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Zamir O, Yarns BC, Lagman-Bartolome AM, Jobanputra L, Lawler V, Lay C. Understanding the gaps in headache and migraine treatment with psychological and behavioral interventions: A narrative review. Headache 2023; 63:1031-1039. [PMID: 37638484 DOI: 10.1111/head.14624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE In this narrative review, we summarize relevant literature pertaining to psychosocial risk factors for headache and migraine progression, current behavioral and psychological treatments, and consider promising treatments. BACKGROUND Headache and migraine are common and associated with significant burden and disability. Current treatments targeting psychosocial risk factors show modest outcomes and do not directly address the impact of early life adversity, including the development of maladaptive emotional processing. An intervention that could address these factors and include components of current evidence-based interventions may lead to improved outcomes. METHODS We searched PubMed and Google Scholar for articles through December 2022. Search terms included headache, migraine, psychological interventions, behavioral interventions, cognitive-behavioral therapy, mindfulness, psychiatric comorbidities, adverse childhood experiences, trauma, and emotional processing. RESULTS Trauma and childhood adversity show a correlation with headache and migraine progression. Developmental adversity and trauma interfere with adaptive emotional processing, which may worsen headache and migraine symptoms, while adaptive ways of experiencing emotions are shown to improve symptoms. Current behavioral and psychological interventions, such as cognitive-behavioral and mindfulness therapies, are effective treatments for headache, but they produce small to medium effect sizes and do not directly address the impact of trauma and emotional conflicts-common factors that contribute to chronicity and disability, especially among certain subpopulations of headache patients such as those with migraine. Thus, there exists a gap in current treatment. CONCLUSION There is a gap in headache and migraine treatment for those patients who have a history of trauma, childhood adversity, and maladaptive emotional processing. We suggest that an integrated psychological treatment that includes components of current evidence-based interventions and addresses gaps by focusing on processing trauma-related emotions may improve chronic and debilitating symptoms.
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Affiliation(s)
- Orit Zamir
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
- Wasser Pain Medicine Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Brandon C Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ana Marissa Lagman-Bartolome
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Neurology, Children's Hospital, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Lina Jobanputra
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Lawler
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christine Lay
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Zhang J, Shi P, Du J, Yu H. A study based on functional near-infrared spectroscopy: Cortical responses to music interventions in patients with myofascial pain syndrome. Front Hum Neurosci 2023; 17:1119098. [PMID: 36778036 PMCID: PMC9911431 DOI: 10.3389/fnhum.2023.1119098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023] Open
Abstract
Object This study measured cerebral blood oxygen changes in patients with myofascial pain syndrome (MPS) using functional near-infrared spectroscopy (fNIRS). The aim was to investigate the effect of music intervention on pain relief in MPS patients. Materials and methods A total of 15 patients with MPS participated in this study. A self-controlled block task design was used to collect the oxy-hemoglobin ([HbO2]) and deoxy-hemoglobin ([HbR]) concentrations in the prefrontal cortex (PFC) and motor cortex using fNIRS. The cerebral cortex response and channel connectivity were further analyzed. In the experiment, the therapist was asked to apply compression of 3-4 kg/cm2 vertically using the thumb to induce pain. Soothing synthetic music with frequencies of 8-150 Hz and 50-70 dB was used as the audio for the music intervention. Result Compared to the group without music intervention, the activation of brain regions showed a decreasing trend in the group with music intervention under the onset of pain. The results of paired t-tests showed that nine of the data were significantly different (p < 0.05). It was also found that with music intervention, inter-channel connectivity was diminished. Besides, their dorsolateral prefrontal cortex (dlPFC) was significantly correlated with the anterior prefrontal cortex (aPFC) for pain response (r = 0.82), and weakly correlated with the premotor cortex (r = 0.40). Conclusion This study combines objective assessment indicators and subjective scale assessments to demonstrate that appropriate music interventions can be effective in helping to relieve pain to some extent. The analgesic mechanisms between relevant brain regions under music intervention were explored in depth. New insights into effective analgesic methods and quantitative assessment of pain conditions are presented.
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Fernandez A, Urwicz L, Vuilleumier P, Berna C. Impact of hypnosis on psychophysiological measures: A scoping literature review. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2022; 64:36-52. [PMID: 34748461 DOI: 10.1080/00029157.2021.1873099] [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] [Indexed: 01/01/2023]
Abstract
Exploring psychophysiological changes during hypnosis can help to better understand the nature and extent of the hypnotic phenomenon by characterizing its influence on the autonomic nervous system (ANS), in addition to its central brain effects. Hypnosis is thought to induce a relaxation response, yet studies using objective psychophysiological measures alongside hypnosis protocols show various results. We review this literature and clarify the effects of hypnosis on psychophysiological indices of ANS activity and more specifically of the stress/relaxation response, such as heart rate variability and electrodermal activity. Studies reporting psychophysical measures during hypnosis were identified by a series of Pubmed searches. Data was extracted with an interest for the influence of hypnotizability and effects of specific suggestions or tasks on the findings. We found 49 studies comprising 1315 participants, 45 concerning healthy volunteers and only 4 on patients. Sixteen compared high vs. low hypnotizable people; 30 measured heart rate, 18 measured heart rate variability, 25 electrodermal activity, and 23 respiratory signals as well as other physiological parameters. Globally, results converge to show reductions in sympathetic responses and/or increases in parasympathetic tone under hypnosis. Several methodological limitations are underscored, such as older studies (N = 16) using manual analyses, small sample sizes (<30, N = 31), as well as uncontrolled multiple comparisons. Nevertheless, we confirm that hypnosis leads to a physiological relaxation response and highlight promising avenues for this research. Suggestions are made for guiding future work in this field.
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Affiliation(s)
- Aurore Fernandez
- Center of Complementary and Integrative Medicine, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Leah Urwicz
- Center of Complementary and Integrative Medicine, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Laboratory of Behavioral Neurology and Imaging of Cognition, Department of Fundamental Neuroscience, University of Geneva, Geneva, Switzerland
- Swiss Center of Affective Sciences, Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Patrik Vuilleumier
- Laboratory of Behavioral Neurology and Imaging of Cognition, Department of Fundamental Neuroscience, University of Geneva, Geneva, Switzerland
- Swiss Center of Affective Sciences, Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Chantal Berna
- Center of Complementary and Integrative Medicine, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
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WANG Y, YANG Y, WANG Y, ZHANG J, ZHAI W, LI S, WU M, HE J, RONG P. Transcutaneous auricular vague nerve stimulation improved brain connection activity on patients of disorders of consciousness: a pilot study. J TRADIT CHIN MED 2022; 42:463-471. [PMID: 35610018 PMCID: PMC9924658 DOI: 10.19852/j.cnki.jtcm.2022.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To evaluate the clinical effect of transcutaneous auricular vagus nerve nerve stimulation (taVNS) on disorders of consciousness (DOC) patients with Coma Recovery Scale-Revised (CRS-R) and cerebral cortex activity by electroencephalogram (EEG) detection. METHODS Randomized controlled methods were used to evaluate the clinical effect of taVNS on patients with DOC. Twelve patients with initial CRS-R of 6-10 were randomly divided into the treatment group of taVNS and control group of transcutaneous non-auricular vague nerve stimulation (tnVNS). According to clinical diagnosis, the treatment group was divided into vegetative state (VS) group and minimally conscious state (MCS) group. RESULTS The energy of delta and beta bands is positively correlated with the brain activity of patients. taVNS has different regulatory effects on patients with different conscious States. In taVNS group, the energy of delta band in local brain regions changed significantly. Significant changes in brain connection activity were limited to local brain regions. While in patients with MCS in the taVNS group, delta and beta band energy significantly changed in multiple brain regions and cross-brain connection activity also changed significantly. CONCLUSION These findings suggest that taVNS may be a related extra method for arousing patients' awakening by improving brain connection activity. And the effect is remarkable in MCS patients.
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Affiliation(s)
- Yifei WANG
- 1 Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yi YANG
- 2 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100700, Beijing, China
| | - Yu WANG
- 1 Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jinling ZHANG
- 1 Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Weihang ZHAI
- 1 Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shaoyuan LI
- 1 Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Mozheng WU
- 1 Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jianghong HE
- 2 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100700, Beijing, China
- HE Jianghong, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100700, Beijing, China, Telephone: +86-13718482149; +86-13717951390
| | - Peijing RONG
- 1 Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
- Prof. RONG Peijing, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
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Colomer-Carbonell A, Sanabria-Mazo JP, Hernández-Negrín H, Borràs X, Suso-Ribera C, García-Palacios A, Muchart J, Munuera J, D'Amico F, Maes M, Younger JW, Feliu-Soler A, Rozadilla-Sacanell A, Luciano JV. Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost-utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study). BMJ Open 2022; 12:e055351. [PMID: 34992118 PMCID: PMC8739052 DOI: 10.1136/bmjopen-2021-055351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION There is evidence that low-dose naltrexone (LDN; <5.0 mg/day) reduces pain and improves the quality of life of people with fibromyalgia syndrome (FMS). However, no randomised controlled trials with long-term follow-ups have been carried out. The INNOVA study will evaluate the add-on efficacy, safety, cost-utility and neurobiological effects of LDN for reducing pain in patients with FMS, with a 1-year follow-up. METHODS AND ANALYSIS A single-site, prospective, randomised, double-blinded, placebo-controlled, parallel design phase III trial will be performed. Eligibility criteria include being adult, having a diagnosis of FMS and experiencing pain of 4 or higher on a 10-point numerical rating scale. Participants will be randomised to a LDN intervention group (4.5 mg/day) or to a placebo control group. Clinical assessments will be performed at baseline (T0), 3 months (T1), 6 months (T2) and 12 months (T3). The primary endpoint will be pain intensity. A sample size of 60 patients per study arm (120 in total), as calculated prior to recruitment for sufficient power, will be monitored between January 2022 and August 2024. Assessment will also include daily ecological momentary evaluations of FMS-related symptoms (eg, pain intensity, fatigue and sleep disturbance), and side effects via ecological momentary assessment through the Pain Monitor app during the first 3 months. Costs and quality-adjusted life years will be also calculated. Half of the participants in each arm will be scanned with MRI at T0 and T1 for changes in brain metabolites related to neuroinflammation and central sensitisation. Inflammatory biomarkers in serum will also be measured. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and community engagement activities. TRIAL REGISTRATION NUMBER NCT04739995.
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Affiliation(s)
- Ariadna Colomer-Carbonell
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Halbert Hernández-Negrín
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Universidad de Ciencias Médicas de Villa Clara, Santa Clara, Cuba
| | - Xavier Borràs
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain
| | - Jordi Muchart
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Josep Munuera
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Francesco D'Amico
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | | | - Albert Feliu-Soler
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | | | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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Medina S, O’Daly OG, Howard MA, Feliu-Soler A, Luciano JV. Differential Brain Perfusion Changes Following Two Mind–Body Interventions for Fibromyalgia Patients: an Arterial Spin Labelling fMRI Study. Mindfulness (N Y) 2022; 13:449-461. [PMID: 35222735 PMCID: PMC8831296 DOI: 10.1007/s12671-021-01806-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 12/20/2022]
Abstract
Objectives Further mechanistic insight on mind–body techniques for fibromyalgia (FMS) is needed. Arterial spin labelling (ASL) imaging can capture changes in regional cerebral blood flow (rCBF) that relate to spontaneous pain. Methods We recruited FMS patients undergoing either mindfulness-based stress reduction training (MBSR, n = 14) or a psychoeducational programme (FibroQoL, n = 18), and a control FMS group with no add-on treatment (n = 14). We acquired whole-brain rCBF maps and self-report measures at baseline and following treatment and explored interaction effects in brain perfusion between the treatment group and session with a focus on the amygdala, the insula and the anterior cingulate cortex (ACC). Results We identified a significant interaction effect in the amygdala, which corresponded with rCBF decreases following FibroQoL specifically. At baseline, rCBF in the amygdala for the FibroQoL group correlated with pain catastrophizing and anxiety scores, but not after treatment, suggesting a decoupling between activity in the amygdala and negative emotional symptoms of FMS as a consequence of treatment. Baseline rCBF correlated positively with pain symptoms in the ACC and the anterior insula across all patients; moreover, the correlation between rCBF changes post intervention in the insula and pain improvement was negative for both treatments and significantly different from the control group. We suggest that there is disruption of the typical relationship between clinical pain and activity as a product of these two nonpharmacological therapies. Conclusions We have demonstrated that different mind-to-body treatments correspond to differential changes in clinical symptoms and brain activity patterns, which encourages future research investigating predictors of treatment response. Trial Registration NCT02561416. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-021-01806-2.
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Affiliation(s)
- Sonia Medina
- Department of Neuroimaging, King’s College London, London, UK
| | - Owen G. O’Daly
- Department of Neuroimaging, King’s College London, London, UK
| | | | - Albert Feliu-Soler
- Department of Clinical & Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
| | - Juan V. Luciano
- Department of Clinical & Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
- Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
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Zang Y, Zhang Y, Lai X, Yang Y, Guo J, Gu S, Zhu Y. Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:3671800. [PMID: 34745280 PMCID: PMC8570850 DOI: 10.1155/2021/3671800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study was aimed to summarize and analyze the quality of the available evidence in systematic reviews (SRs) of repetitive transcranial magnetic stimulation (rTMS) on the non-motor cortex (non-M1) for neuropathic pain (NP) through an evidence mapping approach. METHODS We follow the Global Evidence Mapping (GEM) methodology. Searches were conducted in PubMed, EMBASE, Epistemonikos, and the Cochrane Library. The study type was restricted to SRs with or without meta-analysis. All literature published before January 23, 2021, were included. The methodological quality of the included SRs was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). Data were extracted according to a defined population-intervention-comparison-outcome (PICO) framework from primary studies that included SRs. The same PICO was categorized into PICOs according to interventions (stimulation target, frequency, number of sessions (short: 1-5 sessions, medium: 5-10 sessions, and long: >10 sessions)) and comparison (sham rTMS or other targets). The evidence mapping was presented in tables and a bubble plot. RESULTS A total of 23 SRs were included. According to the AMSTAR-2, 20 SRs scored "very low" in terms of methodological quality, 2 SRs scored "low," and 1 SR scored "high." A total of 17 PICOs were extracted. The dorsolateral prefrontal cortex (DLPFC) is the most studied of the non-motor cortex targets. PICOs of DLPFC, premotor cortex (PMC), frontal cortex, and secondary somatosensory cortex (S2) were mainly categorized with a "potentially better" conclusion. High-frequency (5-20 Hz) rTMS of non-M1 usually lead to "potentially better" conclusions. CONCLUSIONS DLPFC, PMC, frontal cortex, and S2 seem to be promising new targets for rTMS treatment of certain NP. Evidence mapping is a useful and reliable methodology to identify and present the existing evidence gap that more research efforts are necessary in order to highlight the optimal stimulation protocols for non-M1 targets and standardize parameters to fill the evidence gaps of rTMS. Further investigation is advised to improve the methodological quality and the reporting process of SRs.
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Affiliation(s)
- Yaning Zang
- Department of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yongni Zhang
- School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Xigui Lai
- Department of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yujie Yang
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Jiabao Guo
- Department of Rehabilitation Medicine, The Second School of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shanshan Gu
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Yi Zhu
- Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Tang Z, Zhou J, Long H, Gao Y, Wang Q, Li X, Wang Y, Lai W, Jian F. Molecular mechanism in trigeminal nerve and treatment methods related to orthodontic pain. J Oral Rehabil 2021; 49:125-137. [PMID: 34586644 DOI: 10.1111/joor.13263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/02/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Orthodontic treatment is the main treatment approach for malocclusion. Orthodontic pain is an inevitable undesirable adverse reaction during orthodontic treatment. It is reported orthodontic pain has become one of the most common reason that patients withdraw from orthodontic treatment. Therefore, understanding the underlying mechanism and finding treatment of orthodontic pain are in urgent need. AIMS This article aims to sort out the mechanisms and treatments of orthodontic pain, hoping to provide some ideas for future orthodontic pain relief. MATERIALS Tooth movement will cause local inflammation. Certain inflammatory factors and cytokines stimulating the trigeminal nerve and further generating pain perception, as well as drugs and molecular targeted therapy blocking nerve conduction pathways, will be reviewed in this article. METHOD We review and summaries current studies related to molecular mechanisms and treatment approaches in orthodontic pain control. RESULTS Orthodontics pain related influencing factors and molecular mechanisms has been introduced. Commonly used clinical methods in orthodontic pain control has been evaluated. DISCUSSION With the clarification of more molecular mechanisms, the direction of orthodontic pain treatment will shift to targeted drugs.
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Affiliation(s)
- Ziwei Tang
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiawei Zhou
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hu Long
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yanzi Gao
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qingxuan Wang
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaolong Li
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wenli Lai
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fan Jian
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Chen XF, Guo Y, Lu XQ, Qi L, Xu KH, Chen Y, Li GX, Ding JP, Li J. Aberrant Intraregional Brain Activity and Functional Connectivity in Patients With Diarrhea-Predominant Irritable Bowel Syndrome. Front Neurosci 2021; 15:721822. [PMID: 34539337 PMCID: PMC8446353 DOI: 10.3389/fnins.2021.721822] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose The appearance and aggravation of diarrhea-predominant irritable bowel syndrome (IBS-D) have proven to be closely related to psychosocial factors. We aimed to measure altered spontaneous brain activity and functional connectivity (FC) in patients with IBS-D using resting-state functional magnetic resonance imaging (RS-fMRI) and to analyze the relationship between these parameters and emotional symptoms. Methods Thirty-six adult IBS-D patients and thirty-six demographic-matched healthy controls (HCs) underwent RS-fMRI scans. After processing RS-fMRI data, the values of the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) of the two groups were compared. The abnormal regions were selected as the regions of interest to compare whole-brain seed-based FC between the groups. The relationships between RS-fMRI data and mood and gastrointestinal symptoms were analyzed using correlation and mediation analyses. Results Compared with HCs, IBS-D patients showed increased ALFF in the right cerebellum posterior lobe, the right lingual gyrus/calcarine, the right postcentral gyrus, the right superior frontal gyrus (SFG), and middle frontal gyrus (MFG), with decreased ALFF in the right inferior parietal lobule, the right striatum, the right anterior cingulated cortex, the right insula, the right hippocampus, the right thalamus, the right midbrain, and the left precuneus. IBS-D patients showed increased ReHo in the bilateral lingual gyrus/calcarine, the bilateral SFG, the right MFG, and the right postcentral gyrus, with decreased ReHo in the orbital part of the left inferior frontal gyrus and the right supplementary motor area. Patients showed enhanced FC between the left precuneus and the bilateral orbitofrontal cortex (OFC). There was a positive correlation between increased ALFF values in the right midbrain and anxiety-depression symptoms in IBS-D patients, and the mediating effect of gastrointestinal symptoms indirectly caused this correlation. Conclusion IBS-D patients had dysregulated spontaneous activity and FC in regions related to pain regulation and emotional arousal involved in prefrontal–limbic–midbrain circuit and somatosensory processing. The development of mood disorders in IBS-D patients may be partly related to the dysfunction of components in the dopamine pathway (especially the midbrain, OFC) due to visceral pain.
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Affiliation(s)
- Xiao-Fei Chen
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yun Guo
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xing-Qi Lu
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Le Qi
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.,Medical College, Hangzhou Normal University, Hangzhou, China
| | - Kuang-Hui Xu
- Medical College, Hangzhou Normal University, Hangzhou, China
| | - Yong Chen
- Medical College, Hangzhou Normal University, Hangzhou, China
| | - Guo-Xiong Li
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Jian-Ping Ding
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.,Medical College, Hangzhou Normal University, Hangzhou, China
| | - Jie Li
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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Pratscher S, Mickle AM, Marks JG, Rocha H, Bartsch F, Schmidt J, Tejera L, Garcia S, Custodero C, Jean F, Garvan C, Johnson AJ, Pop R, Greene A, Woods AJ, Staud R, Fillingim RB, Keil A, Sibille KT. Optimizing Chronic Pain Treatment with Enhanced Neuroplastic Responsiveness: A Pilot Randomized Controlled Trial. Nutrients 2021; 13:1556. [PMID: 34063083 PMCID: PMC8147927 DOI: 10.3390/nu13051556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic pain affects mental and physical health and alters brain structure and function. Interventions that reduce chronic pain are also associated with changes in the brain. A number of non-invasive strategies can promote improved learning and memory and increase neuroplasticity in older adults. Intermittent fasting and glucose administration represent two such strategies with the potential to optimize the neurobiological environment to increase responsiveness to recognized pain treatments. The purpose of the pilot study was to test the feasibility and acceptability of intermittent fasting and glucose administration paired with a recognized pain treatment activity, relaxation and guided imagery. A total of 32 adults (44% W, 56% M), 50 to 85 years of age, with chronic knee pain for three months or greater participated in the study. Four sessions were completed over an approximate two-week period. Findings indicate the ability to recruit, randomize, and retain participants in the protocol. The procedures and measures were reasonable and completed without incident. Participant adherence was high and exit interview feedback positive. In summary, the pilot study was feasible and acceptable, providing the evidence necessary to move forward with a larger clinical trial.
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Affiliation(s)
- Steven Pratscher
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
- Department of Community of Dentistry, University of Florida, Gainesville, FL 32611, USA;
| | - Angela M. Mickle
- Department of Community of Dentistry, University of Florida, Gainesville, FL 32611, USA;
| | - John G. Marks
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
| | - Harold Rocha
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; (H.R.); (F.B.); (S.G.); (A.K.)
| | - Felix Bartsch
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; (H.R.); (F.B.); (S.G.); (A.K.)
| | - Jeffrey Schmidt
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL 32816, USA;
| | - Lazaro Tejera
- Department of Interdisciplinary Medicine, University of Bari, 70125 Bari, Italy; (L.T.); (C.C.)
| | - Steven Garcia
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; (H.R.); (F.B.); (S.G.); (A.K.)
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari, 70125 Bari, Italy; (L.T.); (C.C.)
| | - Federlin Jean
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL 32611, USA;
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL 32611, USA;
| | - Alisa J. Johnson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
- Department of Community of Dentistry, University of Florida, Gainesville, FL 32611, USA;
| | - Ralisa Pop
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
| | - Anthony Greene
- Counseling and Wellness Center, University of Florida, Gainesville, FL 32611, USA;
| | - Adam J. Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory Clinical Translational Research, University of Florida, Gainesville, FL 32611, USA;
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
- Department of Community of Dentistry, University of Florida, Gainesville, FL 32611, USA;
| | - Andreas Keil
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; (H.R.); (F.B.); (S.G.); (A.K.)
| | - Kimberly T. Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL 32611, USA;
- Department of Anesthesiology, University of Florida, Gainesville, FL 32611, USA;
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Shanthanna H, Busse J, Wang L, Kaushal A, Harsha P, Suzumura EA, Bhardwaj V, Zhou E, Couban R, Paul J, Bhandari M, Thabane L. Addition of corticosteroids to local anaesthetics for chronic non-cancer pain injections: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2020; 125:779-801. [PMID: 32798067 DOI: 10.1016/j.bja.2020.06.062] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite common use, the benefit of adding steroids to local anaesthetics (SLA) for chronic non-cancer pain (CNCP) injections is uncertain. We performed a systematic review and meta-analysis of English-language RCTs to assess the benefit and safety of adding steroids to local anaesthetics (LA) for CNCP. METHODS We searched MEDLINE, EMBASE, and CENTRAL databases from inception to May 2019. Trial selection and data extraction were performed in duplicate. Outcomes were guided by the Initiative in Methods, Measurements, and Pain Assessment in Clinical Trials (IMMPACT) statement with pain improvement as the primary outcome and pooled using random effects model and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CIs). RESULTS Among 5097 abstracts, 73 trials were eligible. Although SLA increased the rate of success (42 trials, 3592 patients; RR=1.14; 95% CI, 1.03-1.25; number needed to treat [NNT], 13), the effect size decreased by nearly 50% (NNT, 22) with the removal of two intrathecal injection studies. The differences in pain scores with SLA were not clinically meaningful (54 trials, 4416 patients, MD=0.44 units; 95% CI, 0.24-0.65). No differences were observed in other outcomes or adverse events. No subgroup effects were detected based on clinical categories. Meta-regression showed no significant association with steroid dose or length of follow-up and pain relief. CONCLUSIONS Addition of cortico steroids to local anaesthetic has only small benefits and a potential for harm. Injection of local anaesthetic alone could be therapeutic, beyond being diagnostic. A shared decision based on patient preferences should be considered. If used, one must avoid high doses and series of steroid injections. CLINICAL TRIAL REGISTRATION PROSPERO #: CRD42015020614.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.
| | - Jason Busse
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Li Wang
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Alka Kaushal
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Prathiba Harsha
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Erica A Suzumura
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Varun Bhardwaj
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Edward Zhou
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Rachel Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Candido Santos L, Gushken F, Gadotti GM, Dias BDF, Marinelli Pedrini S, Barreto MESF, Zippo E, Pinto CB, Piza PVDT, Fregni F. Intracortical Inhibition in the Affected Hemisphere in Limb Amputation. Front Neurol 2020; 11:720. [PMID: 32849197 PMCID: PMC7406670 DOI: 10.3389/fneur.2020.00720] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/12/2020] [Indexed: 12/18/2022] Open
Abstract
Phantom limb pain (PLP) affects up to 80% of amputees. Despite the lack of consensus about the etiology and pathophysiology of phantom experiences, previous evidence pointed out the role of changes in motor cortex excitability as an important factor associated with amputation and PLP. In this systematic review, we investigated changes in intracortical inhibition as indexed by transcranial magnetic stimulation (TMS) in amputees and its relationship to pain. Four electronic databases were screened to identify studies using TMS to measure cortical inhibition, such as short intracortical inhibition (SICI), long intracortical inhibition (LICI) and cortical silent period (CSP). Seven articles were included and evaluated cortical excitability comparing the affected hemisphere with the non-affected hemisphere or with healthy controls. None of them correlated cortical disinhibition and clinical parameters, such as the presence or intensity of PLP. However, most studies showed decreased SICI in amputees affected hemisphere. These results highlight that although SICI seems to be changed in the affected hemisphere in amputees, most of the studies did not investigate its clinical correlation. Thus, the question of whether they are a valid diagnostic marker remains unanswered. Also, the results were highly variable for both measurements due to the heterogeneity of study designs and group comparisons in each study. Although these results underscore the role of inhibitory networks after amputation, more studies are needed to investigate the role of a decreased inhibitory drive in the motor cortex to the cause and maintenance of PLP.
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Affiliation(s)
- Ludmilla Candido Santos
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | | | | | | | | | | | - Emanuela Zippo
- Faculdade Israelita de Ciências da Saúde, São Paulo, Brazil
| | - Camila Bonin Pinto
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | | | - Felipe Fregni
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
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Mayer EA, Labus J, Aziz Q, Tracey I, Kilpatrick L, Elsenbruch S, Schweinhardt P, Van Oudenhove L, Borsook D. Role of brain imaging in disorders of brain-gut interaction: a Rome Working Team Report. Gut 2019; 68:1701-1715. [PMID: 31175206 PMCID: PMC6999847 DOI: 10.1136/gutjnl-2019-318308] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 12/12/2022]
Abstract
Imaging of the living human brain is a powerful tool to probe the interactions between brain, gut and microbiome in health and in disorders of brain-gut interactions, in particular IBS. While altered signals from the viscera contribute to clinical symptoms, the brain integrates these interoceptive signals with emotional, cognitive and memory related inputs in a non-linear fashion to produce symptoms. Tremendous progress has occurred in the development of new imaging techniques that look at structural, functional and metabolic properties of brain regions and networks. Standardisation in image acquisition and advances in computational approaches has made it possible to study large data sets of imaging studies, identify network properties and integrate them with non-imaging data. These approaches are beginning to generate brain signatures in IBS that share some features with those obtained in other often overlapping chronic pain disorders such as urological pelvic pain syndromes and vulvodynia, suggesting shared mechanisms. Despite this progress, the identification of preclinical vulnerability factors and outcome predictors has been slow. To overcome current obstacles, the creation of consortia and the generation of standardised multisite repositories for brain imaging and metadata from multisite studies are required.
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Affiliation(s)
- Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Qasim Aziz
- Neurogastroenterology Group, Queen Mary University of London, London, UK
| | - Irene Tracey
- Departments of Anaesthetics and Clinical Neurology, Pembroke College, Oxford, UK
| | - Lisa Kilpatrick
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sigrid Elsenbruch
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg, Duisburg, Germany
| | | | - Lukas Van Oudenhove
- Translational Research in GastroIntestinal Disorders, KU Leuven Department of Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
| | - David Borsook
- Center for Pain and the Brain, Boston Children's, Massachusetts General and McLean Hospitals, Harvard Medical School, Boston, Massachusetts, USA
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14
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Brain mechanisms impacted by psychological therapies for pain: identifying targets for optimization of treatment effects. Pain Rep 2019; 4:e767. [PMID: 31579858 PMCID: PMC6727993 DOI: 10.1097/pr9.0000000000000767] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/02/2019] [Accepted: 05/25/2019] [Indexed: 12/13/2022] Open
Abstract
Psychological therapies, such as cognitive behavioral therapy, are widely used multifaceted approaches that have been shown to improve pain-related functioning. A small but growing number of studies have used brain imaging to support the use of psychological therapies for pain. Although these studies have led to an increased understanding of how therapies may engage neural systems, there are multiple technical and conceptual challenges to consider. Based on the current literature, several components of effective psychological therapies for pain may be supported by changes in neural circuitry, which are most consistently represented by diminished activation and/or reduced hyperconnectivity in brain regions related to pain processing, emotion, and cognitive control. Findings may vary based on methodological approaches used and may also differ depending on targets of treatment. To provide a nuanced understanding of the current literature, specific targets and components of effective treatments for which a neural basis has been investigated are reviewed. These treatment components include catastrophic thinking about pain, increasing self-efficacy, mindfulness, anxiety symptom reduction, and exposure-based approaches. In general, such strategies have the potential to normalize regional hyperactivations and reduce hyperconnectivity in brain regions associated with nociceptive processing, cognition, and emotion, although additional research is needed. By determining if there are indeed distinct brain mechanisms engaged by different components of psychological therapy and evidence for specific changes in neural function after these interventions, future therapies may be more optimally tailored for individuals afflicted with chronic pain.
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15
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Liu LY, Zhang RL, Chen L, Zhao HY, Cai J, Wang JK, Guo DQ, Cui YJ, Xing GG. Chronic stress increases pain sensitivity via activation of the rACC-BLA pathway in rats. Exp Neurol 2018; 313:109-123. [PMID: 30586593 DOI: 10.1016/j.expneurol.2018.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/21/2018] [Indexed: 01/05/2023]
Abstract
Exposure to chronic stress can produce maladaptive neurobiological changes in pathways associated with pain processing, which may cause stress-induced hyperalgesia (SIH). However, the underlying mechanisms still remain largely unknown. In previous studies, we have reported that the amygdala is involved in chronic forced swim (FS) stress-induced depressive-like behaviors and the exacerbation of neuropathic pain in rats, of which, the basolateral amygdala (BLA) and the central nucleus of the amygdala (CeA) are shown to play important roles in the integration of affective and sensory information including nociception. Here, using in vivo multichannel recording from rostal anterior cingulate cortex (rACC) and BLA, we found that chronic FS stress (CFSS) could increase the pain sensitivity of rats in response to low intensity innoxious stimuli (LIS) and high intensity noxious stimuli (HNS) imposed upon the hindpaw, validating the occurrence of SIH in stressed rats. Moreover, we discovered that CFSS not only induced an increased activity of rACC neuronal population but also produced an augmented field potential power (FPP) of rACC local field potential (LFP), especially in low frequency theta band as well as in high frequency low gamma band ranges, both at the baseline state and under LIS and HNS conditions. In addition, by using a cross-correlation method and a partial directed coherence (PDC) algorithm to analyze the LFP oscillating activity in rACC and BLA, we demonstrated that CFSS could substantially promote the synchronization between rACC and BLA regions, and also enhanced the neural information flow from rACC to BLA. We conclude that exposure of chronic FS stress to rats could result in an increased activity of rACC neuronal population and promote the functional connectivity and the synchronization between rACC and BLA regions, and also enhance the pain-related neural information flow from rACC to BLA, which likely underlie the pathogenesis of SIH.
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Affiliation(s)
- Ling-Yu Liu
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China
| | - Rui-Ling Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Henan, Xinxiang 453002, China
| | - Lin Chen
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China
| | - Hong-Yan Zhao
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China
| | - Jie Cai
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China; Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Beijing 100083, China
| | - Jia-Kang Wang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Da-Qing Guo
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Yan-Jun Cui
- Department of Internal Medicine, Peking University Hospital, Beijing 100871, China.
| | - Guo-Gang Xing
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China; The Second Affiliated Hospital of Xinxiang Medical University, Henan, Xinxiang 453002, China; Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Beijing 100083, China.
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16
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Ludwig NN, Sil S, Khowaja MK, Cohen LL, Dampier C. Executive Functioning Mediates the Relationship Between Pain Coping and Quality of Life in Youth With Sickle Cell Disease. J Pediatr Psychol 2018; 43:1160-1169. [PMID: 30053072 PMCID: PMC6199175 DOI: 10.1093/jpepsy/jsy057] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 02/02/2023] Open
Abstract
Objective Sickle cell disease (SCD) is a lifelong condition characterized by pain, which is associated with reduced health-related quality of life (HRQL). Data suggest that patients with SCD vary in how they cope and their neurocognitive abilities. This study aimed to characterize executive functioning and pain coping styles in children with SCD experiencing a range of pain frequency (i.e., chronic, episodic, and asymptomatic) and to examine whether executive functioning mediates the relationship between pain coping and HRQL. Method Participants included 100 children and adolescents with SCD between the ages of 8 and 18 years (M = 13.53, SD = 2.8) and their parents who were recruited during outpatient SCD clinic visits in a children's hospital. Children completed questionnaires related to pain experience and pain coping. Parents completed questionnaires about demographic information, their child's executive functioning, and HRQL. Results Pain intensity, executive dysfunction, and engagement in emotion-focused coping (i.e., internalizing/catastrophizing and externalizing) predicted poor HRQL. In addition, engagement in emotion-focused coping predicted executive dysfunction. Multivariate analysis of covariance revealed executive functioning did not differ based on pain frequency; however, executive functioning was a significant mediator that helped explain the relationships between distraction and emotion-focused coping techniques on HRQL. Conclusion Findings support that executive functioning is an important factor in understanding the relationship between pain coping and HRQL in youth with SCD. Future research is warranted to examine the potential impact of executive functioning on the utility of interventions targeting adaptive pain coping in youth with SCD.
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Affiliation(s)
| | - Soumitri Sil
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine
- Children’s Healthcare of Atlanta
| | | | - Lindsey L Cohen
- Department of Psychology, Georgia State University
- Children’s Healthcare of Atlanta
| | - Carlton Dampier
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine
- Children’s Healthcare of Atlanta
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Opioid-Independent and Opioid-Mediated Modes of Pain Modulation. J Neurosci 2018; 38:9047-9058. [PMID: 30201765 DOI: 10.1523/jneurosci.0854-18.2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/20/2018] [Accepted: 08/14/2018] [Indexed: 12/13/2022] Open
Abstract
Pain is regulated endogenously through both opioid and non-opioid mechanisms. We hypothesized that two novel pain modulation tasks, one drawing on context/expectations and one using voluntary reappraisal, would show differing levels of opioid dependence. Specifically, we expected that naloxone would block context-related analgesia, whereas mental imagery-based pain reappraisal would be opioid-independent.A double-blind, placebo-controlled intravenous naloxone versus saline crossover design was used. Twenty healthy volunteers completed the two modulation tasks with acute heat stimuli calibrated to induce moderate pain. In the mental imagery task, participants imagined either a "pleasant" or a "comparison" scenario during painful heat. In the relative relief task, moderate heat stimuli coincided with visual cues eliciting relief from the expectation of intense pain, and were compared with moderate heat stimuli delivered under the expectation of non-painful warmth. Both "pleasant imagery" and "relative relief" conditions significantly improved ratings of pain intensity and pleasantness during saline treatment. Indeed, the target stimuli in both tasks, which had been calibrated to induce moderate pain, were rated as mildly pleasant. Furthermore, consistently with the main hypothesis, blocking endogenous opioid signaling with naloxone did not significantly affect imagery-induced regulation of pain intensity or pleasantness. In contrast, the relative relief-induced pain regulation (i.e., context/expectation) was blocked by naloxone. We conclude that endogenous opioid signaling is necessary for expectation-related relative relief analgesia, but not for pain reappraisal through mental imagery. These results support mental imagery as a powerful and clinically relevant strategy for regulating pain affect also in patients where endogenous opioid mechanisms might be compromised.SIGNIFICANCE STATEMENT Neurotransmitter systems in the human brain can be probed through antagonist drugs. Studies using the opioid antagonist naloxone have demonstrated that the brain relies on both opioid and non-opioid mechanisms to downregulate pain. This holds clinical relevance given altered endogenous opioid processes in many chronic pain conditions. The present study used a double-blinded, placebo-controlled naloxone blockage of endogenous opioids in healthy humans to show differential opioid involvement in two pain modulation tasks. Context/expectation-driven (relative relief-related) analgesia was blocked by naloxone. In contrast, pain reappraisal through mental imagery was intact despite opioid receptor blockade, suggesting opioid independence. These results support mental imagery as a powerful, clinically relevant strategy for regulating pain as it does not rely on a functioning opioidergic system.
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Gatchel RJ, Reuben DB, Dagenais S, Turk DC, Chou R, Hershey AD, Hicks GE, Licciardone JC, Horn SD. Research Agenda for the Prevention of Pain and Its Impact: Report of the Work Group on the Prevention of Acute and Chronic Pain of the Federal Pain Research Strategy. THE JOURNAL OF PAIN 2018; 19:837-851. [DOI: 10.1016/j.jpain.2018.02.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 01/13/2023]
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Nascimento SS, Oliveira LR, DeSantana JM. Correlations between brain changes and pain management after cognitive and meditative therapies: A systematic review of neuroimaging studies. Complement Ther Med 2018; 39:137-145. [DOI: 10.1016/j.ctim.2018.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 01/20/2023] Open
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Abstract
Acute vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD). Multiple complex pathophysiological processes can result in pain during a VOC. Despite significant improvements in the understanding and management of SCD, little progress has been made in the management of pain in SCD, although new treatments are being explored. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment of VOC pain, but new classes of drugs are being tested to prevent and treat acute pain. Advancements in the understanding of the pathophysiology of SCD and pain and the pharmacogenomics of opioids have yet to be effectively utilized in the management of VOC. Opioid tolerance and opioid-induced hyperalgesia are significant problems associated with the long-term use of opioids, and better strategies for chronic pain therapy are needed. This report reviews the mechanisms of pain associated with acute VOC, describes the current management of VOC, and describes some of the new therapies under evaluation for the management of acute VOC in SCD.
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Delivet H, Dugue S, Ferrari A, Postone S, Dahmani S. Efficacy of Self-hypnosis on Quality of Life For Children with Chronic Pain Syndrome. Int J Clin Exp Hypn 2018; 66:43-55. [PMID: 29319458 DOI: 10.1080/00207144.2018.1396109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to assess the efficacy of self-hypnosis in a therapeutic education program (TEP) for the management of chronic pain in 26 children aged 7 to 17 years. Outcomes of the study were a total or a partial (at least 1) achievement of the therapeutic goals (pain, quality of sleeping, schooling, and functional activity). Sixteen patients decreased their pain intensity, 10 reached all of their therapeutic goals, and 9 reached them partially. Self-hypnosis was the only component of the TEP associated with these improvements. The current study supports the efficacy of self-hypnosis in our TEP program for chronic pain management in children.
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Affiliation(s)
- Honorine Delivet
- b Robert Debré University Hospital , Paris Diderot University, and Paris Descarte University , France
| | - Sophie Dugue
- a Robert Debré University Hospital , Paris Diderot University , France
| | - Alexis Ferrari
- a Robert Debré University Hospital , Paris Diderot University , France
| | - Silvia Postone
- a Robert Debré University Hospital , Paris Diderot University , France
| | - Souhayl Dahmani
- a Robert Debré University Hospital , Paris Diderot University , France
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Emmert K, Breimhorst M, Bauermann T, Birklein F, Rebhorn C, Van De Ville D, Haller S. Active pain coping is associated with the response in real-time fMRI neurofeedback during pain. Brain Imaging Behav 2017; 11:712-721. [PMID: 27071949 PMCID: PMC5486591 DOI: 10.1007/s11682-016-9547-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback is used as a tool to gain voluntary control of activity in various brain regions. Little emphasis has been put on the influence of cognitive and personality traits on neurofeedback efficacy and baseline activity. Here, we assessed the effect of individual pain coping on rt-fMRI neurofeedback during heat-induced pain. Twenty-eight healthy subjects completed the Coping Strategies Questionnaire (CSQ) prior to scanning. The first part of the fMRI experiment identified target regions using painful heat stimulation. Then, subjects were asked to down-regulate the pain target brain region during four neurofeedback runs with painful heat stimulation. Functional MRI analysis included correlation analysis between fMRI activation and pain ratings as well as CSQ ratings. At the behavioral level, the active pain coping (first principal component of CSQ) was correlated with pain ratings during neurofeedback. Concerning neuroimaging, pain sensitive regions were negatively correlated with pain coping. During neurofeedback, the pain coping was positively correlated with activation in the anterior cingulate cortex, prefrontal cortex, hippocampus and visual cortex. Thermode temperature was negatively correlated with anterior insula and dorsolateral prefrontal cortex activation. In conclusion, self-reported pain coping mechanisms and pain sensitivity are a source of variance during rt-fMRI neurofeedback possibly explaining variations in regulation success. In particular, active coping seems to be associated with successful pain regulation.
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Affiliation(s)
- Kirsten Emmert
- Department of Radiology and Medical Informatics, CIBM, University Hospital Geneva, Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
- Medical Image Processing Laboratory, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Markus Breimhorst
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Bauermann
- Institute of Neuroradiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Cora Rebhorn
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dimitri Van De Ville
- Department of Radiology and Medical Informatics, CIBM, University Hospital Geneva, Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Medical Image Processing Laboratory, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sven Haller
- Affidea Centre de Diagnostic Radiologique de Carouge CDRC, Geneva, Switzerland
- Faculty of Medicine of the University of Geneva, Geneva, Switzerland
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Germany
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Cortico-Accumbens Regulation of Approach-Avoidance Behavior Is Modified by Experience and Chronic Pain. Cell Rep 2017; 19:1522-1531. [DOI: 10.1016/j.celrep.2017.04.073] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/29/2017] [Accepted: 04/26/2017] [Indexed: 12/22/2022] Open
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Kelleher SA, Dorfman CS, Plumb Vilardaga JC, Majestic C, Winger J, Gandhi V, Nunez C, Van Denburg A, Shelby RA, Reed SD, Murphy S, Davidian M, Laber EB, Kimmick GG, Westbrook KW, Abernethy AP, Somers TJ. Optimizing delivery of a behavioral pain intervention in cancer patients using a sequential multiple assignment randomized trial SMART. Contemp Clin Trials 2017; 57:51-57. [PMID: 28408335 DOI: 10.1016/j.cct.2017.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/21/2017] [Accepted: 04/08/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Pain is common in cancer patients and results in lower quality of life, depression, poor physical functioning, financial difficulty, and decreased survival time. Behavioral pain interventions are effective and nonpharmacologic. Traditional randomized controlled trials (RCT) test interventions of fixed time and dose, which poorly represent successive treatment decisions in clinical practice. We utilize a novel approach to conduct a RCT, the sequential multiple assignment randomized trial (SMART) design, to provide comparative evidence of: 1) response to differing initial doses of a pain coping skills training (PCST) intervention and 2) intervention dose sequences adjusted based on patient response. We also examine: 3) participant characteristics moderating intervention responses and 4) cost-effectiveness and practicality. METHODS/DESIGN Breast cancer patients (N=327) having pain (ratings≥5) are recruited and randomly assigned to: 1) PCST-Full or 2) PCST-Brief. PCST-Full consists of 5 PCST sessions. PCST-Brief consists of one 60-min PCST session. Five weeks post-randomization, participants re-rate their pain and are re-randomized, based on intervention response, to receive additional PCST sessions, maintenance calls, or no further intervention. Participants complete measures of pain intensity, interference and catastrophizing. CONCLUSIONS Novel RCT designs may provide information that can be used to optimize behavioral pain interventions to be adaptive, better meet patients' needs, reduce barriers, and match with clinical practice. This is one of the first trials to use a novel design to evaluate symptom management in cancer patients and in chronic illness; if successful, it could serve as a model for future work with a wide range of chronic illnesses.
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Affiliation(s)
- Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Jen C Plumb Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Catherine Majestic
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Joseph Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Vicky Gandhi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Christine Nunez
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Alyssa Van Denburg
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Susan Murphy
- Department of Statistics, University of Michigan, Ann Arbor, MI, United States
| | - Marie Davidian
- Department of Statistics, North Carolina State University, Raleigh, NC, United States
| | - Eric B Laber
- Department of Statistics, North Carolina State University, Raleigh, NC, United States
| | - Gretchen G Kimmick
- Department of Internal Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kelly W Westbrook
- Department of Internal Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Amy P Abernethy
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.
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Gerdle B, Ernberg M, Mannerkorpi K, Larsson B, Kosek E, Christidis N, Ghafouri B. Increased Interstitial Concentrations of Glutamate and Pyruvate in Vastus Lateralis of Women with Fibromyalgia Syndrome Are Normalized after an Exercise Intervention - A Case-Control Study. PLoS One 2016; 11:e0162010. [PMID: 27695113 PMCID: PMC5047648 DOI: 10.1371/journal.pone.0162010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 08/12/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is associated with central alterations, but controversies exist regarding the presence and role of peripheral factors. Microdialysis (MD) can be used in vivo to study muscle alterations in FMS. Furthermore for chronic pain conditions such as FMS, the mechanisms for the positive effects of exercise are unclear. This study investigates the interstitial concentrations of algesics and metabolites in the vastus lateralis muscle of 29 women with FMS and 28 healthy women before and after an exercise intervention. METHODS All the participants went through a clinical examination and completed a questionnaire. In addition, their pressure pain thresholds (PPTs) in their upper and lower extremities were determined. For both groups, MD was conducted in the vastus lateralis muscle before and after a 15-week exercise intervention of mainly resistance training of the lower limbs. Muscle blood flow and interstitial muscle concentrations of lactate, pyruvate, glutamate, glucose, and glycerol were determined. RESULTS FMS was associated with significantly increased interstitial concentrations of glutamate, pyruvate, and lactate. After the exercise intervention, the FMS group exhibited significant decreases in pain intensity and in mean interstitial concentrations of glutamate, pyruvate, and glucose. The decrease in pain intensity in FMS correlated significantly with the decreases in pyruvate and glucose. In addition, the FMS group increased their strength and endurance. CONCLUSION This study supports the suggestion that peripheral metabolic and algesic muscle alterations are present in FMS patients and that these alterations contribute to pain. After an exercise intervention, alterations normalized, pain intensity decreased (but not abolished), and strength and endurance improved, all findings that suggest the effects of exercise are partially peripheral.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Malin Ernberg
- Karolinska Institute, Department of Dental Medicine, Section of Orofacial Pain and Jaw Function and Scandinavian Centre for Orofacial Neuroscience (SCON), Stockholm, Sweden
| | - Kaisa Mannerkorpi
- Section of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, Gothenburg, Sweden
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience and Osher Centre for Integrative Medicine, Karolinska Institute, Stockholm, Sweden
| | - Nikolaos Christidis
- Karolinska Institute, Department of Dental Medicine, Section of Orofacial Pain and Jaw Function and Scandinavian Centre for Orofacial Neuroscience (SCON), Stockholm, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Rafati F, Soltaninejad M, Aflatoonian MR, Mashayekhi F. POSTOPERATIVE PAIN: MANAGEMENT AND DOCUMENTATION BY IRANIAN NURSES. Mater Sociomed 2016; 28:36-40. [PMID: 27047265 PMCID: PMC4789620 DOI: 10.5455/msm.2016.28.36-40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/05/2016] [Indexed: 11/21/2022] Open
Abstract
Background: Pain is one of the most common symptoms experienced by patients after surgeries. Inadequate postoperative pain management is an international problem and the need to improve its management is well documented. The aim of the study was to assess nursing reports related to the patients’ pain intensity and quality, concomitant symptoms, use of scales in pain assessment, and compliance with the national guideline after surgery. Methods: This study was a retrospective cohort; samples were nurse records of patients who had elective surgery. Result: Only 6% of the patients’ pain records included pain intensity which was not measured with standard scales. More than half of all injections were opioid analgesic which is in contrast to the guidelines of the Iranian Ministry of Health. Pain assessment was higher in women and by nurses with more than 15 years of working experience. Conclusion: to conclude, the patients’ pain was not assessed properly in terms of intensity, quality, and associated symptoms. Therefore, training and motivating nurses is very important in this context and should be incorporated in nurses’ academic and continuous educational courses.
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Affiliation(s)
- Foozieh Rafati
- Razi Nursing and Midwifery College Kerman, Iran; Psychiatric Nursing Lecturer, Faculty Member of Jiroft University of Medical Sciences, Jiroft, Iran
| | - Maryam Soltaninejad
- Critical Care Nursing, Department of Nursing and Midwifery, Kerman University of Medical, Kerman, Iran
| | - Mohamad Reza Aflatoonian
- Department of Infectious and Tropical Disease Research Center, HSR Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Mashayekhi
- Msc Critical Care Nursing Lecturer, Faculty Member of Jiroft University of Medical Sciences, Jiroft, Iran
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27
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Hassan MA, Fraser M, Conway BA, Allan DB, Vuckovic A. The mechanism of neurofeedback training for treatment of central neuropathic pain in paraplegia: a pilot study. BMC Neurol 2015; 15:200. [PMID: 26462651 PMCID: PMC4604632 DOI: 10.1186/s12883-015-0445-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/29/2015] [Indexed: 01/30/2023] Open
Abstract
Background Central neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia. Methods Patients’ EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions Results. Six out of seven patients reported immediate reduction of pain during neurofeedback training. Best results were achieved with suppressing Ɵ and higher β (20–30 Hz) power and reinforcing α power at C4. Four patients reported clinically significant long-term reduction of pain (>30 %) which lasted at least a month beyond the therapy. EEG during neurofeedback revealed a wide spread modulation of power in all three frequency bands accompanied with changes in the coherence most notable in the beta band. The standardized low resolution electromagnetic tomography analysis of EEG before and after neurofeedback therapy showed the statistically significant reduction of power in beta frequency band in all tested patients. Areas with reduced power included the Dorsolateral Prefrontal Cortex, the Anterior Cingulate Cortex and the Insular Cortex. Conclusions Neurofeedback training produces both immediate and longer term reduction of central neuropathic pain that is accompanied with a measurable short and long term modulation of cortical activity. Controlled trials are required to confirm the efficacy of this neurofeedback protocol on treatment of pain. The study is a registered UKCRN clinical trial Nr 9824.
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Affiliation(s)
- Muhammad Abul Hassan
- Rehabilitation Engineering and Assistive technologies, Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK. .,Department of Biomedical Engineering, NED University of Engineering and Technology, Karachi, Pakistan.
| | - Matthew Fraser
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.
| | - Bernard A Conway
- Department of Biomedical Engineering, University of Strathclyde, Strathclyde, UK.
| | - David B Allan
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.
| | - Aleksandra Vuckovic
- Rehabilitation Engineering and Assistive technologies, Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK. .,Biomedical Engineering Research Division, School of Engineering, University of Glasgow, James Watt building (south), G12 8QQ, Glasgow, UK.
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Osumi M, Sumitani M, Wake N, Sano Y, Ichinose A, Kumagaya SI, Kuniyoshi Y, Morioka S. Structured movement representations of a phantom limb associated with phantom limb pain. Neurosci Lett 2015; 605:7-11. [DOI: 10.1016/j.neulet.2015.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/25/2015] [Accepted: 08/05/2015] [Indexed: 02/06/2023]
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Wang J, Wu D, Shen Y, Zhang Y, Xu Y, Tang X, Wang R. Cognitive behavioral therapy eases orthodontic pain: EEG states and functional connectivity analysis. Oral Dis 2015; 21:572-82. [PMID: 25644503 DOI: 10.1111/odi.12314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/31/2014] [Accepted: 01/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the effects of CBT on electroencephalogram activity in patients with orthodontic pain. METHODS We recruited 24 young (18-28 years), healthy individuals with matched baseline characteristics, including pain intensity, anxiety levels, personality traits, and life-quality scores. Participants were randomly assigned to either the CBT intervention group (n = 12) or the blank control group (n = 12). Multichannel continuous electroencephalogram signals and visual analog scale (VAS) scores were recorded before and after initial archwire placement for 1 week. A 1-month follow-up was conducted, when participants' daily VAS scores were recorded. RESULTS The overall EEG spectral power of the CBT group was lower than that of the control group, especially in the theta (4-7 Hz) and beta (14-30 Hz) bands during the treatment period. An enhanced coupling of theta and beta frequencies was observed in frontal and occipital electrodes, respectively. The EEG power in delta and theta bands correlated positively with pain intensity. Network coherence for the CBT group exhibited higher connectivity in the theta band. CONCLUSIONS Specific cerebral responses to CBT instructions could be detected with continuous electroencephalograms and related to orthodontic pain processing, which may provide a new insight in exploring CBT for orthodontic pain control.
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Affiliation(s)
- J Wang
- Department of Stomatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - D Wu
- School of Computer and Information, Beijing Jiaotong University, Beijing, China
| | - Y Shen
- Department of Stomatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Y Zhang
- Department of Stomatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Y Xu
- Department of Stomatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - X Tang
- Department of Stomatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - R Wang
- Department of Stomatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Abstract
Abstract
Background:
Diverting attention away from noxious stimulation (i.e., distraction) is a common pain-coping strategy. Its effects are variable across individuals, however, and the authors hypothesized that chronic pain patients who reported higher levels of pain catastrophizing would derive less pain-reducing benefit from distraction.
Methods:
Chronic pain patients (n = 149) underwent psychometric and quantitative sensory testing, including assessment of the temporal summation of pain in the presence and absence of a distracting motor task.
Results:
A simple distraction task decreased temporal summation of pain overall, but, surprisingly, a greater distraction analgesia was observed in high catastrophizers. This enhanced distraction analgesia in high catastrophizers was not altered when controlling for current pain scores, depression, anxiety, or opioid use (analysis of covariance [ANCOVA]: F = 8.7, P < 0.005). Interestingly, the magnitude of distraction analgesia was inversely correlated with conditioned pain modulation (Pearson R = −0.23, P = 0.005).
Conclusion:
Distraction produced greater analgesia among chronic pain patients with higher catastrophizing, suggesting that catastrophizing’s pain-amplifying effects may be due in part to greater attention to pain, and these patients may benefit from distraction-based pain management approaches. Furthermore, these data suggest that distraction analgesia and conditioned pain modulation may involve separate underlying mechanisms.
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31
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Karlsson L, Gerdle B, Ghafouri B, Bäckryd E, Olausson P, Ghafouri N, Larsson B. Intramuscular pain modulatory substances before and after exercise in women with chronic neck pain. Eur J Pain 2014; 19:1075-85. [DOI: 10.1002/ejp.630] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 12/14/2022]
Affiliation(s)
- L. Karlsson
- Department of Pain and Rehabilitation Center; Linköping University; Sweden
- Department of Medical and Health Sciences (IMH); Linköping University; Sweden
| | - B. Gerdle
- Department of Pain and Rehabilitation Center; Linköping University; Sweden
- Department of Medical and Health Sciences (IMH); Linköping University; Sweden
| | - B. Ghafouri
- Department of Pain and Rehabilitation Center; Linköping University; Sweden
- Department of Medical and Health Sciences (IMH); Linköping University; Sweden
- Occupational and Environmental Medicine; Department of Clinical and Experimental Medicine (IKE); Faculty of Health Sciences; Linköping University; Sweden
- Centre of Occupational and Environmental Medicine; UHL, County Council; Linköping Sweden
| | - E. Bäckryd
- Department of Pain and Rehabilitation Center; Linköping University; Sweden
- Department of Medical and Health Sciences (IMH); Linköping University; Sweden
| | - P. Olausson
- Department of Pain and Rehabilitation Center; Linköping University; Sweden
- Department of Medical and Health Sciences (IMH); Linköping University; Sweden
| | - N. Ghafouri
- Department of Pain and Rehabilitation Center; Linköping University; Sweden
- Department of Medical and Health Sciences (IMH); Linköping University; Sweden
| | - B. Larsson
- Department of Pain and Rehabilitation Center; Linköping University; Sweden
- Department of Medical and Health Sciences (IMH); Linköping University; Sweden
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Schreiber KL, Kehlet H, Belfer I, Edwards RR. Predicting, preventing and managing persistent pain after breast cancer surgery: the importance of psychosocial factors. Pain Manag 2014; 4:445-59. [DOI: 10.2217/pmt.14.33] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Papuga MO, Burke JR, Dougherty PE. The reliability of a novel magnetic resonance compatible electro-pneumatic device for delivering a painful pressure stimulus over the lumbar spine. Somatosens Mot Res 2014; 32:51-60. [DOI: 10.3109/08990220.2014.960559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Darbari DS, Ballas SK, Clauw DJ. Thinking beyond sickling to better understand pain in sickle cell disease. Eur J Haematol 2014; 93:89-95. [DOI: 10.1111/ejh.12340] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Deepika S. Darbari
- Division of Hematology; Department of Pediatrics; Center for Cancer and Blood Disorders; Children's National Medical Center; George Washington University; Washington DC USA
| | - Samir K. Ballas
- Department of Medicine; Cardeza Foundation; Jefferson Medical College; Thomas Jefferson University; Philadelphia PA USA
| | - Daniel J. Clauw
- Departments of Anesthesia, Medicine and Psychiatry; University of Michigan Medical School; Ann Arbor MI USA
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Bushnell MC, Ceko M, Low LA. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci 2013; 14:502-11. [PMID: 23719569 DOI: 10.1038/nrn3516] [Citation(s) in RCA: 1189] [Impact Index Per Article: 108.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic pain is one of the most prevalent health problems in our modern world, with millions of people debilitated by conditions such as back pain, headache and arthritis. To address this growing problem, many people are turning to mind-body therapies, including meditation, yoga and cognitive behavioural therapy. This article will review the neural mechanisms underlying the modulation of pain by cognitive and emotional states - important components of mind-body therapies. It will also examine the accumulating evidence that chronic pain itself alters brain circuitry, including that involved in endogenous pain control, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic.
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Affiliation(s)
- M Catherine Bushnell
- National Center for Complementary and Alternative Medicine, National Institutes of Health, 35 Convent Drive, Room 1C917, MSC 3711, Bethesda, Maryland 20892-3711, USA. . gov
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Greening SG, Osuch EA, Williamson PC, Mitchell DGV. The neural correlates of regulating positive and negative emotions in medication-free major depression. Soc Cogn Affect Neurosci 2013; 9:628-37. [PMID: 23482626 DOI: 10.1093/scan/nst027] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Depressive cognitive schemas play an important role in the emergence and persistence of major depressive disorder (MDD). The current study adapted emotion regulation techniques to reflect elements of cognitive behavioural therapy (CBT) and related psychotherapies to delineate neurocognitive abnormalities associated with modulating the negative cognitive style in MDD. Nineteen non-medicated patients with MDD and 19 matched controls reduced negative or enhanced positive feelings elicited by emotional scenes while undergoing functional magnetic resonance imaging. Although both groups showed significant emotion regulation success as measured by subjective ratings of affect, the controls were significantly better at modulating both negative and positive emotion. Both groups recruited regions of dorsolateral prefrontal cortex and ventrolateral prefrontal cortex (VLPFC) when regulating negative emotions. Only in controls was this accompanied by reduced activity in sensory cortices and amygdala. Similarly, both groups showed enhanced activity in VLPFC and ventral striatum when enhancing positive affect; however, only in controls was ventral striatum activity correlated with regulation efficacy. The results suggest that depression is associated with both a reduced capacity to achieve relief from negative affect despite recruitment of ventral and dorsal prefrontal cortical regions implicated in emotion regulation, coupled with a disconnect between activity in reward-related regions and subjective positive affect.
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Affiliation(s)
- Steven G Greening
- Brain and Mind Institute, Natural Sciences Building, University of Western Ontario, London, Ontario N6A 5B7, Canada.
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Fairhurst M, Fairhurst K, Berna C, Tracey I. An fMRI study exploring the overlap and differences between neural representations of physical and recalled pain. PLoS One 2012; 7:e48711. [PMID: 23119093 PMCID: PMC3485317 DOI: 10.1371/journal.pone.0048711] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/03/2012] [Indexed: 01/08/2023] Open
Abstract
Implementing a recall paradigm without hypnosis, we use functional MRI (fMRI) to explore and compare nociceptive and centrally-driven pain experiences. We posit that a trace of a recent nociceptive event can be used to create sensory-re-experiencing of pain that can be qualified in terms of intensity and vividness. Fifteen healthy volunteers received three levels of thermal stimuli (warm, low pain and high pain) and subsequently were asked to recall and then rate this experience. Neuroimaging results reveal that recalling a previous sensory experience activates an extensive network of classical pain processing structures except the contralateral posterior insular cortex. Nociceptive-specific activation of this structure and the rated intensity difference between physical and recalled pain events allow us to investigate the link between the quality of the original nociceptive stimulus and the mental trace, as well as the differences between the accompanying neural responses. Additionally, by incorporating the behavioural ratings, we explored which brain regions were separately responsible for generating either an accurate or vivid recall of the physical experience. Together, these observations further our understanding of centrally-mediated pain experiences and pain memory as well as the potential relevance of these factors in the maintenance of chronic pain.
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Affiliation(s)
- Merle Fairhurst
- Nuffield Division Anaesthetics, Nuffield Department Clinical Neurosciences, Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, Oxford, England, United Kingdom.
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Schweinhardt P, Bushnell MC. Neuroimaging of pain: insights into normal and pathological pain mechanisms. Neurosci Lett 2012; 520:129-30. [PMID: 22704200 DOI: 10.1016/j.neulet.2012.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Petra Schweinhardt
- Faculty of Dentistry, McGill University, Strathcona Anatomy and Dentistry Bldg., Room 2/38F, 3640 University Street, Montreal, H3A 2B2 Quebec, Canada.
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