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Kaplan CM, Kelleher E, Irani A, Schrepf A, Clauw DJ, Harte SE. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nat Rev Neurol 2024; 20:347-363. [PMID: 38755449 DOI: 10.1038/s41582-024-00966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Nociplastic pain is a mechanistic term used to describe pain that arises or is sustained by altered nociception, despite the absence of tissue damage. Although nociplastic pain has distinct pathophysiology from nociceptive and neuropathic pain, these pain mechanisms often coincide within individuals, which contributes to the intractability of chronic pain. Key symptoms of nociplastic pain include pain in multiple body regions, fatigue, sleep disturbances, cognitive dysfunction, depression and anxiety. Individuals with nociplastic pain are often diffusely tender - indicative of hyperalgesia and/or allodynia - and are often more sensitive than others to non-painful sensory stimuli such as lights, odours and noises. This Review summarizes the risk factors, clinical presentation and treatment of nociplastic pain, and describes how alterations in brain function and structure, immune processing and peripheral factors might contribute to the nociplastic pain phenotype. This article concludes with a discussion of two proposed subtypes of nociplastic pain that reflect distinct neurobiological features and treatment responsivity.
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Affiliation(s)
- Chelsea M Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Eoin Kelleher
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anushka Irani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Division of Rheumatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
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Svensson P. Could painful temporomandibular disorders be nociplastic in nature? A critical review and new proposal. Acta Odontol Scand 2024; 83:144-150. [PMID: 38623025 PMCID: PMC11302400 DOI: 10.2340/aos.v83.40586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 04/17/2024]
Abstract
Classification of temporomandibular disorders (TMD) and, indeed, all types of orofacial pains has significantly progressed in the last decade based on international consensus work and operationalized clustering of signs and symptoms. A challenging gap nevertheless continues to exist in terms of understanding the underlying pain mechanisms and link to management. Recently, a novel mechanistic descriptor 'nociplastic pain' was introduced, and diagnostic algorithms and characteristic features were proposed. This narrative and critical review aim to discuss to what extent could painful TMD conditions fit into this category. Moreover, a number of less common types of orofacial pain could possibly also reflect nociplastic pain mechanisms. A model to differentiate TMD pain mechanisms is proposed, and the implications for management are discussed. The purpose of this review is to stimulate original and novel research into mechanisms of orofacial pain and hopefully thereby improve management of the individual patient.
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Affiliation(s)
- Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus C, Denmark; Faculty of Dentistry, Malmø University, Malmö, Sweden; Scandinavian Center for Orofacial Neurosciences, Aarhus University, Aarhus C, Denmark.
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3
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Baggen JHM, Koevoets AC, Koutris M, Steegers MAH, Lobbezoo F. Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history. BMC Oral Health 2024; 24:22. [PMID: 38178030 PMCID: PMC10768420 DOI: 10.1186/s12903-023-03796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
The aims of this qualitative research were (1) to gain more insight in the diagnostic and treatment history of patients with chronic temporomandibular disorder (TMD) pain; (2) to get a deeper understanding of possible factors that are involved in the possible delay in setting a TMD-pain diagnosis and receiving appropriate treatment; and (3) to get a deeper understanding of the perspectives and experiences of chronic TMD-pain patients on the possible improvement of various aspects of their diagnostic and treatment journey.MethodsIn this narrative research, semi-structured interviews took place with patients who experienced chronic orofacial pain (OFP) for at least three years before getting diagnosed with, and treated for, TMD pain by an OFP specialist in an interprofessional setting.ResultsIn total, ten patients were interviewed in-depth. Patients experienced their chronic OFP in different ways, but all reported a significant impact of their pain on their quality of life. All patients visited numerous health care professionals before their TMD diagnosis was set. Among others, they underwent anti-neuropathic pain medication therapies and invasive surgeries, which did not significantly reduce their chronic OFP. The interprofessional TMD-pain treatment reduced the suffering of the chronic OFP substantially, also 6 months after the start of therapy, and improved the quality of life for all patients. In most of them, the OFP intensity was also decreased.ConclusionChronic TMD-pain patients with a history of neuropathic pain treatment may experience a long journey until receiving the appropriate diagnosis and treatment. This stresses the need to improve the implementation of chronic TMD-pain guidelines.
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Affiliation(s)
- Jeanne H M Baggen
- Department of Orofacial Pain & Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan, 3004, 1081 LA, Amsterdam, The Netherlands.
| | - Anna C Koevoets
- Department of Orofacial Pain & Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan, 3004, 1081 LA, Amsterdam, The Netherlands
| | - Michail Koutris
- Department of Orofacial Pain & Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan, 3004, 1081 LA, Amsterdam, The Netherlands
| | - Monique A H Steegers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Anesthesiology, Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain & Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan, 3004, 1081 LA, Amsterdam, The Netherlands
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Cazzaniga S, Real G, Finazzi S, Lorini LF, Forget P, Bugada D. How to Modulate Peripheral and Central Nervous System to Treat Acute Postoperative Pain and Prevent Pain Persistence. Curr Neuropharmacol 2024; 22:23-37. [PMID: 37563811 PMCID: PMC10716883 DOI: 10.2174/1570159x21666230810103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 08/12/2023] Open
Abstract
Chronic postoperative pain (CPSP) is a major issue after surgery, which may impact on patient's quality of life. Traditionally, CPSP is believed to rely on maladaptive hyperalgesia and risk factors have been identified that predispose to CPSP, including acute postoperative pain. Despite new models of prediction are emerging, acute pain is still a modifiable factor that can be challenged with perioperative analgesic strategies. In this review we present the issue of CPSP, focusing on molecular mechanism underlying the development of acute and chronic hyperalgesia. Also, we focus on how perioperative strategies can impact directly or indirectly (by reducing postoperative pain intensity) on the development of CPSP.
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Affiliation(s)
- Sara Cazzaniga
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Giovanni Real
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Simone Finazzi
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Luca F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Patrice Forget
- School of Medicine, Medical Sciences and Nutrition, Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom
- Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, Scotland, United Kingdom
| | - Dario Bugada
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
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Valentine TR, Kratz AL. Feasibility, reliability, and validity of ambulatory cognitive tests in fibromyalgia and matched controls. J Int Neuropsychol Soc 2023; 29:893-901. [PMID: 36762635 PMCID: PMC10412734 DOI: 10.1017/s1355617723000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE This observational study examined the feasibility, reliability, and validity of repeated ambulatory cognitive tests in fibromyalgia (FM). METHOD Adults with FM (n = 50) and matched controls (n = 50) completed lab-based neuropsychological tests (NIH Toolbox) followed by eight days of smartphone-based ambulatory testing of processing speed (symbol search) and working memory (dot memory) five times daily. Feasibility was assessed based on response rates. Reliability was evaluated using overall average between-person reliabilities for the full assessment period and by determining the number of assessment days necessary to attain reliabilities of >.80 and >.90. To assess convergent validity, correlations were calculated between ambulatory test scores and NIH Toolbox scores. Test performance was contrasted between the FM and non-FM groups to examine known-groups validity. RESULTS Average rates of response to the ambulatory cognitive tests were 89.5% in FM and 90.0% in non-FM. Overall average between-person reliabilities were ≥.96. In FM, between-person reliability exceeded .90 after two days for symbol search and three days for dot memory. Symbol search scores correlated with NIH Toolbox processing speed scores in both groups, though there were no significant group differences in symbol search performance. Dot memory scores correlated with NIH Toolbox working memory scores in both groups. FM participants exhibited worse dot memory performance than did non-FM participants. CONCLUSIONS Repeated ambulatory tests of processing speed and working memory demonstrate feasibility and reliability in FM, though evidence for construct validity is mixed. The findings demonstrate promise for future research and clinical applications of this approach to assessing cognition in FM.
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Affiliation(s)
- Thomas R. Valentine
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Anna L. Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Kmiecik MJ, Tu FF, Clauw DJ, Hellman KM. Multimodal hypersensitivity derived from quantitative sensory testing predicts pelvic pain outcome: an observational cohort study. Pain 2023; 164:2070-2083. [PMID: 37226937 PMCID: PMC10440257 DOI: 10.1097/j.pain.0000000000002909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/09/2023] [Indexed: 05/26/2023]
Abstract
ABSTRACT Multimodal hypersensitivity (MMH)-greater sensitivity across multiple sensory modalities (eg, light, sound, temperature, pressure)-is associated with the development of chronic pain. However, previous MMH studies are restricted given their reliance on self-reported questionnaires, narrow use of multimodal sensory testing, or limited follow-up. We conducted multimodal sensory testing on an observational cohort of 200 reproductive-aged women, including those at elevated risk for chronic pelvic pain conditions and pain-free controls. Multimodal sensory testing included visual, auditory, and bodily pressure, pelvic pressure, thermal, and bladder pain testing. Self-reported pelvic pain was examined over 4 years. A principal component analysis of sensory testing measures resulted in 3 orthogonal factors that explained 43% of the variance: MMH, pressure pain stimulus response, and bladder hypersensitivity. The MMH and bladder hypersensitivity factors correlated with baseline self-reported menstrual pain, genitourinary symptoms, depression, anxiety, and health. Over time, MMH increasingly predicted pelvic pain and was the only component to predict outcome 4 years later, even when adjusted for baseline pelvic pain. Multimodal hypersensitivity was a better predictor of pelvic pain outcome than a questionnaire-based assessment of generalized sensory sensitivity. These results suggest that MMHs overarching neural mechanisms convey more substantial long-term risk for pelvic pain than variation in individual sensory modalities. Further research on the modifiability of MMH could inform future treatment developments in chronic pain.
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Affiliation(s)
- Matthew J. Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F. Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Daniel J. Clauw
- Departments of Anesthesiology, Medicine, and Psychiatry, Chronic Pain and Fatigue Research Center, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kevin M. Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Steinmann J, Lewis A, Ellmers TJ, Jones M, MacBean V, Kal E. Validating the Breathing Vigilance Questionnaire for use in dysfunctional breathing. Eur Respir J 2023; 61:2300031. [PMID: 37024133 DOI: 10.1183/13993003.00031-2023] [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: 07/19/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Dysfunctional breathing is common among people with and without primary respiratory pathology. While anxiety can contribute to dysfunctional breathing, the underpinning mechanism is unclear. One explanation is that anxiety induces conscious, vigilant monitoring of breathing, disrupting "automatic" breathing mechanics. We validated a new tool that quantifies such breathing-related "vigilance": the Breathing Vigilance Questionnaire (Breathe-VQ). METHODS 323 healthy adults (mean (range) age 27.3 (18-71) years; 161 males) were analysed. We developed an initial Breathe-VQ (11 items, 1-5 Likert scale) based on the Pain Vigilance and Awareness Scale, using feedback from the target population and clinicians. At baseline, participants completed the Breathe-VQ, Nijmegen Questionnaire (NQ), State-Trait Anxiety Inventory form 2 and Movement-Specific Reinvestment Scale (assessing general conscious processing). 83 people repeated the Breathe-VQ 3 weeks later. RESULTS Five items were removed based on item-level analysis. The resulting six-item Breathe-VQ questionnaire (score range 6-30) has excellent internal (α=0.892) and test-retest reliability (intraclass correlation 0.810), a minimal detectable change of 6.5 and no floor/ceiling effects. Validity was evidenced by significant positive correlations with trait anxiety and conscious processing scores (r=0.35-0.46). Participants at high risk of having dysfunctional breathing (NQ >23; n=76) had significantly higher Breathe-VQ score (mean±sd 19.1±5.0) than low-risk peers (n=225; mean±sd 13.8±5.4; p<0.001). In this "high risk of dysfunctional breathing" group, Breathe-VQ and NQ scores were significantly associated (p=0.005), even when controlling for risk factors (e.g. trait anxiety). CONCLUSIONS The Breathe-VQ is a valid and reliable tool to measure breathing vigilance. High breathing vigilance may contribute to dysfunctional breathing and could represent a therapeutic target. Further research is warranted to test Breathe-VQ's prognostic value and assess intervention effects.
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Affiliation(s)
- Jennifer Steinmann
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
- J. Steinmann and A. Lewis are joint first authors
| | - Adam Lewis
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
- Centre for Smart Technology Advancements for Health and Rehabilitation, Brunel University London, London, UK
- J. Steinmann and A. Lewis are joint first authors
| | - Toby J Ellmers
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
| | - Mandy Jones
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Vicky MacBean
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
- Centre for Smart Technology Advancements for Health and Rehabilitation, Brunel University London, London, UK
| | - Elmar Kal
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
- Centre for Smart Technology Advancements for Health and Rehabilitation, Brunel University London, London, UK
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
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Pinto AM, Luís M, Geenen R, Palavra F, Lumley MA, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, Häuser W, Kosek E, López-Solà M, Mease P, Marques TR, Jacobs JWG, Castilho P, da Silva JAP. Neurophysiological and Psychosocial Mechanisms of Fibromyalgia: A Comprehensive Review and Call for An Integrative Model. Neurosci Biobehav Rev 2023:105235. [PMID: 37207842 DOI: 10.1016/j.neubiorev.2023.105235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023]
Abstract
Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fibromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the understanding, assessment, and intervention for fibromyalgia.
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Affiliation(s)
- Ana Margarida Pinto
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal; University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal.
| | - Mariana Luís
- Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal.
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Martinus J. Langeveldgebouw, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, the Netherlands.
| | - Filipe Palavra
- Centre for Child Development, Neuropediatric Unit. Pediatric Hospital, Coimbra Hospital and University Centre, Avenida Afonso Romão, 3000-602 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7908, Detroit, MI 48202, USA.
| | - Jacob N Ablin
- Internal Medicine H, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
| | - Kirstine Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Jaime Branco
- Rheumatology Department, Egas Moniz Hospital - Lisboa Ocidental Hospital Centre (CHLO-EPE), R. da Junqueira 126, 1349-019 Lisbon, Portugal; Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal.
| | - Dan Buskila
- Ben Gurion University of the Negev Beer-Sheba, Israel.
| | - João Castelhano
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, Department of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec, Canada, H3G 1A4.
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm 171 77, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA.
| | - Tiago Reis Marques
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, South Kensington, London SW7 2BU, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London WC2R 2LS, UK.
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
| | - Paula Castilho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal.
| | - José A P da Silva
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
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Harper DE, Gopinath K, Smith JL, Gregory M, Ichesco E, Aronovich S, Harris RE, Harte SE, Clauw DJ, Fleischer CC. Characterization of visual processing in temporomandibular disorders using functional magnetic resonance imaging. Brain Behav 2023; 13:e2916. [PMID: 36793184 PMCID: PMC10013945 DOI: 10.1002/brb3.2916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/20/2022] [Accepted: 01/15/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND AND PURPOSE Many patients with chronic pain report hypersensitivity not only to noxious stimuli, but also to other modalities including innocuous touch, sound, and light, possibly due to differences in the processing of these stimuli. The goal of this study was to characterize functional connectivity (FC) differences between subjects with temporomandibular disorders (TMD) and pain-free controls during a visual functional magnetic resonance imaging (fMRI) task that included an unpleasant, strobing visual stimulus. We hypothesized the TMD cohort would exhibit maladaptations in brain networks consistent with multisensory hypersensitivities observed in TMD patients. METHODS This pilot study included 16 subjects, 10 with TMD and 6 pain-free controls. Clinical pain was characterized using self-reported questionnaires. Visual task-based fMRI data were collected on a 3T MR scanner and used to determine differences in FC via group independent component analysis. RESULTS Compared to controls, subjects with TMD exhibited abnormally increased FC between the default mode network and lateral prefrontal areas involved in attention and executive function, and impaired FC between the frontoparietal network and higher order visual processing areas. CONCLUSIONS The results indicate maladaptation of brain functional networks, likely due to deficits in multisensory integration, default mode network function, and visual attention and engendered by chronic pain mechanisms.
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Affiliation(s)
- Daniel E Harper
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kaundinya Gopinath
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mia Gregory
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Eric Ichesco
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery and Hospital Dentistry, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Candace C Fleischer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, Georgia, USA
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10
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Haider S, Janowski AJ, Lesnak JB, Hayashi K, Dailey DL, Chimenti R, Frey-Law LA, Sluka KA, Berardi G. A comparison of pain, fatigue, and function between post-COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: a survey study. Pain 2023; 164:385-401. [PMID: 36006296 PMCID: PMC9797623 DOI: 10.1097/j.pain.0000000000002711] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT A growing number of individuals report prolonged symptoms following acute Coronavirus-19 (COVID-19) infection, known as post-COVID-19 condition (post-COVID-19). While studies have emerged investigating the symptom sequelae of post-COVID-19, there has been limited investigation into the characterization of pain, fatigue, and function in these individuals, despite initial reports of a clinical phenotype similar to fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). This study aimed to characterize multiple symptom domains in individuals reporting post-COVID-19 and compare its clinical phenotype with those with FMS and CFS. A total of 707 individuals with a single or comorbid diagnosis of post-COVID-19, FMS, and/or CFS completed multiple surveys assessing self-reported pain, fatigue, physical and cognitive function, catastrophizing, kinesiophobia, anxiety, depression, dyspnea, and sleep quality. In all 3 diagnoses, elevated pain, fatigue, anxiety, depression, catastrophizing, and kinesiophobia were reported. Physical and cognitive function were similarly impacted among individuals with post-COVID-19, FMS, and CFS; however, individuals with post-COVID-19 reported lower pain and fatigue than FMS and CFS. The comorbid diagnosis of post-COVID-19 with FMS and/or CFS further exacerbated pain, fatigue, and psychological domains when compared with post-COVID-19 alone. In summary, individuals with post-COVID-19 report a symptom phenotype similar to FMS and CFS, negatively impacting cognitive and physical function, but with less severe pain and fatigue overall. These findings may help direct future investigations of the benefit of a biopsychosocial approach to the clinical management of post-COVID-19.
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Affiliation(s)
- Saman Haider
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Adam J. Janowski
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Joseph B. Lesnak
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Kazuhiro Hayashi
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Dana L. Dailey
- Department of Physical Therapy, St. Ambrose University, Davenport, IA 52803
| | - Ruth Chimenti
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Laura A. Frey-Law
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Giovanni Berardi
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA 52242
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11
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Poluha RL, Canales GDLT, Ferreira DM, Stuginski-Barbosa J, Conti PCR. Catastrophizing and Hypervigilance Influence Subjective Sleep Quality in Painful TMD Patients. J Oral Facial Pain Headache 2023; 37:47-53. [PMID: 36917236 PMCID: PMC10586571 DOI: 10.11607/ofph.3269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/12/2022] [Indexed: 03/16/2023]
Abstract
Aims: To determine sleep quality and associated factors in a group of patients with painful TMDs. Methods: The medical records of 80 patients with arthralgia and/or myofascial pain were reviewed and compared to a healthy control group. Data about sex, age, subjective pain, physical activity, social activity, subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]), pain vigilance (Pain Vigilance and Awareness Questionnaire [PVAQ]), and pain catastrophizing (Pain Catastrophizing Scale [PCS]) were collected. Relationships between PSQI, age, pain intensity, PVAQ, and PCS in the TMD group were also analyzed. Data from the control group were used to transform the PSQI results into T-scores, which were then used to divide the TMD group into two subgroups: normal and impaired sleep. Results: TMD patients presented a significantly higher (P < .001) PSQI score than the control group. Also, in the TMD group, there was a low to moderate correlation between PSQI and pain intensity and a significant correlation between PVAQ and PCS. The impaired sleep group presented a significantly higher (P < .001) PSQI T-score than the normal sleep group. Univariate analysis showed that subjective pain, social activity, and the PCS total and subscale scores differed significantly between the different PSQI T-score groups. The comparison between TMD pain patients and control subjects showed a significantly higher prevalence of T-score discordance in almost all PSQI components in TMD patients with impaired sleep. Conclusion: Subjective sleep quality in painful TMD patients could be associated with and influenced by psychosocial factors (catastrophizing and hypervigilance), social activity, and pain intensity.
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12
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Smith JL, Allen JW, Fleischer CC, Harper DE. Topology of pain networks in patients with temporomandibular disorder and pain-free controls with and without concurrent experimental pain: A pilot study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:966398. [PMID: 36324873 PMCID: PMC9619074 DOI: 10.3389/fpain.2022.966398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
Temporomandibular disorders (TMD) involve chronic pain in the masticatory muscles and jaw joints, but the mechanisms underlying the pain are heterogenous and vary across individuals. In some cases, structural, functional, and metabolic changes in the brain may underlie the condition. In the present study, we evaluated the functional connectivity between 86 regions of interest (ROIs), which were chosen based on previously reported neuroimaging studies of pain and differences in brain morphology identified in an initial surface-based morphometry analysis. Our main objectives were to investigate the topology of the network formed by these ROIs and how it differs between individuals with TMD and chronic pain (n = 16) and pain-free control participants (n = 12). In addition to a true resting state functional connectivity scan, we also measured functional connectivity during a 6-min application of a noxious cuff stimulus applied to the left leg. Our principal finding is individuals with TMD exhibit more suprathreshold correlations (higher nodal degree) among all ROIs but fewer "hub" nodes (i.e., decreased betweenness centrality) across conditions and across all pain pathways. These results suggest is this pain-related network of nodes may be "over-wired" in individuals with TMD and chronic pain compared to controls, both at rest and during experimental pain.
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Affiliation(s)
- Jeremy L. Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Jason W. Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States,Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Candace C. Fleischer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Daniel E. Harper
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, United States,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States,Correspondence: Daniel E. Harper
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13
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical mechanisms of visual hypersensitivity in women at risk for chronic pelvic pain. Pain 2022; 163:1035-1048. [PMID: 34510138 PMCID: PMC8882209 DOI: 10.1097/j.pain.0000000000002469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Increased sensory sensitivity across non-nociceptive modalities is a common symptom of chronic pain conditions and is associated with chronic pain development. Providing a better understanding of the brain-behavior relationships that underlie multimodal hypersensitivity (MMH) may clarify the role of MMH in the development of chronic pain. We studied sensory hypersensitivity in a cohort of women (n = 147) who had diary confirmation of menstrual status and were enriched with risk factors for chronic pelvic pain, such as dysmenorrhea and increased bladder sensitivity. We administered 2 experimental tasks to evaluate the cross-modal relationship between visual and visceral sensitivity. Visual sensitivity was probed by presenting participants with a periodic pattern-reversal checkerboard stimulus presented across 5 brightness intensities during electroencephalography recording. Self-reported visual unpleasantness ratings for each brightness intensity were simultaneously assessed. Visceral sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visually evoked cortical activity increased with brightness intensity across the entire scalp, especially at occipital electrode sites. Visual stimulation-induced unpleasantness was associated with provoked bladder pain and evoked primary visual cortex activity. However, the relationship between unpleasantness and cortical activity was moderated by provoked bladder pain. These results demonstrate that activity in the primary visual cortex is not greater in individuals with greater visceral sensitivity. We hypothesize that downstream interpretation or integration of this signal is amplified in individuals with visceral hypersensitivity. Future studies aimed at reducing MMH in chronic pain conditions should prioritize targeting of cortical mechanisms responsible for aberrant downstream sensory integration.
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Affiliation(s)
- Matthew J. Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F. Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L. Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E. Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E. Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M. Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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14
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Hamed R, Mizrachi L, Granovsky Y, Issachar G, Yuval-Greenberg S, Bar-Shalita T. Neurofeedback Therapy for Sensory Over-Responsiveness-A Feasibility Study. SENSORS 2022; 22:s22051845. [PMID: 35270991 PMCID: PMC8914621 DOI: 10.3390/s22051845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/22/2022]
Abstract
Background: Difficulty in modulating multisensory input, specifically the sensory over-responsive (SOR) type, is linked to pain hypersensitivity and anxiety, impacting daily function and quality of life in children and adults. Reduced cortical activity recorded under resting state has been reported, suggestive of neuromodulation as a potential therapeutic modality. This feasibility study aimed to explore neurofeedback intervention in SOR. Methods: Healthy women with SOR (n = 10) underwent an experimental feasibility study comprising four measurement time points (T1—baseline; T2—preintervention; T3—postintervention; T4—follow-up). Outcome measures included resting-state EEG recording, in addition to behavioral assessments of life satisfaction, attaining functional goals, pain sensitivity, and anxiety. Intervention targeted the upregulation of alpha oscillatory power over ten sessions. Results: No changes were detected in all measures between T1 and T2. Exploring the changes in brain activity between T2 and T4 revealed power enhancement in delta, theta, beta, and gamma oscillatory bands, detected in the frontal region (p = 0.03−<0.001; Cohen’s d = 0.637−1.126) but not in alpha oscillations. Furthermore, a large effect was found in enhancing life satisfaction and goal attainment (Cohen’s d = 1.18; 1.04, respectively), and reduced pain sensitivity and anxiety trait (Cohen’s d = 0.70). Conclusion: This is the first study demonstrating the feasibility of neurofeedback intervention in SOR.
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Affiliation(s)
- Ruba Hamed
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
| | - Limor Mizrachi
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
| | - Yelena Granovsky
- Laboratory of Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Rambam Health Care Campus, Technion, Haifa 3109601, Israel;
| | - Gil Issachar
- Biomedical Engineering Department, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Shlomit Yuval-Greenberg
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 6997801, Israel;
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-525437631
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15
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Fernandes-Magalhaes R, Ferrera D, Peláez I, Martín-Buro MC, Carpio A, De Lahoz ME, Barjola P, Mercado F. Neural correlates of the attentional bias towards pain-related faces in fibromyalgia patients: An ERP study using a dot-probe task. Neuropsychologia 2022; 166:108141. [PMID: 34995568 DOI: 10.1016/j.neuropsychologia.2021.108141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND One of the major cognitive deficits in fibromyalgia has been linked to the hypervigilance phenomenon. It is mainly reflected as a negative bias for allocating attentional resources towards both threatening and pain-related information. Although the interest in its study has recently grown, the neural temporal dynamics of the attentional bias in fibromyalgia still remains an open question. METHOD Fifty participants (25 fibromyalgia patients and 25 healthy control subjects) performed a dot-probe task. Two types of facial expressions (pain-related and neutral) were employed as signal stimuli. Then, as a target stimulus, a single dot replaced the location of one of these two faces. Event-related potentials (ERP) in response to facial expressions and target stimulation (i.e., dot) were recorded. Reaction time (RT) and accuracy measures in the experimental task were collected as behavioural outcomes. RESULTS Temporal dynamics of brain electrical activity were analysed on two ERP components (P2 and N2a) sensitive to the facial expressions meaning. Pain-related faces elicited higher frontal P2 amplitudes than neutral faces for the whole sample. Interestingly, an interaction effect between group and facial expressions was also found showing that pain-related faces elicited enhanced P2 amplitudes (at fronto-central regions, in this case) compared to neutral faces only when the group of patients was considered. Furthermore, higher P2 amplitudes were observed in response to pain-related faces in patients with fibromyalgia compared to healthy control participants. Additionally, a shorter latency of P2 (at centro-parietal regions) was also detected for pain-related facial expressions compared to neutral faces. Regarding the amplitude of N2a, it was lower for patients as compared to the control group. Non-relevant effects of the target stimulation on the ERPs were found. However, patients with fibromyalgia exhibited slower RT to locate the single dot for incongruent trials as compared to congruent and neutral trials. CONCLUSIONS Data suggest the presence of an attentional bias in fibromyalgia that it would be followed by a deficit in the allocation of attentional resources to further process pain-related information. Altogether the current results suggest that attentional biases in fibromyalgia might be explained by automatic attentional mechanisms, which seem to be accompanied by an alteration of more strategic or controlled attentional components.
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Affiliation(s)
- Roberto Fernandes-Magalhaes
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain; Clinical Foundation of the Rey Juan Carlos University, Madrid, Spain
| | - David Ferrera
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Irene Peláez
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | | | - Alberto Carpio
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - María Eugenia De Lahoz
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Paloma Barjola
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Francisco Mercado
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
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16
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Harte SE, Wiseman J, Wang Y, Smith AR, Yang CC, Helmuth M, Kreder K, Kruger GH, Gillespie BW, Amundsen C, Kirkali Z, Lai HH. Experimental Pain and Auditory Sensitivity in Overactive Bladder Syndrome: A Symptoms of the Lower Urinary Tract Dysfunction Research Network (LURN) Study. J Urol 2022; 207:161-171. [PMID: 34428922 PMCID: PMC9237822 DOI: 10.1097/ju.0000000000002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to investigate the presence of nonbladder sensory abnormalities in participants with overactive bladder syndrome (OAB). MATERIALS AND METHODS Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study participants with OAB symptoms and controls were recruited from 6 U.S. tertiary referral centers. Quantitative sensory testing (QST) was performed to determine pressure pain sensitivity at the thumbnail bed and auditory sensitivity. Fixed and mixed effect multivariable linear regressions and Weibull models were used to compare QST responses between groups. Pearson correlations were used to assess the relationship between QST measures. Associations between QST and self-reported symptoms were explored with linear regression. RESULTS A total of 297 participants were analyzed (191 OAB, 106 controls; 76% white, 51% male). OAB cases were older than controls (57.4 vs 52.2 years, p=0.015). No significant differences in experimental thumbnail (nonbladder) pain or auditory sensitivity were detected between OAB cases and controls. Correlations between pressure and auditory derived metrics were weak to moderate overall for both groups, with some significantly stronger correlations for cases. Exploratory analyses indicated increased pressure pain and auditory sensitivity were modestly associated with greater self-reported bladder pain and pain interference with physical function. CONCLUSIONS As a group, no significant differences between OAB cases and controls were observed in experimental nonbladder pain or auditory sensitivity during QST. Associations between QST outcomes and clinical pain raise the possibility of centrally mediated sensory amplification in some individuals with OAB.
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Affiliation(s)
- Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jon Wiseman
- Arbor Research Collaborative for Health, Ann Arbor, MI USA
| | - Ying Wang
- Department of Anesthesia, Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Claire C. Yang
- Department of Urology, University of Washington, Seattle, WA, 98195-6510 USA
| | | | - Karl Kreder
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Grant H. Kruger
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Cindy Amundsen
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - H. Henry Lai
- Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
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17
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Augière T, Desjardins A, Paquette Raynard E, Brun C, Pinard AM, Simoneau M, Mercier C. Tactile Detection in Fibromyalgia: A Systematic Review and a Meta-Analysis. FRONTIERS IN PAIN RESEARCH 2021; 2:740897. [PMID: 35295451 PMCID: PMC8915638 DOI: 10.3389/fpain.2021.740897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Fibromyalgia is a chronic pain syndrome characterized by sensorimotor deficits and distortions of body representation, that could both be caused by alterations in sensory processing. Several studies suggest a hypersensitivity to various sensory stimulations in fibromyalgia but results on detection of both noxious and non-noxious tactile stimulation, which are particularly relevant for body representation and motor control, remain conflicting. Therefore, the aim of this study is to systematically review and quantify the detection thresholds to noxious and non-noxious tactile stimuli in individuals with fibromyalgia compared to pain-free controls. A systematic review and a meta-analysis were performed in the MEDLINE, EMBASE, CINAHL, Cochrane, PsycInfo and Web of Science databases using keywords related to fibromyalgia, tactile pain detection threshold, tactile detection threshold and quantitative sensory testing. Nineteen studies were included in the review, with 12 in the meta-analysis. Despite the heterogeneity of the results, the data from both the review and from the meta-analysis suggest a trend toward hyperalgesia and no difference of sensitivity to non-noxious tactile stimuli in participants with fibromyalgia compared to healthy controls. This contradicts the hypothesis of a general increase in responsiveness of the central nervous system to noxious and non-noxious stimulations in fibromyalgia. This study shows no alteration of the sensitivity to non-noxious tactile stimulation in fibromyalgia, suggesting that an altered unimodal processing is not sufficient to explain symptoms such as sensorimotor impairments and body representation distortions. Future research should investigate whether alterations in multisensory integration could contribute to these symptoms.
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Affiliation(s)
- Tania Augière
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Audrey Desjardins
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Martin Simoneau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada
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18
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Payano Sosa JS, Da Silva JT, Burrowes SAB, Yoo SY, Keaser ML, Meiller TF, Seminowicz DA. Time of Day Influences Psychophysical Measures in Women With Burning Mouth Syndrome. Front Neurosci 2021; 15:698164. [PMID: 34658757 PMCID: PMC8519262 DOI: 10.3389/fnins.2021.698164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Burning mouth syndrome (BMS) is a chronic orofacial pain condition that mainly affects postmenopausal women. BMS type I patients report little to no spontaneous pain in the morning and increases in pain through the day, peaking in the afternoon. Quantitative sensory testing (QST) findings from BMS type 1 patients are inconsistent as they fail to capture this temporal variation. We examined how QST in BMS type 1 (n = 18) compared to healthy participants (n = 33) was affected by time of day. QST of the face and forearm included warmth detection threshold (WDT), cold detection threshold (CDT), and heat pain thresholds (HPT), ratings of suprathreshold heat, and pressure pain thresholds (PPT), and was performed twice: once in the morning and once in the afternoon. Compared to healthy participants, BMS patients had higher pain sensitivity to phasic heat stimuli at most temperatures (35°C U = 126.5, p = 0.0006, 39°C U = 186.5, p = 0.0386, 41°C U = 187.5, p = 0.0412, 43°C U = 171, p = 0.0167, 45°C U = 168.5, p = 0.0146) on the forearm, but no differences in pain thresholds (HPT and PPT) regardless of time of day or body area tested. BMS patients had higher WDT (U = 123, p = 0.0172), and lower CDT (U = 98, p = 0.0021) of the forearm and lower WDT of the face (U = 55, p = 0.0494). The differences in forearm WDT (U = 71.5, p = 0.0113) and CDT (U = 70, p = 0.0096) were most pronounced in the morning. In summary, BMS type I patients had increased pain sensitivity on the forearm, but no differences in pain thresholds on the face or forearm. Patients also showed altered thermal sensitivity, which depended on body area tested (heightened in the orofacial region but blunted on the forearm), and was more pronounced in the morning plausibly due to hypervigilance.
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Affiliation(s)
- Janell S Payano Sosa
- Program in Neuroscience, University of Maryland, Baltimore, Baltimore, MD, United States.,Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.,Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Joyce T Da Silva
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.,Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States.,Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Soo Y Yoo
- Montefiore Medical Center, The Bronx, NY, United States
| | - Michael L Keaser
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.,Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Timothy F Meiller
- Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States
| | - David A Seminowicz
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.,Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
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19
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Otsuru N, Ogawa M, Yokota H, Miyaguchi S, Kojima S, Saito K, Inukai Y, Onishi H. Auditory change-related cortical response is associated with hypervigilance to pain in healthy volunteers. Eur J Pain 2021; 26:349-355. [PMID: 34528347 PMCID: PMC9292983 DOI: 10.1002/ejp.1863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
Background Patients with chronic pain exhibit hypervigilance (heightened responsiveness to stimuli) to innocuous auditory stimuli as well as noxious stimuli. “Generalized hypervigilance” suggests that individuals who show heightened responsiveness to one sensory system also show hypervigilance to other modalities. However, research exploring the existence of generalized hypervigilance in healthy subjects is limited. Methods We investigated whether hypervigilance to pain is associated with auditory stimuli in healthy subjects using the pain vigilance and awareness questionnaire (PVAQ) and auditory change‐related cortical responses (ACRs). ACRs are thought to reflect a change detection system, based on preceding sensory memory. We recorded ACRs under conditions that varied in terms of the accumulation of sensory memory as follows: short‐ACR, with short preceding continuous stimuli and long‐ACR, with long preceding continuous stimuli. In addition, the attention to pain (PVAQ‐AP) and attention to changes in pain (PVAQ‐ACP) subscales were evaluated. Results Amplitudes of long‐ACR showed significant positive correlations with PVAQ‐ACP, whereas those of short‐ACR did not show any significant correlations. Conclusions Generalized hypervigilance may be observed even in healthy subjects. ACR may be a useful index to evaluate the hypervigilance state in the human brain.
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Affiliation(s)
- Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Mayu Ogawa
- Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Shota Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Sho Kojima
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Kei Saito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Yasuto Inukai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
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20
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Staud R, Godfrey MM, Robinson ME. Fibromyalgia Patients Are Not Only Hypersensitive to Painful Stimuli But Also to Acoustic Stimuli. THE JOURNAL OF PAIN 2021; 22:914-925. [PMID: 33636370 DOI: 10.1016/j.jpain.2021.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 12/31/2022]
Abstract
Fibromyalgia is a chronic widespread pain syndrome associated with hypersensitivity to nociceptive stimuli. This increased sensitivity of FM patients has been associated with central sensitization of dorsal horn neurons. Increasing evidence, however, suggests that the mechanisms of FM hypersensitivity not only affect pain but include light, smell, and sound. We hypothesized that supraspinal augmentation of sensory input including sound represent a hallmark of FM. We tested 23 FM patients and 28 healthy controls (HC) for sensory augmentation of nociceptive and non-nociceptive sensations: For assessment of nociceptive augmentation we used sensitivity adjusted mechanical and heat ramp & hold stimuli and for assessment of sound augmentation, we applied wideband noise stimuli using a random-staircase design. Quantitative sensory testing demonstrated increased heat and mechanical pain sensitivity in FM participants (P < .001). The sound pressures needed to report mild, moderate, and intense sound levels were significantly lower in FM compared to HC (P < .001), consistent with auditory augmentation. FM patients are not only augmenting noxious sensations but also sound, suggesting that FM augmentation mechanisms are not only operant in the spinal cord but also in the brain. Whether the central nervous system mechanisms for auditory and nociceptive augmentation are similar, needs to be determined in future studies. PERSPECTIVE: This study presents QST evidence that the hypersensitivity of FM patients is not limited to painful stimuli but also to innocuous stimuli like sound. Our results suggest that abnormal brain mechanisms may be responsible for the increased sensitivity of FM patients.
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Affiliation(s)
- Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida.
| | | | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
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21
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Malmström EM, Magnusson M, Holmberg J, Karlberg M, Fransson PA. Dizziness and localized pain are often concurrent in patients with balance or psychological disorders. Scand J Pain 2021; 20:353-362. [PMID: 31881001 DOI: 10.1515/sjpain-2019-0121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
Background and aims Symptoms of dizziness and pain are both common complaints and the two symptoms often seem to coincide. When symptoms appear concomitant for sustained periods of time the symptoms might maintain and even exacerbate each other, sometimes leading to psychological distress. In order to evaluate such comorbidity we studied patients referred to a vestibular unit and to a psychiatric outpatient clinic with respectively balance disorders and psychological issues. Methods Consecutive patients referred to a vestibular unit (n = 49) and a psychiatric outpatient clinic (n = 62) answered the Dizziness Handicap Inventory (DHI) questionnaire and a questionnaire detailing occurrence of dizziness and pain. Results The experience of dizziness and pain often coincided within individuals across both clinical populations, especially if the pain was located to the neck/shoulder or the back (p = 0.006). Patients who reported dizziness had significantly more often pain (p = 0.024); in the head (p = 0.002), neck/shoulders (p = 0.003) and feet (p = 0.043). Moreover, patients who reported dizziness stated significantly higher scoring on emotional (p < 0.001) and functional (p < 0.001) DHI sub-scales. Furthermore, patients who reported an accident in their history suffered significantly more often from dizziness (p = 0.039) and pain (p < 0.001); in the head (p < 0.001), neck/shoulders (p < 0.001) and arms (p = 0.045) and they scored higher on the emotional (p = 0.004) and functional (p = 0.002) DHI sub-scales. Conclusions The findings suggest comorbidity to exist between dizziness and neck/shoulder or back pain in patients seeking health care for balance disorders or psychological issues. Patients suffering from dizziness and pain, or with both symptoms, also reported higher emotional and functional strain. Thus, healthcare professionals should consider comorbidity when determining diagnosis and consequent measures. Implications Clinicians need to have a broader "receptive scope" in both history and clinical examinations, and ask for all symptoms. Although the patients in this study visited a vestibular unit respectively a psychological clinic, they commonly reported pain conditions when explicitly asked for this symptom. A multimodal approach is thus to favor, especially when the symptoms persist, for the best clinical management.
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Affiliation(s)
- Eva-Maj Malmström
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Måns Magnusson
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Holmberg
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mikael Karlberg
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Per-Anders Fransson
- Department of Clinical Sciences, Lund University, S-221 85 Lund, Sweden, Fax: +46 46 211 09 68
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22
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Examining attentional biases, interpretation biases, and attentional control in people with and without chronic pain. Pain 2021; 162:2110-2119. [PMID: 33769370 DOI: 10.1097/j.pain.0000000000002212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
ABSTRACT Psychological models of chronic pain (CP) highlight cognitive-processing biases (ie, attentional biases, interpretation biases, and attentional control) as pivotal processes that uniquely and synergistically impact the development and maintenance of CP. Very few studies explore multiple cognitive biases, and no studies have examined these 3 processes together in a CP sample. Furthermore, there is a lack of research investigating the relationship between these cognitive processes and pain-relevant variables (eg, pain intensity and pain catastrophising). The current study aimed to (1) compare attentional biases, interpretation biases, and attentional control in people with and without CP, (2) explore their interrelationships, and (3) explore their association with pain-related variables. Seventy-four participants with CP and 66 without pain volunteered. Participants completed a visual scanning task with eye tracking, a recognition task, and a flanker task. Traditional and Bayesian analysis indicated no effect of pain status on cognitive-processing biases. All participants, regardless of pain status, demonstrated attentional biases towards pain on some indices of early and late attention, but not interpretation bias or attentional control. There was weak evidence of associations between attentional biases, interpretation biases, and attentional control. Pain intensity was significantly correlated with interpretation biases, and follow-up analyses revealed people with high pain intensity demonstrated an interpretation bias towards pain significantly more than those with low pain intensity. Findings suggest that attentional biases towards pain are ubiquitous, but for people with moderate-to-severe pain, interpretation biases may have a role worthy of further research.
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23
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Sachau J, Kersebaum D, Baron R, Dickenson AH. Unusual Pain Disorders - What Can Be Learned from Them? J Pain Res 2021; 13:3539-3554. [PMID: 33758536 PMCID: PMC7980038 DOI: 10.2147/jpr.s287603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Pain is common in many different disorders and leads to a significant reduction in quality of life in the affected patients. Current treatment options are limited and often result in insufficient pain relief, partly due to the incomplete understanding of the underlying pathophysiological mechanisms. The identification of these pathomechanisms is therefore a central object of current research. There are also a number of rare pain diseases, that are generally little known and often undiagnosed, but whose correct diagnosis and examination can help to improve the management of pain disorders in general. In some of these unusual pain disorders like sodium-channelopathies or sensory modulation disorder the underlying pathophysiological mechanisms have only recently been unravelled. These mechanisms might serve as pharmacological targets that may also play a role in subgroups of other, more common pain diseases. In other unusual pain disorders, the identification of pathomechanisms has already led to the development of new drugs. A completely new therapeutic approach, the gene silencing, can even stop progression in hereditary transthyretin amyloidosis and porphyria, ie in pain diseases that would otherwise be rapidly fatal if left untreated. Thus, pain therapists and researchers should be aware of these rare and unusual pain disorders as they offer the unique opportunity to study mechanisms, identify new druggable targets and finally because early diagnosis might save many patient lives.
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Affiliation(s)
- Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Dilara Kersebaum
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
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24
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Broadbent P, Liossi C, Schoth DE. Attentional bias to somatosensory stimuli in chronic pain patients: a systematic review and meta-analysis. Pain 2021; 162:332-352. [PMID: 32833792 DOI: 10.1097/j.pain.0000000000002040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
ABSTRACT This systematic review and meta-analysis aimed to evaluate the evidence pertaining to attentional bias for painful and nonpainful somatosensory stimuli in individuals with chronic pain. Eligible studies were identified through searches of Medline, PsycINFO, CINAHL, Web of Science, Scopus, and Cochrane Library databases. Search terms were words and phrases organised into 3 concept blocks: pain condition, cognitive process, and stimuli/paradigm. The search identified 29 eligible studies (reporting 32 eligible experiments), of which quantitative meta-analysis was possible for 16 studies (19 experiments). The meta-analysis found that chronic pain patients, excluding somatoform pain patients, showed significantly greater attentional bias to stimuli in the somatosensory modality than healthy controls (k = 9, g = 0.34). In addition, meta-analysis of studies that used a temporal order judgement task found that patients with unilateral chronic pain showed a spatial attentional bias away from somatosensory stimuli (k = 7, effect estimate = 22.43 ms) and visual stimuli (k = 2, effect estimate = 13.75 ms) on or near the painful body side. Most studies of attentional bias to the somatosensory modality recruited samples of patients with fibromyalgia, whereas most studies of spatial attentional bias assessed patients with complex regional pain syndrome. The extent to which these results generalise to other pain conditions is therefore unclear. We recommend future research test spatial and modality attentional biases across chronic pain conditions and examine the psychometric properties of attentional bias measurement paradigms for use with chronic pain populations. PROSPERO registration number CRD42019124510.
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Affiliation(s)
- Philippa Broadbent
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- Paediatric Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Daniel E Schoth
- Department of Psychology, University of Southampton, Southampton, United Kingdom
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25
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33501463 PMCID: PMC7836135 DOI: 10.1101/2020.12.03.20242032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Multisensory hypersensitivity (MSH), which refers to persistent discomfort across sensory modalities, is a risk factor for chronic pain. Developing a better understanding of the neural contributions of disparate sensory systems to MSH may clarify its role in the development of chronic pain. We recruited a cohort of women (n=147) enriched with participants with menstrual pain at risk for developing chronic pain. Visual sensitivity was measured using a periodic pattern-reversal stimulus during EEG. Self-reported visual unpleasantness ratings were also recorded. Bladder pain sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visual stimulation induced unpleasantness was associated with bladder pain and evoked primary visual cortex excitation; however, the relationship between unpleasantness and cortical excitation was moderated by bladder pain. Thus, future studies aimed at reversing the progression of MSH into chronic pain should prioritize targeting of cortical mechanisms responsible for maladaptive sensory input integration.
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Affiliation(s)
- Matthew J Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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26
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Samartin-Veiga N, González-Villar AJ, Triñanes Y, Gómez-Perretta C, Carrillo-de-la-Peña MT. Effects of intensity, attention and medication on auditory-evoked potentials in patients with fibromyalgia. Sci Rep 2020; 10:21904. [PMID: 33318554 PMCID: PMC7736365 DOI: 10.1038/s41598-020-78377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/12/2020] [Indexed: 11/09/2022] Open
Abstract
Fibromyalgia (FM) has been associated to an increased processing of somatosensory stimuli, but its generalization to other sensory modalities is under discussion. To clarify this, we studied auditory event-related potentials (AEPs) to stimuli of different intensity in patients with FM and healthy controls (HCs), considering the effects of attention mechanisms and medication. We performed two experiments: In study 1 (n = 50 FM, 60 HCs), the stimuli were presented randomly within the sequence; in study 2 (n = 28 FM, 30 HCs), they were presented in blocks of the same intensity. We analyzed intensity and group effects on N1-P2 amplitude and, only for the FM group, the effect of medication and the correlation between AEPs and clinical variables. Contrary to the expectation, the patients showed a trend of reduced AEPs to the loudest tones (study 1) or no significant differences with the HCs (study 2). Medication with central effects significantly reduced AEPs, while no significant relationships between the N1-P2 amplitude/intensity function and patients’ symptoms were observed. The findings do not provide evidence of augmented auditory processing in FM. Nevertheless, given the observed effect of medication, the role of sensory amplification as an underlying pathophysiological mechanism in fibromyalgia cannot be discarded.
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Affiliation(s)
- N Samartin-Veiga
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - A J González-Villar
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Psychological Neuroscience Lab, Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
| | - Y Triñanes
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - M T Carrillo-de-la-Peña
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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27
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Hollins M, Athans L. Perceptual amplification following sustained attention: implications for hypervigilance. Exp Brain Res 2020; 239:279-288. [PMID: 33151350 DOI: 10.1007/s00221-020-05910-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
It is known that attending to a cutaneous stimulus briefly increases its subjective intensity. The purpose of the present study was to determine whether an extended period of attention would produce a longer-lasting perceptual amplification. Eighty subjects were assigned alternately to experimental and control groups. Members of the two groups received identical series of tactile stimuli (near-threshold von Frey filaments applied to the forearm), but those in the experimental group carried out a two-interval forced-choice detection task that required attention to the filaments, while subjects in the control group attended instead to a video game. After this initial phase, all subjects gave magnitude estimates of the intensity of a wide range of von Frey filaments. The experimental group gave estimates 42% greater than those of the control group, both for filaments used in the initial phase, and others not presented previously; the perceptual amplification did not, however, transfer to a different type of pressure stimulus, a 5 mm-diameter rod applied to the skin. The aftereffect of sustained attention lasted for at least 15 min. This phenomenon, demonstrated in normal subjects, may have implications for the hypervigilance of some chronic pain patients, which is characterized by both heightened attention to pain and long-lasting perceptual amplification of noxious stimuli.
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Affiliation(s)
- Mark Hollins
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Luke Athans
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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28
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Rustamov N, Wagenaar-Tison A, Doyer E, Piché M. Electrophysiological investigation of the contribution of attention to altered pain inhibition processes in patients with irritable bowel syndrome. J Physiol Sci 2020; 70:46. [PMID: 33023474 PMCID: PMC10717774 DOI: 10.1186/s12576-020-00774-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022]
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with chronic abdominal pain and altered pain processing. The aim of this study was to examine whether attentional processes contribute to altered pain inhibition processes in patients with IBS. Nine female patients with IBS and nine age-/sex-matched controls were included in a pain inhibition paradigm using counter-stimulation and distraction with electroencephalography. Patients with IBS showed no inhibition of pain-related brain activity by heterotopic noxious counter-stimulation (HNCS) or selective attention. In the control group, HNCS and selective attention decreased the N100, P260 and high-gamma oscillation power. In addition, pain-related high-gamma power in sensorimotor, anterior cingulate and left dorsolateral prefrontal cortex was decreased by HNCS and selective attention in the control group, but not in patients with IBS. These results indicate that the central pain inhibition deficit in IBS reflects interactions between several brain processes related to pain and attention.
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Affiliation(s)
- Nabi Rustamov
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Alice Wagenaar-Tison
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Elysa Doyer
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
- CogNAC Research Group, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
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29
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Yin Y, He S, Xu J, You W, Li Q, Long J, Luo L, Kemp GJ, Sweeney JA, Li F, Chen S, Gong Q. The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies. J Headache Pain 2020; 21:78. [PMID: 32560622 PMCID: PMC7304152 DOI: 10.1186/s10194-020-01131-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/25/2020] [Indexed: 02/08/2023] Open
Abstract
Chronic pain surrounding the temporomandibular joints and masticatory muscles is often the primary chief complaint of patients with temporomandibular disorders (TMD) seeking treatment. Yet, the neuro-pathophysiological basis underlying it remains to be clarified. Neuroimaging techniques have provided a deeper understanding of what happens to brain structure and function in TMD patients with chronic pain. Therefore, we performed a systematic review of magnetic resonance imaging (MRI) studies investigating structural and functional brain alterations in TMD patients to further unravel the neurobiological underpinnings of TMD-related pain. Online databases (PubMed, EMBASE, and Web of Science) were searched up to August 3, 2019, as complemented by a hand search in reference lists. A total of 622 papers were initially identified after duplicates removed and 25 studies met inclusion criteria for this review. Notably, the variations of MRI techniques used and study design among included studies preclude a meta-analysis and we discussed the findings qualitatively according to the specific neural system or network the brain regions were involved in. Brain changes were found in pathways responsible for abnormal pain perception, including the classic trigemino-thalamo-cortical system and the lateral and medial pain systems. Dysfunction and maladaptive changes were also identified in the default mode network, the top-down antinociceptive periaqueductal gray-raphe magnus pathway, as well as the motor system. TMD patients displayed altered brain activations in response to both innocuous and painful stimuli compared with healthy controls. Additionally, evidence indicates that splint therapy can alleviate TMD-related symptoms by inducing functional brain changes. In summary, MRI research provides important novel insights into the altered neural manifestations underlying chronic pain in TMD.
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Affiliation(s)
- Yuanyuan Yin
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Shushu He
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jingchen Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wanfang You
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qian Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jingyi Long
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lekai Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Psychiatry, University of Cincinnati, Cincinnati, OH, USA
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China. .,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Song Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
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30
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Hubbard CS, Lazaridou A, Cahalan CM, Kim J, Edwards RR, Napadow V, Loggia ML. Aberrant Salience? Brain Hyperactivation in Response to Pain Onset and Offset in Fibromyalgia. Arthritis Rheumatol 2020; 72:1203-1213. [PMID: 32017421 DOI: 10.1002/art.41220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While much brain research on fibromyalgia (FM) focuses on the study of hyperresponsiveness to painful stimuli, some studies suggest that the increased pain-related brain activity often reported in FM studies may be partially explained by stronger responses to salient aspects of the stimulation rather than, or in addition to, the stimulation's painfulness. Therefore, this study was undertaken to test our hypothesis that FM patients would demonstrate elevated brain responses to both pain onset and offset-2 salient sensory events of opposing valences. METHODS Thirty-eight FM patients (mean ± SD age 46.1 ± 13.4 years; 33 women) and 15 healthy controls (mean ± SD age 45.5 ± 12.4; 10 women) received a moderately painful pressure stimulus to the leg during blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. Stimulus onset and offset transients were analyzed using a general linear model as stick functions. RESULTS During pain onset, higher BOLD signal response was observed in FM patients compared to healthy controls in dorsolateral and ventrolateral prefrontal cortices (DLPFC and VLPFC, respectively), orbitofrontal cortex (OFC), frontal pole, and precentral gyrus (PrCG). During pain offset, higher and more widespread BOLD signal response was demonstrated in FM patients compared to controls in frontal regions significantly hyperactivated in response to onset. In FM patients, some of these responses were positively correlated with pain unpleasantness ratings (VLPFC, onset; r = 0.35, P = 0.03), pain catastrophizing scores (DLPFC, offset; r = 0.33, P = 0.04), or negatively correlated with stimulus intensity (OFC, offset; r = -0.35, P = 0.03) (PrCG, offset; r = -0.39, P = 0.02). CONCLUSION Our results suggest that the increased sensitivity exhibited by FM patients in response to the onset and offset of painful stimuli may reflect a more generalized hypersensitivity to salient sensory events, and that brain hyperactivation may be a mechanism potentially involved in the generalized hypervigilance to salient stimuli in FM.
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Affiliation(s)
- Catherine S Hubbard
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Jieun Kim
- Massachusetts General Hospital, Charlestown
| | - Robert R Edwards
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vitaly Napadow
- Harvard Medical School, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Marco L Loggia
- Harvard Medical School, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
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Kratz AL, Whibley D, Kim S, Williams DA, Clauw DJ, Sliwinski M. The Role of Environmental Distractions in the Experience of Fibrofog in Real-World Settings. ACR Open Rheumatol 2020; 2:214-221. [PMID: 32237225 PMCID: PMC7164629 DOI: 10.1002/acr2.11130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Perceived cognitive dysfunction in people with fibromyalgia (FM), "fibrofog," is commonly reported and has been demonstrated in neurocognitive testing. Distractibility and inattention have been implicated as potential contributors to fibrofog, but the role of environmental distractions has not been explored. In this study, ambulatory assessment methods were used to examine whether FM is related to more environmental distractions and to examine the impact of distractions on subjective and objective cognitive functioning. METHODS Fifty people with FM and 50 age-, sex-, and education-matched controls without FM completed 8 consecutive days of ambulatory assessments. Five times per day, participants reported perceived cognitive functioning and environmental distractions and completed validated tests of processing speed and working memory. RESULTS The FM group reported distractions in a higher proportion of the ambulatory cognitive testing sessions (40.5%) compared with the group without FM (29.8%; P < 0.001) and more often reported multiple simultaneous distractions. For both groups, sound was the most common distraction. The group with FM reported more distractions caused by light, and the group without FM reported more social distractions. Group differences in subjective and objective cognitive functioning were not augmented during distraction relative to during periods of no distraction. There were no group differences in within-person changes in cognitive functioning as a function of distraction. CONCLUSION The group with FM reported more distractions than the group without FM; both groups reported poorer processing speed when distracted, and the effects of distraction on test performance did not differ significantly by group. Findings suggest that sensitivity to environmental distractions may play a role in the experience of cognitive dysfunction in FM.
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Affiliation(s)
| | - Daniel Whibley
- University of Michigan, Ann Arbor, and School of Medicine, Medical Sciences, and Nutrition, University of AberdeenAberdeenUnited Kingdom
| | - Samsuk Kim
- University of Detroit MercyDetroitMichigan
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İnal Ö, Aras B, Salar S. Investigation of the relationship between kinesiophobia and sensory processing in fibromyalgia patients. Somatosens Mot Res 2020; 37:92-96. [PMID: 32208874 DOI: 10.1080/08990220.2020.1742104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose/aim: The aims of this study are to investigate the relationship between kinesiophobia and sensory processing in fibromyalgia (FM) patients and obtain new information about kinesiophobia in light of these results.Materials and methods: This study has been conducted with 82 literate subjects aged 18-65 years and diagnosed with FM based on ACR 2010 diagnostic criteria. Fibromyalgia Impact Questionnaire was used for measuring functional status in FM patients, The Tampa Scale of Kinesiophobia was used for determine the levels of kinesiophobia and Adolescent/Adult Sensory Profile was used for determine the characteristics of sensory process patterns of the individuals.Results: Among the participants, sensory sensitivity scores of 65.85% and sensation avoiding scores of 40.24% were higher than that in the general population. Sensation seeking scores of 48.78% the subjects were lower compared to the general population. A significant and weak positive correlation was found between the kinesiophobia scores and responses of sensory sensitivity and sensation avoiding (r = 0.23, p = 0.04; z = 0.29, p = 0.01)Conclusion: This is the first study conducted to investigate the relationship between kinesiophobia and sensory processing in fibromyalgia patients. However, different studies investigating this subject are warranted in order to be able to generalize the findings and increase the value of evidence.
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Affiliation(s)
- Özgü İnal
- Faculty of Health Sciences, Department of Occupational Therapy, Trakya University, Edirne, Turkey
| | - Berke Aras
- Department of Physical Medicine and Rehabilitation, Kastamonu Rehabilitation Centre, Kastamonu, Turkey
| | - Sinem Salar
- Department of Occupational Therapy Edirne, Faculty of Health Sciences, Trakya University, Edirne, Turkey
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Emerson NM, Meeker TJ, Greenspan JD, Saffer MI, Campbell CM, Korzeniewska A, Lenz FA. Missed targets, reaction times, and arousal are related to trait anxiety and attention to pain during an experimental vigilance task with a painful target. J Neurophysiol 2020; 123:462-472. [PMID: 31596643 PMCID: PMC7052634 DOI: 10.1152/jn.00331.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
Although hypervigilance may play a role in some clinical pain syndromes, experimental vigilance toward painful stimuli has been studied infrequently. We evaluated vigilance toward pain by using a continuous performance task (CPT), in which subjects responded to moderately intense painful target stimuli, occurring in a train of mildly painful nontargets. We assessed nondetected targets (misses), reaction times (RTs), and psychological activation (tense arousal). During time on task in CPTs of other sensory modalities, there is an increase in misses and RTs (vigilance decrement). We hypothesized that our CPT would influence vigilance performance related to pain, anxiety, and limitation of attentional resources. The results showed a decrement in vigilance over time as misses increased, although RTs were unchanged. While mind-wandering did not influence vigilance performance, intrinsic attention to pain drove both hit RTs and number of misses. This resulted in pain-focused subjects performing worse on the CPT pain task with slower RTs and more misses per block. During the CPT, the change in stimulus salience was related to the change in pain intensity, while pain unpleasantness correlated with tense arousal. CPT performance during experimental vigilance to pain and psychological activation were related to trait anxiety, as measured by the Spielberger State-Trait Anxiety Inventory and neuroticism, as measured by the NEO five factor inventory. Trait anxiety and neuroticism may play important roles in an individual's predisposition to dwell on pain and interpret pain as threatening.NEW & NOTEWORTHY Subjects detected moderately painful target stimuli in a train of mildly painful nontarget stimuli, which resulted in vigilance performance metrics including missed targets, reaction times, and psychological activation. These performance metrics were related to intrinsic attention to pain and trait anxiety. Subjects with high trait anxiety and neuroticism scores, with a predisposition to attend to pain, had greater tense arousal and poorer vigilance performance, which may be important psychological aspects of vigilance to pain.
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Affiliation(s)
- Nichole M Emerson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Timothy J Meeker
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Joel D Greenspan
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
- Department of Neural and Pain Sciences and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, Maryland
| | - Mark I Saffer
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Fred A Lenz
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
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Hollins M, Bryen CP, Taylor D. Effects of chronic pain history on perceptual and cognitive inhibition. Exp Brain Res 2020; 238:321-332. [PMID: 31907554 DOI: 10.1007/s00221-019-05715-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023]
Abstract
Measures of sensory and cognitive inhibition were obtained from university students with and without a history of chronic pain. The form of sensory inhibition measured was diffuse noxious inhibitory controls (DNIC), the capacity of a painful stimulus to reduce the subjective intensity of a second stimulus delivered to a remote body site. To measure cognitive inhibition, the Stroop effect was used. Participants with a history of chronic pain showed less DNIC (i.e., less sensory inhibition) than the healthy controls, but had a smaller Stroop effect (indicating greater cognitive inhibition). The fact that chronic pain history is associated with opposite changes in these two measures casts doubt on the view that the two inhibitory processes are related. Scores on each experimental measure were equivalent in pain-history subjects with ongoing chronic pain and those whose chronic pain had resolved. This equivalence suggests that chronic pain in childhood or adolescence may have lingering effects on sensory and cognitive inhibition.
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Affiliation(s)
- Mark Hollins
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Chloe P Bryen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Dillon Taylor
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Lapp HS, Sabatowski R, Weidner K, Croy I, Gossrau G. C-tactile touch perception in migraineurs – a case-control study. Cephalalgia 2019; 40:478-492. [DOI: 10.1177/0333102419889349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Migraine is characterized by sensory hypersensitivity and habituation deficits. Slow brushing over the skin activates C-tactile nerve fibers, which mediate pleasant touch and analgesic effects in healthy subjects. As this function is altered in painful conditions, we aimed to examine whether the C-tactile processing is disrupted in migraines. Methods To psychophysically assess C-tactile function, we applied optimal and suboptimal C-tactile stroking stimuli on the dorsal forearm (body reference area) and the trigeminally innervated skin of 52 interictal migraineurs and 52 matched healthy controls. For habituation testing, 60 repeated C-tactile optimal stimuli were presented in both test areas. The participants rated each stimulus on a visual analogue scale by intensity, pleasantness, and painfulness. Results Regarding C-tactile function, migraineurs showed unphysiological rating patterns but no significantly different pleasantness ratings than controls. During repeated stimulation, controls showed stable pleasantness ratings while migraineurs’ ratings decreased, especially in those experiencing tactile allodynia during headaches. Migraineurs taking triptans responded like controls. Conclusion The C-tactile function of migraineurs is subclinically altered. Repeated C-tactile stimulation leads to altered habituation but differs from previous work by the direction of the changes. Although the pathophysiology remains unknown, causative mechanisms could include central and peripheral neuronal sensitization, tactile allodynia and hedonic stimulus attributions.
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Affiliation(s)
- Hanna Sophie Lapp
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| | - Rainer Sabatowski
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
- Department of Anesthesiology, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| | - Gudrun Gossrau
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
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Association Between the 2011 Fibromyalgia Survey Criteria and Multisite Pain Sensitivity in Knee Osteoarthritis. Clin J Pain 2019; 34:909-917. [PMID: 29642237 DOI: 10.1097/ajp.0000000000000619] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The present study evaluated the relationship between the 2011 American College of Rheumatology fibromyalgia (FM) survey criteria and quantitative sensory testing (QST). MATERIALS AND METHODS Patients with knee osteoarthritis scheduled to undergo knee arthroplasty completed the FM survey criteria and self-report measures assessing clinical symptoms. Patients also underwent a battery of QST procedures at the surgical knee and remote body sites, including pressure algometry, conditioned pain modulation, and temporal summation. All assessments were completed before surgery. FM survey criteria were used to calculate a continuous FM score indicating FM severity. RESULTS A total of 129 patients were analyzed. Of these, 52.7% were female, 93.8% were Caucasian, and 3.8% met the FM survey criteria for FM classification. Mean age for females (63.6 y) and males (64.7 y) was similar. Females and males differed significantly in nearly every outcome, including FM severity, clinical pain, anxiety, depression, and pressure pain sensitivity. In females, FM scores significantly correlated with pressure pain sensitivity, but not conditioned pain modulation or temporal summation, such that increased sensitivity was associated with greater FM severity at all body sites examined. In addition, as FM scores increased, the association between pain sensitivity at the surgical knee and pain sensitivity at remote body sites also increased. No relationship between FM score and QST was observed in males. DISCUSSION We demonstrated an association between diffuse hyperalgesia as measured by QST and FM severity in females with knee osteoarthritis. These results suggest that the FM survey criteria may represent a marker of pain centralization in females with potential utility in clinical decision making.
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Bar-Shalita T, Granovsky Y, Parush S, Weissman-Fogel I. Sensory Modulation Disorder (SMD) and Pain: A New Perspective. Front Integr Neurosci 2019; 13:27. [PMID: 31379526 PMCID: PMC6659392 DOI: 10.3389/fnint.2019.00027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/01/2019] [Indexed: 01/17/2023] Open
Abstract
Sensory modulation disorder (SMD) affects sensory processing across single or multiple sensory systems. The sensory over-responsivity (SOR) subtype of SMD is manifested clinically as a condition in which non-painful stimuli are perceived as abnormally irritating, unpleasant, or even painful. Moreover, SOR interferes with participation in daily routines and activities (Dunn, 2007; Bar-Shalita et al., 2008; Chien et al., 2016), co-occurs with daily pain hyper-sensitivity, and reduces quality of life due to bodily pain. Laboratory behavioral studies have confirmed abnormal pain perception, as demonstrated by hyperalgesia and an enhanced lingering painful sensation, in children and adults with SMD. Advanced quantitative sensory testing (QST) has revealed the mechanisms of altered pain processing in SOR whereby despite the existence of normal peripheral sensory processing, there is enhanced facilitation of pain-transmitting pathways along with preserved but delayed inhibitory pain modulation. These findings point to central nervous system (CNS) involvement as the underlying mechanism of pain hypersensitivity in SOR. Based on the mutual central processing of both non-painful and painful sensory stimuli, we suggest shared mechanisms such as cortical hyper-excitation, an excitatory-inhibitory neuronal imbalance, and sensory modulation alterations. This is supported by novel findings indicating that SOR is a risk factor and comorbidity of chronic non-neuropathic pain disorders. This is the first review to summarize current empirical knowledge investigating SMD and pain, a sensory modality not yet part of the official SMD realm. We propose a neurophysiological mechanism-based model for the interrelation between pain and SMD. Embracing the pain domain could significantly contribute to the understanding of this condition’s pathogenesis and how it manifests in daily life, as well as suggesting the basis for future potential mechanism-based therapies.
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Affiliation(s)
- Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yelena Granovsky
- Laboratory of Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Technion-Israel Institute of Technology, Rambam Health Care Campus, Haifa, Israel
| | - Shula Parush
- School of Occupational Therapy, Faculty of Medicine of Hadassah, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Irit Weissman-Fogel
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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van Son D, de Rover M, De Blasio FM, van der Does W, Barry RJ, Putman P. Electroencephalography theta/beta ratio covaries with mind wandering and functional connectivity in the executive control network. Ann N Y Acad Sci 2019; 1452:52-64. [PMID: 31310007 PMCID: PMC6852238 DOI: 10.1111/nyas.14180] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/17/2019] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
Abstract
The ratio between frontal resting‐state electroencephalography (EEG) theta and beta frequency power (theta/beta ratio, TBR) is negatively related to cognitive control. It is unknown which psychological processes during resting state account for this. Increased theta and reduced beta power are observed during mind wandering (MW), and MW is related to decreased connectivity in the executive control network (ECN) and increased connectivity in the default mode network (DMN). The goal of this study was to test if MW‐related fluctuations in TBR covary with such functional variation in ECN and DMN connectivity and if this functional variation is related to resting‐state TBR. Data were analyzed for 26 participants who performed a 40‐min breath‐counting task and reported the occurrence of MW episodes while EEG was measured and again during magnetic resonance imaging. Frontal TBR was higher during MW than controlled thought and this was marginally related to resting‐state TBR. DMN connectivity was higher and ECN connectivity was lower during MW. Greater ECN connectivity during focus than MW was correlated to lower TBR during focus than MW. These results provide the first evidence of the neural correlates of TBR and its functional dynamics and further establish TBR's usefulness for the study of executive control, in normal and potentially abnormal psychology.
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Affiliation(s)
- Dana van Son
- Institute of Psychology, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Mischa de Rover
- Institute of Psychology, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Frances M De Blasio
- Brain and Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Willem van der Does
- Institute of Psychology, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Robert J Barry
- Brain and Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter Putman
- Institute of Psychology, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
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Rahman MS, Yau JM. Somatosensory interactions reveal feature-dependent computations. J Neurophysiol 2019; 122:5-21. [DOI: 10.1152/jn.00168.2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Our ability to perceive and discriminate textures is based on the processing of high-frequency vibrations generated on the fingertip as it scans across a surface. Although much is known about the processing of vibration amplitude and frequency information when cutaneous stimulation is experienced at a single location on the body, how these stimulus features are processed when touch occurs at multiple locations is poorly understood. We evaluated participants’ ability to discriminate tactile cues (100–300 Hz) on one hand while they ignored distractor cues experienced on their other hand. We manipulated the relative positions of the hands to characterize how limb position influenced cutaneous touch interactions. In separate experiments, participants judged either the frequency or intensity of mechanical vibrations. We found that vibrations experienced on one hand always systematically modulated the perception of vibrations on the other hand. Notably, bimanual interaction patterns and their sensitivity to hand locations differed according to stimulus feature. Somatosensory interactions in intensity perception were only marked by attenuation that was invariant to hand position manipulations. In contrast, interactions in frequency perception consisted of both bias and sensitivity changes that were more pronounced when the hands were held in close proximity. We implemented models to infer the neural computations that mediate somatosensory interactions in the intensity and frequency dimensions. Our findings reveal obligatory and feature-dependent somatosensory interactions that may be supported by both feature-specific and feature-general operations. NEW & NOTEWORTHY Little is known about the neural computations mediating feature-specific sensory interactions between the hands. We show that vibrations experienced on one hand systematically modulate the perception of vibrations felt on the other hand. Critically, interaction patterns and their dependence on the relative positions of the hands differed depending on whether participants judged vibration intensity or frequency. These results, which we recapitulate with models, imply that somatosensory interactions are mediated by feature-dependent neural computations.
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Affiliation(s)
| | - Jeffrey M. Yau
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas
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Gruszka P, Stammen C, Bissantz N, Jensen MP. Pain vs. comfort diary: A fully remote app-based experiment. Eur J Pain 2019; 23:1674-1687. [PMID: 31233662 DOI: 10.1002/ejp.1446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Focusing on pain while completing a pain diary might have detrimental effects on pain intensity. Inverted comfort ratings might be used instead. METHODS A fully remote app-based registered experiment was conducted to investigate the effects of a pain versus comfort diary on 7-day recall ratings of pain intensity during a 3-week period. The diary included questions about past, current and expected pain or comfort. Randomization took place by the study app, thereby controlling for effects of experimenter bias. RESULTS Contrary to the study hypothesis, multilevel regression showed a more pronounced decrease in 7-day recall ratings of pain in the group who rated pain intensity daily (n = 184) than in the group who rated comfort daily (n = 205, B = -0.17, p = 0.034). There were no between-group differences in secondary outcomes (comfort, depressive symptoms, pain interference and happiness). Exploratory analyses revealed more pronounced decreases in pain intensity in participants who experienced less frequent pain in the previous 6 months. Correlations between pain and comfort ratings decreased from -0.39 at baseline to -0.06 after 3 weeks. CONCLUSIONS The findings do not support the potential beneficial effects of replacing diary ratings of pain intensity with diary ratings of comfort. The unexpected decreases among those who completed daily pain diaries might have been due to the inclusion of questions about expected pain. Decreasing correlations between pain and comfort ratings suggest that comfort ratings are not merely inverted pain ratings; rather, they appear to assess a domain distinct from pain intensity. SIGNIFICANCE The positive effects of pain diaries on pain trajectories appear to constitute a reliable effect and not a methodological artefact. Pain diaries should be investigated systematically to identify ways to optimize their effects on clinical outcomes. Comfort diaries, however, do not appear to be an efficacious substitute for pain diaries; if the current findings replicate, they indicate that primary care practitioners should continue to use pain diaries in clinical care.
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Affiliation(s)
- Piotr Gruszka
- Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Nicolai Bissantz
- Faculty of Mathematics, Ruhr-Universität Bochum, Bochum, Germany
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar. J Am Coll Cardiol 2019; 73:1207-1228. [PMID: 30871704 DOI: 10.1016/j.jacc.2018.11.059] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 12/26/2022]
Abstract
Postural orthostatic tachycardia syndrome (POTS), the most common form of orthostatic intolerance in young people, affects approximately 500,000 people in the United States alone, typically young women at the peak of their education and the beginning of their working lives. This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood. There are multiple contributing factors and numerous potential mimics. This review details the most current views on the potential causes, comorbid conditions, proposed subtypes, differential diagnoses, evaluations, and treatment of POTS from cardiological and neurological perspectives.
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Affiliation(s)
- Meredith Bryarly
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lauren T Phillips
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Steven Vernino
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas; Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Sustained and repeated mouth opening leads to development of painful temporomandibular disorders involving macrophage/microglia activation in mice. Pain 2019. [PMID: 29533386 DOI: 10.1097/j.pain.0000000000001206] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Temporomandibular disorder (TMD) is a set of heterogeneous musculoskeletal conditions involving the temporomandibular joint (TMJ) and/or the masticatory muscles. Up to 33% of the population has had at least 1 symptom of TMD with 5% to 10% of them requiring treatment. Common symptoms include limited jaw movement, joint sound, and pain in the orofacial area. Once TMD becomes chronic, it can be debilitating with comorbidities that greatly reduce one's overall quality of life. However, the underlying mechanism of TMD is unclear because of the multicausative nature of the disease. Here, we report a novel mouse model of TMD where a bite block was placed in between the upper and lower incisors such that the mouth was kept maximally open for 1.5 hours per day for 5 days. After sustained mouth opening, mice developed persistent orofacial mechanical allodynia and TMJ dysfunction. At the cellular level, we found masseter muscle dystrophy, and increased proteoglycan deposition and hypertrophic chondrocytes in the mandibular condyle. Increased F4/80 macrophages were also observed in the masseter muscles and the TMJ posterior synovium. We also found ATF3 neuronal injury and increased F4/80 macrophages in the trigeminal ganglia. Microglia activation was observed in the trigeminal subnucleus caudalis. Inhibiting macrophage and microglia activation with a colony stimulating factor-1 receptor inhibitor prevented the development of orofacial mechanical allodynia, but not TMJ dysfunction. This study suggests that mouth opening for an extended period during dental treatments or oral intubations may risk the development of chronic TMD and inflammation associated with macrophage and microglia in the tissue and trigeminal system contributes to the development of TMD pain.
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Frontal EEG theta/beta ratio during mind wandering episodes. Biol Psychol 2019; 140:19-27. [DOI: 10.1016/j.biopsycho.2018.11.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/10/2018] [Accepted: 11/14/2018] [Indexed: 12/29/2022]
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Lai HH, Naliboff B, Liu AB, Amundsen CL, Shimony JS, Magnotta VA, Shaffer JJ, Gilliam RL, Wiseman JB, Helmuth ME, Andreev VP, Kirkali Z, Harte SE. The LURN Research Network Neuroimaging and Sensory Testing (NIST) Study: Design, protocols, and operations. Contemp Clin Trials 2018; 74:76-87. [PMID: 30248454 PMCID: PMC6203612 DOI: 10.1016/j.cct.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
The Neuroimaging and Sensory Testing (NIST) Study of the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is a cross-sectional, case-control study designed to investigate whether disrupted brain connectivity and sensory processing are associated with abnormal lower urinary tract symptoms (LUTS) in patients with overactive bladder syndrome (OAB). The NIST Study tests the hypotheses that patients with urinary urgency will demonstrate: (1) abnormal functional and structural connectivity of brain regions involved in urinary sensation on magnetic resonance imaging (MRI), and (2) hypersensitivity to painful (pressure) and non-painful (auditory) sensory stimuli on quantitative sensory testing (QST), compared to controls. Male and female adults (18 years or older) who present at one of the six participating LURN clinical centers for clinical care of their LUTS, with symptoms of urinary urgency with or without urgency urinary incontinence, are eligible to participate. The NIST Study is the largest MRI and QST study of its kind, yielding a neuroimaging and sensory testing dataset unprecedented in OAB research. Advanced multi-modal techniques are used to understand brain functional and structural connectivity, including gray matter volume, and sensory function. Unlike previous MRI studies which involved invasive catheterization and repeated cycles of non-physiologic bladder filling and emptying via a catheter, we use a water ingestion protocol to mimic more physiological bladder filling through natural diuresis. Furthermore, these data will be used in concert with other phenotyping data to improve our understanding of clinically meaningful subtypes of patients with LUTS in order to improve patient care and management outcomes.
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Affiliation(s)
- H Henry Lai
- Departments of Surgery (Urology) and Anesthesiology, Washington University in St. Louis, St. Louis, MO, United States.
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Alice B Liu
- Department of Urology, University of Washington, Seattle, WA, United States
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St Louis, St. Louis, MO, United States
| | - Vincent A Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Joseph J Shaffer
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Robin L Gilliam
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
| | | | | | - Victor P Andreev
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Steven E Harte
- Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan, Ann Arbor, MI, United States
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Schrepf A, Williams DA, Gallop R, Naliboff B, Basu N, Kaplan C, Harper DE, Landis R, Clemens JQ, Strachan E, Griffith JW, Afari N, Hassett A, Pontari MA, Clauw DJ, Harte SE. Sensory sensitivity and symptom severity represent unique dimensions of chronic pain: a MAPP Research Network study. Pain 2018; 159:2002-2011. [PMID: 29863527 PMCID: PMC6705610 DOI: 10.1097/j.pain.0000000000001299] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic overlapping pain conditions (COPCs) are characterized by aberrant central nervous system processing of pain. This "centralized pain" phenotype has been described using a large and diverse set of symptom domains, including the spatial distribution of pain, pain intensity, fatigue, mood imbalances, cognitive dysfunction, altered somatic sensations, and hypersensitivity to external stimuli. Here, we used 3 cohorts, including patients with urologic chronic pelvic pain syndrome, a mixed pain cohort with other COPCs, and healthy individuals (total n = 1039) from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network to explore the factor structure of symptoms of centralized pain. Using exploratory and confirmatory factor analysis, we identified 2 general factors in all 3 cohorts, one characterized by a broad increased sensitivity to internal somatic sensations,environmental stimuli, and diffuse pain, termed Generalized Sensory Sensitivity, and one characterized by constitutional symptoms-Sleep, Pain, Affect, Cognition, Energy (SPACE). Longitudinal analyses in the urologic chronic pelvic pain syndrome cohort found the same 2-factor structure at month 6 and 1 year, suggesting that the 2-factor structure is reproducible over time. In secondary analyses, we found that Generalized Sensory Sensitivity particularly is associated with the presence of comorbid COPCs, whereas SPACE shows modest associations with measures of disability and urinary symptoms. These factors may represent an important and distinct continuum of symptoms that are indicative of the centralized pain phenotype at high levels. Future research of COPCs should accommodate the measurement of each factor.
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Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - David A. Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles CA, USA
| | - Neil Basu
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Chelsea Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel E. Harper
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Niloofar Afari
- VA San Diego Healthcare System and Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Afton Hassett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Daniel J. Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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The effect of industrial noise exposure on attention, reaction time, and memory. Int Arch Occup Environ Health 2018; 92:111-116. [DOI: 10.1007/s00420-018-1361-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/18/2018] [Indexed: 01/12/2023]
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Dabiri D, Harper DE, Kapila Y, Kruger GH, Clauw DJ, Harte S. Applications of sensory and physiological measurement in oral-facial dental pain. SPECIAL CARE IN DENTISTRY 2018; 38:395-404. [PMID: 30194771 PMCID: PMC6282998 DOI: 10.1111/scd.12323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/01/2018] [Accepted: 08/05/2018] [Indexed: 12/01/2022]
Abstract
Dentists regularly employ a variety of self‐report and sensory techniques to aid in the diagnosis and treatment of tooth‐related disease. Many of these techniques leverage principles borrowed from psychophysics, the quantitative measurement of the relationship between stimuli and evoked sensations, which falls under the larger umbrella of quantitative sensory testing (QST). However, most clinicians fail to meet the bar for what could be considered quantitative sensory testing, and instead focus on qualitative and dichotomous “yes/no” aspects of sensory experience. With our current subjective measurements for pain assessments, diagnosis and treatment of dental pain in young children and individuals (any age) with severe cognitive impairment rely extensively on third‐party observations. Consequently, the limitation of inadequate pain diagnosis can lead to poor pain management. In this review, it discusses mechanisms that underlie acute and chronic dental pain. It details the measurement of somatosensory responses and pulpal blood flow as objective measures of tooth health and pain. It proposes that bridging these varied methodologies will significantly improve diagnosis and treatment of orofacial pain and pathology. It concludes that improving the precision of sensory measurements could yield important improvements in diagnostic challenges in pulpal pathology for noncommunicative and cognitively impaired individuals.
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Affiliation(s)
- Darya Dabiri
- Chronic Pain & Fatigue Research Center, Department of Anesthesiology, University of Michigan Medicine, Ann Arbor, Michigan
| | - Daniel E Harper
- Chronic Pain & Fatigue Research Center, Department of Anesthesiology, University of Michigan Medicine, Ann Arbor, Michigan
| | - Yvonne Kapila
- Division of Periodontology, Department of Orofacial Sciences, University of California San Francisco, San Francisco, California
| | - Grant H Kruger
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Chronic Pain & Fatigue Research Center, Department of Anesthesiology, University of Michigan Medicine, Ann Arbor, Michigan
| | - Steven Harte
- Chronic Pain & Fatigue Research Center, Department of Anesthesiology, University of Michigan Medicine, Ann Arbor, Michigan
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Cognitive deficits in fibromyalgia syndrome are associated with pain responses to low intensity pressure stimulation. PLoS One 2018; 13:e0201488. [PMID: 30067829 PMCID: PMC6070250 DOI: 10.1371/journal.pone.0201488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/15/2018] [Indexed: 11/19/2022] Open
Abstract
Background Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain and diffuse tenderness, accompanied by complaints including morning stiffness, fatigue, insomnia and affective symptoms. In addition, affected patients frequently experience cognitive impairments such as concentration difficulties, forgetfulness or problems in planning and decision-making. These deficits are commonly ascribed to interference between nociceptive and cognitive processing. Method The present study investigated the association of cognitive performance with (a) pain responses to low intensity pressure stimulation (0.45–2.25 kg/cm2), (b) responses to stronger (above-threshold) stimulation (2.70 kg/cm2), and (c) pain threshold and tolerance in 42 women with FMS. Tests of attention, memory, processing speed, and executive functions were applied. Results While no significant correlations were seen for pain threshold and pain tolerance, inverse associations arose between pain intensity ratings during pressure stimulation and performance in all evaluated cognitive domains. The magnitude of the correlations increased with decreasing stimulus intensity. Conclusions It may be concluded that pain experience during somatosensory stimulation of low intensity is more closely related to attention, memory and executive functions in FMS than the traditional measures of pain threshold and pain tolerance. Considering that pain responses to low intensity stimulation reflect the hyperalgesia and allodynia phenomena characterizing FMS, it may be hypothesized that central nervous pain sensitization is involved in cognitive impairments in the disorder.
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Affiliation(s)
- Steven E. Harte
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Richard E. Harris
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Daniel J. Clauw
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
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