjardins A, Paquette Raynard E, Brun C, Pinard AM, Simoneau M, Mercier C. Tactile Detection in Fibromyalgia: A Systematic Review and a Meta-Analysis. FRONTIERS IN PAIN RESEARCH 2021; 2:740897. [PMID: 35295451 PMCID: PMC8915638 DOI: 10.3389/fpain.2021.740897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Fibromyalgia is a chronic pain syndrome characterized by sensorimotor deficits and distortions of body representation, that could both be caused by alterations in sensory processing. Several studies suggest a hypersensitivity to various sensory stimulations in fibromyalgia but results on detection of both noxious and non-noxious tactile stimulation, which are particularly relevant for body representation and motor control, remain conflicting. Therefore, the aim of this study is to systematically review and quantify the detection thresholds to noxious and non-noxious tactile stimuli in individuals with fibromyalgia compared to pain-free controls. A systematic review and a meta-analysis were performed in the MEDLINE, EMBASE, CINAHL, Cochrane, PsycInfo and Web of Science databases using keywords related to fibromyalgia, tactile pain detection threshold, tactile detection threshold and quantitative sensory testing. Nineteen studies were included in the review, with 12 in the meta-analysis. Despite the heterogeneity of the results, the data from both the review and from the meta-analysis suggest a trend toward hyperalgesia and no difference of sensitivity to non-noxious tactile stimuli in participants with fibromyalgia compared to healthy controls. This contradicts the hypothesis of a general increase in responsiveness of the central nervous system to noxious and non-noxious stimulations in fibromyalgia. This study shows no alteration of the sensitivity to non-noxious tactile stimulation in fibromyalgia, suggesting that an altered unimodal processing is not sufficient to explain symptoms such as sensorimotor impairments and body representation distortions. Future research should investigate whether alterations in multisensory integration could contribute to these symptoms.
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Affiliation(s)
- Tania Augière
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Audrey Desjardins
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Martin Simoneau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
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27
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Kosek E, Clauw D, Nijs J, Baron R, Gilron I, Harris RE, Mico JA, Rice ASC, Sterling M. Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain 2021; 162:2629-2634. [PMID: 33974577 DOI: 10.1097/j.pain.0000000000002324] [Citation(s) in RCA: 199] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Daniel Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, The University of Michigan, Ann Arbor, MI, United States
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Ixelles, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Department of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ralf Baron
- Division of Neurological Pain Research and -therapy, Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, The University of Michigan, Ann Arbor, MI, United States
| | - Juan-Antonio Mico
- Department of Neuroscience, Pharmacology & Psychiatry, Biomedical Research Center on Mental Health (CIBERSAM), University of Cádiz, Cádiz, Spain
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Herston, Australia
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28
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Otsuru N, Ogawa M, Yokota H, Miyaguchi S, Kojima S, Saito K, Inukai Y, Onishi H. Auditory change-related cortical response is associated with hypervigilance to pain in healthy volunteers. Eur J Pain 2021; 26:349-355. [PMID: 34528347 PMCID: PMC9292983 DOI: 10.1002/ejp.1863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
Background Patients with chronic pain exhibit hypervigilance (heightened responsiveness to stimuli) to innocuous auditory stimuli as well as noxious stimuli. “Generalized hypervigilance” suggests that individuals who show heightened responsiveness to one sensory system also show hypervigilance to other modalities. However, research exploring the existence of generalized hypervigilance in healthy subjects is limited. Methods We investigated whether hypervigilance to pain is associated with auditory stimuli in healthy subjects using the pain vigilance and awareness questionnaire (PVAQ) and auditory change‐related cortical responses (ACRs). ACRs are thought to reflect a change detection system, based on preceding sensory memory. We recorded ACRs under conditions that varied in terms of the accumulation of sensory memory as follows: short‐ACR, with short preceding continuous stimuli and long‐ACR, with long preceding continuous stimuli. In addition, the attention to pain (PVAQ‐AP) and attention to changes in pain (PVAQ‐ACP) subscales were evaluated. Results Amplitudes of long‐ACR showed significant positive correlations with PVAQ‐ACP, whereas those of short‐ACR did not show any significant correlations. Conclusions Generalized hypervigilance may be observed even in healthy subjects. ACR may be a useful index to evaluate the hypervigilance state in the human brain.
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Affiliation(s)
- Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Mayu Ogawa
- Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Shota Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Sho Kojima
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Kei Saito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Yasuto Inukai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
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29
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Staud R, Godfrey MM, Robinson ME. Fibromyalgia Patients Are Not Only Hypersensitive to Painful Stimuli But Also to Acoustic Stimuli. THE JOURNAL OF PAIN 2021; 22:914-925. [PMID: 33636370 DOI: 10.1016/j.jpain.2021.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 12/31/2022]
Abstract
Fibromyalgia is a chronic widespread pain syndrome associated with hypersensitivity to nociceptive stimuli. This increased sensitivity of FM patients has been associated with central sensitization of dorsal horn neurons. Increasing evidence, however, suggests that the mechanisms of FM hypersensitivity not only affect pain but include light, smell, and sound. We hypothesized that supraspinal augmentation of sensory input including sound represent a hallmark of FM. We tested 23 FM patients and 28 healthy controls (HC) for sensory augmentation of nociceptive and non-nociceptive sensations: For assessment of nociceptive augmentation we used sensitivity adjusted mechanical and heat ramp & hold stimuli and for assessment of sound augmentation, we applied wideband noise stimuli using a random-staircase design. Quantitative sensory testing demonstrated increased heat and mechanical pain sensitivity in FM participants (P < .001). The sound pressures needed to report mild, moderate, and intense sound levels were significantly lower in FM compared to HC (P < .001), consistent with auditory augmentation. FM patients are not only augmenting noxious sensations but also sound, suggesting that FM augmentation mechanisms are not only operant in the spinal cord but also in the brain. Whether the central nervous system mechanisms for auditory and nociceptive augmentation are similar, needs to be determined in future studies. PERSPECTIVE: This study presents QST evidence that the hypersensitivity of FM patients is not limited to painful stimuli but also to innocuous stimuli like sound. Our results suggest that abnormal brain mechanisms may be responsible for the increased sensitivity of FM patients.
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Affiliation(s)
- Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida.
| | | | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
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30
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Jamison RN, Edwards RR, Curran S, Wan L, Ross EL, Gilligan CJ, Gozani SN. Effects of Wearable Transcutaneous Electrical Nerve Stimulation on Fibromyalgia: A Randomized Controlled Trial. J Pain Res 2021; 14:2265-2282. [PMID: 34335055 PMCID: PMC8318714 DOI: 10.2147/jpr.s316371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Fibromyalgia is a chronic condition characterized by widespread pain and interference with daily activities. The aim of this study is to assess the benefit of transcutaneous electrical nerve stimulation (TENS) for persons diagnosed with fibromyalgia. Patients and Methods Adults meeting diagnostic criteria for fibromyalgia were randomized in a double-blind trial to receive either an active (n=62) or sham (n=57) wearable TENS device for 3-months. Subjects were classified as having lower or higher pain sensitivity by Quantitative Sensory Testing (QST). Patient Global Impression of Change (PGIC, primary outcome) and secondary efficacy measures including Fibromyalgia Impact Questionnaire (FIQR), Brief Pain Inventory (BPI) and painDETECT questionnaire (PDQ) were assessed at baseline, 6-weeks and 3-months. Treatment effects were determined by a mixed model for repeated measures (MMRM) analysis of the intention-to-treat (ITT) population (N=119). A pre-specified subgroup analysis of pain sensitivity was conducted using an interaction term in the model. Results No differences were found between active and sham treatment on PGIC scores at 3-months (0.34, 95% CI [−0.37, 1.04], p=0.351) in the ITT population. However, in subjects with higher pain sensitivity (n=60), PGIC was significantly greater for active treatment compared to sham (1.19, 95% CI [0.24, 2.13], p=0.014). FIQR total score (−7.47, 95% CI [−12.46, −2.48], p=0.003), FIQR pain item (−0.62, 95% CI [−1.17, −0.06], p=0.029), BPI Interference (−0.70, 95% CI [−1.30, −0.11], p=0.021) and PDQ (−1.69, 95% CI [−3.20, −0.18], p=0.028) exhibited significant improvements for active treatment compared to sham in the ITT population. Analgesics use was stable and comparable in both groups. Conclusion This study demonstrated modest treatment effects of reduced disease impact, pain and functional impairment from wearable TENS in individuals with fibromyalgia. Subjects with higher pain sensitivity exhibited larger treatment effects than those with lower pain sensitivity. Wearable TENS may be a safe treatment option for people with fibromyalgia. Clinicaltrials.gov Registration NCT03714425.
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Affiliation(s)
- Robert N Jamison
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Samantha Curran
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Limeng Wan
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Edgar L Ross
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Christopher J Gilligan
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
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31
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Goebel A, Krock E, Gentry C, Israel MR, Jurczak A, Urbina CM, Sandor K, Vastani N, Maurer M, Cuhadar U, Sensi S, Nomura Y, Menezes J, Baharpoor A, Brieskorn L, Sandström A, Tour J, Kadetoff D, Haglund L, Kosek E, Bevan S, Svensson CI, Andersson DA. Passive transfer of fibromyalgia symptoms from patients to mice. J Clin Invest 2021; 131:e144201. [PMID: 34196305 DOI: 10.1172/jci144201] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/11/2021] [Indexed: 12/25/2022] Open
Abstract
Fibromyalgia syndrome (FMS) is characterized by widespread pain and tenderness, and patients typically experience fatigue and emotional distress. The etiology and pathophysiology of fibromyalgia are not fully explained and there are no effective drug treatments. Here we show that IgG from FMS patients produced sensory hypersensitivity by sensitizing nociceptive neurons. Mice treated with IgG from FMS patients displayed increased sensitivity to noxious mechanical and cold stimulation, and nociceptive fibers in skin-nerve preparations from mice treated with FMS IgG displayed an increased responsiveness to cold and mechanical stimulation. These mice also displayed reduced locomotor activity, reduced paw grip strength, and a loss of intraepidermal innervation. In contrast, transfer of IgG-depleted serum from FMS patients or IgG from healthy control subjects had no effect. Patient IgG did not activate naive sensory neurons directly. IgG from FMS patients labeled satellite glial cells and neurons in vivo and in vitro, as well as myelinated fiber tracts and a small number of macrophages and endothelial cells in mouse dorsal root ganglia (DRG), but no cells in the spinal cord. Furthermore, FMS IgG bound to human DRG. Our results demonstrate that IgG from FMS patients produces painful sensory hypersensitivities by sensitizing peripheral nociceptive afferents and suggest that therapies reducing patient IgG titers may be effective for fibromyalgia.
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Affiliation(s)
- Andreas Goebel
- Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.,Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Emerson Krock
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Clive Gentry
- King's College London, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, Guy's Campus, London, United Kingdom
| | - Mathilde R Israel
- King's College London, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, Guy's Campus, London, United Kingdom
| | - Alexandra Jurczak
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Carlos Morado Urbina
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Katalin Sandor
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Nisha Vastani
- King's College London, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, Guy's Campus, London, United Kingdom
| | - Margot Maurer
- King's College London, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, Guy's Campus, London, United Kingdom
| | - Ulku Cuhadar
- King's College London, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, Guy's Campus, London, United Kingdom
| | - Serena Sensi
- Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Yuki Nomura
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Joana Menezes
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Azar Baharpoor
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Louisa Brieskorn
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Sandström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Tour
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Diana Kadetoff
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Spine Center, Upplands Väsby, Sweden
| | - Lisbet Haglund
- Department of Surgery, Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Stuart Bevan
- King's College London, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, Guy's Campus, London, United Kingdom
| | - Camilla I Svensson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - David A Andersson
- King's College London, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, Guy's Campus, London, United Kingdom
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de Siqueira SRDT, de Siqueira JTT, Teixeira MJ. Sensory characteristics according to chronic diseases and chronic pain in adults: cross-sectional study. Pain Manag 2021; 11:603-611. [PMID: 33998281 DOI: 10.2217/pmt-2020-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate somatosensory, gustative and olfactory characteristics of subjects according to their chronic diseases and the presence of chronic pain complaints. Materials & methods: A total of 254 chronic pain patients and 52 healthy subjects were evaluated with a clinical and sensory systematized evaluation. Statistical analysis consisted of Fisher's exact, Student's t-tests, Pearson's co-efficient and multivariate nonlinear/logistic regressions. Results: Patients had more chronic diseases (p < 0.001) than healthy subjects. Chronic pain was associated with vibratory hypoesthesia (p = 0.047) and sour hypergeusia (p = 0.001) and several chronic diseases correlated with sensory features. Hyposmia was strongly associated with chronic pain symptoms, chronic diseases and cardiovascular disease. Conclusion: The sensory findings observed suggest the need for further investigation about the overlap between the olfactory function, pain chronification, chronic diseases and cognitive impairment in these patients.
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Affiliation(s)
| | | | - Manoel Jacobsen Teixeira
- Department of Neurology, Chairman of Neurosurgery, Medical School, University of São Paulo, Sao Paulo, SP, Brazil
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Sachau J, Kersebaum D, Baron R, Dickenson AH. Unusual Pain Disorders - What Can Be Learned from Them? J Pain Res 2021; 13:3539-3554. [PMID: 33758536 PMCID: PMC7980038 DOI: 10.2147/jpr.s287603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Pain is common in many different disorders and leads to a significant reduction in quality of life in the affected patients. Current treatment options are limited and often result in insufficient pain relief, partly due to the incomplete understanding of the underlying pathophysiological mechanisms. The identification of these pathomechanisms is therefore a central object of current research. There are also a number of rare pain diseases, that are generally little known and often undiagnosed, but whose correct diagnosis and examination can help to improve the management of pain disorders in general. In some of these unusual pain disorders like sodium-channelopathies or sensory modulation disorder the underlying pathophysiological mechanisms have only recently been unravelled. These mechanisms might serve as pharmacological targets that may also play a role in subgroups of other, more common pain diseases. In other unusual pain disorders, the identification of pathomechanisms has already led to the development of new drugs. A completely new therapeutic approach, the gene silencing, can even stop progression in hereditary transthyretin amyloidosis and porphyria, ie in pain diseases that would otherwise be rapidly fatal if left untreated. Thus, pain therapists and researchers should be aware of these rare and unusual pain disorders as they offer the unique opportunity to study mechanisms, identify new druggable targets and finally because early diagnosis might save many patient lives.
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Affiliation(s)
- Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Dilara Kersebaum
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
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Rehm S, Sachau J, Hellriegel J, Forstenpointner J, Børsting Jacobsen H, Harten P, Gierthmühlen J, Baron R. Pain matters for central sensitization: sensory and psychological parameters in patients with fibromyalgia syndrome. Pain Rep 2021; 6:e901. [PMID: 33718743 PMCID: PMC7952123 DOI: 10.1097/pr9.0000000000000901] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/11/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022] Open
Abstract
Sensory abnormalities through quantitative sensory testing in fibromyalgia were not substantially influenced by psychological comorbidities. A significant subgroup showed signs of central sensitization, influenced by pain intensity. Introduction: Patients suffering from fibromyalgia syndrome (FMS) are heterogenous. They often present with sensory abnormalities and comorbidities. Objectives: We aimed to answer the following questions: (1) Is there a specific somatosensory profile in our patient cohort? (2) Can we detect subgroups characterized by a specific combination of sensory and psychological features? and (3) Do psychological parameters influence sensory signs? Methods: In 87 patients with FMS quantitative sensory testing was performed on the hand and evaluated in combination with questionnaire results regarding pain, psychological comorbidities, sleep, and functionality. Results: Patients presented different somatosensory patterns, but no specific subgroups regarding sensory signs and psychological features were detected. Hypersensitivity for noxious mechanical and thermal stimuli and hyposensitivity for nonnoxious mechanical stimuli were the most prominent features. Thirty-one percent of patients showed signs of central sensitization as indicated by abnormally increased pinprick hyperalgesia or dynamic mechanical allodynia. Central sensitization was associated with higher pain intensities (P < 0.001). Only a small influence of psychiatric comorbidities on mechanical pain sensitivity (P = 0.044) and vibration detection (P = 0.028) was found, which was partly associated with high pain intensities. A small subgroup of patients (11.4%) demonstrated thermal hyposensitivity (loss of small-fiber function). Conclusion: Patients with FMS showed various somatosensory abnormalities. These were not significantly influenced by psychological comorbidities. Signs for central sensitization were detected in about one-third of patients and associated with higher pain intensities. This supports the notion of central sensitization being a major pathophysiological mechanism in FMS, whereas small-fiber loss may be less important.
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Affiliation(s)
- Stefanie Rehm
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Jana Hellriegel
- Division of Psychiatry, Imland Klinik Rendsburg, Rendsburg, Germany
| | - Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.,Department of Anesthesia, Critical Care and Pain Medicine, Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Mind-Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Janne Gierthmühlen
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Bonello C, Girdwood M, De Souza K, Trinder NK, Lewis J, Lazarczuk SL, Gaida JE, Docking SI, Rio EK. Does isometric exercise result in exercise induced hypoalgesia in people with local musculoskeletal pain? A systematic review. Phys Ther Sport 2021; 49:51-61. [PMID: 33601254 DOI: 10.1016/j.ptsp.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this review was to investigate if exercise induced hypoalgesia (EIH) occurs following isometric muscle contraction in people with local musculoskeletal symptoms. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL & SportDiscus electronic databases were searched (inception to April 2020). ELIGIBILITY CRITERIA Two authors independently evaluated eligibility. Randomised controlled and crossover (repeated measures) trials that measured the effects of isometric exercise in participants with localised musculoskeletal pain during, and up to 2 hours after isometric exercise were included. Other inclusion criteria included comparison to another intervention, or comparison to healthy controls. Primary outcomes were experimentally induced pain thresholds and secondary outcomes included measures of pain sensitivity from clinical testing. RESULTS 13 studies with data from 346 participants were included for narrative synthesis. EIH was reported in some upper and lower limb studies but there were no consistent data to show isometric exercises were superior to comparison interventions. CONCLUSION There was no consistent evidence for EIH following isometric exercise in people with musculoskeletal pain. These findings are different to those reported in asymptomatic populations (where EIH is consistently demonstrated) as well as conditions associated with widespread symptoms such as fibromyalgia (where isometric exercise may induce hyperalgesia). Although well tolerated when prescribed, isometric exercise did not induce EIH consistently for people seeking care for local musculoskeletal symptoms. The variance in the dose, location of contraction and intensity of protocols included in this review may explain the inconsistent findings. Further work is required to better understand endogenous analgesia in musculoskeletal pain conditions.
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Affiliation(s)
- Christian Bonello
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Michael Girdwood
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Keith De Souza
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Nicola K Trinder
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom; Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Stephanie L Lazarczuk
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Jamie E Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Australian Capital Territory, Australia
| | - Sean I Docking
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Ebonie K Rio
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33501463 PMCID: PMC7836135 DOI: 10.1101/2020.12.03.20242032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Multisensory hypersensitivity (MSH), which refers to persistent discomfort across sensory modalities, is a risk factor for chronic pain. Developing a better understanding of the neural contributions of disparate sensory systems to MSH may clarify its role in the development of chronic pain. We recruited a cohort of women (n=147) enriched with participants with menstrual pain at risk for developing chronic pain. Visual sensitivity was measured using a periodic pattern-reversal stimulus during EEG. Self-reported visual unpleasantness ratings were also recorded. Bladder pain sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visual stimulation induced unpleasantness was associated with bladder pain and evoked primary visual cortex excitation; however, the relationship between unpleasantness and cortical excitation was moderated by bladder pain. Thus, future studies aimed at reversing the progression of MSH into chronic pain should prioritize targeting of cortical mechanisms responsible for maladaptive sensory input integration.
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Affiliation(s)
- Matthew J Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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English A, Drummond PD. Acoustic startle stimuli inhibit pain but do not alter nociceptive flexion reflexes to sural nerve stimulation. Psychophysiology 2021; 58:e13757. [PMID: 33448016 DOI: 10.1111/psyp.13757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 01/08/2023]
Abstract
Acoustic startle stimuli inhibit pain, but whether this is due to a cross-modal inhibitory process or some other mechanism is uncertain. To investigate this, electrical stimulation of the sural nerve either preceded or followed an acoustic startle stimulus (by 200 ms) or was presented alone in 30 healthy participants. Five electrical stimuli, five acoustic startle stimuli, 10 startle + electrical stimuli, and 10 electrical + startle stimuli were presented in mixed order at intervals of 30-60 s. Effects of the startle stimulus on pain ratings, pupillary dilatation and nociceptive flexion reflexes to the electric shock were assessed. The acoustic startle stimulus inhibited electrically evoked pain to the ensuing electric shock (p < .001), and the electrical stimulus inhibited the perceived loudness of a subsequent acoustic startle stimulus (p < .05). However, the startle stimulus did not affect electrically evoked pain when presented 200 ms after the electric shock, and electrically evoked pain did not influence the perceived loudness of a prior startle stimulus. Furthermore, stimulus order did not influence the pupillary responses or nociceptive flexion reflexes. These findings suggest that acoustic startle stimuli transiently inhibit nociceptive processing and, conversely, that electrical stimuli inhibit subsequent auditory processing. These inhibitory effects do not seem to involve spinal gating as nociceptive flexion reflexes to the electric shock were unaffected by stimulus order. Thus, cross-modal interactions at convergence points in the brainstem or higher centers may inhibit responses to the second stimulus in a two-stimulus train.
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Affiliation(s)
- Amber English
- Discipline of Psychology, Murdoch University, Perth, WA, Australia
| | - Peter D Drummond
- Discipline of Psychology, Murdoch University, Perth, WA, Australia
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38
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Samartin-Veiga N, González-Villar AJ, Triñanes Y, Gómez-Perretta C, Carrillo-de-la-Peña MT. Effects of intensity, attention and medication on auditory-evoked potentials in patients with fibromyalgia. Sci Rep 2020; 10:21904. [PMID: 33318554 PMCID: PMC7736365 DOI: 10.1038/s41598-020-78377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/12/2020] [Indexed: 11/09/2022] Open
Abstract
Fibromyalgia (FM) has been associated to an increased processing of somatosensory stimuli, but its generalization to other sensory modalities is under discussion. To clarify this, we studied auditory event-related potentials (AEPs) to stimuli of different intensity in patients with FM and healthy controls (HCs), considering the effects of attention mechanisms and medication. We performed two experiments: In study 1 (n = 50 FM, 60 HCs), the stimuli were presented randomly within the sequence; in study 2 (n = 28 FM, 30 HCs), they were presented in blocks of the same intensity. We analyzed intensity and group effects on N1-P2 amplitude and, only for the FM group, the effect of medication and the correlation between AEPs and clinical variables. Contrary to the expectation, the patients showed a trend of reduced AEPs to the loudest tones (study 1) or no significant differences with the HCs (study 2). Medication with central effects significantly reduced AEPs, while no significant relationships between the N1-P2 amplitude/intensity function and patients’ symptoms were observed. The findings do not provide evidence of augmented auditory processing in FM. Nevertheless, given the observed effect of medication, the role of sensory amplification as an underlying pathophysiological mechanism in fibromyalgia cannot be discarded.
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Affiliation(s)
- N Samartin-Veiga
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - A J González-Villar
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Psychological Neuroscience Lab, Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
| | - Y Triñanes
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - M T Carrillo-de-la-Peña
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Hollins M, Athans L. Perceptual amplification following sustained attention: implications for hypervigilance. Exp Brain Res 2020; 239:279-288. [PMID: 33151350 DOI: 10.1007/s00221-020-05910-y] [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: 03/17/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
It is known that attending to a cutaneous stimulus briefly increases its subjective intensity. The purpose of the present study was to determine whether an extended period of attention would produce a longer-lasting perceptual amplification. Eighty subjects were assigned alternately to experimental and control groups. Members of the two groups received identical series of tactile stimuli (near-threshold von Frey filaments applied to the forearm), but those in the experimental group carried out a two-interval forced-choice detection task that required attention to the filaments, while subjects in the control group attended instead to a video game. After this initial phase, all subjects gave magnitude estimates of the intensity of a wide range of von Frey filaments. The experimental group gave estimates 42% greater than those of the control group, both for filaments used in the initial phase, and others not presented previously; the perceptual amplification did not, however, transfer to a different type of pressure stimulus, a 5 mm-diameter rod applied to the skin. The aftereffect of sustained attention lasted for at least 15 min. This phenomenon, demonstrated in normal subjects, may have implications for the hypervigilance of some chronic pain patients, which is characterized by both heightened attention to pain and long-lasting perceptual amplification of noxious stimuli.
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Affiliation(s)
- Mark Hollins
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Luke Athans
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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40
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Duarte D, Bauer CCC, Pinto CB, Saleh Velez FG, Estudillo-Guerra MA, Pacheco-Barrios K, Gunduz ME, Crandell D, Merabet L, Fregni F. Cortical plasticity in phantom limb pain: A fMRI study on the neural correlates of behavioral clinical manifestations. Psychiatry Res Neuroimaging 2020; 304:111151. [PMID: 32738724 PMCID: PMC9394643 DOI: 10.1016/j.pscychresns.2020.111151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 12/29/2022]
Abstract
The neural mechanism of phantom limb pain (PLP) is related to the intense brain reorganization process implicating plasticity after deafferentation mostly in sensorimotor system. There is a limited understanding of the association between the sensorimotor system and PLP. We used a novel task-based functional magnetic resonance imaging (fMRI) approach to (1) assess neural activation within a-priori selected regions-of-interested (motor cortex [M1], somatosensory cortex [S1], and visual cortex [V1]), (2) quantify the cortical representation shift in the affected M1, and (3) correlate these changes with baseline clinical characteristics. In a sample of 18 participants, we found a significantly increased activity in M1 and S1 as well as a shift in motor cortex representation that was not related to PLP intensity. In an exploratory analyses (not corrected for multiple comparisons), they were directly correlated with time since amputation; and there was an association between increased activity in M1 with a lack of itching sensation and V1 activation was negatively correlated with PLP. Longer periods of amputation lead to compensatory changes in sensory-motor areas; and itching seems to be a protective marker for less signal changes. We confirmed that PLP intensity is not associated with signal changes in M1 and S1 but in V1.
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Affiliation(s)
- D Duarte
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA; Department of Psychiatry and Behavioural Neurosciences, McMaster University. 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - C C C Bauer
- McGovern Institute for Brain Research, MIT. 43 Vassar St, Cambridge, MA 02139, USA; Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus UNAM 3001, 76230 Juriquilla, Querétaro, 76230, México; Department of Psychology, Northeastern University, 805 Columbus Avenue, Boston, MA 02139, USA.
| | - C B Pinto
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA
| | - F G Saleh Velez
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA; University of Chicago Medical Center, Department of Neurology, University of Chicago. 5841 S Maryland Ave # C411, Chicago, IL 60637, USA
| | - M A Estudillo-Guerra
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA
| | - K Pacheco-Barrios
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru. Av. La Fontana 750 Edificio El Cubo, La Molina - Perú
| | - M E Gunduz
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA
| | - D Crandell
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA
| | - L Merabet
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School. 243 Charles St, Boston, MA 02114, USA
| | - F Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA; Massachusetts General Hospital, Harvard Medical School. 55 Fruit St, Boston, MA 02114, USA.
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41
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Wang D, Merkle SL, Lee JE, Sluka KA, Rakel B, Graven-Nielsen T, Frey-Law LA. Multisensory Sensitivity is Related to Deep-Tissue but Not Cutaneous Pain Sensitivity in Healthy Individuals. J Pain Res 2020; 13:2493-2508. [PMID: 33116791 PMCID: PMC7548328 DOI: 10.2147/jpr.s267972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Some individuals with chronic pain find daily life sensations (eg, noise, light, or touch) aversive. This amplification of multisensory sensations has been associated with centrally mediated plasticity; for example, greater multisensory sensitivity (MSS) occurs in patients with fibromyalgia than rheumatoid arthritis. However, whether MSS preferentially relates to pain measures which reflect central influences (eg, dynamic quantitative sensory testing (QST) or referred pain), or whether the MSS-pain relationship requires priming from chronic pain, is unknown. Thus, this cross-sectional study investigated the relationships between MSS assessed in a pain-free state and evoked pain sensitivity. METHODS Experimental intramuscular infusion pain and multiple static and dynamic QST were assessed in 465 healthy, pain-free adults: pain thresholds using pressure (PPTs) and heat (HPTs), temporal summation of pain (TSP) using pressure, heat or punctate stimuli, and conditioned pain modulation (CPM) using pressure or heat test stimuli. MSS was assessed using 7 items from Barsky's Somatosensory Amplification Scale. Differences in pain and QST between sex-specific MSS quartiles were assessed, adjusting for multiple comparisons. All participants completed at least one intramuscular infusion condition, but not all were asked to complete each QST (n=166-465). RESULTS Both static and dynamic QST differed between highest and lowest MSS quartiles using pressure stimuli: lower PPTs (adjusted-p<0.01); increased pressure TSP (adjusted-p=0.02); lower pressure CPM (adjusted-p=0.01). However, none of the heat or punctate QST measures (HPTs, TSP, or CPM) differed between MSS quartiles (adjusted-p>0.05). Odds of experiencing TSP or referred pain was not greater, whereas CPM was 8-fold less likely, in those with highest MSS. CONCLUSION Normal variation in non-noxious MSS is related to both static and dynamic pain sensitivity, without sensitization associated with chronic pain, but is dependent on the QST stimulus. Thus, common influences on MSS and pain sensitivity may involve central mechanisms but are likely more complex than previously recognized.
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Affiliation(s)
- Dan Wang
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Shannon L Merkle
- United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, USA
| | - Jennifer E Lee
- Department of Psychology, Mount Mercy University, Cedar Rapids, IA, USA
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Barbara Rakel
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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42
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Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol 2020; 16:645-660. [DOI: 10.1038/s41584-020-00506-w] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
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Risk of hearing loss in patients with fibromyalgia: A nationwide population-based retrospective cohort study. PLoS One 2020; 15:e0238502. [PMID: 32881903 PMCID: PMC7470261 DOI: 10.1371/journal.pone.0238502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/10/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives Our objectives are to examine whether patients with fibromyalgia (FM) present an increased risk of hearing loss (HL) compared with those without FM and to explore the relationship between comorbidities/drugs and development of HL in patients with FM. Furthermore, we investigated the incidence rate of different types of HL and the joint effects for HL with FM and comorbidities. Methods This population-based retrospective cohort study included patients with new-onset FM from 2000 to 2002 (the FM group) and age- and sex-matched randomized patients without FM (the non-FM group) from Taiwan’s National Health Insurance Research Database. Patients were followed up from baseline (3 months after FM diagnosis) until death, withdrawal, HL development, or December 31, 2013. The primary outcome was the risk of HL, which was assessed using Cox proportional-hazards analysis. Results The overall HL risk in the FM group was 1.46-fold (95% confidence interval [CI]: 1.38–1.55) higher than that in the non-FM group after adjustment for sex, age, and comorbidities (p < 0.0001). Patients with FM had significantly greater sensorineural HL (adjusted hazard ratio = 1.46, 95% CI: 1.37–1.56) than those without FM. Patients with FM having comorbidities of diabetes, hyperlipidemia, depression, and Meniere’s disease had a higher risk of HL than those without FM. Conclusion Our findings support the notion that FM influences HL and is in line with the hypothesis that the FM mechanism is related to a central nervous system abnormality in sensory processing. Health care professionals should provide appropriate screening for the risk of HL and prevention and counseling methods for patients with FM.
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Hubbard CS, Lazaridou A, Cahalan CM, Kim J, Edwards RR, Napadow V, Loggia ML. Aberrant Salience? Brain Hyperactivation in Response to Pain Onset and Offset in Fibromyalgia. Arthritis Rheumatol 2020; 72:1203-1213. [PMID: 32017421 DOI: 10.1002/art.41220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While much brain research on fibromyalgia (FM) focuses on the study of hyperresponsiveness to painful stimuli, some studies suggest that the increased pain-related brain activity often reported in FM studies may be partially explained by stronger responses to salient aspects of the stimulation rather than, or in addition to, the stimulation's painfulness. Therefore, this study was undertaken to test our hypothesis that FM patients would demonstrate elevated brain responses to both pain onset and offset-2 salient sensory events of opposing valences. METHODS Thirty-eight FM patients (mean ± SD age 46.1 ± 13.4 years; 33 women) and 15 healthy controls (mean ± SD age 45.5 ± 12.4; 10 women) received a moderately painful pressure stimulus to the leg during blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. Stimulus onset and offset transients were analyzed using a general linear model as stick functions. RESULTS During pain onset, higher BOLD signal response was observed in FM patients compared to healthy controls in dorsolateral and ventrolateral prefrontal cortices (DLPFC and VLPFC, respectively), orbitofrontal cortex (OFC), frontal pole, and precentral gyrus (PrCG). During pain offset, higher and more widespread BOLD signal response was demonstrated in FM patients compared to controls in frontal regions significantly hyperactivated in response to onset. In FM patients, some of these responses were positively correlated with pain unpleasantness ratings (VLPFC, onset; r = 0.35, P = 0.03), pain catastrophizing scores (DLPFC, offset; r = 0.33, P = 0.04), or negatively correlated with stimulus intensity (OFC, offset; r = -0.35, P = 0.03) (PrCG, offset; r = -0.39, P = 0.02). CONCLUSION Our results suggest that the increased sensitivity exhibited by FM patients in response to the onset and offset of painful stimuli may reflect a more generalized hypersensitivity to salient sensory events, and that brain hyperactivation may be a mechanism potentially involved in the generalized hypervigilance to salient stimuli in FM.
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Affiliation(s)
- Catherine S Hubbard
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Jieun Kim
- Massachusetts General Hospital, Charlestown
| | - Robert R Edwards
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vitaly Napadow
- Harvard Medical School, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Marco L Loggia
- Harvard Medical School, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
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Boehme R, van Ettinger-Veenstra H, Olausson H, Gerdle B, Nagi SS. Anhedonia to Gentle Touch in Fibromyalgia: Normal Sensory Processing but Abnormal Evaluation. Brain Sci 2020; 10:brainsci10050306. [PMID: 32443443 PMCID: PMC7288027 DOI: 10.3390/brainsci10050306] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022] Open
Abstract
Social touch is important for interpersonal interaction. Gentle touch and slow brushing are typically perceived as pleasant, the degree of pleasantness is linked to the activity of the C-tactile (CT) fibers, a class of unmyelinated nerves in the skin. The inability to experience pleasure in general is called anhedonia, a common phenomenon in the chronic pain condition fibromyalgia. Here, we studied the perception and cortical processing of gentle touch in a well-characterized cohort of fibromyalgia. Patients and controls participated in functional brain imaging while receiving tactile stimuli (brushing) on the forearm. They were asked to provide ratings of pleasantness of the tactile stimulus and ongoing pain. We found high distress, pain catastrophizing, and insomnia, and a low perceived state of health in fibromyalgia. Further, patients rated both slow (CT-optimal) and fast (CT-suboptimal) brushing as less pleasant than healthy participants. While there was no difference in brain activity during touch, patients showed deactivation in the right posterior insula (contralateral to the stimulated arm) during pleasantness rating and activation during pain rating. The opposite pattern was observed in healthy participants. Voxel-based morphometry analysis revealed reduced grey matter density in patients, in the bilateral hippocampus and anterior insula. Our results suggest anhedonia to gentle touch in fibromyalgia with intact early-stage sensory processing but dysfunctional evaluative processing. These findings contribute to our understanding of the mechanisms underlying anhedonia in fibromyalgia.
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Affiliation(s)
- Rebecca Boehme
- Center for Social and Affective Neuroscience, Linköping University, 58185 Linköping, Sweden; (H.O.); (S.S.N.)
- Center for Medical Image Science and Visualization (CMIV), 58185 Linköping, Sweden; (H.v.E.-V.); (B.G.)
- Correspondence:
| | - Helene van Ettinger-Veenstra
- Center for Medical Image Science and Visualization (CMIV), 58185 Linköping, Sweden; (H.v.E.-V.); (B.G.)
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185 Linköping, Sweden
| | - Håkan Olausson
- Center for Social and Affective Neuroscience, Linköping University, 58185 Linköping, Sweden; (H.O.); (S.S.N.)
- Center for Medical Image Science and Visualization (CMIV), 58185 Linköping, Sweden; (H.v.E.-V.); (B.G.)
- Department of Clinical Neurophysiology, Linköping University, 58185 Linköping, Sweden
| | - Björn Gerdle
- Center for Medical Image Science and Visualization (CMIV), 58185 Linköping, Sweden; (H.v.E.-V.); (B.G.)
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185 Linköping, Sweden
| | - Saad S. Nagi
- Center for Social and Affective Neuroscience, Linköping University, 58185 Linköping, Sweden; (H.O.); (S.S.N.)
- Department of Clinical Neurophysiology, Linköping University, 58185 Linköping, Sweden
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Quantitative assessment of nonpelvic pressure pain sensitivity in urologic chronic pelvic pain syndrome: a MAPP Research Network study. Pain 2020; 160:1270-1280. [PMID: 31050659 DOI: 10.1097/j.pain.0000000000001505] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Experimental pain sensitivity was assessed in individuals with urologic chronic pelvic pain syndrome (UCPPS) as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. A series of computer-controlled pressure stimuli were delivered to the thumbnail bed, an asymptomatic site distant from the area of UCPPS pain that is considered to be indicative of overall body pain threshold. Stimuli were rated according to a standardized magnitude estimation protocol. Pain sensitivity in participants with UCPPS was compared with healthy controls and a mixed pain group composed of individuals with other chronic overlapping pain conditions, including fibromyalgia, chronic fatigue, and irritable bowel syndromes. Data from 6 participating MAPP testing sites were pooled for analysis. Participants with UCPPS (n = 153) exhibited an intermediate pain sensitivity phenotype: they were less sensitive relative to the mixed pain group (n = 35) but significantly more sensitive than healthy controls (n = 100). Increased pain sensitivity in patients with UCPPS was associated with both higher levels of clinical pain severity and more painful body areas outside the pelvic region. Exploratory analyses in participants with UCPPS revealed that pain sensitivity increased during periods of urologic symptom flare and that less pressure pain sensitivity at baseline was associated with a greater likelihood of subsequent genitourinary pain improvement 1 year later. The finding that individuals with UCPPS demonstrate nonpelvic pain hypersensitivity that is related to clinical symptoms suggests that central nervous system mechanisms of pain amplification contribute to UCPPS.
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Cil ÖÇ, Zateri C, Güçlü O, Oymak S, Tezcan E. The effect of fibromyalgia treatment on tinnitus. Am J Otolaryngol 2020; 41:102390. [PMID: 31926598 DOI: 10.1016/j.amjoto.2020.102390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We investigated the frequency of tinnitus in fibromyalgia patients and the effect of drugs used for routine fibromyalgia on tinnitus. METHODS We included 101 diagnosed fibromyalgia patients. After detailed ear nose throat examination, audiometric tests and tinnitus handicap index (THI) were performed. After the tests, routine treatment for fibromyalgia was started by the physical therapy and rehabilitation department. Two months after the beginning of the treatment, THI were repeated again and the results were statistically evaluated. RESULTS All patients included in the study were women. 74.3% of the patients had tinnitus. Pregabalin and selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant-treated patients were evaluated; In both groups, there was a statistically significant difference between pre- and post-treatment tinnitus levels (p < .001). However, there was no statistically significant difference between pregabalin group and diloxetine group according to treatment results. CONCLUSIONS The incidence of tinnitus is high in fibromyalgia patients. That pregabalin and duloxetine agents routinely used in fibromyalgia require further experimental and human studies in order to be able to use in tinnitus.
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Affiliation(s)
- Ö Çaglar Cil
- Onsekiz Mart University, Medical School, Otorhinolaryngology Department.
| | - C Zateri
- Onsekiz Mart University, Medical School, Physical Medicine and Rehabilitation Department
| | - O Güçlü
- Onsekiz Mart University, Medical School, Otorhinolaryngology Department
| | - S Oymak
- Onsekiz Mart University, Medical School, Public Health Department
| | - E Tezcan
- Onsekiz Mart University, Medical School, Otorhinolaryngology Department
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İnal Ö, Aras B, Salar S. Investigation of the relationship between kinesiophobia and sensory processing in fibromyalgia patients. Somatosens Mot Res 2020; 37:92-96. [PMID: 32208874 DOI: 10.1080/08990220.2020.1742104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose/aim: The aims of this study are to investigate the relationship between kinesiophobia and sensory processing in fibromyalgia (FM) patients and obtain new information about kinesiophobia in light of these results.Materials and methods: This study has been conducted with 82 literate subjects aged 18-65 years and diagnosed with FM based on ACR 2010 diagnostic criteria. Fibromyalgia Impact Questionnaire was used for measuring functional status in FM patients, The Tampa Scale of Kinesiophobia was used for determine the levels of kinesiophobia and Adolescent/Adult Sensory Profile was used for determine the characteristics of sensory process patterns of the individuals.Results: Among the participants, sensory sensitivity scores of 65.85% and sensation avoiding scores of 40.24% were higher than that in the general population. Sensation seeking scores of 48.78% the subjects were lower compared to the general population. A significant and weak positive correlation was found between the kinesiophobia scores and responses of sensory sensitivity and sensation avoiding (r = 0.23, p = 0.04; z = 0.29, p = 0.01)Conclusion: This is the first study conducted to investigate the relationship between kinesiophobia and sensory processing in fibromyalgia patients. However, different studies investigating this subject are warranted in order to be able to generalize the findings and increase the value of evidence.
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Affiliation(s)
- Özgü İnal
- Faculty of Health Sciences, Department of Occupational Therapy, Trakya University, Edirne, Turkey
| | - Berke Aras
- Department of Physical Medicine and Rehabilitation, Kastamonu Rehabilitation Centre, Kastamonu, Turkey
| | - Sinem Salar
- Department of Occupational Therapy Edirne, Faculty of Health Sciences, Trakya University, Edirne, Turkey
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Schrepf A, Moser S, Harte SE, Basu N, Kaplan C, Kolarik E, Tsodikov A, Brummett CM, Clauw DJ. Top down or bottom up? An observational investigation of improvement in fibromyalgia symptoms following hip and knee replacement. Rheumatology (Oxford) 2020; 59:594-602. [PMID: 31411333 PMCID: PMC7998337 DOI: 10.1093/rheumatology/kez303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/05/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Many patients with osteoarthritis have comorbid symptoms of FM, but it is unknown how these symptoms respond to surgical procedures that address nociceptive input in the periphery, such as total joint replacement. Here we explore differences in clinical characteristics between patients whose FM symptoms do and do not improve following total hip or knee replacement. METHODS Participants were 150 patients undergoing knee or hip replacement who had a minimum FM survey score of 4 or greater prior to surgery. The top tertile of patients experiencing the most improvement in FM symptoms at month 6 were categorized as 'Improve' (n = 48) while the bottom two tertiles were categorized as 'Worsen/Same' (n = 102). Baseline symptom characteristics were compared between groups, as well as improvement in overall pain severity, surgical pain severity and physical function at 6 months. RESULTS The Worsen/Same group had higher levels of fatigue, depression and surgical site pain at baseline (all P < 0.05). Additionally, they improved less on overall pain severity and physical functioning 6 months after surgery (both P < 0.05). CONCLUSION Most patients derive significant benefit in improvement of comorbid FM symptoms following total joint replacement, but a substantial proportion do not. Understanding the neurobiological basis for these different trajectories may help inform clinical judgment and improve patient care.
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Affiliation(s)
- Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Moser
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Neil Basu
- Department of Rheumatology, Institute of Infection, Immunity & Inflammation, University of Glasgow, UK
| | - Chelsea Kaplan
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Ellen Kolarik
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Tsodikov
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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