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Pozo-Rosich P, Alpuente A, Silberstein SD, Burstein R. Insights from 25 years of onabotulinumtoxinA in migraine - mechanisms and management. Nat Rev Neurol 2024; 20:555-568. [PMID: 39160284 DOI: 10.1038/s41582-024-01002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/21/2024]
Abstract
OnabotulinumtoxinA (BTX-A) was first linked to beneficial effects in migraine 25 years ago and was approved by the FDA for preventive treatment of chronic migraine in 2010. The treatment has since had a major impact on the well-being of people with chronic migraine. The clinical development programme for BTX-A and research since its approval have provided insights into the neuromodulatory sensory effect of BTX-A, how it can control chronic migraine despite its peripheral action, and the underlying biology of migraine as a disease. In this Review, we consider the impact that BTX-A has had on the management of chronic migraine and on the research field. We discuss the insights provided by clinical research, encompassing the clinical trials and subsequent real-world evidence, and the mechanistic insights provided by preclinical and translational research. We also provide an overview of future directions of research in the field BTX-A in migraine and the clinical translation of this research.
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Affiliation(s)
- Patricia Pozo-Rosich
- Headache & Neurological Pain Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Alicia Alpuente
- Headache & Neurological Pain Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA
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2
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Moloney NA, Lenoir D. Assessment of neuropathic pain following cancer treatment. Anat Rec (Hoboken) 2024; 307:309-319. [PMID: 36700536 DOI: 10.1002/ar.25161] [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: 08/21/2022] [Revised: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 01/27/2023]
Abstract
Neuropathic cancer pain (NCP) is prevalent affecting up to 58% of those with persistent pain following cancer treatment. Neuropathic pain can develop from malignancy, after neural tissue insult during surgery and/or exposure to radiation or neurotoxic agents used as part of cancer treatment regimens. Pain following cancer treatment is commonly under-treated and one barrier identified is poor recognition of pain and inadequate assessment. Recognition of the presence of NCP is important to inform pain management, which is challenging to treat and warrants the use of specific treatments to target neuropathic mechanisms. In this review, approaches for screening and classifying NCP are described. These include screening questionnaires and the application of the updated neuropathic pain grading system in a cancer context. The evidence from neuropathic pain related assessments in cancer populations is provided and highlighted under different neuropathic pain grades. Recommendations for assessment in practice are provided.
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Affiliation(s)
- Niamh A Moloney
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Dorine Lenoir
- Pain in Motion International Research Group, Ghent, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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3
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Frahm KS, Gervasio S, Arguissain F, Mouraux A. Influence of skin type and laser wavelength on laser-evoked potentials. Eur J Pain 2023; 27:1226-1238. [PMID: 37358263 DOI: 10.1002/ejp.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/03/2023] [Accepted: 06/08/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Infrared laser stimulation is a valuable tool in pain research, its primary application being the recording of laser-evoked brain potentials (LEPs). Different types of laser stimulators, varying in their skin penetrance, are likely to have a large influence on the LEPs, when stimulating different skin types. The aim of this study was to investigate how LEPs depend on laser type and skin location. METHODS Two different laser stimulators (CO2 and Nd:YAP) were used to compare LEPs in healthy subjects. Stimuli were delivered to the hand dorsum and palm to investigate the effects of skin type on the evoked responses. Stimulus-evoked brain responses were recorded using EEG and perceived intensity ratings were recorded. Computational modelling was used to investigate the observed differences. RESULTS LEPs evoked by stimulation of the hairy skin were similar between CO2 and Nd:YAP stimulation. In contrast, LEPs elicited from the palm were markedly different and barely present for CO2 stimulation. There was a significant interaction between laser type and skin type (RM-ANOVA, p < 0.05) likely due to smaller CO2 LEPs in the palm. CO2 stimuli to the palm also elicited significantly lower perceived intensities. The computational model showed that the observed differences were explainable by the laser absorption characteristics and skin thickness affecting the temperature profile at the dermo-epidermal junction (DEJ). CONCLUSIONS This study shows that LEP elicitation depends on the combination of laser penetrance and skin type. Low penetrance stimuli, from a CO2 laser, elicited significantly lower LEPs and perceived intensities in the palm. SIGNIFICANCE This study showed that the elicitation of laser-evoked potentials in healthy humans greatly depends on the combination of laser stimulator type and skin type. It was shown that high penetrance laser stimuli are capable of eliciting responses in both hairy and glabrous skin, whereas low penetrance stimuli barely elicited responses from the glabrous skin. Computational modelling was used to demonstrate that the results could be fully explained by the combination of laser type and skin thickness.
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Affiliation(s)
- Ken Steffen Frahm
- Integrative Neuroscience Group, CNAP - Center for Neuroplasticity and Pain, SMI©, Department of Health Science & Technology, Aalborg University, Aalborg, Denmark
| | - Sabata Gervasio
- Neural Engineering and Neurophysiology Group, SMI©, Department of Health Science & Technology, Aalborg University, Aalborg, Denmark
| | - Federico Arguissain
- Integrative Neuroscience Group, CNAP - Center for Neuroplasticity and Pain, SMI©, Department of Health Science & Technology, Aalborg University, Aalborg, Denmark
| | - André Mouraux
- Université Catholique de Louvain, Institute of Neuroscience (IoNS), Faculty of Medicine, Bruxelles, Belgium
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4
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Wei L, Ji L, Miao Y, Han X, Li Y, Wang Z, Fu J, Guo L, Su Y, Zhang Y. Constipation in DM are associated with both poor glycemic control and diabetic complications: Current status and future directions. Biomed Pharmacother 2023; 165:115202. [PMID: 37506579 DOI: 10.1016/j.biopha.2023.115202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Constipation is a major complications of diabetes mellitus. With the accelerating prevalence of diabetes worldwide and an aging population, there is considerable research interest regarding the altered function and structure of the gastrointestinal tract in diabetic patients. Despite current advances in hyperglycemic treatment strategies, the specific pathogenesis of diabetic constipation remains unknown. Patients with constipation, may be reluctant to eat regularly, which may worsen glycemic control and thus worsen symptoms associated with underlying diabetic bowel disease. This paper presents a review of the complex relationship between diabetes and constipation, exploring the morphological alterations and biomechanical remodeling associated with intestinal motility dysfunction, as well as alterations in intestinal neurons, cellular signaling pathways, and oxidative stress. Further studies focusing on new targets that may play a role in the pathogenesis of diabetic constipation may, provide new ideas for the development of novel therapies to treat or even prevent diabetic constipation.
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Affiliation(s)
- Luge Wei
- Tianjin University of Traditional Chinese Medicine, China.
| | - Lanqi Ji
- Tianjin University of Traditional Chinese Medicine, China
| | - Yulu Miao
- Tianjin University of Traditional Chinese Medicine, China
| | - Xu Han
- Tianjin University of Traditional Chinese Medicine, China
| | - Ying Li
- Tianjin University of Traditional Chinese Medicine, China
| | - Zhe Wang
- Tianjin University of Traditional Chinese Medicine, China
| | - Jiafeng Fu
- Tianjin University of Traditional Chinese Medicine, China
| | - Liuli Guo
- Tianjin University of Traditional Chinese Medicine, China
| | - Yuanyuan Su
- Tianjin University of Traditional Chinese Medicine, China
| | - Yanjun Zhang
- Tianjin University of Traditional Chinese Medicine, China; First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, China
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5
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McDaniel AL, Dimitrov TN, Bruehl SP, Monroe TB, Failla MD, Cowan RL, Ryan C, Anderson AR. Psychophysics of Pain: A Methodological Introduction. Pain Manag Nurs 2023; 24:442-451. [PMID: 36948969 PMCID: PMC10440278 DOI: 10.1016/j.pmn.2023.02.006] [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: 06/28/2022] [Revised: 12/29/2022] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
For over 100 years, psychophysics ..÷ the scientific study between physical stimuli and sensation ... has been successfully employed in numerous scientific and healthcare disciplines, as an objective measure of sensory phenomena. This manuscript provides an overview of fundamental psychophysical concepts, emphasizing pain and research application..÷defining common terms, methods, and procedures.Psychophysics can provide systematic and objective measures of sensory perception that can be used by nursing scientists to explore complex, subjective phenomena..÷such as pain perception. While there needs to be improved standardization of terms and techniques, psychophysical approaches are diverse and may be tailored to address or augment current research paradigms. The interdisciplinary nature of psychophysics..÷like nursing..÷provides a unique lens for understanding how our perceptions are influenced by measurable sensations. While the quest to understand human perception is far from complete, nursing science has an opportunity to contribute to pain research by using the techniques and methods available through psychophysical procedures.
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Affiliation(s)
- Aaron L McDaniel
- From The Ohio State University College of Nursing, Columbus, Ohio.
| | | | - Stephen P Bruehl
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd B Monroe
- From The Ohio State University College of Nursing, Columbus, Ohio
| | | | - Ronald L Cowan
- Department of Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Claire Ryan
- Vanderbilt University Medical Center, Nashville, Tennessee
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6
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Fernandez-Fairen M, Calderón-Ospina CA, Chen J, Duarte Vega M, Fernández-Villacorta F, Gómez-García F, López-Almejo L, Manzano-García A, Hernández-Méndez Villamil E, Helito CP, Ruiz-Rodríguez D, Salas-Morales G, Servin-Caamaño A, Lara-Solares A, Puello-Vales M, Vargas-Schaffer G. A Latin American consensus meeting on the essentials of mixed pain. Curr Med Res Opin 2023; 39:451-466. [PMID: 36772818 DOI: 10.1080/03007995.2023.2177401] [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] [Indexed: 02/12/2023]
Abstract
OBJECTIVES The term "mixed pain" has been established when a mixture of different pain components (e.g. nociceptive, neuropathic, and nociplastic) are present. It has gained more and more acceptance amongst pain experts worldwide, but many questions around the concept of mixed pain are still unsolved. The sensation of pain is very personal. Cultural, social, personal experiences, idiomatic, and taxonomic differences should be taken into account during pain assessment. Therefore, a Latin American consensus committee was formed to further elaborate the essentials of mixed pain, focusing on the specific characteristics of the Latin American population. METHODS The current approach was based on a systematic literature search and review carried out in Medline. Eight topics about the definition, diagnosis, and treatment of mixed pain were discussed and voted for by a Latin American consensus committee and recommendations were expressed. RESULTS At the end of the meeting a total of 14 voting sheets were collected. The full consensus was obtained for 21 of 25 recommendations (15 strong agreement and 6 unanimous agreement) formulated for the above described 8 topics (7 of the 8 topics had for all questions at least a strong agreement - 1 topic had no agreement for all 4 questions). CONCLUSION In a subject as complex as mixed pain, a consensus has been reached among Latin American specialists on points related to the definition and essence of this pain, its diagnosis and treatment. Recommendations for diagnosis and treatment of mixed pain in Latin America were raised.
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Affiliation(s)
| | - Carlos Alberto Calderón-Ospina
- Center for Research in Genetics and Genomics (CIGGUR), GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Juythel Chen
- Clínica del Dolor. Hospital Santo Tomás, Ciudad de Panamá, Panama
| | - Manuel Duarte Vega
- Unidad de Medicina Basada en la Evidencia, Nuevo Hospital Civil de Guadalajara, Guadalajara, Mexico
| | | | | | - Leonardo López-Almejo
- Clinica de Cirugia y Rehabilitacion de Plexo Braquial y Nervio, Periférico, Aguascalientes, Mexico
| | | | | | | | - Delia Ruiz-Rodríguez
- Unidad de Tratamiento del Dolor, Servicio Medicina Física y Rehabilitación, Hospital Clínico, Universidad de Chile, Santiago de Chile, Chile
| | | | | | - Argelia Lara-Solares
- Departamento de Medicina del Dolor y Paliativa, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Marcelo Puello-Vales
- Hospital Central de las Fuerzas Armadas Doctor Vinicio Calventi, Santo Domingo, República Dominicana
| | - Grisell Vargas-Schaffer
- Clínica del Dolor, Centro Hospitalario de la Universidad de Montreal (CHUM), Montreal, Canadá
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7
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Wold A, Rådman L, Norman K, Olausson H, Thordstein M. Clinical Evaluation of Nerve Function in Electrical Accident Survivors with Persisting Neurosensory Symptoms. Brain Sci 2022; 12:brainsci12101301. [PMID: 36291235 PMCID: PMC9599311 DOI: 10.3390/brainsci12101301] [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: 08/19/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Work related electrical accidents are prevalent and can cause persisting symptoms. We used clinical neurophysiological techniques to assess neurosensory function following electrical accidents and correlated test results with the patients’ symptoms. Methods: We studied 24 patients who reported persisting neurosensory symptoms following a workplace electrical accident. We assessed nerve function using quantitative sensory testing (QST), thermal roller testing, laser evoked potential (LEP), and electroneurography. The patients’ results were compared with previously established normative data. Results: Altogether, 67% of the patients showed at least one neurosensory impairment with a large heterogeneity in test results across patients. At a group level, we observed significant deviations in in QST, LEP, and sensory and motor neurography. Overall, we found a weak correlation between test results and self-reported symptoms. Conclusions: In a majority of patients with neurosensory symptoms after a workplace electrical accident, neurosensory testing confirmed the existence of an underlying impairment of the nervous system.
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Affiliation(s)
- Andrew Wold
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Correspondence:
| | - Lisa Rådman
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
| | - Kerstin Norman
- National Unit for Health and Safety, Swedish Police Authority, 10226 Stockholm, Sweden
| | - Håkan Olausson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Neuro, Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
| | - Magnus Thordstein
- Neuro, Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Department of Clinical Neurophysiology, Region Östergötland University Hospital, 58185 Linköping, Sweden
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8
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Comparative Efficacy of Tapentadol versus Tapentadol Plus Duloxetine in Patients with Chemotherapy-Induced Peripheral Neuropathy (CIPN): A Randomized Non-Inferiority Clinical Trial. Cancers (Basel) 2022; 14:cancers14164002. [PMID: 36010995 PMCID: PMC9406344 DOI: 10.3390/cancers14164002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a common complication due to treatment with many commonly used anti-cancer agents. CIPN is a mainly sensory neuropathy that can be characterized by the appearance of motor and autonomic alterations. Clinicians may offer duloxetine (DLX) for patients with cancer experiencing CIPN. Our aim was to assess the non-inferiority of the analgesic effect and safety of tapentadol (TP) alone compared to duloxetine plus tapentadol administered to patients with CIPN. Methods: A total of 114 patients were enrolled in the study and randomized to receive tapentadol in a dosage of 50 to 500 mg/day (n = 56) or tapentadol plus duloxetine in a dosage of 60 to 120 mg/day (n = 58) for a period of 4 weeks. We evaluated the analgesia efficacy, defined as a decrease in pain on the NRS between the first administration and 28 days later. Secondary endpoints included analgesia efficacy at 28 and 42 days, defined by a decrease in DN4 and LEPs, decrease in quality of life, and the incidence of any serious or non-serious adverse events after the first administration. Results: In this randomized, double-blind trial comparing TP and TP plus DLX for CIPN management, TP was feasible and non-inferior to the association with DLX as far as the reduction of pain after chemotherapy at 28 days is concerned. Scores on other rating scales evaluating the quality of life, anxiety and depression, and the characteristics of pain revealed similar improvements associated with tapentadol versus duloxetine at these time points. Conclusion: The use of TP is a safe and effective analgesic therapy in patients with CIPN. Positive effects of TP were noted on the patients’ quality-of-life assessments.
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De Stefano G, Leone C, Di Pietro G, Esposito N, Falco P, Galosi E, Litewczuk D, Mollica C, Truini A, Di Stefano G. Unravelling the role of unmyelinated nerve fibres in trigeminal neuralgia with concomitant continuous pain. Clin Neurophysiol 2022; 142:52-58. [DOI: 10.1016/j.clinph.2022.07.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
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10
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Early life inflammation is associated with spinal cord excitability and nociceptive sensitivity in human infants. Nat Commun 2022; 13:3943. [PMID: 35803920 PMCID: PMC9270448 DOI: 10.1038/s41467-022-31505-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/16/2022] [Indexed: 11/08/2022] Open
Abstract
Immune function and sensitivity to pain are closely related, but the association between early life inflammation and sensory nervous system development is poorly understood-especially in humans. Here, in term-born infants, we measure brain activity and reflex withdrawal activity (using EEG and EMG) and behavioural and physiological activity (using the PIPP-R score) to assess the impact of suspected early-onset neonatal infection on tactile- and noxious-evoked responses. We present evidence that neonatal inflammation (assessed by measuring C-reactive protein levels) is associated with increased spinal cord excitability and evoked brain activity following both tactile and noxious stimulation. There are early indications that this hyperalgesia could be maintained post-inflammation, supporting pre-clinical reports of early-life immune dysfunction influencing pain sensitivity in adults.
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11
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Just Breathe: Improving LEP Outcomes through Long Interval Breathing. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Laser-evoked potentials (LEPs) constitute an objective clinical diagnostic method used to investigate the functioning of the nociceptor system, including signaling in thin peripheral nerve fibers: Aδ and C fibers. There is preliminary evidence that phase locking LEPs with the breathing cycle can improve the parameters used to evaluate LEPs. Methods: We tested a simple breathing protocol as a low-cost improvement to LEP testing of the hands. Twenty healthy participants all underwent three variants of LEP protocols: following a video-guided twelve-second breathing instruction, watching a nature video, or using the classic LEP method of focusing on the hand being stimulated. Results: The breath protocol produced significantly shorter latencies as compared with the nature or classic protocol. It was also the least prone to artifacts and was deemed most acceptable by the subjects. There was no difference between the protocols regarding LEP amplitudes. Conclusions: Using a breathing video can be a simple, low-cost improvement for LEP testing in research and clinical diagnostics.
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12
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Zolezzi DM, Alonso-Valerdi LM, Ibarra-Zarate DI. Chronic neuropathic pain is more than a perception: Systems and methods for an integral characterization. Neurosci Biobehav Rev 2022; 136:104599. [PMID: 35271915 DOI: 10.1016/j.neubiorev.2022.104599] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
The management of chronic neuropathic pain remains a challenge, because pain is subjective, and measuring it objectively is usually out of question. However, neuropathic pain is also a signal provided by maladaptive neuronal activity. Thus, the integral management of chronic neuropathic pain should not only rely on the subjective perception of the patient, but also on objective data that measures the evolution of neuronal activity. We will discuss different objective and subjective methods for the characterization of neuropathic pain. Additionally, the gaps and proposals for an integral management of chronic neuropathic pain will also be discussed. The current management that relies mostly on subjective measures has not been sufficient, therefore, this has hindered advances in pain management and clinical trials. If an integral characterization is achieved, clinical management and stratification for clinical trials could be based on both questionnaires and neuronal activity. Appropriate characterization may lead to an increased effectiveness for new therapies, and a better quality of life for neuropathic pain sufferers.
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Affiliation(s)
- Daniela M Zolezzi
- Escuela de Ingeniería y Ciencias, Tecnológico de Monterrey, Monterrey 64849, Nuevo León, México; Center for Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg 9220, Denmark.
| | | | - David I Ibarra-Zarate
- Escuela de Ingeniería y Ciencias, Tecnológico de Monterrey, Puebla 72453, Puebla, México
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13
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Small-Fiber-Neuropathien. DGNEUROLOGIE 2022; 5. [PMCID: PMC9559077 DOI: 10.1007/s42451-022-00488-x] [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] [Indexed: 11/19/2022]
Abstract
Die Small-Fiber-Neuropathie (SFN) ist eine Erkrankung des peripheren Nervensystems aufgrund einer isolierten oder vorwiegenden Schädigung dünn myelinisierter Aδ-Fasern und/oder unmyelinisierter C‑Fasern. Für die sichere Diagnose einer SFN ist neben der klinischen Symptomatik mit Schmerzen und Sensibilitätsstörungen, typischerweise mit distal betonter Ausbreitung, der apparative Nachweis einer Rarefizierung oder einer Funktionsstörung der dünn myelinisierten Aδ-Fasern und/oder der unmyelinisierten C‑Fasern gefordert. Im vorliegenden Beitrag wird eine Übersicht über die diagnostischen Verfahren zum Nachweis einer SFN sowie über mögliche Ursachen und Behandlungsoptionen gegeben.
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14
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Ren Q, Yang Y, Wo Y, Lu X, Hu L. Different priming effects of empathy on neural processing associated with firsthand pain and nonpain perception. Ann N Y Acad Sci 2021; 1509:184-202. [PMID: 34877680 DOI: 10.1111/nyas.14723] [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: 08/07/2021] [Revised: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
The shared-representation model of empathy is still debated. One of the major questions is whether empathy-eliciting stimuli depicting others' pain selectively activate the representations of self-pain. To address this issue, we assessed the priming effects of empathy-eliciting pictures on firsthand pain and nonpain perception, as well as its associated neural processing. In Experiment 1, when compared with nonpainful pictures depicting individuals' body parts with no injury, participants primed by painful pictures showing individuals' body parts with injury reported higher ratings for perceived intensity, unpleasantness, and salience of nociceptive and auditory stimuli, but they only exhibited increased N2 amplitude in response to nociceptive stimuli. In Experiment 2, the results from another group of participants replicated the observations of Experiment 1 and validated the findings in the non-nociceptive somatosensory modality. Importantly, participants' concern ratings for priming pictures predicted their unpleasantness ratings for subsequent nociceptive stimuli, while participants' attention ratings predicted their unpleasantness ratings for subsequent auditory and tactile stimuli. This finding implies that empathy for pain might influence pain and nonpain perception via different psychological mechanisms. In summary, our findings highlight the existence of pain-selective representations in empathy for pain and contribute to a better understanding of the shared-representation model of empathy.
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Affiliation(s)
- Qiaoyue Ren
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,General and Experimental Psychology Unit, Department of Psychology, LMU Munich, Munich, Germany
| | - Ye Yang
- Centre for Mental Health Research in School of Management, Zunyi Medical University, Zunyi, China
| | - Ye Wo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xuejing Lu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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15
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Frasson E, Tozzi MC, Bordignon M, Motti L, Ferrari F, Torre G, Graziottin A, Monaco S, Bertolasi L. Laser-Evoked Potentials to Pudendal Stimulation in Healthy Subjects: A Pilot Study. J Clin Neurophysiol 2021; 38:317-322. [PMID: 32217884 DOI: 10.1097/wnp.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Laser-evoked potentials (LEPs) are useful neurophysiological tools for investigating the A-delta sensory peripheral fibers and the central nociceptive pathway. The current investigation aims to obtain normative values of LEPs via pudendal nerve stimulation in healthy adult volunteers. METHODS Laser-evoked potentials were recorded in 16 men and 22 women, 22 to 75 years of age, using neodymium and yttrium and aluminum and perovskite laser bilateral stimulation to the pudendal nerve-supplied skin and the dorsal surface of the hands and feet. We assessed the perceptive threshold, latency, and amplitude of the N1 component and main vertex N2-P2 complex. The relationship between gender, age, height, and site of stimulation was statistically analyzed. RESULTS Both in men and in women, laser perceptive threshold increased from genitalia to foot and from hand to foot (P ≤ 0.001). N1 and N2-P2 latencies progressively increased from pudendal area to hand to foot (P ≤ 0.008). N1 and N2-P2 complex LEP amplitudes progressively decreased from hand to genitalia to foot (P ≤ 0.04). The latencies of N1 component and N2-P2 complex of LEPs correlated with body height, whereas the amplitude of the N2-P2 complex correlated negatively with age; no correlations were observed between the latencies and amplitudes with gender. CONCLUSIONS This study provides normative data on pudendal LEPs versus hand and foot LEPs. Incorporation of pudendal LEPs into clinical practice could provide a valuable neurophysiological tool for the study of pelvic pain syndromes.
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Affiliation(s)
- Emma Frasson
- Department of Neurology, AULSS 6 Euganea, Cittadella Hospital, Padua, Italy
| | - Maria Chiara Tozzi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Monia Bordignon
- Department of Management Control, AULSS 6 Euganea, Cittadella Hospital, Padua, Italy
| | - Luisa Motti
- Department of Neurophysiology, Azienda Ospedaliera S. Maria Nuova, Reggio Emilia, Italy ; and
| | - Francesca Ferrari
- Department of Neurophysiology, Azienda Ospedaliera S. Maria Nuova, Reggio Emilia, Italy ; and
| | - Gabriella Torre
- Department of Neurophysiology, Azienda Ospedaliera S. Maria Nuova, Reggio Emilia, Italy ; and
| | - Alessandra Graziottin
- Gynaecology and Medical Sexology Centre, Hospitale San Raffaele Resnati, Milan, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Laura Bertolasi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
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16
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Middleton SJ, Barry AM, Comini M, Li Y, Ray PR, Shiers S, Themistocleous AC, Uhelski ML, Yang X, Dougherty PM, Price TJ, Bennett DL. Studying human nociceptors: from fundamentals to clinic. Brain 2021; 144:1312-1335. [PMID: 34128530 PMCID: PMC8219361 DOI: 10.1093/brain/awab048] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/26/2020] [Accepted: 12/08/2020] [Indexed: 12/14/2022] Open
Abstract
Chronic pain affects one in five of the general population and is the third most important cause of disability-adjusted life-years globally. Unfortunately, treatment remains inadequate due to poor efficacy and tolerability. There has been a failure in translating promising preclinical drug targets into clinic use. This reflects challenges across the whole drug development pathway, from preclinical models to trial design. Nociceptors remain an attractive therapeutic target: their sensitization makes an important contribution to many chronic pain states, they are located outside the blood-brain barrier, and they are relatively specific. The past decade has seen significant advances in the techniques available to study human nociceptors, including: the use of corneal confocal microscopy and biopsy samples to observe nociceptor morphology, the culture of human nociceptors (either from surgical or post-mortem tissue or using human induced pluripotent stem cell derived nociceptors), the application of high throughput technologies such as transcriptomics, the in vitro and in vivo electrophysiological characterization through microneurography, and the correlation with pain percepts provided by quantitative sensory testing. Genome editing in human induced pluripotent stem cell-derived nociceptors enables the interrogation of the causal role of genes in the regulation of nociceptor function. Both human and rodent nociceptors are more heterogeneous at a molecular level than previously appreciated, and while we find that there are broad similarities between human and rodent nociceptors there are also important differences involving ion channel function, expression, and cellular excitability. These technological advances have emphasized the maladaptive plastic changes occurring in human nociceptors following injury that contribute to chronic pain. Studying human nociceptors has revealed new therapeutic targets for the suppression of chronic pain and enhanced repair. Cellular models of human nociceptors have enabled the screening of small molecule and gene therapy approaches on nociceptor function, and in some cases have enabled correlation with clinical outcomes. Undoubtedly, challenges remain. Many of these techniques are difficult to implement at scale, current induced pluripotent stem cell differentiation protocols do not generate the full diversity of nociceptor populations, and we still have a relatively poor understanding of inter-individual variation in nociceptors due to factors such as age, sex, or ethnicity. We hope our ability to directly investigate human nociceptors will not only aid our understanding of the fundamental neurobiology underlying acute and chronic pain but also help bridge the translational gap.
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Affiliation(s)
- Steven J Middleton
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Allison M Barry
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Maddalena Comini
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Yan Li
- Department of Anesthesia and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Pradipta R Ray
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Stephanie Shiers
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Andreas C Themistocleous
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.,Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Megan L Uhelski
- Department of Anesthesia and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xun Yang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Patrick M Dougherty
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Theodore J Price
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - David L Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
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17
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Lenoir D, Willaert W, Coppieters I, Malfliet A, Ickmans K, Nijs J, Vonck K, Meeus M, Cagnie B. Electroencephalography During Nociceptive Stimulation in Chronic Pain Patients: A Systematic Review. PAIN MEDICINE 2021; 21:3413-3427. [PMID: 32488229 DOI: 10.1093/pm/pnaa131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With its high temporal resolution, electroencephalography (EEG), a technique that records electrical activity of cortical neuronal cells, is a potentially suitable technique to investigate human somatosensory processing. By using EEG, the processing of (nociceptive) stimuli can be investigated, along with the functionality of the nociceptive pathway. Therefore, it can be applied in chronic pain patients to objectify whether changes have occurred in nociceptive processing. Typically, so-called event-related potential (ERP) recordings are used, where EEG signals are recorded in response to specific stimuli and characterized by latency and amplitude. OBJECTIVE To summarize whether differences in somatosensory processing occur between chronic pain patients and healthy controls, measured with ERPs, and determine whether this response is related to the subjective pain intensity. DESIGN Systematic review. SETTING AND METHODS PubMed, Web of Science, and Embase were consulted, and 18 case-control studies were finally included. SUBJECTS The chronic pain patients suffered from tension-type headache, back pain, migraine, fibromyalgia, carpal tunnel syndrome, prostatitis, or complex regional pain syndrome. RESULTS Chronic neuropathic pain patients showed increased latencies of the N2 and P2 components, along with a decreased amplitude of the N2-P2 complex, which was also obtained in FM patients with small fiber dysfunction. The latter also showed a decreased amplitude of the N2-P3 and N1-P1 complex. For the other chronic pain patients, the latencies and the amplitudes of the ERP components did not seem to differ from healthy controls. One paper indicated that the N2-P3 peak-to-peak amplitude correlates with the subjective experience of the stimulus. CONCLUSIONS Differences in ERPs with healthy controls can mostly be found in chronic pain populations that suffer from neuropathic pain or where fiber dysfunction is present. In chronic pain populations with other etiological mechanisms, limited differences were found or agreed upon across studies.
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Affiliation(s)
- Dorine Lenoir
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Ward Willaert
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Kelly Ickmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Kristl Vonck
- Department of Neurology, 4Brain, Ghent University Hospital, Ghent, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy - MOVANT Research Group, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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18
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Tucker-Bartley A, Lemme J, Gomez-Morad A, Shah N, Veliu M, Birklein F, Storz C, Rutkove S, Kronn D, Boyce AM, Kraft E, Upadhyay J. Pain Phenotypes in Rare Musculoskeletal and Neuromuscular Diseases. Neurosci Biobehav Rev 2021; 124:267-290. [PMID: 33581222 PMCID: PMC9521731 DOI: 10.1016/j.neubiorev.2021.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/18/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
For patients diagnosed with a rare musculoskeletal or neuromuscular disease, pain may transition from acute to chronic; the latter yielding additional challenges for both patients and care providers. We assessed the present understanding of pain across a set of ten rare, noninfectious, noncancerous disorders; Osteogenesis Imperfecta, Ehlers-Danlos Syndrome, Achondroplasia, Fibrodysplasia Ossificans Progressiva, Fibrous Dysplasia/McCune-Albright Syndrome, Complex Regional Pain Syndrome, Duchenne Muscular Dystrophy, Infantile- and Late-Onset Pompe disease, Charcot-Marie-Tooth Disease, and Amyotrophic Lateral Sclerosis. Through the integration of natural history, cross-sectional, retrospective, clinical trials, & case studies we described pathologic and genetic factors, pain sources, phenotypes, and lastly, existing therapeutic approaches. We highlight that while rare diseases possess distinct core pathologic features, there are a number of shared pain phenotypes and mechanisms that may be prospectively examined and therapeutically targeted in a parallel manner. Finally, we describe clinical and research approaches that may facilitate more accurate diagnosis, monitoring, and treatment of pain as well as elucidation of the evolving nature of pain phenotypes in rare musculoskeletal or neuromuscular illnesses.
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Affiliation(s)
- Anthony Tucker-Bartley
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jordan Lemme
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrea Gomez-Morad
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Nehal Shah
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Miranda Veliu
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Frank Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Rhineland-Palatinate, 55131, Germany
| | - Claudia Storz
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU Munich, Munich, Bavaria, 80539, Germany
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - David Kronn
- Department of Pathology and Pediatrics, New York Medical College, Valhalla, NY, 10595, USA; Medical Genetics, Inherited Metabolic & Lysosomal Storage Disorders Center, Boston Children's Health Physicians, Westchester, NY, 10532, USA
| | - Alison M Boyce
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Eduard Kraft
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU Munich, Munich, Bavaria, 80539, Germany; Interdisciplinary Pain Unit, University Hospital LMU Munich, Munich, 80539, Germany
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA.
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19
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Valeriani M, Liguori S, Vollono C, Testani E, Bangrazi S, Petti F, Liguori A, Germanotta M, Padua L, Pazzaglia C. Homotopic reduction in laser-evoked potential amplitude and laser-pain rating by abdominal acupuncture. Eur J Pain 2020; 25:659-667. [PMID: 33259079 DOI: 10.1002/ejp.1701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The neural mechanism underlying the analgesic effect of acupuncture is largely unknown. We aimed at investigating the effect of abdominal acupuncture (AA) on the laser-evoked potential (LEP) amplitude and laser-pain rating to stimulation of body parts either homotopic or heterotopic to the treated acupoint. METHODS Laser-evoked potentials were recorded from 13 healthy subjects to stimulation of the right wrist (RW), left wrist (LW) and right foot (RF). LEPs were obtained before, during and after the AA stimulation of an abdominal area corresponding to the representation of the RW. Subjective laser-pain rating was collected after each LEP recording. RESULTS The amplitude of the N2/P2 LEP component was significantly reduced during AA and 15 min after needle removal to both RW (F = 4.14, p = .02) and LW (F = 5.48, p = .008) stimulation, while the N2/P2 amplitude to RF stimulation (F = 0.94, p = .4) remained unchanged. Laser-pain rating was reduced during AA and 15 min after needle removal only to RW stimulation (F = 5.67, p = .007). CONCLUSION Our findings showing an AA effect on LEP components to both the ipsilateral and contralateral region homotopic to the treated area, without any LEP change to stimulation of a heterotopic region, suggest that the AA analgesia is mediated by a segmental spinal mechanism. SIGNIFICANCE Although abdominal acupuncture has demonstrated to be effective in the reduction in laser-evoked potential (LEP) amplitude and laser-pain rating, the exact mechanism of this analgesic effect is not known. In the current study, we found that treatment of an area in the "turtle representation" of the body led to a topographical pattern of LEP amplitude inhibition that can be mediated by a segmental spinal mechanism.
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Affiliation(s)
- Massimiliano Valeriani
- Department of Neuroscience, Pediatric Hospital Bambino Gesù, IRCCS, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | | | - Catello Vollono
- Neurofisiopatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | | | | | | | - Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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20
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Paparella G, Di Stefano G, Fasolino A, Di Pietro G, Colella D, Truini A, Cruccu G, Berardelli A, Bologna M. Painful stimulation increases spontaneous blink rate in healthy subjects. Sci Rep 2020; 10:20014. [PMID: 33203984 PMCID: PMC7672065 DOI: 10.1038/s41598-020-76804-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022] Open
Abstract
Spontaneous blink rate is considered a biomarker of central dopaminergic activity. Recent evidence suggests that the central dopaminergic system plays a role in nociception. In the present study, we aimed to investigate whether pain modulates spontaneous blink rate in healthy subjects. We enrolled 15 participants. Spontaneous blink rate was quantified with an optoelectronic system before and after: (1) a painful laser stimulation, and (2) an acoustic startling stimulation. In control experiments, we investigated whether laser stimulation effects depended on stimulation intensity and whether laser stimulation induced any changes in the blink reflex recovery cycle. Finally, we investigated any relationship between spontaneous blink rate modification and pain modulation effect during the cold pressor test. Laser, but not acoustic, stimulation increased spontaneous blink rate. This effect was independent of stimulation intensity and negatively correlated with pain perception. No changes in trigeminal-facial reflex circuit excitability were elicited by laser stimulation. The cold pressor test also induced an increased spontaneous blink rate. Our study provides evidence on the role of dopamine in nociception and suggests that dopaminergic activity may be involved in pain modulation. These findings lay the groundwork for further investigations in patients with pathological conditions characterized by dopaminergic deficit and pain.
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Affiliation(s)
| | - Giulia Di Stefano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alessandra Fasolino
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Giuseppe Di Pietro
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Andrea Truini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Giorgio Cruccu
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, IS, Italy. .,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
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21
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Squintani G, Rasera A, Segatti A, Concon E, Bonetti B, Valeriani M, Tinazzi M. Conditioned pain modulation affects the N2/P2 complex but not the N1 wave: A pilot study with laser-evoked potentials. Eur J Pain 2020; 25:550-557. [PMID: 33170987 DOI: 10.1002/ejp.1693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The 'pain-inhibits-pain' effect stems from neurophysiological mechanisms involving endogenous modulatory systems termed diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM). Laser-evoked potentials (LEPs) components, the N2/P2 complex, and the N1 wave, reflect the medial and lateral pain pathway, respectively: anatomically, the lateral thalamic nuclei (LT) project mainly to the somatosensory cortex (N1 generator), while the medial thalamic nuclei (MT) are bound to the limbic cortices (N2/P2 generators). METHODS We applied a CPM protocol in which the test stimulus was laser stimulation and the conditioning stimulus was a cold pressor test. LEPs recordings were obtained from 15 healthy subjects in three different conditions: baseline, during heterotopic noxious conditioning stimulation (HNCS) and post-HNCS. RESULTS We observed a significant reduction in N2/P2 amplitude during HNCS and a return to pre-test amplitude post-HNCS, whereas the N1 wave remained unchanged during and post-HNCS. CONCLUSIONS Our results indicate that CPM affects only the medial pain system. The spinothalamic tract (STT) transmits to both the LT and the MT, while the spinoreticulothalamic (SRT) projects only to the MT. The reduction in the amplitude of the N2/P2 complex and the absence of change in the N1 wave suggest that DNIC inhibition on the dorsal horn neurons affects only pain transmission via the SRT, while the neurons that give rise to the STT are not involved. The N1 wave can be a reliable neurophysiological parameter for assessment of STT function in clinical practice, as it does not seem to be influenced by CPM. SIGNIFICANCE No reports have described the effect of DNIC on lateral and medial pain pathways. We studied the N1 wave and the N2/P2 complex to detect changes during a CPM protocol. We found a reduction in the amplitude of the N2/P2 complex and no change in the N1 wave. This suggests that the DNIC inhibitory effect on dorsal horns neurons affects only pain transmission via the SRT, whereas the neurons that give rise to the STT are not involved.
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Affiliation(s)
- Giovanna Squintani
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Rasera
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| | - Alessia Segatti
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elisa Concon
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Bruno Bonetti
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michele Tinazzi
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy
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22
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Galosi E, Di Pietro G, La Cesa S, Di Stefano G, Leone C, Fasolino A, Di Lionardo A, Leonetti F, Buzzetti R, Mollica C, Cruccu G, Truini A. Differential involvement of myelinated and unmyelinated nerve fibers in painful diabetic polyneuropathy. Muscle Nerve 2020; 63:68-74. [PMID: 32996600 DOI: 10.1002/mus.27080] [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] [Received: 02/26/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND We aimed at evaluating the differential involvement of large myelinated Aβ-, small myelinated Aδ-, and unmyelinated C-fibers in patients with diabetic polyneuropathy and how they contribute to neuropathic pain. METHODS We collected clinical and diagnostic test variables in 133 consecutive patients with diabetic polyneuropathy. All patients underwent Aβ-fiber mediated nerve conduction study, Aδ-fiber mediated laser-evoked potentials and skin biopsy mainly assessing unmyelinated C-fibers. RESULTS Pure large-fiber and small-fiber polyneuropathy were relatively uncommon; conversely mixed-fiber polyneuropathy was the most common type of diabetic polyneuropathy (74%). The frequency of neuropathic pain was similar in the three different polyneuropathies. Ongoing burning pain and dynamic mechanical allodynia were similarly associated with specific small-fiber related variables. CONCLUSIONS Diabetic polyneuropathy mainly manifests as a mixed-fiber polyneuropathy, simultaneously involving Aβ-, Aδ-, and C-fibers. In most patients, neuropathic pain is distinctly associated with small-fiber damage. The evidence that the frequency of neuropathic pain does not differ across pure large-, pure small-, and mixed-fiber polyneuropathy, raises the possibility that in patients with pure large-fiber polyneuropathy nociceptive nerve terminal involvement might be undetected by standard diagnostic techniques.
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Affiliation(s)
- Eleonora Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Di Pietro
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Silvia La Cesa
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giulia Di Stefano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Caterina Leone
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Di Lionardo
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Frida Leonetti
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Raffaella Buzzetti
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Cristina Mollica
- Dipartimento di Metodi e Modelli per l'Economia, il Territorio e la Finanza, Sapienza University of Rome, Rome, Italy
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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23
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Goudman L, Daenen L, Mouraux A, Nijs J, Cras P, Roussel N, Moens M, Coppieters I, Huysmans E, De Kooning M. Processing of Laser-Evoked Potentials in Patients with Chronic Whiplash-Associated Disorders, Chronic Fatigue Syndrome, and Healthy Controls: A Case-Control Study. PAIN MEDICINE 2020; 21:2553-2563. [PMID: 32289826 DOI: 10.1093/pm/pnaa068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to investigate patients with neuropathic pain, as they can provide an objective account of the functional status of thermo-nociceptive pathways. The goal of this study was to explore the functioning of the nociceptive afferent pathways by examining LEPs in patients with chronic whiplash-associated disorders (cWAD), patients with chronic fatigue syndrome (CFS), and healthy controls (HCs). DESIGN Case-control study. SETTING A single medical center in Belgium. SUBJECTS The LEPs of 21 patients with cWAD, 19 patients with CFS, and 18 HCs were analyzed in this study. METHODS All participants received brief nociceptive CO2 laser stimuli applied to the dorsum of the left hand and left foot while brain activity was recorded with a 32-channel electroencephalogram (EEG). LEP signals and transient power modulations were compared between patient groups and HCs. RESULTS No between-group differences were found for stimulus intensity, which was supraliminal for Aδ fibers. The amplitudes and latencies of LEP wave components N1, N2, and P2 in patients with cWAD and CFS were statistically similar to those of HCs. There were no significant differences between the time-frequency maps of EEG oscillation amplitude between HCs and both patient populations. CONCLUSIONS EEG responses of heat-sensitive Aδ fibers in patients with cWAD and CFS revealed no significant differences from the responses of HCs. These findings thus do not support a state of generalized central nervous system hyperexcitability in those patients.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Liesbeth Daenen
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Knowledge, Information and Research Center (KIR), Group Idewe, Louvain, Belgium
| | - Andre Mouraux
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Patrick Cras
- Laboratory of Neurology, Translational Neurosciences, University of Antwerp, Wilrijk, Belgium.,Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Campus, Drie Eiken, Wilrijk, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Margot De Kooning
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
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24
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Uygur-Kucukseymen E, Castelo-Branco L, Pacheco-Barrios K, Luna-Cuadros MA, Cardenas-Rojas A, Giannoni-Luza S, Zeng H, Gianlorenco AC, Gnoatto-Medeiros M, Shaikh ES, Caumo W, Fregni F. Decreased neural inhibitory state in fibromyalgia pain: A cross-sectional study. Neurophysiol Clin 2020; 50:279-288. [PMID: 32654884 DOI: 10.1016/j.neucli.2020.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Chronic pain is one of the most common and challenging symptoms in fibromyalgia (FM). Currently, self-reported pain is the main criterion used by clinicians assessing patients with pain. However, it is subjective, and multiple factors can affect pain levels. In this study, we investigated the neural correlates of FM pain using conditioned pain modulation (CPM), electroencephalography (EEG), and transcranial magnetic stimulation (TMS). METHODS In this cross-sectional neurophysiological analysis of a randomized, double-blind controlled trial, 36 patients with fibromyalgia were included. We analyzed CPM, EEG variables and TMS measures and their correlation with pain levels as measured by a visual analog scale. Univariate and multivariate linear regression analyses were performed to identify the predictors of pain severity. RESULTS We found: (1) no association between pain levels and CPM; (2) an association between reduced alpha and beta power over the central region in resting-EEG and higher pain levels; (3) an association between smaller event-related desynchronization (ERD) responses in theta and delta bands over the central region and higher pain levels; (4) an association between smaller ERD responses in theta and delta bands and smaller intracortical inhibition and higher intracortical facilitation ratios; (5) an association between smaller ERD responses in delta band and reduced CPM. CONCLUSIONS Our results do not support CPM as a biomarker for pain intensity in FM. However, our specific EEG findings showing the relationship between pain, CPM and TMS measures suggest that FM leads to a disruption of inhibitory neural modulators and thus support CPM as a likely predictive marker of disrupted pain modulation system. These neurophysiological markers need to be further explored in potential future trials as to find novel targets for the treatment of FM.
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Affiliation(s)
- Elif Uygur-Kucukseymen
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA
| | - Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Maria Alejandra Luna-Cuadros
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA
| | - Stefano Giannoni-Luza
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA
| | - Huiyan Zeng
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA; Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Anna Carolyna Gianlorenco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA; Department of Physical Therapy, Federal University of Sao Carlos, Brazil
| | - Marina Gnoatto-Medeiros
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA
| | - Emad Salman Shaikh
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA
| | - Wolnei Caumo
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96-13th Street, Charlestown, Boston, MA, USA.
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25
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Geroin C, Di Vico IA, Squintani G, Segatti A, Bovi T, Tinazzi M. Effects of safinamide on pain in Parkinson's disease with motor fluctuations: an exploratory study. J Neural Transm (Vienna) 2020; 127:1143-1152. [PMID: 32572581 DOI: 10.1007/s00702-020-02218-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022]
Abstract
Pain is a common and disabling non-motor symptom (NMS) of Parkinson's disease (PD), which occurs through the course of the disease, often unrecognized and undertreated. For this study, we evaluated the efficacy and safety of safinamide to reduce pain in PD patients with motor fluctuations. A total of 13 PD patients with pain receiving safinamide (Xadago®, 100 mg/daily) were prospectively evaluated for 12 weeks. The primary outcome measures were changes in the total score of the King's Pain Scale for Parkinson's Disease (KPPS), Brief Pain Inventory (BPI) Intensity and Interference, and the Numeric Rating Scale (NRS). Secondary outcomes were the proportion of pain responders, changes in the Clinical Global Impression of Change (CGI), the Parkinson's disease Quality of Life 39 (PDQ39), the Unified Parkinson's Disease Rating Scale parts III and IV (UPDRS III and IV), and laser-evoked potentials (LEPs). LEPs were used to assess potential changes in the central processing of nociceptive inputs. The safety profile was evaluated based on the occurrence of treatment-emergent side effects and the dropout rate. After 12 weeks of add-on safinamide therapy, a significant improvement was noted in the primary (KPPS, BPI Intensity and interference, and NRS) and the secondary outcomes (UPDRS III, IV, CGI, and PDQ39). No significant changes in LEP complexes were observed. All patients completed the study and no treatment-emergent side effects were reported. Our preliminary findings suggest that safinamide 100 mg/day may be effective for the management of pain in PD patients with motor fluctuations and is safe. Further randomized controlled trials are needed to confirm its efficacy.
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Affiliation(s)
- Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
| | - Ilaria A Di Vico
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Giovanna Squintani
- UOC Neurologia A, Department of Neurosciences, AOUI Verona, Verona, Italy
| | - Alessia Segatti
- UOC Neurologia A, Department of Neurosciences, AOUI Verona, Verona, Italy
| | - Tommaso Bovi
- UOC Neurologia A, Department of Neurosciences, AOUI Verona, Verona, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
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26
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Schlereth T. Guideline "diagnosis and non interventional therapy of neuropathic pain" of the German Society of Neurology (deutsche Gesellschaft für Neurologie). Neurol Res Pract 2020; 2:16. [PMID: 33324922 PMCID: PMC7650069 DOI: 10.1186/s42466-020-00063-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/03/2020] [Indexed: 12/17/2022] Open
Abstract
2019 the DGN (Deutsche Gesellschaft für Neurology) published a new guideline on the diagnosis and non-interventional therapy of neuropathic pain of any etiology excluding trigeminal neuralgia and CRPS (complex regional pain syndrome). Neuropathic pain occurs after lesion or damage of the somatosensory system. Besides clinical examination several diagnostic procedures are recommended to assess the function of nociceptive A-delta and C-Fibers (skin biopsy, quantitative sensory testing, Laser-evoked potentials, Pain-evoked potentials, corneal confocal microscopy, axon reflex testing). First line treatment in neuropathic pain is pregabalin, gabapentin, duloxetine and amitriptyline. Second choice drugs are topical capsaicin and lidocaine, which can also be considered as primary treatment in focal neuropathic pain. Opioids are considered as third choice treatment. Botulinum toxin can be considered as a third choice drug for focal limited pain in specialized centers only. Carbamazepine and oxcarbazepine cannot be generally recommended, but might be helpful in single cases. In Germany, cannabinoids can be prescribed, but only after approval of reimbursement. However, the use is not recommended, and can only be considered as off-label therapy within a multimodal therapy concept.
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Affiliation(s)
- Tanja Schlereth
- DKD Helios Hospital Wiesbaden, Aukammallee 33, 65191 Wiesbaden, Germany
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27
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Does Motor Cortex Engagement During Movement Preparation Differentially Inhibit Nociceptive Processing in Patients with Chronic Whiplash Associated Disorders, Chronic Fatigue Syndrome and Healthy Controls? An Experimental Study. J Clin Med 2020; 9:jcm9051520. [PMID: 32443565 PMCID: PMC7290436 DOI: 10.3390/jcm9051520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with chronic fatigue syndrome (CFS) and chronic whiplash associated disorders (cWAD) present a reduced ability to activate central descending nociceptive inhibition after exercise, compared to measurements before exercise. It was hypothesised that a dysfunctional motor-induced inhibition of nociception partly explains this dysfunctional exercise-induced hypoalgesia. This study investigates if engagement of the motor system during movement preparation inhibits nociception-evoked brain responses in these patients as compared to healthy controls (HC). METHODS The experiment used laser-evoked potentials (LEPs) during three conditions (no task, mental task, movement preparation) while recording brain activity with a 32-channel electroencephalogram in 21 patients with cWAD, 20 patients with CFS and 18 HC. Two-factor mixed design Analysis of variance were used to evaluate differences in LEP amplitudes and latencies. RESULTS No differences in N1, N2, N2P2, and P2 LEP amplitudes were found between the HC, CFS, and cWAD groups. After nociceptive stimulation, N1, N2 (only at hand location), N2P2, and P2 LEP amplitudes significantly decreased during movement preparation compared to no task (within group differences). CONCLUSION Movement preparation induces a similar attenuation of LEPs in patients with CFS, patients with cWAD and HC. These findings do not support reduced motor-induced nociceptive inhibition in these patients.
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28
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de Tommaso M, Betti V, Bocci T, Bolognini N, Di Russo F, Fattapposta F, Ferri R, Invitto S, Koch G, Miniussi C, Piccione F, Ragazzoni A, Sartucci F, Rossi S, Arcara G, Berchicci M, Bianco V, Delussi M, Gentile E, Giovannelli F, Mannarelli D, Marino M, Mussini E, Pauletti C, Pellicciari MC, Pisoni A, Raggi A, Valeriani M. Pearls and pitfalls in brain functional analysis by event-related potentials: a narrative review by the Italian Psychophysiology and Cognitive Neuroscience Society on methodological limits and clinical reliability-part I. Neurol Sci 2020; 41:2711-2735. [PMID: 32388645 DOI: 10.1007/s10072-020-04420-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/13/2020] [Indexed: 12/14/2022]
Abstract
Event-related potentials (ERPs) are obtained from the electroencephalogram (EEG) or the magnetoencephalogram (MEG, event-related fields (ERF)), extracting the activity that is time-locked to an event. Despite the potential utility of ERP/ERF in cognitive domain, the clinical standardization of their use is presently undefined for most of procedures. The aim of the present review is to establish limits and reliability of ERP medical application, summarize main methodological issues, and present evidence of clinical application and future improvement. The present section of the review focuses on well-standardized ERP methods, including P300, Contingent Negative Variation (CNV), Mismatch Negativity (MMN), and N400, with a chapter dedicated to laser-evoked potentials (LEPs). One section is dedicated to proactive preparatory brain activity as the Bereitschaftspotential and the prefrontal negativity (BP and pN). The P300 and the MMN potentials have a limited but recognized role in the diagnosis of cognitive impairment and consciousness disorders. LEPs have a well-documented usefulness in the diagnosis of neuropathic pain, with low application in clinical assessment of psychophysiological basis of pain. The other ERP components mentioned here, though largely applied in normal and pathological cases and well standardized, are still confined to the research field. CNV, BP, and pN deserve to be largely tested in movement disorders, just to explain possible functional changes in motor preparation circuits subtending different clinical pictures and responses to treatments.
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Affiliation(s)
- Marina de Tommaso
- Applied Neurophysiology and Pain Unit-AnpLab-University of Bari Aldo Moro, Bari, Italy
| | - Viviana Betti
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia (Santa Lucia Foundation), Rome, Italy
| | - Tommaso Bocci
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology & NeuroMi, University of Milano Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico, Milan, Italy
| | - Francesco Di Russo
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | | | - Sara Invitto
- INSPIRE - Laboratory of Cognitive and Psychophysiological Olfactory Processes, University of Salento, Lecce, Italy
| | - Giacomo Koch
- IRCCS Fondazione Santa Lucia (Santa Lucia Foundation), Rome, Italy.,Department of Neuroscience, Policlinico Tor Vergata, Rome, Italy
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy.,Cognitive Neuroscience Section, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Francesco Piccione
- Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Aldo Ragazzoni
- Unit of Neurology and Clinical Neurophysiology, Fondazione PAS, Scandicci, Florence, Italy
| | - Ferdinando Sartucci
- Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,CNR Institute of Neuroscience, Pisa, Italy
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience Siena Brain Investigation and Neuromodulation Lab (SI-BIN Lab), University of Siena, Siena, Italy
| | - Giorgio Arcara
- Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Marika Berchicci
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Valentina Bianco
- IRCCS Fondazione Santa Lucia (Santa Lucia Foundation), Rome, Italy.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain Unit-AnpLab-University of Bari Aldo Moro, Bari, Italy
| | - Eleonora Gentile
- Applied Neurophysiology and Pain Unit-AnpLab-University of Bari Aldo Moro, Bari, Italy
| | - Fabio Giovannelli
- Section of Psychology - Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Florence, Italy
| | - Daniela Mannarelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Marco Marino
- Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Elena Mussini
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Caterina Pauletti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Alberto Pisoni
- Department of Psychology & NeuroMi, University of Milano Bicocca, Milan, Italy
| | - Alberto Raggi
- Unit of Neurology, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy
| | - Massimiliano Valeriani
- Neurology Ward Unit, Bambino Gesù Hospital, Rome, Italy. .,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark.
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29
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Heid C, Mouraux A, Treede RD, Schuh-Hofer S, Rupp A, Baumgärtner U. Early gamma-oscillations as correlate of localized nociceptive processing in primary sensorimotor cortex. J Neurophysiol 2020; 123:1711-1726. [PMID: 32208893 DOI: 10.1152/jn.00444.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Recent studies put forward the idea that stimulus-evoked gamma-band oscillations (GBOs; 30-100 Hz) play a specific role in nociception. So far, evidence for the specificity of GBOs for nociception, their possible involvement in nociceptive sensory discriminatory abilities, and knowledge regarding their cortical sources is just starting to grow. To address these questions, we used electroencephalography (EEG) to record brain activity evoked by phasic nociceptive laser stimuli and tactile stimuli applied at different intensities to the right hand and foot of 12 healthy volunteers. The EEG was analyzed in the time domain to extract phase-locked event-related brain potentials (ERPs) and in three regions of interest in the time-frequency domain (delta/theta, 40-Hz gamma, 70-Hz gamma) to extract stimulus-evoked changes in the magnitude of non-phase-locked brain oscillations. Both nociceptive and tactile stimuli, matched with respect to subjective intensity, elicited phase locked ERPs of increasing amplitude with increasing stimulus intensity. In contrast, only nociceptive stimuli elicited a significant enhancement of GBOs (65-85 Hz, 150-230 ms after stimulus onset), whose magnitude encoded stimulus intensity, whereas tactile stimuli led to a GBO decrease. Following nociceptive hand stimulation, the topographical distribution of GBOs was maximal at contralateral electrode C3, whereas maximum activity following foot stimulation was recorded at the midline electrode Cz, compatible with generation of GBOs in the representations of the hand and foot of the primary sensorimotor cortex, respectively. The differential behavior of high-frequency GBOs and low-frequency 40-Hz GBOs is indicating different functional roles and regions in sensory processing.NEW & NOTEWORTHY Gamma-band oscillations show hand-foot somatotopy compatible with generation in primary sensorimotor cortex and are present following nociceptive but not tactile stimulation of the hand and foot in humans.
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Affiliation(s)
- C Heid
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - A Mouraux
- Institute of Neuroscience (IONS), Université catholique de Louvain, Brussels B-1200, Belgium
| | - R-D Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - S Schuh-Hofer
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - A Rupp
- Department of Neurology, Section of Biomagnetism, University of Heidelberg, Heidelberg, Germany
| | - U Baumgärtner
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany.,Department of Human Medicine, Faculty of Life Sciences, Medical School Hamburg (MSH), Hamburg, Germany
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30
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Santoro M, Vollono C, Pazzaglia C, Di Sipio E, Giordano R, Padua L, Arendt‐Nielsen L, Valeriani M. ZNRD1‐AS
and
RP11‐819C21.1
long non‐coding RNA changes following painful laser stimulation correlate with laser‐evoked potential amplitude and habituation in healthy subjects: A pilot study. Eur J Pain 2020; 24:593-603. [DOI: 10.1002/ejp.1511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 12/27/2022]
Affiliation(s)
| | - Catello Vollono
- Unit of Neurophysiopathology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Costanza Pazzaglia
- Unit of High Intensity NeurorehabilitationFondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | | | - Rocco Giordano
- Center for Neuroplasticity and Pain (CNAP) SMI Department of Health Science and Technology Faculty of Medicine Aalborg University Aalborg Denmark
| | - Luca Padua
- Università Cattolica del Sacro Cuore Rome Italy
- Unit of High Intensity NeurorehabilitationFondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Lars Arendt‐Nielsen
- Center for Neuroplasticity and Pain (CNAP) SMI Department of Health Science and Technology Faculty of Medicine Aalborg University Aalborg Denmark
| | - Massimiliano Valeriani
- Neurology Unit, Ospedale Pediatrico Bambino Gesú IRCCSPiazza di Sant'Onofrio Rome Italy
- Center for Sensory-Motor Interaction Aalborg University Aalborg Denmark
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31
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S2k-Leitlinie: Diagnose und nicht interventionelle Therapie neuropathischer Schmerzen. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42451-019-00139-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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32
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Van Assche DCF, Plaghki L, Masquelier E, Hatem SM. Fibromyalgia syndrome—A laser‐evoked potentials study unsupportive of small nerve fibre involvement. Eur J Pain 2019; 24:448-456. [DOI: 10.1002/ejp.1501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 02/02/2023]
Affiliation(s)
| | - Leon Plaghki
- Institute of Neuroscience Université catholique de Louvain Brussels Belgium
| | - Etienne Masquelier
- Institute of Neuroscience Université catholique de Louvain Brussels Belgium
- Multidisciplinary Pain Center CHU UCL Namur, site Godinne Yvoir Belgium
| | - Samar M. Hatem
- Physical Medicine and Rehabilitation Brugmann University Hospital Brussels Belgium
- Institute of Neuroscience Université catholique de Louvain Brussels Belgium
- Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium
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Casasnovas C, Ruiz M, Schlüter A, Naudí A, Fourcade S, Veciana M, Castañer S, Albertí A, Bargalló N, Johnson M, Raymond GV, Fatemi A, Moser AB, Villarroya F, Portero-Otín M, Artuch R, Pamplona R, Pujol A. Biomarker Identification, Safety, and Efficacy of High-Dose Antioxidants for Adrenomyeloneuropathy: a Phase II Pilot Study. Neurotherapeutics 2019; 16:1167-1182. [PMID: 31077039 PMCID: PMC6985062 DOI: 10.1007/s13311-019-00735-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
X-Adrenoleukodystrophy (X-ALD) and its adult-onset, most prevalent variant adrenomyeloneuropathy (AMN) are caused by mutations in the peroxisomal transporter of the very long-chain fatty acid ABCD1. AMN patients classically present spastic paraparesis that can progress over decades, and a satisfactory treatment is currently lacking. Oxidative stress is an early culprit in X-ALD pathogenesis. A combination of antioxidants halts the clinical progression and axonal damage in a murine model of AMN, providing a strong rationale for clinical translation. In this phase II pilot, open-label study, 13 subjects with AMN were administered a high dose of α-tocopherol, N-acetylcysteine, and α-lipoic acid in combination. The primary outcome was the validation of a set of biomarkers for monitoring the biological effects of this and future treatments. Functional clinical scales, the 6-minute walk test (6MWT), electrophysiological studies, and cerebral MRI served as secondary outcomes. Most biomarkers of oxidative damage and inflammation were normalized upon treatment, indicating an interlinked redox and inflammatory homeostasis. Two of the inflammatory markers, MCP1 and 15-HETE, were predictive of the response to treatment. We also observed a significant decrease in central motor conduction time, together with an improvement or stabilization of the 6MWT in 8/10 subjects. This study provides a series of biomarkers that are useful to monitor redox and pro-inflammatory target engagement in future trials, together with candidate biomarkers that may serve for patient stratification and disease progression, which merit replication in future clinical trials. Moreover, the clinical results suggest a positive signal for extending these studies to phase III randomized, placebo-controlled, longer-term trials with the actual identified dose. ClinicalTrials.gov Identifier: NCT01495260.
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Affiliation(s)
- Carlos Casasnovas
- Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Feixa Llarga s/n, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
| | - Montserrat Ruiz
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
- Institute of Neuropathology, Bellvitge Biomedical Research Institute, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Agatha Schlüter
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
- Institute of Neuropathology, Bellvitge Biomedical Research Institute, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alba Naudí
- Biomedical Research Institute of Lleida, Montserrat Roig 2, 25008, Lleida, Spain
| | - Stéphane Fourcade
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
- Institute of Neuropathology, Bellvitge Biomedical Research Institute, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Misericordia Veciana
- Neurophysiology Unit, Neurology Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sara Castañer
- Centre Bellvitge, Institut de Diagnòstic per la Imatge, Feixa Llarga s/n, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonia Albertí
- Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Feixa Llarga s/n, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Bargalló
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain
- Magnetic Resonance Imaging Core Facility, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Johnson
- Deparment of Neurology and Pediatrics, University of Minnesota Medical Center, 516 Delaware Street Southeast, Minneapolis, Minnesota, 55455, USA
| | - Gerald V Raymond
- Deparment of Neurology and Pediatrics, University of Minnesota Medical Center, 516 Delaware Street Southeast, Minneapolis, Minnesota, 55455, USA
| | - Ali Fatemi
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205, USA
| | - Ann B Moser
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205, USA
| | - Francesc Villarroya
- Departament de Bioquimica i Biologia Molecular and Institute of Biomedicine of the University of Barcelona, Facultat de Biologia, Universitat de Barcelona, Avinguda Diagonal 645, 08028, Barcelona, Spain
- Center for Biomedical Research in Physiopathology of Obesity and Nutrition, Bellvitge Biomedical Research Institute, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
| | - Manuel Portero-Otín
- Biomedical Research Institute of Lleida, Montserrat Roig 2, 25008, Lleida, Spain
| | - Rafael Artuch
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Reinald Pamplona
- Biomedical Research Institute of Lleida, Montserrat Roig 2, 25008, Lleida, Spain
| | - Aurora Pujol
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain.
- Institute of Neuropathology, Bellvitge Biomedical Research Institute, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.
- Catalan Institution of Research and Advanced Studies, Passeig de Lluís Companys 23, 08010, Barcelona, Spain.
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Jones MD, Nuzzo JL, Taylor JL, Barry BK. Aerobic Exercise Reduces Pressure More Than Heat Pain Sensitivity in Healthy Adults. PAIN MEDICINE 2019; 20:1534-1546. [PMID: 30649457 DOI: 10.1093/pm/pny289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The hypoalgesic effects of exercise are well described, but there are conflicting findings for different modalities of pain; in particular for mechanical vs thermal noxious stimuli, which are the most commonly used in studies of exercise-induced hypoalgesia. The aims of this study were 1) to investigate the effect of aerobic exercise on pressure and heat pain thresholds that were well equated with regard to their temporal and spatial profile and 2) to identify whether changes in the excitability of nociceptive pathways-measured using laser-evoked potentials-accompany exercise-induced hypoalgesia. SUBJECTS Sixteen healthy adults recruited from the University of New South Wales. METHODS Pressure and heat pain thresholds and pain ratings to laser stimulation and laser-evoked potentials were measured before and after aerobic cycling exercise and an equivalent period of light activity. RESULTS Pressure pain thresholds increased substantially after exercise (rectus femoris: 29.6%, d = 0.82, P < 0.001; tibialis anterior: 26.9%, d = 0.61, P < 0.001), whereas heat pain thresholds did not (tibialis anterior: 4.2%, d = 0.30, P = 0.27; foot: 0.44%, d = 0.02, P = 1). Laser-evoked potentials and laser heat pain ratings also changed minimally after exercise (d = -0.59 to 0.3, P > 0.06). CONCLUSIONS This is the first investigation to compare the effects of exercise on pressure and heat pain using the same stimulation site and pattern. The results show that aerobic exercise reduces mechanical pain sensitivity more than thermal pain sensitivity.
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Affiliation(s)
- Matthew D Jones
- School of Medical Sciences, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia
| | - James L Nuzzo
- School of Medical Sciences, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia
| | - Janet L Taylor
- School of Medical Sciences, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, Edith Cowan University, Perth, Australia
| | - Benjamin K Barry
- School of Medical Sciences, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,School of Clinical Medicine, The University of Queensland, Brisbane, Australia
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Bocci T, De Carolis G, Ferrucci R, Paroli M, Mansani F, Priori A, Valeriani M, Sartucci F. Cerebellar Transcranial Direct Current Stimulation (ctDCS) Ameliorates Phantom Limb Pain and Non-painful Phantom Limb Sensations. THE CEREBELLUM 2019; 18:527-535. [DOI: 10.1007/s12311-019-01020-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Fiorelli A, Pace C, Cascone R, Carlucci A, De Ruberto E, Izzo AC, Passavanti B, Chiodini P, Pota V, Aurilio C, Santini M, Sansone P. Preventive skin analgesia with lidocaine patch for management of post-thoracotomy pain: Results of a randomized, double blind, placebo controlled study. Thorac Cancer 2019; 10:631-641. [PMID: 30806017 PMCID: PMC6449230 DOI: 10.1111/1759-7714.12975] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/22/2018] [Accepted: 12/23/2018] [Indexed: 12/18/2022] Open
Abstract
Background To evaluate whether pre‐emptive skin analgesia using a lidocaine patch 5% would improve the effects of systemic morphine analgesia for controlling acute post‐thoracotomy pain. Methods This was a double‐blind, placebo controlled, prospective study. Patients were randomly assigned to receive lidocaine 5% patch (lidocaine group) or a placebo (placebo group) three days before thoracotomy. Postoperative analgesia was induced in all cases with intravenous morphine analgesia. The intergroup differences were assessed in order to evaluate whether the lidocaine patch 5% would have effects on pain intensity when at rest and after coughing (primary end‐point) on morphine consumption, on the recovery of respiratory function, and on peripheral painful pathways measured with N2 and P2 laser‐evoked potential (secondary end‐points). Results A total of 90 patients were randomized, of whom 45 were allocated to the lidocaine group and 45 to the placebo group. Lidocaine compared with the placebo group showed a significant reduction in pain intensity both at rest (P = 0.013) and after coughing (P = 0.015), and in total morphine consumption (P = 0.001); and also showed a better recovery of flow expiratory volume in one second (P = 0.025) and of forced vital capacity (P = 0.037). The placebo group compared with the lidocaine group presented a reduction in amplitude of N2 (P = 0.001) and P2 (P = 0.03), and an increase in the latency of N2 (P = 0.023) and P2 (P = 0.025) laser‐evoked potential. Conclusions The preventive skin analgesia with lidocaine patch 5% seems to be a valid adjunct to intravenous morphine analgesia for controlling post‐thoracotomy pain. However, our initial results should be corroborated/confirmed by larger studies.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Pace
- Anesthesia and Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Cascone
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Annalisa Carlucci
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele De Ruberto
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Anna Cecilia Izzo
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Beatrice Passavanti
- Anesthesia and Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Chiodini
- Statistical Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Pota
- Anesthesia and Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Aurilio
- Anesthesia and Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pasquale Sansone
- Anesthesia and Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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Electroencephalography and magnetoencephalography in pain research-current state and future perspectives. Pain 2019; 159:206-211. [PMID: 29944612 DOI: 10.1097/j.pain.0000000000001087] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
Clinical neurophysiologic investigation of pain pathways in humans is based on specific techniques and approaches, since conventional methods of nerve conduction studies and somatosensory evoked potentials do not explore these pathways. The proposed techniques use various types of painful stimuli (thermal, laser, mechanical, or electrical) and various types of assessments (measurement of sensory thresholds, study of nerve fiber excitability, or recording of electromyographic reflexes or cortical potentials). The two main tests used in clinical practice are quantitative sensory testing and pain-related evoked potentials (PREPs). In particular, PREPs offer the possibility of an objective assessment of nociceptive pathways. Three types of PREPs can be distinguished depending on the type of stimulation used to evoke pain: laser-evoked potentials, contact heat evoked potentials, and intraepidermal electrical stimulation evoked potentials (IEEPs). These three techniques investigate both small-diameter peripheral nociceptive afferents (mainly Aδ nerve fibers) and spinothalamic tracts without theoretically being able to differentiate the level of lesion in the case of abnormal results. In routine clinical practice, PREP recording is a reliable method of investigation for objectifying the existence of a peripheral or central lesion or loss of function concerning the nociceptive pathways, but not the existence of pain. Other methods, such as nerve fiber excitability studies using microneurography, more directly reflect the activities of nociceptive axons in response to provoked pain, but without detecting or quantifying the presence of spontaneous pain. These methods are more often used in research or experimental study design. Thus, it should be kept in mind that most of the results of neurophysiologic investigation performed in clinical practice assess small fiber or spinothalamic tract lesions rather than the neuronal mechanisms directly at the origin of pain and they do not provide objective quantification of pain.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Excitabilité Nerveuse et Thérapeutique, Faculté de Médecine de Créteil, Université Paris-Est-Créteil, Hôpital Henri Mondor, Créteil, France; Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Créteil, France.
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Morgalla MH, de Barros Filho MF, Chander BS, Soekadar SR, Tatagiba M, Lepski G. Neurophysiological Effects of Dorsal Root Ganglion Stimulation (DRGS) in Pain Processing at the Cortical Level. Neuromodulation 2018; 22:36-43. [PMID: 30561852 DOI: 10.1111/ner.12900] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Dorsal root ganglion stimulation (DRGS) has been used successfully against localized neuropathic pain. Nevertheless, the effects of DRGS on pain processing, particularly at the cortical level, remain largely unknown. In this study, we investigated whether positive responses to DRGS treatment would alter patients' laser-evoked potentials (LEP). METHODS We prospectively enrolled 12 adult patients with unilateral localized neuropathic pain in the lower limbs or inguinal region and followed them up for six months. LEPs were assessed at baseline, after one month of DRGS, and after six months of DRGS. Clinical assessment included the Numerical Rating Scale (NRS), Brief Pain Inventory (BPI), SF-36, and Beck Depression Inventory (BDI). For each patient, LEP amplitudes and latencies of the N2 and P2 components on the deafferented side were measured and compared to those of the healthy side and correlated with pain intensity, as measured with the NRS. RESULTS At the one- and six-month follow-ups, N2-P2 amplitudes were significantly greater and NRS scores were significantly lower compared with baseline (all p's < 0.01). There was a negative correlation between LEP amplitudes and NRS scores (rs = -0.31, p < 0.10). CONCLUSIONS DRGS is able to restore LEPs to normal values in patients with localized neuropathic pain, and LEP alterations are correlated with clinical response in terms of pain intensity.
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Affiliation(s)
| | - Marcos Fortunato de Barros Filho
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.,Applied Neurotechnology Laboratory, Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.,Division of Functional Neurosurgery, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Bankim Subhash Chander
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.,Applied Neurotechnology Laboratory, Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Surjo Raphael Soekadar
- Applied Neurotechnology Laboratory, Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.,Clinical Neurotechnology Laboratory, Neuroscience Research Center (NWFZ) & Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Guilherme Lepski
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.,Division of Functional Neurosurgery, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Pazzaglia C, Vollono C, Testani E, Coraci D, Granata G, Padua L, Valeriani M. Low-Frequency rTMS of the Primary Motor Area Does Not Modify the Response of the Cerebral Cortex to Phasic Nociceptive Stimuli. Front Neurosci 2018; 12:878. [PMID: 30555294 PMCID: PMC6281959 DOI: 10.3389/fnins.2018.00878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/12/2018] [Indexed: 01/12/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique of cortical stimulation. Although the exact mechanism of action is not clearly understood, it has been postulated that rTMS action on pain depends most on stimulation sites and stimulation parameters. Most studies concern high-frequency rTMS of the primary motor cortex (M1). High-frequency rTMS over motor cortex seems to induce an analgesic effect while contrasting results were reported after low-frequency rTMS. The aim of the current study was to investigate the effects of 1 Hz rTMS stimulation over the left primary motor cortex on subjective laser pain rating and laser evoked potential (LEP) amplitudes in healthy subjects. Subjects underwent two different sessions (real and sham rTMS) according to a cross-sectional design. In each session, LEPs and laser-pain rating to stimulation of both right and left hand dorsum were collected before 1 Hz rTMS over the left M1 area (baseline), which lasted 20 min. Then, LEPs and laser-pain rating were measured immediately after rTMS (T0), after 20 min from T0 (T0+20), and after 40 min from T0 (T0+40). We could not find any modification of both laser-pain rating and LEP parameters (latencies and amplitudes) following 1 Hz rTMS. Therefore, our results show that the low-frequency rTMS of the M1 area does not change the response of the cerebral cortex to pain.
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Affiliation(s)
- Costanza Pazzaglia
- Unit of High Intensity Neurorehabilitation, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Catello Vollono
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Elisa Testani
- Department of Neurological and Neurosensory Sciences, University Hospital of Siena, Siena, Italy
| | | | - Giuseppe Granata
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luca Padua
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.,Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Valeriani
- Department of Neuroscience, Pediatric Hospital Bambino Gesù, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Yoon SY, Oh J. Neuropathic cancer pain: prevalence, pathophysiology, and management. Korean J Intern Med 2018; 33:1058-1069. [PMID: 29929349 PMCID: PMC6234399 DOI: 10.3904/kjim.2018.162] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/07/2018] [Indexed: 12/27/2022] Open
Abstract
Neuropathic cancer pain (NCP) is caused by nerve damage attributable to the cancer per se, and/or treatments including chemotherapy, radiotherapy, and surgery; the prevalence is reported to be as high as 40%. The etiologies of NCP include direct nerve invasion or nerve compression by the cancer, neural toxicity, chemotherapy, and radiotherapy. NCP is subdivided into plexopathy, radiculopathy, and peripheral neuropathies, among several other categories. The clinical characteristics of NCP differ from those of nociceptive pain in terms of both the hypersensitivity symptoms (burning, tingling, and an electrical sensation) and the hyposensitivity symptoms (numbness and muscle weakness). Recovery requires several months to years, even after recovery from injury. Management is complex; NCP does not usually respond to opioids, although treatments may feature both opioids and adjuvant drugs including antidepressants, anticonvulsants, and anti-arrhythmic agents, all of which improve the quality-of-life. This review addresses the pathophysiology, clinical characteristics and management of NCP, and factors rendering pain control difficult.
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Affiliation(s)
- So Young Yoon
- Division of Oncology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
- Correspondence to Jeeyoung Oh, M.D. Department of Neurology, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: +82-2-2030-7564 Fax: +82-2-2030-5169 E-mail:
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Fischer M, Höffken O, Özgül ÖS, Maier C. Bilaterally prolonged latencies of pain-related evoked potentials in peripheral nerve injuries. Neurosci Lett 2018; 684:78-85. [PMID: 30008381 DOI: 10.1016/j.neulet.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cross-sectional study to test the applicability of pain-related evoked potentials (PREP) for the diagnosis of peripheral nerve injuries (PNI). INTRODUCTION Patients with generalized polyneuropathies show prolonged latencies and decreased amplitudes of PREP indicating an impairment of A-delta fibers. Although these fibers are frequently affected in PNI, it is unclear, if PREP-testing detects PNI comparable to Nerve Conduction Studies (NCS). METHODS 23 patients with PNI of one upper limb underwent bilateral PREP-testing (using concentric surface electrodes) and NCS. 41 healthy controls underwent PREP-testing only. We determined pain thresholds, N1-latencies and N1P1-amplitudes of PREP and analyzed them for group and side-to-side differences. Small-fiber function was evaluated using thermal detection thresholds of Quantitative Sensory Testing (QST). N1-latencies above a cut-off calculated by ROC-analysis were defined as abnormal in order to compare detection rates of PREP and NCS. RESULTS Patients with PNI showed bilaterally prolonged N1-latencies (ipsilateral: 167.0 ± 40.7 ms vs. 141.2 ± 20.5 ms / contralateral: 160.0 ± 41.0 ms vs. 140.2 ± 23.9 ms) without a significant side-to-side difference. Pain thresholds were increased on the affected side only (4.6 ± 5.2 mA vs. 2.4 ± 1.4 mA (controls)). N1P1-amplitudes did not differ between patients and controls. 7 (32%) patients showed prolonged N1-latencies (>176 ms) of PREP. NCS were abnormal in 16 (73%) cases. 13 (59%) patients showed thermal hypoesthesia in QST. CONCLUSION Contrary to our expectations, we found bilaterally prolonged N1-latencies and normal N1P1-amplitudes in patients with PNI. Our findings support the hypothesis of a bilateral generation of PREP and indicate that PREP are not suitable for the diagnosis of PNI.
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Affiliation(s)
- Marc Fischer
- Department of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bochum, Germany.
| | - Oliver Höffken
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bochum, Germany.
| | - Özüm Simal Özgül
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bochum, Germany.
| | - Christoph Maier
- Department of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bochum, Germany.
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Valeriani M, Pazzaglia C, Rizzo V, Quartarone A, Vollono C. Laser evoked potential amplitude and laser-pain rating reduction during high-frequency non-noxious somatosensory stimulation. Clin Neurophysiol 2018; 129:920-925. [DOI: 10.1016/j.clinph.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 02/02/2018] [Accepted: 02/14/2018] [Indexed: 12/30/2022]
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Functional MRI and laser-evoked potentials evaluation in Charcot-Marie-Tooth syndrome. Neurol Sci 2018; 39:1185-1189. [DOI: 10.1007/s10072-018-3401-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
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Bocci T, De Carolis G, Paroli M, Barloscio D, Parenti L, Tollapi L, Valeriani M, Sartucci F. Neurophysiological Comparison Among Tonic, High Frequency, and Burst Spinal Cord Stimulation: Novel Insights Into Spinal and Brain Mechanisms of Action. Neuromodulation 2018; 21:480-488. [PMID: 29314454 DOI: 10.1111/ner.12747] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 12/15/2022]
Abstract
RATIONALE Spinal cord stimulation (SCS) is an effective option for neuropathic pain treatment. New technological developments, as high-frequency (HF) and theta burst stimulation (TBS), have shown promising results, although putative mechanisms of action still remain debated. METHODS thirty patients with lower back pain were enrolled and underwent LF, HF, and TBS. Laser evoked potentials (LEPs) were recorded by using a Nd:YAG laser. Amplitudes and latencies of the main two components (N1, N2/P2) were compared among different experimental sessions. Changes in resting motor threshold (RMT), cortical silent period (cSP), short intracortical inhibition (SICI), and intracortical facilitation (ICF) were also evaluated. RESULTS TBS dampened LEP amplitudes compared with LF (N1: p = 0.032; N2/P2: p < 0.0001) and HF stimulation (N1: p = 0.029; N2/P2: p < 0.0001, Holm-Sidak post-hoc test). Concurrently, TBS increased N1 latency, when compared with baseline and LF stimulation (p = 0.009 and 0.0033). Whereas RMT and SICI did not change among experimental conditions, TBS significantly prolonged cSP duration compared with baseline (p = 0.002), LF (p = 0.048), and HF-SCS (p = 0.016); finally, both HF (p = 0.004) and TBS (p = 0.0039) increased ICF. CONCLUSION TBS modulates medial and lateral pain pathways through distinct mechanisms, possibly involving both GABA(a)ergic and Glutamatergic networks at an intracortical level. These results may have implications for therapy and for the choice of best stimulation protocol.
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Affiliation(s)
- Tommaso Bocci
- Department of Clinical and Experimental Medicine, Section of Neurophysiopathology, Pisa University Medical School, Pisa, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Mery Paroli
- Pain Therapy Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Davide Barloscio
- Department of Clinical and Experimental Medicine, Section of Neurophysiopathology, Pisa University Medical School, Pisa, Italy
| | - Laura Parenti
- Department of Clinical and Experimental Medicine, Section of Neurophysiopathology, Pisa University Medical School, Pisa, Italy
| | - Lara Tollapi
- Pain Therapy Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Massimiliano Valeriani
- Division of Neurology, Ospedale Bambino Gesù, IRCCS, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Ferdinando Sartucci
- Department of Clinical and Experimental Medicine, Section of Neurophysiopathology, Pisa University Medical School, Pisa, Italy.,Neuroscience Institute, National Research Council Pisa, Pisa, Italy
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Sansone P, Passavanti MB, Fiorelli A, Aurilio C, Colella U, De Nardis L, Donatiello V, Pota V, Pace MC. Efficacy of the topical 5% lidocaine medicated plaster in the treatment of chronic post-thoracotomy neuropathic pain. Pain Manag 2017; 7:189-196. [DOI: 10.2217/pmt-2016-0060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: To assess the efficacy of the topical 5% lidocaine medicated plaster (Versatis®, Grünenthal GmbH, Aachen, Germany) in patients with post-thoracotomy neuropathic pain. Patients & methods: Patients were randomized to receive the topical 5% lidocaine medicated plaster (n = 33) or non-medicated placebo plasters (n = 30) for 12 h every day for 8 weeks. Laser-evoked potentials (LEPs) were measured, and various questionnaires/scales completed. Results: Numeric Rating Scale pain scores improved significantly (p < 0.01) more in topical 5% lidocaine medicated plaster than in placebo recipients. The same was true for N2 and P2 LEP latency and amplitude, and other parameters. Conclusion: The study included neurophysiological findings and confirmed the efficacy of the topical 5% lidocaine medicated plaster in patients with chronic post-thoracotomy neuropathic pain.
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Affiliation(s)
- Pasquale Sansone
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Maria Beatrice Passavanti
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - Caterina Aurilio
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Umberto Colella
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Lorenzo De Nardis
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Valerio Donatiello
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Vincenzo Pota
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Maria Caterina Pace
- Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
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Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers 2017; 3:17002. [PMID: 28205574 PMCID: PMC5371025 DOI: 10.1038/nrdp.2017.2] [Citation(s) in RCA: 1239] [Impact Index Per Article: 177.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7-10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain.
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Affiliation(s)
- Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing and Department of Anesthesiology School of Medicine, University of Maryland, 655 West Lombard Street, 21201 Baltimore, Maryland, USA
| | - Taylor Ludman
- Department of Pain and Translational Symptom Science, School of Nursing and Department of Anesthesiology School of Medicine, University of Maryland, 655 West Lombard Street, 21201 Baltimore, Maryland, USA
| | - Didier Bouhassira
- INSERM, Unit 987, Ambroise Paré Hospital, UVSQ, Boulogne Billancourt, France
| | - Ralf Baron
- Department of Neurology, Division of Neurological Pain Research and Therapy, Klinik fur Neurologie Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - David Yarnitsky
- Department of Neurology, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Nadine Attal
- Pain Evaluation and Treatment Centre of Hôpital Ambroise Paré, Paris, France
| | - Nanna B Finnerup
- Department of Clinical Medicine - The Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eija Kalso
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Robert H Dworkin
- Department of Anesthesiology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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