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Sandri A, Cecchini MP, Riello M, Zanini A, Nocini R, Fiorio M, Tinazzi M. Pain, Smell, and Taste in Adults: A Narrative Review of Multisensory Perception and Interaction. Pain Ther 2021; 10:245-268. [PMID: 33635507 PMCID: PMC8119564 DOI: 10.1007/s40122-021-00247-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/13/2021] [Indexed: 12/31/2022] Open
Abstract
Every day our sensory systems perceive and integrate a variety of stimuli containing information vital for our survival. Pain acts as a protective warning system, eliciting a response to remove harmful stimuli; it may also be a symptom of an illness or present as a disease itself. There is a growing need for additional pain-relieving therapies involving the multisensory integration of smell and taste in pain modulation, an approach that may provide new strategies for the treatment and management of pain. While pain, smell, and taste share common features and are strongly linked to emotion and cognition, their interaction has been poorly explored. In this review, we provide an overview of the literature on pain modulation by olfactory and gustatory substances. It includes adult human studies investigating measures of pain threshold, tolerance, intensity, and/or unpleasantness. Due to the limited number of studies currently available, we have structured this review as a narrative in which we comment on experimentally induced and clinical pain separately on pain–smell and pain–taste interaction. Inconsistent study findings notwithstanding, pain, smell, and taste seem to interact at both the behavioral and the neural levels. Pain intensity and unpleasantness seem to be affected more by olfactory substances, whereas pain threshold and tolerance are influenced by gustatory substances. Few pilot studies to date have investigated these effects in clinical populations. While the current results are promising for the future, more evidence is needed to elucidate the link between the chemical senses and pain. Doing so has the potential to improve and develop novel options for pain treatment.
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Affiliation(s)
- Angela Sandri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Maria Paola Cecchini
- Anatomy and Histology Section, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marianna Riello
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alice Zanini
- Anatomy and Histology Section, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Otolaryngology Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology , University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Zamyad M, Abbasnejad M, Esmaeili-Mahani S, Sheibani V, Raoof M. Pain influences food preference and food-related memory by activating the basolateral amygdala in rats. Exp Brain Res 2021; 239:79-93. [PMID: 33104830 DOI: 10.1007/s00221-020-05961-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022]
Abstract
The amygdala has been demonstrated to contribute to pain-related behavior and food preference. Here, the effect of pain on food preference and food-matched visual-cue memory, in the presence or absence of a basolateral amygdala (BLA) lesion, has been evaluated using a novel innovative apparatus and protocol. Forty adult male Wistar rats were randomly divided into five groups (n = 8) as follows: control, pain, ibuprofen + pain, BLA lesion, BLA lesion + pain groups. Bilateral lesions of the BLA were produced by passing a current of 1.5 mA for 7 s. Pain was induced on the right hind paw of the rats by sub-plantar injection of 50 μl of 2.5% formalin. The animals were encountered with four different meals including wholemeal, wholemeal + sugar, white flour, and biscuit. Each test session consisted of six trials with inter-trial intervals of 15 min. The number of visits to each meal zone and port, the amount of time spent in each food zone and port, traveled distance in each food zone, food consumption per each visit and the total food consumption were recorded. The control group showed a high biscuit preference and low white flour preference. Rats suffering BLA lesion and rats in the BLA lesion + pain group exhibited a shifted preference curve. They had a bias toward eating wholemeal + sugar rather than white flour and biscuit. This group also showed an impaired spatial memory. In conclusion, our findings suggest that the BLA may be involved in pain-induced food preference and food-matched visual-cue memory.
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Affiliation(s)
- Mahnaz Zamyad
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, P.O. Box: 76135-133, Kerman, Iran
| | - Mehdi Abbasnejad
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, P.O. Box: 76135-133, Kerman, Iran.
| | - Saeed Esmaeili-Mahani
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, P.O. Box: 76135-133, Kerman, Iran
- Laboratory of Molecular Neuroscience, Kerman Neuroscience Research Center (KNRC), Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Sheibani
- Laboratory of Molecular Neuroscience, Kerman Neuroscience Research Center (KNRC), Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Raoof
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Giuliani C, Franceschi C, Luiselli D, Garagnani P, Ulijaszek S. Ecological Sensing Through Taste and Chemosensation Mediates Inflammation: A Biological Anthropological Approach. Adv Nutr 2020; 11:1671-1685. [PMID: 32647890 PMCID: PMC7666896 DOI: 10.1093/advances/nmaa078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/24/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
Ecological sensing and inflammation have evolved to ensure optima between organism survival and reproductive success in different and changing environments. At the molecular level, ecological sensing consists of many types of receptors located in different tissues that orchestrate integrated responses (immune, neuroendocrine systems) to external and internal stimuli. This review describes emerging data on taste and chemosensory receptors, proposing them as broad ecological sensors and providing evidence that taste perception is shaped not only according to sense epitopes from nutrients but also in response to highly diverse external and internal stimuli. We apply a biological anthropological approach to examine how ecological sensing has been shaped by these stimuli through human evolution for complex interkingdom communication between a host and pathological and symbiotic bacteria, focusing on population-specific genetic diversity. We then focus on how these sensory receptors play a major role in inflammatory processes that form the basis of many modern common metabolic diseases such as obesity, type 2 diabetes, and aging. The impacts of human niche construction and cultural evolution in shaping environments are described with emphasis on consequent biological responsiveness.
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Affiliation(s)
- Cristina Giuliani
- Department of Biological, Geological, and Environmental Sciences (BiGeA), Laboratory of Molecular Anthropology and Centre for Genome Biology, University of Bologna, Bologna, Italy
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
- Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
| | - Claudio Franceschi
- Laboratory of Systems Medicine of Healthy Aging and Department of Applied Mathematics, Lobachevsky University, Nizhny Novgorod, Russia
| | - Donata Luiselli
- Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
- Department of Cultural Heritage (DBC), Laboratory of Ancient DNA (aDNALab), Campus of Ravenna, University of Bologna, Bologna, Italy
| | - Paolo Garagnani
- Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden
| | - Stanley Ulijaszek
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
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Cecchini MP, Riello M, Sandri A, Zanini A, Fiorio M, Tinazzi M. Smell and taste dissociations in the modulation of tonic pain perception induced by a capsaicin cream application. Eur J Pain 2020; 24:1946-1955. [PMID: 32780473 DOI: 10.1002/ejp.1644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pain is a subjective experience characterized by sensory (intensity) and emotional (unpleasantness) aspects. Although literature reports behavioural effects on pain due to smell and taste influence, to our knowledge the relationship between tonic pain induced by a capsaicin cream and these chemosensory systems has never been explored before. The aim of this study was to investigate the modulation of olfactory and gustatory substances having different valence on tonic pain perception mediated by a capsaicin cream application. METHODS Sixty healthy volunteers were included in two separated experiments (N = 30 smell; N = 30 taste) and underwent different valence smell and taste stimulations, while receiving painful stimuli. Perception of pain intensity (the sensory component) and unpleasantness (the affective component) was measured with a numerical rating scale, both during the two aforementioned experiments. RESULTS Pain unpleasantness rating showed differences only in the smell experiment between the two odourous conditions. In particular, pleasant odour induced lower ratings of pain unpleasantness, while no significant results were found for intensity. Regarding taste, we could not observe significant effects nor for pain unpleasantness or intensity. CONCLUSIONS These findings highlight the potential role of pleasant odours in influencing the affective aspects of pain perception induced by this kind of tonic pain. Such evidence might provide new insight for using chemosensory substances as analgesics for modulating the cognitive aspects of neuropathic pain. SIGNIFICANCE This work shows the effect of smell on the emotional component of tonic pain, experimentally induced by capsaicin cream application. Previous literature investigated tonic pain in interaction with smell and/or taste stimuli, but mainly with physical methods such as temperature. Our findings add new information in this field, contributing to a deeper insight on the role of olfaction on this particular kind of tonic pain perception. This approach could open to new investigations aimed to consider odours for pain management.
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Affiliation(s)
- Maria Paola Cecchini
- Anatomy and Histology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marianna Riello
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Sandri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alice Zanini
- Anatomy and Histology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Riello M, Cecchini MP, Zanini A, Di Chiappari M, Tinazzi M, Fiorio M. Perception of phasic pain is modulated by smell and taste. Eur J Pain 2019; 23:1790-1800. [PMID: 31291496 DOI: 10.1002/ejp.1453] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pain perception is a multimodal experience composed of sensory, emotional and cognitive dimensions. Accumulating evidence suggests that the chemical senses can influence pain perception, but their relation with phasic pain is still unknown. The aim of this study was to investigate the influence of smell and taste having different valence on phasic pain. METHODS Twenty-eight healthy volunteers received sweet, bitter and neutral odours or gustatory substances while receiving painful stimuli consisting of electrical shocks. Tactile threshold, pain threshold and pain tolerance were collected using the psychophysical method of limits at baseline and in association with smell and taste. Perception of pain intensity and unpleasantness was measured with a numerical rating scale. RESULTS Sweet smell induced lower ratings of pain intensity than bitter smell when stimuli were delivered at pain threshold. Sweet smell also induced lower ratings of pain unpleasantness than neutral smell when stimuli were delivered at pain tolerance. Sweet taste induced lower ratings of pain unpleasantness than bitter taste when stimuli were delivered at pain threshold. Conversely, pain threshold and pain tolerance per se were not affected by smell and taste. CONCLUSIONS These findings highlight an effect of sweet substances in reducing the subjective perception of pain intensity and unpleasantness associated to phasic pain. SIGNIFICANCE By demonstrating the link between smell, taste and phasic pain this study may have a translational impact in clinical conditions characterized by so-called shock-like pain, such as neuropathic pain.
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Affiliation(s)
- Marianna Riello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Paola Cecchini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alice Zanini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Miguel Di Chiappari
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Reward Processing under Chronic Pain from the Perspective of "Liking" and "Wanting": A Narrative Review. Pain Res Manag 2019; 2019:6760121. [PMID: 31149319 PMCID: PMC6501242 DOI: 10.1155/2019/6760121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/06/2019] [Accepted: 04/04/2019] [Indexed: 11/29/2022]
Abstract
The therapeutic goals of patients with chronic pain are not only to relieve pain but also to improve the quality of life. Chronic pain negatively affects various aspects of daily life, such as by decreasing the motivation to work and reward sensitivity, which may lead to difficulties in daily life or even unemployment. Human and animal studies have shown that chronic pain damages reward processing; the exploration of associated internal mechanisms may aid the development of treatments to repair this damage. Incentive salience theory, used widely to describe reward processing, divides this processing into “liking” (reward-induced hedonic sensory impact) and “wanting” (reward-induced motivation) components. It has been employed to explain pathological changes in reward processing induced by psychiatric disorders. In this review, we summarize the findings of studies of reward processing under chronic pain and examine the effects of chronic pain on “liking” and “wanting.” Evidence indicates that chronic pain compromises the “wanting” component of reward processing; we also discuss the neural mechanisms that may mediate this effect. We hope that this review aids the development of therapies to improve the quality of life of patients with chronic pain.
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Abstract
The study of taste has been guided throughout much of its history by the conceptual framework of psychophysics, where the focus was on quantification of the subjective experience of the taste sensations. By the mid-20th century, data from physiologic studies had accumulated sufficiently to assemble a model for the function of receptors that must mediate the initial stimulus of tastant molecules in contact with the tongue. But the study of taste as a receptor-mediated event did not gain momentum until decades later when the actual receptor proteins and attendant signaling mechanisms were identified and localized to the highly specialized taste-responsive cells of the tongue. With those discoveries a new opportunity to examine taste as a function of receptor activity has come into focus. Pharmacology is the science designed specifically for the experimental interrogation and quantitative characterization of receptor function at all levels of inquiry from molecules to behavior. This review covers the history of some of the major concepts that have shaped thinking and experimental approaches to taste, the seminal discoveries that have led to elucidation of receptors for taste, and how applying principles of receptor pharmacology can enhance understanding of the mechanisms of taste physiology and perception.
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Affiliation(s)
- R Kyle Palmer
- Opertech Bio, Inc., Pennovation Center, Philadelphia, Pennsylvania
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Pelletier R, Bourbonnais D, Higgins J. Nociception, pain, neuroplasticity and the practice of Osteopathic Manipulative Medicine. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Yeung AWK. Bibliometric Study on Functional Magnetic Resonance Imaging Literature (1995–2017) Concerning Chemosensory Perception. CHEMOSENS PERCEPT 2018. [DOI: 10.1007/s12078-018-9243-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Hedonic and motivational responses to food reward are unchanged in rats with neuropathic pain. Pain 2017; 157:2731-2738. [PMID: 27548047 DOI: 10.1097/j.pain.0000000000000695] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Rewards influence responses to acute painful stimuli, but the relationship of chronic pain to hedonic or motivational aspects of reward is not well understood. We independently evaluated hedonic qualities of sweet or bitter tastants and motivation to seek food reward in rats with experimental neuropathic pain induced by L5/6 spinal nerve ligation. Hedonic response was measured by implantation of intraoral catheters to allow passive delivery of liquid solutions, and "liking/disliking" responses were scored according to a facial reactivity scale. Spinal nerve ligation rats did not differ from controls in either "liking" or "disliking" reactions to intraoral sucrose or quinine, respectively, at postsurgery day 21, suggesting no differences in perceived hedonic value of sweet or bitter tastants. To assess possible motivational deficits during acute and chronic pain, we used fixed- and progressive-ratio response paradigms of sucrose pellet presentation in rats with transient inflammatory or chronic neuropathic pain. Assessment of response acquisition and break points under the progressive ratio schedule revealed no differences between sham and spinal nerve ligation rats for up to 120 days after injury. However, rats with inflammation showed decrements in lever pressing and break points on days 1 and 2 after complete Freund adjuvant injection that normalized by day 4, consistent with transient ongoing pain. Thus, although acute ongoing inflammatory pain may transiently reduce reward motivation, we did not detect influences of chronic neuropathic pain on hedonic or motivational responses to food rewards. Adaptations that allow normal reward responding to food regardless of chronic pain may be of evolutionary benefit to promote survival.
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A pain in the bud? Implications of cross-modal sensitivity for pain experience. Atten Percept Psychophys 2017; 78:2348-2356. [PMID: 27743264 DOI: 10.3758/s13414-016-1217-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is growing evidence that enhanced sensitivity to painful clinical procedures and chronic pain are related to greater sensitivity to other sensory inputs, such as bitter taste. We examined cross-modal sensitivities in two studies. Study 1 assessed associations between bitter taste sensitivity, pain tolerance, and fear of pain in 48 healthy young adults. Participants were classified as non-tasters, tasters and super-tasters using a bitter taste test (6-n-propythiouracil; PROP). The latter group had significantly higher fear of pain (Fear of Pain Questionnaire) than tasters (p=.036, effect size r = .48). There was only a trend for an association between bitter taste intensity ratings and intensity of pain at the point of pain tolerance in a cold pressor test (p=.04). In Study 2, 40 healthy young adults completed the Adolescent/Adult Sensory Profile before rating intensity and unpleasantness of innocuous (33 °C), moderate (41 °C), and high intensity (44 °C) thermal pain stimulations. The sensory-sensitivity subscale was positively correlated with both intensity and unpleasantness ratings. Canonical correlation showed that only sensitivity to audition and touch (not taste/smell) were associated with intensity of moderate and high (not innocuous) thermal stimuli. Together these findings suggest that there are cross-modal associations predominantly between sensitivity to exteroceptive inputs (i.e., taste, touch, sound) and the affective dimensions of pain, including noxious heat and intolerable cold pain, in healthy adults. These cross-modal sensitivities may arise due to greater psychological aversion to salient sensations, or from shared neural circuitry for processing disparate sensory modalities.
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Taste intensity modulates effective connectivity from the insular cortex to the thalamus in humans. Neuroimage 2016; 135:214-22. [PMID: 27132544 DOI: 10.1016/j.neuroimage.2016.04.057] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 04/24/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022] Open
Abstract
Evaluation of taste intensity is one of the most important perceptual abilities in our daily life. In contrast with extensive research findings regarding the spatial representation of taste in the insula and thalamus, little is known about how the thalamus and insula communicate and reciprocally influence their activities for processing taste intensity. To examine this neurophysiological relationship, we investigated the modulatory effect of intensity of saltiness on connections in the network processing taste signals in the human brain. These "effective connectivity" relationships refer to the neurophysiological influence (including direction and strength of influence) of one brain region on another. Healthy adults (N=34), including 17 males and 17 females (mean age=21.3years, SD=2.4; mean body mass index (BMI)=20.2kg/m(2), SD=2.1) underwent functional magnetic resonance imaging as they tasted three concentrations of sodium chloride solutions. By effective connectivity analysis with dynamic causal modeling, we show that taste intensity enhances top-down signal transmission from the insular cortex to the thalamus. These results are the first to demonstrate the modulatory effect of taste intensity on the taste network in the human brain.
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A single thalamic target for deep brain stimulation to treat hemi-body pain syndrome. Acta Neurochir (Wien) 2015; 157:1519-23. [PMID: 26159322 DOI: 10.1007/s00701-015-2504-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/29/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients experiencing hemi-body pain represent a difficult problem when using the thalamus as a DBS target given its anatomical topology. METHODS A 50-year-old HIV positive male underwent a right unilateral thalamic DBS to treat his severe left hemi-body central post-stroke pain following years of unsuccessful medication therapy. RESULTS The final active contact of the electrode corresponded to stimulation of the nucleus ventrocaudalis parvocellularis internis, which has provided prolonged pain relief. CONCLUSION To our knowledge this was the first time this pattern of pain was treated by a single thalamic DBS electrode, suggesting stimulation in this region may be a feasible target for achieving relief from chronic severe hemi-body pain.
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Tsay A, Allen T, Proske U, Giummarra M. Sensing the body in chronic pain: A review of psychophysical studies implicating altered body representation. Neurosci Biobehav Rev 2015; 52:221-32. [DOI: 10.1016/j.neubiorev.2015.03.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 12/11/2014] [Accepted: 03/06/2015] [Indexed: 01/29/2023]
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Wolrich J, Poots AJ, Kuehler BM, Rice ASC, Rahman A, Bantel C. Is number sense impaired in chronic pain patients? Br J Anaesth 2014; 113:1024-31. [PMID: 25082664 PMCID: PMC4235572 DOI: 10.1093/bja/aeu255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Recent advances in imaging have improved our understanding of the role of the brain in painful conditions. Discoveries of morphological changes have been made in patients with chronic pain, with little known about the functional consequences when they occur in areas associated with ‘number-sense’; thus, it can be hypothesized that chronic pain impairs this sense. Methods First, an audit of the use of numbers in gold-standard pain assessment tools in patients with acute and chronic pain was undertaken. Secondly, experiments were conducted with patients with acute and chronic pain and healthy controls. Participants marked positions of numbers on lines (number marking), before naming numbers on pre-marked lines (number naming). Finally, subjects bisected lines flanked with ‘2’ and ‘9’. Deviations from expected responses were determined for each experiment. Results Four hundred and ninety-four patients were audited; numeric scores in the ‘moderate’ and ‘severe’ pain categories were significantly higher in chronic compared with acute pain patients. In experiments (n=150), more than one-third of chronic pain patients compared with 1/10th of controls showed greater deviations from the expected in number marking and naming indicating impaired number sense. Line bisection experiments suggest prefrontal and parietal cortical dysfunction as cause of this impairment. Conclusions Audit data suggest patients with chronic pain interpret numbers differently from acute pain sufferers. Support is gained by experiments indicating impaired number sense in one-third of chronic pain patients. These results cast doubts on the appropriateness of the use of visual analogue and numeric rating scales in chronic pain in clinics and research.
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Affiliation(s)
- J Wolrich
- Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK
| | - A J Poots
- NIHR CLAHRC for NWL, Department of Medicine, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK
| | - B M Kuehler
- Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - A S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - A Rahman
- Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK
| | - C Bantel
- Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
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Bastian B, Jetten J, Hornsey MJ. Gustatory pleasure and pain. The offset of acute physical pain enhances responsiveness to taste. Appetite 2014; 72:150-5. [PMID: 24416797 DOI: 10.1016/j.appet.2013.10.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The idea that pain may serve to produce pleasurable states has been noted by theorists and, more recently, substantiated by empirical findings. We explored the possibility that, beyond producing positive hedonic states, the offset of pain may serve to enhance the capacity for gustatory pleasure. Across three studies we examined whether pain offset may enhance responsiveness to taste. In Study 1 participants enjoyed chocolate more after the experience of pain compared to completing a similar but non-painful task. In Study 2, pain offset increased the perceived intensity of a range of tastes, both pleasant and unpleasant, indicating that the effects of pain offset are not limited to the processing of positive hedonic stimuli. In Study 3, pain offset increased sensitivity to different flavors. The findings suggest that the offset of acute pain increases awareness of, and therefore sensitivity to, gustatory input, thereby enhancing the capacity for gustatory pleasure.
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Bastian B, Jetten J, Hornsey MJ, Leknes S. The Positive Consequences of Pain: A Biopsychosocial Approach. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2014; 18:256-279. [PMID: 24727972 DOI: 10.1177/1088868314527831] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pain is mostly thought of as a problem-as debilitating or harmful. Despite its unpleasantness, however, under some conditions pain can be associated with positive consequences. In this review, we explore these positive biological, psychological, and social consequences of pain. We highlight three different domains in which pain may be considered to have positive consequences. First, pain facilitates pleasure by providing an important contrast for pleasurable experiences, increasing sensitivity to sensory input, and facilitating self-rewarding behavior. Second, pain augments self-regulation and enhancement by increasing cognitive control, reducing rumination, and demonstrating virtue. Third, pain promotes affiliation by arousing empathy from others, motivating social connection, and enhancing group formation. Drawing on evidence scattered across a range of academic fields, we provide for reflection on how pain is represented, generate insights into pain-seeking behavior, and draw attention to the role of painful experiences in maximizing positive outcomes.
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Geha P, deAraujo I, Green B, Small DM. Decreased food pleasure and disrupted satiety signals in chronic low back pain. Pain 2014; 155:712-722. [DOI: 10.1016/j.pain.2013.12.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/10/2013] [Accepted: 12/20/2013] [Indexed: 01/22/2023]
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21
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Dorsher PT. Invited commentary on central hypersensitivity in patients with subacromial impingement syndrome. Arch Phys Med Rehabil 2012; 94:209-10; disscussion 211-2. [PMID: 22878229 DOI: 10.1016/j.apmr.2012.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 07/21/2012] [Indexed: 11/18/2022]
Abstract
Pain pressure threshold (PPT) measurement by handheld algometer has been validated as a tool to identify and quantitate myofascial pain sites in an individual. The average of 3 readings at a given muscle site is used, so the standard error of measurement of these devices must be considered when determining whether PPT differences between muscle sites represent true changes. This commentary discusses this issue.
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Affiliation(s)
- Peter T Dorsher
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, FL, USA.
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Abstract
UNLABELLED BACKGROUND The mechanisms subserving deep spinal pain have not been studied as well as those related to the skin and to deep pain in peripheral limb structures. The clinical phenomenology of deep spinal pain presents unique features which call for investigations which can explain these at a mechanistic level. METHODS Targeted searches of the literature were conducted and the relevant materials reviewed for applicability to the thesis that deep spinal pain is distinctive from deep pain in the peripheral limb structures. Topics related to the neuroanatomy and neurophysiology of deep spinal pain were organized in a hierarchical format for content review. RESULTS Since the 1980's the innervation characteristics of the spinal joints and deep muscles have been elucidated. Afferent connections subserving pain have been identified in a distinctive somatotopic organization within the spinal cord whereby afferents from deep spinal tissues terminate primarily in the lateral dorsal horn while those from deep peripheral tissues terminate primarily in the medial dorsal horn. Mechanisms underlying the clinical phenomena of referred pain from the spine, poor localization of spinal pain and chronicity of spine pain have emerged from the literature and are reviewed here, especially emphasizing the somatotopic organization and hyperconvergence of dorsal horn "low back (spinal) neurons". Taken together, these findings provide preliminary support for the hypothesis that deep spine pain is different from deep pain arising from peripheral limb structures. CONCLUSIONS This thesis addressed the question "what is different about spine pain?" Neuroanatomic and neurophysiologic findings from studies in the last twenty years provide preliminary support for the thesis that deep spine pain is different from deep pain arising from peripheral limb structures.
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Affiliation(s)
- Howard Vernon
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
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Bartoshuk LM, Catalanotto F, Hoffman H, Logan H, Snyder DJ. Taste damage (otitis media, tonsillectomy and head and neck cancer), oral sensations and BMI. Physiol Behav 2012; 107:516-26. [PMID: 22728784 DOI: 10.1016/j.physbeh.2012.06.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 06/08/2012] [Accepted: 06/13/2012] [Indexed: 11/15/2022]
Abstract
Otitis media and tonsillectomy are associated with enhanced palatability of energy dense foods and with weight gain. Otitis media can damage the chorda tympani nerve (CN VII); tonsillectomy and head and neck radiation treatment can damage the glossopharyngeal nerve (CN IX). Both of these nerves function prominently in taste sensation. The present study utilizes these sources of damage to study central interactions among the nerves that mediate oral sensations. Mild damage restricted to one of these nerves can actually intensify sensations evoked from undamaged nerves (i.e., whole-mouth taste, oral tactile sensations evoked by fats and irritants). These intensifications may result from disruption of central inhibitory taste circuits, as taste damage appears to disinhibit other oral sensory nerves. In addition, mild damage restricted to one taste nerve can intensify odors perceived from foods in the mouth during chewing and swallowing (i.e., retronasal olfaction); this may be a secondary consequence of the intensification of whole-mouth taste. Damage to both nerves leads to widespread oral sensory loss. At present, the link between sensory alterations and weight gain has not been established for adults (e.g., does increased fat preference occur in individuals with oral sensory intensifications, those with losses, or both?). Finally, pain in non-oral locations is also related to taste loss. When participants rated "the most intense pain of any kind they had ever experienced," those with the greatest taste loss gave the highest ratings. These effects suggest that taste loss significantly influences long-term health outcomes.
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Affiliation(s)
- Linda M Bartoshuk
- University of Florida, 4073 SW 21st Terrace, Gainesville, FL 32608, USA.
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Steiger F, Wirth B, de Bruin ED, Mannion AF. Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:575-98. [PMID: 22072093 DOI: 10.1007/s00586-011-2045-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 09/14/2011] [Accepted: 10/07/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest. This review aims to analyse the specificity of the effect by examining the relationship between the changes in clinical outcome (pain, disability) and the changes in the targeted aspects of physical function (muscle strength, mobility, muscular endurance) after exercise therapy. METHODS We searched for exercise therapy trials for cLBP published up to 15 April 2010 in Medline, Embase, Cochrane Library, Cinahl, and PEDro. Two independent reviewers selected studies according to the inclusion criteria. DATA EXTRACTION one author extracted the data of the articles. RESULTS DATA SYNTHESIS 16 studies with a total of 1,476 participants met the inclusion criteria. There was little evidence supporting a relationship between the changes in pain or physical function and the changes in performance for the following measures: mobility (no correlation in 9 studies, weak correlation in 1 study), trunk extension strength (7 and 2, respectively), trunk flexion strength (4 and 1, respectively) and back muscle endurance (7 and 0, respectively). Changes in disability showed no correlation with changes in mobility in three studies and a weak correlation in two; for strength, the numbers were four (no correlation) and two (weak correlation), respectively. CONCLUSIONS The findings do not support the notion that the treatment effects of exercise therapy in cLBP are directly attributable to changes in the musculoskeletal system. Future research aimed at increasing the effectiveness of exercise therapy in cLBP should explore the coincidental factors influencing symptom improvement.
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Affiliation(s)
- F Steiger
- Institute of Human Movement Sciences and Sport, ETH Zürich, Zurich, Switzerland
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25
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Al'Absi M, Nakajima M, Hooker S, Wittmers L, Cragin T. Exposure to acute stress is associated with attenuated sweet taste. Psychophysiology 2011; 49:96-103. [PMID: 22091733 DOI: 10.1111/j.1469-8986.2011.01289.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 07/20/2011] [Indexed: 12/20/2022]
Abstract
This study examined the effects of stress on taste perception. Participants (N = 38; 21 women) completed two laboratory sessions: one stress (public speaking, math, and cold pressor) and one control rest session. The taste perception test was conducted at the end of each session and included rating the intensity and pleasantness of sweet, salty, sour, and savory solutions at suprathreshold concentrations. Cardiovascular, hormonal, and mood measures were collected throughout the sessions. Participants showed the expected changes in cardiovascular, hormonal, and mood measures in response to stress. Reported intensity of the sweet solution was significantly lower on the stress day than on the rest day. Cortisol level poststress predicted reduced intensity of salt and sour, suggesting that stress-related changes in adrenocortical activity were related to reduced taste intensity. Results indicate that acute stress may alter taste perception, and ongoing research investigates the extent to which these changes mediate effects of stress on appetite.
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Affiliation(s)
- Mustafa Al'Absi
- Duluth Medical Research Institute, University of Minnesota Medical School, Duluth, Minnesota 55812, USA.
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27
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Wilder-Smith OH. Chronic Pain and Surgery: A Review of New Insights from Sensory Testing. J Pain Palliat Care Pharmacother 2011; 25:146-59. [DOI: 10.3109/15360288.2010.505256] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Minor JS, Epstein JB. Burning mouth syndrome and secondary oral burning. Otolaryngol Clin North Am 2011; 44:205-19, vii. [PMID: 21093630 DOI: 10.1016/j.otc.2010.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Burning mouth syndrome is a complex disorder of unclear etiology that is most prevalent in perimenopausal women. It is often accompanied by dysguesia and subjective xerostomia. Recent evidence implicates both central and peripheral neuropathies, possibly representing a phantom pain syndrome in some patients. Ensuring that the patient's oral burning is not secondary to some other local or systemic factor is central to appropriate management. Current standard therapies include clonazepam, paroxetine, and cognitive behavioral therapy, and several promising new alternatives are described.
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Affiliation(s)
- Jacob S Minor
- Department of Otolaryngology, University of Colorado at Denver, Denver, CO 80045, USA.
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Apkarian VA, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2010; 152:S49-S64. [PMID: 21146929 DOI: 10.1016/j.pain.2010.11.010] [Citation(s) in RCA: 486] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 11/09/2010] [Indexed: 12/23/2022]
Affiliation(s)
- Vania A Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Departments of Anesthesia and Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Wand BM, Parkitny L, O'Connell NE, Luomajoki H, McAuley JH, Thacker M, Moseley GL. Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. ACTA ACUST UNITED AC 2010; 16:15-20. [PMID: 20655796 DOI: 10.1016/j.math.2010.06.008] [Citation(s) in RCA: 226] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Chronic back pain is no exception. There is a growing sentiment, with accompanying theory, that these brain changes contribute to chronic back pain, although empirical support is lacking. This paper reviews the structural and functional changes of the brain that have been observed in people with chronic back pain. We cast light on the clinical implications of these changes and the possibilities for new treatments but we also advise caution against concluding their efficacy in the absence of solid evidence to this effect.
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Affiliation(s)
- Benedict Martin Wand
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
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Nixdorf DR, John MT, Schierz O, Bereiter DA, Hellekant G. Self-reported severity of taste disturbances correlates with dysfunctional grade of TMD pain. J Oral Rehabil 2009; 36:792-800. [PMID: 19747196 DOI: 10.1111/j.1365-2842.2009.01996.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Altered central neural processing of sensory information may be associated with temporomandibular disorders (TMD) pain. The objectives of this study were to compare the prevalence of self-reported taste disturbances in TMD pain patients and in a control population, and to determine whether frequency of taste disturbances was correlated with dysfunctional grade of TMD pain. Subjects were 2026 people within a German population sample and 301 consecutive TMD patients diagnosed using the Research Diagnostic Criteria. Taste disturbances were measured using two questions from the Oral Health Impact Profile. Dysfunctional grade of TMD pain was measured with the Graded Chronic Pain Scale. A two-sample test of proportions revealed that TMD patients reported a greater frequency of taste disturbances, 6%, than did the general population subjects, 2% (P < 0.001). Moreover, the frequency of taste disturbances correlated with the dysfunctional grade of TMD pain. For each 1 unit increase in taste disturbance, the odds of observing a higher grade of TMD pain increased by 29% (95% CI: 3-63%, P = 0.03). Analysis by individual taste question and adjustment for age and gender did not substantially affect the results. These findings are consistent with a central neural dysfunction in TMD pain and suggest that a common neural substrate may underlie sensory disturbances of multiple modalities in chronic pain patients. Further research regarding taste disturbances and trigeminally mediated pains such as in TMD is warranted.
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Affiliation(s)
- D R Nixdorf
- Division of TMD & Orofacial Pain, School of Dentistry, University of Minnesota, 6-320 Moos Tower, 515 Delaware Street S.E., Minneapolis, MN 55455, USA.
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Klasser GD, Fischer DJ, Epstein JB. Burning Mouth Syndrome: Recognition, Understanding, and Management. Oral Maxillofac Surg Clin North Am 2008; 20:255-71, vii. [DOI: 10.1016/j.coms.2007.12.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wand BM, O'Connell NE. Chronic non-specific low back pain - sub-groups or a single mechanism? BMC Musculoskelet Disord 2008; 9:11. [PMID: 18221521 PMCID: PMC2266926 DOI: 10.1186/1471-2474-9-11] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 01/25/2008] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Low back pain is a substantial health problem and has subsequently attracted a considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions for chronic non-specific low back pain indicate limited effectiveness for most commonly applied interventions and approaches. DISCUSSION Many clinicians challenge the results of clinical trials as they feel that this lack of effectiveness is at odds with their clinical experience of managing patients with back pain. A common explanation for this discrepancy is the perceived heterogeneity of patients with chronic non-specific low back pain. It is felt that the effects of treatment may be diluted by the application of a single intervention to a complex, heterogeneous group with diverse treatment needs. This argument presupposes that current treatment is effective when applied to the correct patient. An alternative perspective is that the clinical trials are correct and current treatments have limited efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important that the sub-grouping paradigm is closely examined. This paper argues that there are numerous problems with the sub-grouping approach and that it may not be an important reason for the disappointing results of clinical trials. We propose instead that current treatment may be ineffective because it has been misdirected. Recent evidence that demonstrates changes within the brain in chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of cortical reorganisation and degeneration. This perspective offers interesting insights into the chronic low back pain experience and suggests alternative models of intervention. SUMMARY The disappointing results of clinical research are commonly explained by the failure of researchers to adequately attend to sub-grouping of the chronic non-specific low back pain population. Alternatively, current approaches may be ineffective and clinicians and researchers may need to radically rethink the nature of the problem and how it should best be managed.
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Affiliation(s)
- Benedict Martin Wand
- School of Health Sciences, University of Notre Dame, Australia, 19 Mouat St, Fremantle WA 6959, Australia
| | - Neil Edward O'Connell
- Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex UB8 3PH, UK
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Baliki MN, Geha PY, Apkarian AV. Spontaneous pain and brain activity in neuropathic pain: functional MRI and pharmacologic functional MRI studies. Curr Pain Headache Rep 2007; 11:171-7. [PMID: 17504643 DOI: 10.1007/s11916-007-0187-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Functional brain imaging studies in chronic neuropathic pain patients have lagged far behind equivalent studies in acute pain. In the past few years, this trend has begun to shift. This article discusses the novel approach of studying brain activity for spontaneous pain and its modulation by pharmacologic manipulation. We argue that the approach provides a solid methodology for studying clinical (especially neuropathic) pain and patient populations, and moreover, that the latest results using this approach imply that distinct clinical chronic pain conditions seem to involve specific brain circuitry, which is also distinct from the brain activity commonly observed in acute pain.
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Affiliation(s)
- Marwan N Baliki
- Northwestern University Feinberg School of Medicine, Department of Physiology, Chicago, IL 60611, USA
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Erden V, Basaranoglu G, Korkut Y, Delatioglu H, Yangin Z, Kiroglu S. Relation between bitter taste sensitivity and incidence or intensity of propofol injection pain. Eur J Anaesthesiol 2006; 24:516-20. [PMID: 17087841 DOI: 10.1017/s0265021506001396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE In human beings, pain and taste perception are two major sensory inputs. We investigated whether increasing bitter taste sensitivity would increase intensity or incidence of pain associated with propofol, and whether there is a relationship between bitter sensitivity and venepuncture pain. METHODS One hundred (50 males, 50 females) American Society of Anesthesiologists Grade I adults undergoing elective surgery were included in this study. Determination of the taste thresholds employed a series of propylthiouracil solutions. The filter paper disk method was used to measure the taste threshold. A 20-G intravenous (i.v.) cannula was inserted in the dorsum of the non-dominant hand. Venepuncture pain was assessed by using a numerical rating scale (NRS; 0, no pain and 10, extreme pain). Propofol 10 mL (100 mg) was injected over 30 s. Assessment of pain with i.v. propofol was made using a 4-point scale: 0, no pain; 1, mild pain; 2, moderate pain; 3, severe pain. RESULTS The NRS score of venepuncture pain was 2.8 +/- 1.5. Sixty patients had pain during propofol injection. There was statistically significant correlation between bitter sensitivity and propofol injection pain, and between bitter sensitivity and venepuncture pain (P < 0.05). CONCLUSIONS We conclude that increased bitter taste sensitivity correlates with increased intensity or incidence of propofol injection pain and NRS of venepuncture pain.
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Affiliation(s)
- V Erden
- Department of Anesthesiology, Vakif Gureba Hospital, Istanbul, Turkey
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Geha PY, Baliki MN, Chialvo DR, Harden RN, Paice JA, Apkarian AV. Brain activity for spontaneous pain of postherpetic neuralgia and its modulation by lidocaine patch therapy. Pain 2006; 128:88-100. [PMID: 17067740 DOI: 10.1016/j.pain.2006.09.014] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 08/04/2006] [Accepted: 09/05/2006] [Indexed: 11/27/2022]
Abstract
Postherpetic neuralgia (PHN) is a debilitating chronic pain condition, yet there is a lack of knowledge regarding underlying brain activity. Here we identify brain regions involved in spontaneous pain of PHN (n=11) and determine its modulation with Lidoderm therapy (patches of 5% lidocaine applied to the PHN affected body part). Continuous ratings of fluctuations of spontaneous pain during fMRI were contrasted to ratings of fluctuations of a bar observed during scanning, at three sessions: (1) pre-treatment baseline, (2) after 6h of Lidoderm treatment, and (3) after 2 weeks of Lidoderm use. Overall brain activity for spontaneous pain of PHN involved affective and sensory-discriminative areas: thalamus, primary and secondary somatosensory, insula and anterior cingulate cortices, as well as areas involved in emotion, hedonics, reward, and punishment: ventral striatum, amygdala, orbital frontal cortex, and ventral tegmental area. Generally, these activations decreased at sessions 2 and 3, except right anterior insular activity which increased with treatment. The sensory and affective activations only responded to the short-term treatment (6h of Lidoderm); while the ventral striatum and amygdala (reward-related regions) decreased mainly with longer-term treatment (2 weeks of Lidoderm). Pain properties: average magnitude of spontaneous pain, and responses on Neuropathic Pain Scale (NPS), decreased with treatment. The ventral striatal and amygdala activity best reflected changes in NPS, which was modulated only with longer-term treatment. The results show a specific brain activity pattern for PHN spontaneous pain, and implicate areas involved in emotions and reward as best reflecting changes in pain with treatment.
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Affiliation(s)
- P Y Geha
- Department of Physiology, Northwestern University, Feinberg School of Medicine, 303 East Chicago Ave, Chicago, IL 60611, USA
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