1
|
Barboza VR, Kubota GT, da Silva VA, Barbosa LM, Arnaut D, Rodrigues ALDL, Galhardoni R, Barbosa ER, Brunoni AR, Teixeira MJ, Cury RG, de Andrade DC. Posterior insula repetitive transcranial magnetic stimulation for chronic pain in patients with Parkinson disease - pain type matters: A double-blinded randomized sham-controlled trial. Neurophysiol Clin 2024; 54:102994. [PMID: 39024845 DOI: 10.1016/j.neucli.2024.102994] [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: 04/24/2024] [Revised: 06/01/2024] [Accepted: 06/01/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES Altered somatosensory processing in the posterior insula may play a role in chronic pain development and contribute to Parkinson disease (PD)-related pain. Posterior-superior insula (PSI) repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to have analgesic effects among patients with some chronic pain conditions. This study aimed at assessing the efficacy of PSI-rTMS for treating PD-related pain. METHODS This was a double-blinded, randomized, sham-controlled, parallel-arm trial (NCT03504748). People with PD (PwP)-related chronic pain underwent five daily PSI-rTMS sessions for a week, followed by once weekly maintenance stimulations for seven weeks. rTMS was delivered at 10 Hz and 80% of the resting motor threshold. The primary outcome was a ≥ 30% pain intensity reduction at 8 weeks compared to baseline. Functionality, mood, cognitive, motor status, and somatosensory thresholds were also assessed. RESULTS Twenty-five patients were enrolled. Mean age was 55.2 ± 9.5 years-old, and 56% were female. Nociceptive pain accounted for 60%, and neuropathic and nociplastic for 20% each. No significant difference was found for 30% pain reduction response rates between active (42.7%) and sham groups (14.6%, p = 0.26). Secondary clinical outcomes and sensory thresholds also did not differ significantly. In a post hoc analysis, PwP with nociceptive pain sub-type experienced more pain relief after active (85.7%) compared to sham PSI-rTMS (25%, p = 0.032). CONCLUSION Our preliminary results suggest that different types of PD-related pain may respond differently to treatment, and therefore people with PD may benefit from having PD-related pain well characterized in research trials and in clinical practice.
Collapse
Affiliation(s)
| | | | | | | | - Debora Arnaut
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | - Ricardo Galhardoni
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Group, Department of Neurology, University of São Paulo., Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira Cesar, Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Andre Russowsky Brunoni
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785 - Cerqueira Cesar, Sao Paulo, Sao Paulo 05403-903, Brazil
| | - Manoel Jacobsen Teixeira
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Movement Disorders Group, Department of Neurology, University of São Paulo., Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira Cesar, Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Group, Department of Neurology, University of São Paulo., Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira Cesar, Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
2
|
Barboza VR, Kubota GT, da Silva VA, Barbosa LM, Arnaut D, Rodrigues ALDL, Galhardoni R, Cury RG, Barbosa ER, Brunoni AR, Teixeira MJ, de Andrade DC. Parkinson's Disease-related Pains are Not Equal: Clinical, Somatosensory and Cortical Excitability Findings in Individuals With Nociceptive Pain. THE JOURNAL OF PAIN 2023; 24:2186-2198. [PMID: 37442404 DOI: 10.1016/j.jpain.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
Chronic pain is a frequent and burdensome nonmotor symptom of Parkinson's disease (PD). PD-related chronic pain can be classified as nociceptive, neuropathic, or nociplastic, the former being the most frequent subtype. However, differences in neurophysiologic profiles between these pain subtypes, and their potential prognostic and therapeutic implications have not been explored yet. This is a cross-sectional study on patients with PD (PwP)-related chronic pain (ie, started with or was aggravated by PD). Subjects were assessed for clinical and pain characteristics through questionnaires and underwent quantitative sensory tests and motor corticospinal excitability (CE) evaluations. Data were then compared between individuals with nociceptive and non-nociceptive (ie, neuropathic or nociplastic) pains. Thirty-five patients were included (51.4% male, 55.7 ± 11.0 years old), 20 of which had nociceptive pain. Patients with nociceptive PD-related pain had lower warm detection threshold (WDT, 33.34 ± 1.39 vs 34.34 ± 1.72, P = .019) and mechanical detection threshold (MDT, 2.55 ± 1.54 vs 3.86 ± .97, P = .007) compared to those with non-nociceptive pains. They also presented a higher proportion of low rest motor threshold values than the non-nociceptive pain ones (64.7% vs 26.6%, P = .048). In non-nociceptive pain patients, there was a negative correlation between WDT and non-motor symptoms scores (r = -.612, P = .045) and a positive correlation between MDT and average pain intensity (r = .629, P = .038), along with neuropathic pain symptom scores (r = .604, P = .049). It is possible to conclude that PD-related chronic pain subtypes have distinctive somatosensory and CE profiles. These preliminary data may help better frame previous contradictory findings in PwP and may have implications for future trial designs aiming at developing individually-tailored therapies. PERSPECTIVE: This work showed that PwP-related nociceptive chronic pain may have distinctive somatosensory and CE profiles than those with non-nociceptive pain subtypes. These data may help shed light on previous contradictory findings in PwP and guide future trials aiming at developing individually-tailored management strategies.
Collapse
Affiliation(s)
| | | | | | | | - Debora Arnaut
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Ricardo Galhardoni
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Andre Russowsky Brunoni
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil; Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg E, Denmark
| |
Collapse
|
3
|
de Andrade DC, Mylius V, Perez-Lloret S, Cury RG, Bannister K, Moisset X, Taricani Kubota G, Finnerup NB, Bouhassira D, Chaudhuri KR, Graven-Nielsen T, Treede RD. Pain in Parkinson disease: mechanistic substrates, main classification systems, and how to make sense out of them. Pain 2023; 164:2425-2434. [PMID: 37318012 DOI: 10.1097/j.pain.0000000000002968] [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: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 06/16/2023]
Abstract
ABSTRACT Parkinson disease (PD) affects up to 2% of the general population older than 65 years and is a major cause of functional loss. Chronic pain is a common nonmotor symptom that affects up to 80% of patients with (Pw) PD both in prodromal phases and during the subsequent stages of the disease, negatively affecting patient's quality of life and function. Pain in PwPD is rather heterogeneous and may occur because of different mechanisms. Targeting motor symptoms by dopamine replacement or with neuromodulatory approaches may only partially control PD-related pain. Pain in general has been classified in PwPD according to the motor signs, pain dimensions, or pain subtypes. Recently, a new classification framework focusing on chronic pain was introduced to group different types of PD pains according to mechanistic descriptors: nociceptive, neuropathic, or neither nociceptive nor neuropathic. This is also in line with the International Classification of Disease-11 , which acknowledges the possibility of chronic secondary musculoskeletal or nociceptive pain due to disease of the CNS. In this narrative review and opinion article, a group of basic and clinical scientists revise the mechanism of pain in PD and the challenges faced when classifying it as a stepping stone to discuss an integrative view of the current classification approaches and how clinical practice can be influenced by them. Knowledge gaps to be tackled by coming classification and therapeutic efforts are presented, as well as a potential framework to address them in a patient-oriented manner.
Collapse
Affiliation(s)
- Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Veit Mylius
- Department of Neurology, Centre for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
- Department of Neurology, Kantonsspital, St. Gallen, Switzerland
| | - Santiago Perez-Lloret
- Observatorio de Salud Pública, Universidad Católica Argentina, Consejo de Investigaciones Científicas y Técnicas (UCA-CONICET), Buenos Aires, Argentina
- Facultad de Medicina, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Rubens G Cury
- Movement Disorders Center, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Gabriel Taricani Kubota
- Department of Neurology, Centre for Neurorehabilitation, Valens, Switzerland
- Pain Center, University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
- Center for Pain Treatment, Institute of Cancer of the State of Sao Paulo, University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Kallol Ray Chaudhuri
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence in Care and Research, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
| |
Collapse
|
4
|
Lanfredini R, Cipriani L. The experience of pain and its ontological modelling from a philosophical point of view: Phenomenological description and ontological revision of the McGill Pain Questionnaire. J Eval Clin Pract 2023; 29:1211-1221. [PMID: 37358237 DOI: 10.1111/jep.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/19/2023] [Indexed: 06/27/2023]
Abstract
The aim of the article is to identify, on the basis of the phenomenological and ontological analysis of the experience of pain and the ways in which this experience is expressed in natural language, an ontological modelling of the language of pain and, at the same time, a revision of the traditional version of the McGill questionnaire. The purpose is to provide a different characterisation and an adequate evaluation of the phenomenon of pain, and, consequently, an effective measure of the actual experience of the suffering subject.
Collapse
Affiliation(s)
| | - Letizia Cipriani
- Department of Humanities, University of Florence, Florence, Italy
| |
Collapse
|
5
|
Pergolizzi J, LeQuang JAK, Coluzzi F, Magnusson P, Lara-Solares A, Varrassi G. Considerations for Pain Assessments in Cancer Patients: A Narrative Review of the Latin American Perspective. Cureus 2023; 15:e40804. [PMID: 37489190 PMCID: PMC10363018 DOI: 10.7759/cureus.40804] [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: 04/06/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
Cancer incidence in Latin America is lower than in Europe or the United States but morbidity and mortality rates are disproportionately high. A barrier to adequate pain control is inadequate pain assessment, which is a relatively easy and inexpensive metric. The objective of this narrative review is to describe pain assessment for cancer patients in Latin America. Cultural factors may influence pain perception, including contextualizing pain as noble or natural suffering and aspects of what is now called "spiritual pain." Unlike other painful conditions, cancer pain may be strongly associated with existential fear, psychosocial distress, anxiety, and spiritual concerns. Pain assessment allows not just quantification of pain intensity but may elucidate pain mechanisms involved or psychosocial aspects that may color the pain. Many current pain assessment instruments capture only pain intensity, which is but one aspect of the pain experience; some have expanded to include functional assessments, mental health status evaluations, and quality of life metrics. A quality-of-life assessment may be appropriate for cancer patients since chronic pain can severely impact function, which can in turn create a vicious cycle by exacerbating pain. The incidence of cancer in Latin America is expected to increase in the ensuing years. Better pain assessment and clinician education are needed to help manage pain in this large and growing patient population.
Collapse
Affiliation(s)
| | | | - Flaminia Coluzzi
- Medical and Surgical Sciences, Sapienza University of Rome, Rome, ITA
| | | | - Argelia Lara-Solares
- Pain and Palliative Care, National Institute of Medical and Nutritional Sciences, Mexico City, MEX
| | | |
Collapse
|
6
|
Raicher I, Zandonai AP, Anghinah IW, Frassetto M, Stump PRNAG, Trindade MAB, Harnik S, Oliveira RA, Macarenco RSS, Doppler K, Üçeyler N, Mello ES, Sommer C, Teixeira MJ, Galhardoni R, de Andrade DC. Mirror peripheral neuropathy and unilateral chronic neuropathic pain: insights from asymmetric neurological patterns in leprosy. Pain 2023; 164:717-727. [PMID: 35972460 DOI: 10.1097/j.pain.0000000000002757] [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: 05/19/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Leprosy-related multiple mononeuropathy offers a pattern of impairment where neuropathy with and without neuropathic pain (NeP) are present in the same individual, thus allowing to investigate peripheral sensory and innervation in both conditions. This cross-sectional study collected data on clinical and neurological examination, pain assessment questionnaires, quantitative sensory test, and intraepidermal nerve fiber density of patients with leprosy and divided the cohort into 2 groups: with NeP (P+) and without NeP (P-). Furthermore, we assessed mirror body areas in the same NeP individuals with bilateral neuropathy also presenting unilateral NeP. Pain-free patients having unilateral neuropathy were controls. A total of 37 P+ and 22 P- patients were evaluated. Limb areas with NeP had signs of C-fiber dysfunction and hyperesthesia on quantitative sensory testing compared with limb areas having neuropathy without NeP. Skin denervation was found in all patients with leprosy. Comparisons of limbs with and without neuropathy and with and without NeP revealed that higher heat pain thresholds (HPTs) were associated with neuropathic pain areas, whereas less altered HPT was correlated with higher fiber density. Furthermore, a relationship was found between time of leprosy treatment termination and more intense neuropathy, expressed by HPT increasing 0.03°C each month. As expected, interindividual comparisons failed to show differences in intraepidermal nerve fiber density and subepidermal plexus areas between P+ and P- patients ( P = 0.2980, P = 0.9044; respectively). Higher HPT and lower mechanical detection threshold were related to NeP. This study pointed out the relevance of intraindividual comparisons including mirror areas when assessing local changes in peripheral NeP.
Collapse
Affiliation(s)
- Irina Raicher
- Department of Neurology, Clinics Hospital of the University of Sao Paulo Medical School, Brazil
- Hospital Israelita Albert Einstein, Pathology Laboratory, Sao Paulo, Brazil
| | | | | | - Mariana Frassetto
- University of Southern Santa Catarina (UNESC), Santa Catarina, Brazil
| | - Patrick R N A G Stump
- Department of Neurology, Clinics Hospital of the University of Sao Paulo Medical School, Brazil
- Instituto Lauro de Souza Lima, Bauru, Brazil
| | - Maria A B Trindade
- Department of Dermatology, Clinics Hospital of the University of Sao Paulo Medical School, Brazil
| | - Simone Harnik
- Department of Statistics of the Institute of Mathematics and Statistics of the University of Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo A Oliveira
- Department of Statistics of the Institute of Mathematics and Statistics of the University of Sao Paulo, Sao Paulo, Brazil
| | | | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Evandro S Mello
- Cancer Institute of Sao Paulo Octavio Frias de Oliveira, University of Sao Paulo, Brazil
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Manoel J Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Daniel C de Andrade
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark
| |
Collapse
|
7
|
Lee JH, Lee HJ, Woo SH, Park YK, Han JH, Choi GY, Heo ES, Kim JS, Park CA, Lee WD, Yang CS, Kim AR, Han CH. Effectiveness and Safety of Acupotomy on Lumbar Spinal Stenosis: A Pragmatic, Pilot, Randomized Controlled Trial. J Pain Res 2023; 16:659-668. [PMID: 36908927 PMCID: PMC9999720 DOI: 10.2147/jpr.s399132] [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: 12/03/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Purpose In Korea, complex treatments such as acupotomy, acupuncture, and physical therapy are performed for lumbar spinal stenosis (LSS). Although there are reports of acupotomy as monotherapy or acupuncture treatment for LSS, pragmatic studies are lacking. Therefore, this study aimed to determine the effectiveness and safety of acupotomy for LSS to provide baseline evidence for a large-scale study. Materials and Methods This pragmatic randomized controlled pilot study enrolled 34 participants and randomly assigned them to two groups (n=17/group). The intervention was conducted for 8 weeks. Acupotomy plus and usual care groups received acupuncture (17 acupoints) and interferential current therapy (ICT) twice weekly; however, the acupotomy plus group received an additional acupotomy (7 acupoints) for treatment of the usual care group. The primary outcome was measured using visual analog scales (VAS), and secondary outcomes were assessed using the self-rated walking distance, short-form McGill Pain Questionnaire (SF-MPQ), and the Oswestry Disability Index (ODI). Outcome measurements were conducted at baseline and 4, 8, and 12 weeks after the commencement of the intervention. Adverse events were assessed at each visit. Hematological and biochemical examinations were performed at screening and week 8. Results Overall, 33 of the 34 participants completed the study, and one participant in the usual care group dropped out. In both groups, VAS scores at weeks 4, 8, and 12 significantly improved compared to baseline. Also, self-rated walking distance, SF-MPQ, and ODI scores were significantly improved at weeks 4, 8, and 12 than at baseline. However, there were no significant differences in the time-dependent and group-to-time interactions between the two groups. In addition, no severe adverse reactions were reported, and there were no significant differences in hematological and biochemical results. Conclusion This study provides baseline data for large-scale studies on the effectiveness and safety of acupotomy in LSS. Clinical Trial Number KCT0006234.
Collapse
Affiliation(s)
- Jung Hee Lee
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Hyun-Jong Lee
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Sang Ha Woo
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Yu-Kyeong Park
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Ji Hoon Han
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Ga-Young Choi
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Eun Sil Heo
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Jae Soo Kim
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Chung A Park
- Department of Diagnostics, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Woo Dong Lee
- Pre-Major of Cosmetics and Pharmaceutics, College of Herbal Bio-Industry, Daegu Haany University, Daegu, Republic of Korea
| | - Chang Sop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ae-Ran Kim
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Chang-Hyun Han
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| |
Collapse
|
8
|
Barbosa LM, Valerio F, Pereira SLA, da Silva VA, de Lima Rodrigues AL, Galhardoni R, Yeng LT, Rosi J, Conforto AB, Lucato LT, Lemos MD, Teixeira MJ, de Andrade DC. Site matters: Central neuropathic pain characteristics and somatosensory findings after brain and spinal cord lesions. Eur J Neurol 2023; 30:1443-1452. [PMID: 36773324 DOI: 10.1111/ene.15744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND It is unknown if different etiologies or lesion topographies influence central neuropathic pain (CNP) clinical manifestation. METHODS We explored the symptom-somatosensory profile relationships in CNP patients with different types of lesions to the central nervous system to gain insight into CNP mechanisms. We compared the CNP profile through pain descriptors, standardized bedside examination, and quantitative sensory test in two different etiologies with segregated lesion locations: the brain, central poststroke pain (CPSP, n = 39), and the spinal cord central pain due to spinal cord injury (CPSCI, n = 40) in neuromyelitis optica. RESULTS Results are expressed as median (25th to 75th percentiles). CPSP presented higher evoked and paroxysmal pain scores compared to CPSCI (p < 0.001), and lower cold thermal limen (5.6°C [0.0-12.9]) compared to CPSCI (20.0°C [4.2-22.9]; p = 0.004). CPSCI also had higher mechanical pain thresholds (784.5 mN [255.0-1078.0]) compared to CPSP (235.2 mN [81.4-1078.0], p = 0.006) and higher mechanical detection threshold compared to control areas (2.7 [1.5-6.2] vs. 1.0 [1.0-3.3], p = 0.007). Evoked pain scores negatively correlated with mechanical pain thresholds (r = -0.38, p < 0.001) and wind-up ratio (r = -0.57, p < 0.001). CONCLUSIONS CNP of different etiologies may present different pain descriptors and somatosensory profiles, which is likely due to injury site differences within the neuroaxis. This information may help better design phenotype mechanism correlations and impact trial designs for the main etiologies of CNP, namely stroke and spinal cord lesions. This study provides evidence that topography may influence pain symptoms and sensory profile. The findings suggest that CNP mechanisms might vary according to pain etiology or lesion topography, impacting future mechanism-based treatment choices.
Collapse
Affiliation(s)
- Luciana Mendonça Barbosa
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil.,Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Fernanda Valerio
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | - Jefferson Rosi
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil.,Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Department of Neurology, University of São Paulo, São Paulo, Brazil.,Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
9
|
Characteristics and prevalence of orofacial pain as an initial symptom of oral and oropharyngeal cancer and its impact on the patient's functionality and quality of life. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:457-464. [DOI: 10.1016/j.oooo.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
|
10
|
Preoperative Predictors for Acute Pain After Photorefractive Keratectomy. Cornea 2022; 41:940-949. [PMID: 35543577 DOI: 10.1097/ico.0000000000003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to identify preoperative predictors for the occurrence of early severe postoperative pain in patients undergoing photorefractive keratectomy (PRK). The implementation of preoperative screening methods may facilitate more specific or aggressive pain therapies specifically targeted to individuals at a high risk of experiencing severe postoperative pain. METHODS This was exploratory research that included patients who underwent PRK. Before PRK, patients were administered a sociodemographic questionnaire, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory and underwent corneal sensitivity and conditioned pain modulation (CPM) tests. Post-PRK pain was assessed using a pain intensity visual analog scale (VAS), and the short-form McGill Pain Questionnaire (SF-MPQ) was completed 21 days before PRK and 1, 24, 48, and 72 hours after PRK. Spearman correlations were calculated for pain scores and preoperative predictors. RESULTS This research included 34 eyes of 34 patients. Preoperative corneal sensitivity was positively correlated with post-PRK pain scores as assessed by VAS and SF-MPQ (rho = 0.39 and rho = 0.41, respectively, P < 0.05). No correlations were found between Pain Catastrophizing Scale, State-Trait Anxiety Inventory, and CPM scores and post-PRK pain scores (P > 0.05). CONCLUSIONS Abnormal presurgical corneal sensitivity was a protective marker for severe pain after PRK, while scores as assessed by VAS and SF-MPQ and CPM were not related to postoperative pain.
Collapse
|
11
|
Barbosa LM, da Silva VA, de Lima Rodrigues AL, Mendes Fernandes DTR, de Oliveira RAA, Galhardoni R, Yeng LT, Junior JR, Conforto AB, Lucato LT, Lemos MD, Peyron R, Garcia-Larrea L, Teixeira MJ, de Andrade DC. Dissecting central post-stroke pain: a controlled symptom-psychophysical characterization. Brain Commun 2022; 4:fcac090. [PMID: 35528229 PMCID: PMC9070496 DOI: 10.1093/braincomms/fcac090] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Central post-stroke pain affects up to 12% of stroke survivors and is notoriously refractory to treatment. However, stroke patients often suffer from other types of pain of non- neuropathic nature (musculoskeletal, inflammatory, complex regional) and no head-to-head comparison of their respective clinical and somatosensory profiles has been performed so far.
We compared 39 patients with definite central neuropathic post-stroke pain with two matched- control groups: 32 patients with exclusively non-neuropathic pain developed after stroke and 31 stroke patients not complaining of pain. Patients underwent deep phenotyping via a comprehensive assessment including clinical exam, questionnaires and quantitative sensory testing to dissect central post-stroke pain from chronic pain in general and stroke.
While central post-stroke pain was mostly located in the face and limbs, non-neuropathic pain was predominantly axial and located in neck, shoulders and knees (p<0.05). Neuropathic Pain Symptom Inventory clusters burning (82.1%, n=32, p<0.001), tingling (66.7%, n= 26, p<0.001) and evoked by cold (64.1%, n=25, p<0.001) occurred more frequently in central post-stroke pain. Hyperpathia, thermal and mechanical allodynia also occurred more commonly in this group (p<0.001), which also presented higher levels of deafferentation (p<0.012) with more asymmetric cold and warm detection thresholds compared to controls. In particular, cold hypoesthesia (considered when the threshold of the affected side was less than 41% of the contralateral threshold) odds ratio was 12 (95%CI: 3.8-41.6) for neuropathic pain. Additionally, cold detection threshold/ warm detection threshold ratio correlated with the presence of neuropathic pain (ρ=-0.4, p< 0.001). Correlations were found between specific neuropathic pain symptom clusters and quantitative sensory testing: paroxysmal pain with cold (ρ=-0.4; p=0.008) and heat pain thresholds (ρ=0.5; p=0.003), burning pain with mechanical detection (ρ= -0.4; p=0.015) and mechanical pain thresholds (ρ=-0.4, p<0.013), evoked pain with mechanical pain threshold (ρ= -0.3; p=0.047). Logistic regression showed that the combination of cold hypoesthesia on quantitative sensory testing, the Neuropathic Pain Symptom Inventory, and the allodynia intensity on bedside examination explained 77% of the occurrence of neuropathic pain.
These findings provide insights into the clinical-psychophysics relationships in central post-stroke pain and may assist more precise distinction of neuropathic from non-neuropathic post-stroke pain in clinical practice and in future trials.
Collapse
Affiliation(s)
| | | | | | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Jefferson Rosi Junior
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Marcelo Delboni Lemos
- Department of Radiology, LIM-44, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Roland Peyron
- NeuroPain team, Lyon Neuroscience Research Center (CRNL), Inserm U1028, CNRS UMR5292, UCBL1, UJM, F-6900, Lyon, France
| | - Luis Garcia-Larrea
- NeuroPain team, Lyon Neuroscience Research Center (CRNL), Inserm U1028, CNRS UMR5292, UCBL1, UJM, F-6900, Lyon, France
| | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Department of Neurology, LIM-62, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark
| |
Collapse
|
12
|
Conceição TO, Cabral L, Laveli-Silva MG, Pacheco JC, Alves MG, Rabelo DC, Laiso R, Maria DA. New potential antiproliferative monophosphoester 2-aminoethyl dihydrogen phosphate in K-562 and K-562 MDR + leukemia cells. Biomed Pharmacother 2021; 142:112054. [PMID: 34463267 DOI: 10.1016/j.biopha.2021.112054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022] Open
Abstract
The main obstacle in the treatment of cancer patients has been resistance to multiple drugs, leading to the need to develop molecules with a higher specificity target. The liposomal formulation DODAC/2-AEH2P has antitumor potential, inducing apoptosis in several tumor types. Human chronic myeloid leukemia K-562 and K-562 Lucena (MDR+) cells were treated with the DODAC carrier and the liposomal formulation 2-AEH2P. Viability, cell cycle phases, apoptosis, marker expression and mitochondrial potential were analyzed. Significant reduction in viability was observed for all treatments. Changes in the distribution of the cell cycle phases and expression of markers involved in the apoptosis pathways were observed. Reduction of the mitochondrial electrical potential mediated by Bcl-2, being regulated by the reduction of the MTCH2 protein linked to the progression of myeloid leukemia and an increase in the pro-apoptotic proteins Bad and Bax, dependent on p53. This study demonstrated a significant therapeutic potential through apoptotic effects in leukemic cells, regardless of the molecular resistance profile (MDR+).
Collapse
Affiliation(s)
- T O Conceição
- Faculty of Medicine, University of Sao Paulo, FMUSP, Sao Paulo, SP, Brazil; Laboratory of Development and Innovation, Butantan Institute, Sao Paulo, SP, Brazil.
| | - Lgs Cabral
- Faculty of Medicine, University of Sao Paulo, FMUSP, Sao Paulo, SP, Brazil; Laboratory of Development and Innovation, Butantan Institute, Sao Paulo, SP, Brazil.
| | - M G Laveli-Silva
- Faculty of Medicine, University of Sao Paulo, FMUSP, Sao Paulo, SP, Brazil; Laboratory of Development and Innovation, Butantan Institute, Sao Paulo, SP, Brazil
| | - J C Pacheco
- Faculty of Medicine, University of Sao Paulo, FMUSP, Sao Paulo, SP, Brazil; Laboratory of Development and Innovation, Butantan Institute, Sao Paulo, SP, Brazil
| | - M G Alves
- Faculty of Medicine, University of Sao Paulo, FMUSP, Sao Paulo, SP, Brazil; Laboratory of Development and Innovation, Butantan Institute, Sao Paulo, SP, Brazil
| | - D C Rabelo
- Faculty of Medicine, University of Sao Paulo, FMUSP, Sao Paulo, SP, Brazil
| | - Ran Laiso
- Laboratory of Development and Innovation, Butantan Institute, Sao Paulo, SP, Brazil
| | - D A Maria
- Faculty of Medicine, University of Sao Paulo, FMUSP, Sao Paulo, SP, Brazil; Laboratory of Development and Innovation, Butantan Institute, Sao Paulo, SP, Brazil.
| |
Collapse
|
13
|
Balloon compression vs radiofrequency for primary trigeminal neuralgia: a randomized, controlled trial. Pain 2021; 162:919-929. [PMID: 32947541 DOI: 10.1097/j.pain.0000000000002070] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
ABSTRACT Surgical procedures are necessary in up to 50% of trigeminal neuralgia patients. Although radiofrequency (RF) is more widely used, it is associated with high intraprocedural costs and long technical learning time. Other simpler procedures such as balloon compression (BC) require a lower training period and have significant lower costs. We evaluated the effects of BC and RF in pain control in primary trigeminal neuralgia in a randomized, double-blinded, head-to-head trial. Individuals were randomly allocated in 1 of 2 groups: BC and RF. Throughout pain, psychological and quality of life measurements were performed at baseline and after surgery. The main outcome was the worst pain in the last 24 hours (0-10) at 6 months postoperatively. After the inclusion of half of the estimated sample, a preplanned interim analysis was performed when 33 patients (62.1 ± 9.4 y.) completed the study. Pain intensity (confidence interval [CI] 95% 0.6 to 3.8, and -0.6 to 2.2, for BC and RF) did not significantly differ. Complications, interference of pain in daily life (CI 95% -0.1 to 2.3 and -0.4 to 2.3, for BC and RF), neuropathic pain symptoms (CI 95% 1.7 to 3.6 and 3.0 to 5.7, for BC and RF), mood (CI 95% 4.8 to 11.5 and 5.5 to 15.1, BC and RF, respectively), medication use, and quality of life (CI 95% 80.4 to 93.1 and 83.9 to 94.2, for BC and RF) were also not different. Radiofrequency presented more paresthetic symptoms than BC at 30 days after intervention. Based on these results, the study was halted due to futility because BC was not superior to RF.
Collapse
|
14
|
Christakou A. Cross-cultural adaptation of the Pain Catastrophizing Scale in Greek clinical population. Hong Kong Physiother J 2021; 41:89-98. [PMID: 34177197 PMCID: PMC8221984 DOI: 10.1142/s1013702521500086] [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: 05/09/2020] [Accepted: 02/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Catastrophizing is an important psychological construct in mediating the behavioral response toward pain. Objective: The purpose of this study is to examine the psychometric properties of the Pain Catastrophizing Scale (PCS) in Greek clinical population. Methods: The scale was administered in 376 patients with chronic cervical and lumbar pain. Test–retest reliability, internal consistency (Cronbach α) and concurrent validity were assessed. Exploratory (EFA) and Confirmatory Factor Analysis (CFA) were used to test the factorial validity of the hypothesized three factor structure. Results: The PCS factors suggested high levels of test–retest reliability, whereas Cronbachs’ α values were acceptable. The EFA yielded a three-factor solution and indicated a marginal fit to the data. CFA procedures indicated a rather acceptable fit to the data. The concurrent validity of the instrument was confirmed. Conclusion: PCS seems to be a reliable and valid instrument in Greek patients with chronic cervical and lumbar pain.
Collapse
Affiliation(s)
- Anna Christakou
- Department of Physiotherapy, University of West Attica, Athens, Greece.,General Hospital of Evaggelismos, Athens, Greece
| |
Collapse
|
15
|
Listik C, Cury RG, da Silva VA, Casagrande SCB, Listik E, Link N, Galhardoni R, Barbosa ER, Teixeira MJ, Ciampi de Andrade D. Abnormal sensory thresholds of dystonic patients are not affected by deep brain stimulation. Eur J Pain 2021; 25:1355-1366. [PMID: 33740316 DOI: 10.1002/ejp.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Unlike motor symptoms, the effects of deep brain stimulation (DBS) on non-motor symptoms associated with dystonia remain unknown. METHODS The objective of this study was to assess the effects of DBS on evoked experimental pain and cutaneous sensory thresholds in a crossover, double-blind on/off study and compare these results with those of healthy volunteers (HV). RESULTS Sixteen patients with idiopathic dystonia (39.9 ± 13 years old, n = 14 generalized) with DBS of the globus pallidus internus underwent a battery of quantitative sensory testing and assessment using a pain top-down modulation system (conditioned pain modulation, CPM). Results for the more and less dystonic body regions were compared in on and off stimulation. The patients' results were compared to age- and sex-matched HV. Descending pain modulation CPM responses in dystonic patients (on-DBS, 11.8 ± 40.7; off-DBS, 1.8 ± 22.1) was abnormally low (defective) compared to HV (-15.6 ± 23.5, respectively p = .006 and p = .042). Cold pain threshold and cold hyperalgesia were 54.8% and 95.7% higher in dystonic patients compared to HV. On-DBS CPM correlated with higher Burke-Fahn-Marsden disability score (r = 0.598; p = .014). While sensory and pain thresholds were not affected by DBS on/off condition, pain modulation was abnormal in dystonic patients and tended to be aggravated by DBS. CONCLUSION The analgesic effects after DBS do not seem to depend on short-duration changes in cutaneous sensory thresholds in dystonic patients and may be related to changes in the central processing of nociceptive inputs.
Collapse
Affiliation(s)
- Clarice Listik
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Valquiria Aparecida da Silva
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Eduardo Listik
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Naira Link
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ricardo Galhardoni
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.,Federal University of ABC, São Bernardo do Campo, SP, Brazil.,School of Medicine, Santo André, SP, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Manoel Jacobsen Teixeira
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Daniel Ciampi de Andrade
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.,Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.,Pain Center, Instituto do Cancer do Estado de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
16
|
Alhalal E, Jackson KT. Evaluation of the Arabic version of the Chronic Pain Grade scale: Psychometric properties. Res Nurs Health 2021; 44:403-412. [PMID: 33586152 DOI: 10.1002/nur.22116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/06/2021] [Accepted: 02/02/2021] [Indexed: 11/07/2022]
Abstract
To increase our understanding of chronic pain in clinical and research contexts, an assessment of its dimensions using reliable and valid self-reported pain measures is imperative. However, well-validated Arabic chronic pain assessment scales are lacking. The Chronic Pain Grade (CPG) scale has been used worldwide, yet an Arabic version of the CPG scale has not yet been validated. Thus, we conducted this study to demonstrate the psychometric properties, including reliability, convergent validity, and construct validity of the Arabic CPG scale. A cross-sectional study was conducted in two hospitals in Saudi Arabia. Data were collected from a convenience sample of 233 chronic pain patients. The confirmatory factor analysis showed an excellent fit with the factor structure of the CPG scale and, thus, supported construct validity. The two identified subscales were pain intensity and pain disability. Convergent validity was supported by having significant correlations between the short-form McGill Pain Questionnaire and CPG subscales. Internal consistency reliability was demonstrated, as Cronbach's α was 0.916 for pain intensity and 0.815 for pain disability. This study provides evidence that the Arabic CPG scale is a reliable and valid measure of chronic pain dimensions, including pain intensity, and pain-related disability. This Arabic version of the CPG scale has the potential to expand research and clinical assessment in the Arab world. Future studies are required for further validation.
Collapse
Affiliation(s)
- Eman Alhalal
- Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Kimberley T Jackson
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| |
Collapse
|
17
|
de Fátima Kirchner L, de Jesus Dutra Dos Reis M. Behavior-analytic intervention for women with fibromyalgia and insomnia: a single subject design. ACTA ACUST UNITED AC 2021; 34:5. [PMID: 33554311 PMCID: PMC7868308 DOI: 10.1186/s41155-020-00169-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 12/25/2020] [Indexed: 11/10/2022]
Abstract
This study evaluated the effects in the pain and sleep, and the clinic significance after an analytic-behavioral intervention to manage the condition of the physical and interpersonal environment related to pain. Four women with fibromyalgia and insomnia participated in a study with intervention withdrawal multiple baseline design and initial, intermediate, final, and follow-up assessments. Self-report instruments were used to assess pain intensity and disability, sleep quality, and insomnia severity, besides the actigraphy. Data showed that the intervention (20 sessions) was effective in reducing the sleep and pain problems in all participants by shifting two participants from clinical to non-clinical status in sleep indicators. The gains were maintained or increased in follow-up measures. However, the results should take into consideration the clinical condition and other variables that may have individually impacted the results.
Collapse
Affiliation(s)
- Luziane de Fátima Kirchner
- Federal Univerisity of São Carlos-UFSCar, KM 235 Washington Luis, São Carlos and São Paulo, 13565-905, Brazil. .,Dom Bosco Catholic University-UCDB, 6000 Tamandaré Avenue, Jardim Seminário, Campo Grande and Mato Grosso do Sul, 79117-900, Brazil.
| | - Maria de Jesus Dutra Dos Reis
- Federal Univerisity of São Carlos-UFSCar, KM 235 Washington Luis, São Carlos and São Paulo, 13565-905, Brazil.,University of São Paulo, São Paulo, Brazil
| |
Collapse
|
18
|
Psychometric Properties of the Abdominal Pain Index (API) in the Iranian Adolescent Population. Pain Res Manag 2021; 2020:2632139. [PMID: 33456634 PMCID: PMC7787814 DOI: 10.1155/2020/2632139] [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: 06/26/2020] [Revised: 09/07/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
Abstract
Considering the high prevalence of abdominal pain in children and adolescents in Iran, it is essential to use appropriate screening tools. One of the most comprehensive, yet concise, tools for this purpose is the Abdominal Pain Index (API). This study aimed to investigate the psychometric properties of the Persian version of the self-report API in adolescents. In this descriptive study, A total of 162 Iranian adolescents in the age range of 12 to 18 years were considered as the sample group, which included two groups of school students (n = 125) and adolescent patients with abdominal pain (n = 37). Clinical sample was selected by the available sampling method, and nonclinical sample was selected by the cluster sampling method. Adolescents in the sample group were selected from both clinical and nonclinical groups in order to evaluate differential validity. Instruments, including API, somatic symptoms subscale of the General Health Questionnaire (GHQ), and McGill Pain Questionnaire (MPQ), were also completed for the participants. Also, to evaluate the construct validity of API, exploratory and confirmatory factor analysis methods were applied. The exploratory factor analysis identified one general factor, and the confirmatory factor analysis results show the model's satisfactory fitting. Also, the researchers' hypothesis, i.e., API is a single-factor model (with five items), was approved. The reliability coefficient of the questionnaire was satisfactory for the total scale (α < 0.7). This study showed that API could be used with considerable confidence for Iranian children and adolescents with chronic pain.
Collapse
|
19
|
Kaziyama H, Barbour J, Galhardoni R, da Silva V, Tesseroli de Siqueira S, Listik C, dos Santos GJ, Yeng LT, Marcolin MA, Raicher I, Teixeira MJ, Ciampi de Andrade D. Sifting the wheat from the chaff? Evidence for the existence of an asymmetric fibromyalgia phenotype. Eur J Pain 2020; 24:1635-1647. [DOI: 10.1002/ejp.1620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Helena Kaziyama
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Instituto de Ortopedia e TraumatologiaDivision of Physical Medicine and RehabilitationUniversity of São Paulo São Paulo Brazil
| | - Julio Barbour
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | - Ricardo Galhardoni
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- School of MedicineUniversity of City of São Paulo (UNICID) São Paulo Brazil
| | - Valquíria da Silva
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | | | - Clarice Listik
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | | | - Lin T. Yeng
- Instituto de Ortopedia e TraumatologiaDivision of Physical Medicine and RehabilitationUniversity of São Paulo São Paulo Brazil
| | | | - Irina Raicher
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
| | - Manoel J. Teixeira
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
| | - Daniel Ciampi de Andrade
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
| |
Collapse
|
20
|
Valerio F, Apostolos-Pereira SL, Sato DK, Callegaro D, Lucato LT, Barboza VR, Silva VA, Galhardoni R, Rodrigues ALDL, Jacobsen Teixeira M, Ciampi de Andrade D. Characterization of pain syndromes in patients with neuromyelitis optica. Eur J Pain 2020; 24:1548-1568. [PMID: 32488917 DOI: 10.1002/ejp.1608] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pain is common and refractory in spinal cord injury (SCI). Currently, most studies evaluated pain in male-predominant traumatic-SCI. Also, concomitant secondary pain syndromes and its temporal evolution were seldom reported. METHODS We aimed to prospectively describe the main and secondary pain and its associated factors in inflammatory-SCI evaluating neuromyelitis optica (NMO) patients. In-remission NMO patients underwent neurological, imaging and autoantibody evaluations. Questionnaires detailing main and secondary pains, functional state, mood, catastrophizing, quality of life (QoL) and "non-motor symptoms" were used at two time points. RESULTS Pain was present in 53 (73.6%) of the 72 patients included. At-level neuropathic pain was the most common main pain syndrome, affecting 32 subjects (60.4% of those with pain). Over 70% (n = 38) of this cohort reported two pain syndromes. Those without pain were significantly younger (26.1 ± 12.7 y.o. in those without pain and 40.1 ± 12.5, 37.2 ± 11.4 y.o. in those whose main pain was neuropathic and non-neuropathic, respectively, p = .001), and no differences in the inflammatory status were observed between groups. On follow-up, one-fifth (n = 11) had a different main pain syndrome from the first visit. Pain impacted QoL as much as disability and motor strength. CONCLUSION Pain is a prevalent and disabling non-motor symptom in NMO-SCI. Most patients experience more than one pain syndrome which can change in time even in the absence of clinical relapse. Age of the inflammatory-SCI was a major determinant of pain. Acknowledging temporal changes and multiplicity of pain syndromes in NMO-SCI may give insights into more precise designs of clinical trials and general management of pain in SCI. SIGNIFICANCE In this longitudinal study with NMO-related SCI, pain affected almost three-quarters of patients with NMO. Over 70% have more than one pain syndrome and at-level neuropathic pain is the most common type of pain syndrome. Patients without pain were significantly younger but had the same burden of inflammatory lesions than those with pain. During follow-up, up to one fifth of patients presented with changes in the main pain syndromes, which can occur even in the absence of clinical activity of the inflammatory disease. In this cohort, Pain affected quality of life as much as disability or motor strength.
Collapse
Affiliation(s)
- Fernanda Valerio
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Samira L Apostolos-Pereira
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Douglas Kazutoshi Sato
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto do Cérebro do Rio Grande do Sul (InsCer), Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Dagoberto Callegaro
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Leandro Tavares Lucato
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Victor Rosseto Barboza
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Valquiria A Silva
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antonia L de Lima Rodrigues
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| |
Collapse
|
21
|
Galhardoni R, Ciampi de Andrade D, Puerta MYT, Brunoni AR, Varotto BLR, de Siqueira JTT, Teixeira MJ, Siqueira SRDT. Altered cortical excitability in persistent idiopathic facial pain. Cephalalgia 2018; 39:219-228. [DOI: 10.1177/0333102418780426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Persistent idiopathic facial pain is a refractory and disabling condition of unknown mechanism and etiology. It has been suggested that persistent idiopathic facial pain patients have not only peripheral generators of pain, but also central nervous system changes that would contribute to the persistence of symptoms. We hypothesized that persistent idiopathic facial pain would have changes in brain cortical excitability as measured by transcranial magnetic stimulation compared to healthy controls. Methods Twenty-nine persistent idiopathic facial pain patients were compared to age- and sex-matched healthy controls and underwent cortical excitability measurements by transcranial magnetic stimulation applied to the cortical representation of the masseter muscle of both hemispheres. Single-pulse stimulation was used to measure the resting motor threshold and suprathreshold motor-evoked potentials. Paired-pulse stimulation was used to assess short intracortical inhibition and intracortical facilitation. Clinical pain and associated symptoms were assessed with validated tools. Results Spontaneous pain was found in 27 (93.1%) and provoked pain was found in two (6.9%) persistent idiopathic facial pain patients. The motor-evoked potentials at 120% and 140% were significantly lower for both hemispheres compared to controls. Persistent idiopathic facial pain patients had lower short-interval intracortical inhibition compared with controls. These changes were correlated with some aspects of quality of life, and higher mood symptoms. These neurophysiological alterations were not influenced by analgesic medication, as similar changes were observed in patients with or without central-acting drugs. Conclusions Persistent idiopathic facial pain is associated with changes in intracortical modulation involving GABAergic mechanisms, which may be related to certain aspects of the pathophysiology of this chronic pain condition. Trial registration: NTC01746355.
Collapse
Affiliation(s)
- Ricardo Galhardoni
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- School of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Pain Center, Cancer Institute of State of São Paulo “Octavio Frias de Oliveira”, São Paulo, Brazil
| | - Mariana YT Puerta
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Bruna LR Varotto
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Dentistry Division of the Central Institute and Experimental Neurosurgery Division of the Psychiatric Institute, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo SP, Brazil
| | - José TT de Siqueira
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Dentistry Division of the Central Institute and Experimental Neurosurgery Division of the Psychiatric Institute, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo SP, Brazil
| | - Manoel J Teixeira
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Pain Center, Cancer Institute of State of São Paulo “Octavio Frias de Oliveira”, São Paulo, Brazil
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Silvia RDT Siqueira
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Dentistry Division of the Central Institute and Experimental Neurosurgery Division of the Psychiatric Institute, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo SP, Brazil
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- School of Arts, Science and Humanities, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
22
|
Massage therapy in cortisol circadian rhythm, pain intensity, perceived stress index and quality of life of fibromyalgia syndrome patients. Complement Ther Clin Pract 2018; 30:85-90. [DOI: 10.1016/j.ctcp.2017.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/04/2017] [Accepted: 12/05/2017] [Indexed: 11/20/2022]
|
23
|
Costa WA, Monteiro MN, Queiroz JF, Gonçalves AK. Pain and quality of life in breast cancer patients. Clinics (Sao Paulo) 2017; 72:758-763. [PMID: 29319722 PMCID: PMC5738557 DOI: 10.6061/clinics/2017(12)07] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the influence of pain on quality of life in breast cancer patients. METHODS A cross-sectional study of 400 patients, including 118 without metastasis, 160 with loco-regional metastasis and 122 with distant metastasis. The instruments used were the European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-Core 30 and the Breast Cancer-specific 23 and short McGill Pain Questionnaire. RESULTS In total, 71.7% of patients reported pain. The most frequent sensory descriptor used by patients was 'jumping.' In the evaluative dimension, the main descriptor chosen was troublesome. The Global Health self-assessment showed pain to be inversely correlated with quality of life: the group without metastasis had a mean score of 55.3 (SD=24.8) for those in pain, which rose to 69.7 (SD=19.2) for those without pain (p=0.001). Subjects with loco-regional metastasis had score of 59.1 (SD=21.3) when in pain, and those without pain had a significantly higher score of 72.4 (SD=18.6) (p<0.001). Patients from the distant metastasis group showed similar results with a mean score of 48.6 (SD=23.1) for those in pain and 67.6 (SD=20.4) for those without pain (p=0.002). Regarding the association of pain intensity and quality of life, patients with distant metastasis and intense pain had the worst scores for quality of life with a functional scale mean of 49.9 (SD=17.3) (p<0.009), a Symptom Scale score of 50.0 (SD=20.1) (p<0.001) and a Global Health Scale score of 39.7 (SD=24.7) (p<0.006). CONCLUSIONS Pain compromises the quality of life of patients with breast cancer, particularly those with advanced stages of the disease.
Collapse
|
24
|
Lopes LCG, Galhardoni R, Silva V, Jorge FMH, Yeng LT, Callegaro D, Chadi G, Teixeira MJ, Ciampi de Andrade D. Beyond weakness: Characterization of pain, sensory profile and conditioned pain modulation in patients with motor neuron disease: A controlled study. Eur J Pain 2017; 22:72-83. [PMID: 28833988 DOI: 10.1002/ejp.1091] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Motor neuron diseases (MND) represent a group of disorders that evolve with inexorable muscle weakness and medical management is based on symptom control. However, deeper characterization of non-motor symptoms in these patients have been rarely reported. METHODS This cross-sectional study aimed to describe non-motor symptoms in MND and their impact on quality of life and functional status, with a focus on pain and sensory changes. Eighty patients (31 females, 55.7 ± 12.9 years old) with MND underwent a neurological examination, pain, mood, catastrophizing and psychophysics assessments [quantitative sensory testing (QST) and conditioned pain modulation (CPM)], and were compared to sex- and age-matched healthy controls (HC). RESULTS Chronic pain was present in 46% of patients (VAS =5.18 ± 2.0). Pain of musculoskeletal origin occurred in 40.5% and was mainly located in the head/neck (51%) and lower back (35%). Neuropathic pain was not present in this sample. Compared to HC, MND patients had a lower cold detection threshold (p < 0.002), and significantly lower CPM scores (4.9 ± 0.2% vs. 22.1 ± 0.2%, p = 0.012). QST/CPM results did not differ between MND patients with and without pain. Pain intensity was statistically correlated with anxiety, depression and catastrophism, and spasticity scores were inversely correlated with CPM (ρ = -0.30, p = 0.026). CONCLUSIONS Pain is frequently reported by patients with MNDs. Somatosensory and CPM changes exist in MNDs and may be related to the neurodegenerative nature of the disease. Further studies should investigate the most appropriate treatment strategies for these patients. SIGNIFICANCE We report a comprehensive evaluation of pain and sensory abnormalities in motor neuron disease (MND) patients. We assessed the different pain syndromes present in MND with validated tools, and described the QST and conditioned pain modulation profiles in a controlled design.
Collapse
Affiliation(s)
- L C G Lopes
- Pain Center, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, São Paulo, Brazil.,Neurology Division, Department of Neurology, São Paulo State University (Unesp) Medical School, Botucatu, Brazil
| | - R Galhardoni
- Pain Center, Department of Neurology, University of São Paulo, Brazil.,Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, Brazil
| | - V Silva
- Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, Brazil
| | - F M H Jorge
- Neuroregeneration Center and ALS Brazil Project, Department of Neurology, University of São Paulo School of Medicine, Brazil
| | - L T Yeng
- Instituto de Ortopedia e Traumatologia, Division of Physical Medicine and Rehabilitation, University of São Paulo, Brazil
| | - D Callegaro
- Neuroimmunology Group, Department of Neurology, University of São Paulo, Brazil
| | - G Chadi
- Neuroregeneration Center and ALS Brazil Project, Department of Neurology, University of São Paulo School of Medicine, Brazil
| | - M J Teixeira
- Pain Center, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, São Paulo, Brazil.,Pain Center, Department of Neurology, University of São Paulo, Brazil.,Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, Brazil
| | - D Ciampi de Andrade
- Pain Center, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, São Paulo, Brazil.,Pain Center, Department of Neurology, University of São Paulo, Brazil.,Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, Brazil
| |
Collapse
|
25
|
de Andrade DC, Jacobsen Teixeira M, Galhardoni R, Ferreira KSL, Braz Mileno P, Scisci N, Zandonai A, Teixeira WGJ, Saragiotto DF, Silva V, Raicher I, Cury RG, Macarenco R, Otto Heise C, Wilson Iervolino Brotto M, Andrade de Mello A, Zini Megale M, Henrique Curti Dourado L, Mendes Bahia L, Lilian Rodrigues A, Parravano D, Tizue Fukushima J, Lefaucheur JP, Bouhassira D, Sobroza E, Riechelmann RP, Hoff PM, Valério da Silva F, Chile T, Dale CS, Nebuloni D, Senna L, Brentani H, Pagano RL, de Souza ÂM. Pregabalin for the Prevention of Oxaliplatin-Induced Painful Neuropathy: A Randomized, Double-Blind Trial. Oncologist 2017; 22:1154-e105. [PMID: 28652279 PMCID: PMC5634769 DOI: 10.1634/theoncologist.2017-0235] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022] Open
Abstract
Lessons Learned. Pregabalin is a medication that can decrease neuronal hyperexcitability, relieve neuropathic pain, and reach stable plasma levels after a titration period of only a few days. Its use during oxaliplatin infusions was not able to decrease the incidence of chronic, oxalipaltin‐related neuropathic pain, compared with placebo.
Background. Patients with colorectal cancer (CRC) receiving oxaliplatin (OXA) develop acute and chronic painful oxaliplatin‐induced peripheral neuropathy (OXAIPN). Acute and chronic OXA‐related neuropathies have different pathophysiological bases, but both lead to a common phenomenon: central sensitization (CS) of nociceptive neuronal networks, leading to increased sensitivity (hyperlgesia, allodynia) in the somatosensory system, the common ground of chronic neuropathic pain. Because CS is related to increased risk of painful OXAIPN, we hypothesized that preemptive use of the anti‐hyperalgesic drug pregabaline (known to decrease CS) during OXA infusions would decrease the incidence of chronic OXAIPN. Methods. Pain‐free, chemotherapy‐naïve CRC patients receiving at least one cycle of modified‐FLOX [5‐FU(500 mg/m2)+leucovorin(20 mg/m2)/week for] 6 weeks+oxaliplatin(85 mg/m2) at weeks 1‐3‐5 every 8 weeks] were randomized (1:1) into the study. Patients received either pregabalin or placebo for 3 days before and 3 days after each OXA infusion and were followed for up to 6 months. Clinical assessments were performed at baseline, at the end of chemotherapy, and after the follow‐up period. The main outcome was average pain at the last visit assessed by the visual analogic scale (0–10) item of the Brief Pain Inventory (BPI). Secondary endpoints were presence of neuropathic pain according to the Douleur Neuropathique‐4 (DN‐4), pain dimensions (short‐ form McGill Pain Questionnaire [MPQ]), Neuropathic Pain Symptom Inventory (NPSI), and changes in nerve conduction studies (NCS) and side effect profile. Results. One hundred ninety‐nine patients (57.0 ± 10.7 years old, 98 female, 101 male) were randomized. Data from 56 patients were not included in the analyses (as they did not receive at least one full cycle of modified FLOX). Data from 78 patients in the pregabalin group and 65 patients in the placebo group were retained for analyses. At the last visit, pain intensity in the pregabalin group was 1.03 (95% confidence interval [CI] = 0.79–1.26), and 0.85 (95% CI = 0.64–1.06) in the placebo group, which did not reach significance. Scores from the BPI, MPQ, DN‐4, NPSI, and NCS and side‐effect profiles and incidence of death did not differ between groups. Quality of life (QoL) score did not differ between groups (placebo = 76.9 ± 23.1, pregabalin group 79.4 ± 20.6). Mood scores were not significantly different between groups (placebo 9.7 [8.1–11.2]; pregabalin 6.8 [5.6–8.0]). Conclusion. The preemptive use of pregabalin during OXA infusions was safe, but did not decrease the incidence of chronic pain related to OXAIPN.
Collapse
Affiliation(s)
- Daniel Ciampi de Andrade
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Divisão de Neurocirurgia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Galhardoni
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Medical School of University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Karine S L Ferreira
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paula Braz Mileno
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Nathalia Scisci
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexandra Zandonai
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - William G J Teixeira
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel F Saragiotto
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valquíria Silva
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Irina Raicher
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Macarenco
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | - Luciana Mendes Bahia
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | - Daniella Parravano
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Julia Tizue Fukushima
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Didier Bouhassira
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Boulogne, France
| | - Evandro Sobroza
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rachel P Riechelmann
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo M Hoff
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Thais Chile
- LIM 23, Instituto de Psiquiatria, Universidade de Sao Paulo, Brazil
| | - Camila S Dale
- Departamento de Anatomia, Instituto de Ciências Biomedicas, Universidade de Sao Paulo, Brazil
| | - Daniela Nebuloni
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luiz Senna
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Helena Brentani
- LIM 23, Instituto de Psiquiatria, Universidade de Sao Paulo, Brazil
| | - Rosana L Pagano
- Laboratory of Neuromodulation and Experimental Pain, Hospital Sírio Libanês, Brazil
| | - Ângela M de Souza
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| |
Collapse
|
26
|
Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain. Lasers Med Sci 2017; 32:419-428. [DOI: 10.1007/s10103-016-2138-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
|
27
|
Terkawi AS, Tsang S, Abolkhair A, Alsharif M, Alswiti M, Alsadoun A, AlZoraigi US, Aldhahri SF, Al-Zhahrani T, Altirkawi KA. Development and validation of Arabic version of the Short-Form McGill Pain Questionnaire. Saudi J Anaesth 2017; 11:S2-S10. [PMID: 28615999 PMCID: PMC5463564 DOI: 10.4103/sja.sja_42_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: The Short-Form McGill Pain Questionnaire (SF-MPQ) is a widely used tool for qualitative and quantitative pain assessment. Our aim was to translate, culturally adapt, and validate the SF-MPQ in Arabic. Methods: A systematic translation process was used to translate the original English SF-MPQ into Arabic. After the pilot study, we validated our version in patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations between SF-MPQ, Brief Pain Inventory [BPI], and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), and face validity. The questionnaire was administered twice to examine responsiveness. Results: A total of 142 participants (68 men and 74 women) were included in this study. Cronbach's α was 0.85 (95% confidence interval: 0.81 – 0.89), and interclass correlation coefficients were 0.71 (0.62–0.79) for the whole scale. SF-MPQ was moderately associated with patients’ present pain (r = 0.55, P < 0.001) and the numerical rating scale (r = 0.42, P < 0.001). The total pain score was moderately correlated with pain severity and interference assessed with the BPI (rs = 0.39 to 0.49, all Ps < 0.001). SF-MPQ total pain score was weakly associated with neuropathic pain assessed with S-LANSS (r = 0.26, P < 0.01). Most patients found the SF-MPQ questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their pain. Conclusion: Our translated version of SF-MPQ was reliable and valid for use among Arabic-speaking patients. The SF-MPQ is a good qualitative and quantitative assessment tool for pain but is only weakly associated with neuropathic pain.
Collapse
Affiliation(s)
- Abdullah Sulieman Terkawi
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA.,Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.,Outcomes Research Consortium, Cleveland, OH, USA
| | - Siny Tsang
- Department of Epidemiology, Columbia University, New York, USA
| | - Abdullah Abolkhair
- Department of Anesthesiology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohammed Alsharif
- Department of Anesthesiology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Mousa Alswiti
- Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Adwa Alsadoun
- Department of Medical/Surgical Nursing, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Saleh F Aldhahri
- Department of Otolaryngology, King Saud University, Riyadh, Saudi Arabia
| | - Tariq Al-Zhahrani
- Department of Anesthesiology, King Saud University, Riyadh, Saudi Arabia
| | | |
Collapse
|
28
|
Mylius V, Ciampi de Andrade D, Cury RG, Teepker M, Ehrt U, Eggert KM, Beer S, Kesselring J, Stamelou M, Oertel WH, Möller JC, Lefaucheur JP. Pain in Parkinson's Disease: Current Concepts and a New Diagnostic Algorithm. Mov Disord Clin Pract 2015; 2:357-364. [PMID: 30363602 DOI: 10.1002/mdc3.12217] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 12/30/2022] Open
Abstract
Background Pain is a significant burden for patients with Parkinson's disease (PD) with a high impact on quality of life. The present article aims at summarizing epidemiological, pathophysiological, clinical, and neurophysiological data regarding pain in PD. Methods In this domain, a procedure of systematic assessment is still lacking for the syndromic diagnosis and should take into account pain characteristics, effects of dopaminergic treatment, motor fluctuations, and non-PD-associated pain. Findings We propose an original questionnaire addressing an algorithm suitable for daily clinical practice. The questionnaire is based on a three-step approach addressing first the relationship between pain and PD (including temporal relationship with the course of the disease, association with motor fluctuations, and impact of antiparkinsonian treatment), before classifying pain into one of three main syndromes (i.e., musculoskeletal pain, psychomotor restlessness pain, and neuropathic pain). Conclusions The proposed questionnaire allows the characteristics of each pain type to be determined according to its relationship with the disease and its treatment. The validation of the clinical use of this questionnaire will be the goal of a forthcoming work.
Collapse
Affiliation(s)
- Veit Mylius
- Department of Neurology Philipps University Marburg Germany.,Department of Neurology Center for Neurorehabilitation Valens Switzerland
| | | | - Rubens Gisbert Cury
- Pain Center Department of Neurology University of São Paulo São Paulo SP Brazil
| | | | - Uwe Ehrt
- Psychiatric Clinic Fachklinikum Bernburg Bernburg Germany
| | | | - Serafin Beer
- Department of Neurology Center for Neurorehabilitation Valens Switzerland
| | - Jürg Kesselring
- Department of Neurology Center for Neurorehabilitation Valens Switzerland
| | - Maria Stamelou
- Department of Neurology Philipps University Marburg Germany.,Movement Disorders Clinic Second Department of Neurology University of Athens Athens Greece
| | | | - Jens Carsten Möller
- Parkinson Center Center for Neurological Rehabilitation Zihlschlacht Switzerland
| | - Jean-Pascal Lefaucheur
- Faculté de Médecine Université Paris Est Créteil Créteil France.,Service de Physiologie-Explorations Fonctionnelles Hôpital Henri Mondor Assistance Publique-Hôpitaux de Paris Créteil France
| |
Collapse
|
29
|
Heinla I, Leidmaa E, Kongi K, Pennert A, Innos J, Nurk K, Tekko T, Singh K, Vanaveski T, Reimets R, Mandel M, Lang A, Lilleväli K, Kaasik A, Vasar E, Philips MA. Gene expression patterns and environmental enrichment-induced effects in the hippocampi of mice suggest importance of Lsamp in plasticity. Front Neurosci 2015; 9:205. [PMID: 26136648 PMCID: PMC4470440 DOI: 10.3389/fnins.2015.00205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/23/2015] [Indexed: 12/31/2022] Open
Abstract
Limbic system associated membrane protein (Lsamp) gene is involved in behavioral adaptation in social and anxiogenic environments and has been associated with a broad spectrum of psychiatric diseases. Here we studied the activity of alternative promoters of Lsamp gene in mice in three rearing conditions (standard housing, environmental enrichment and social isolation) and in two different genetic backgrounds (129S6/SvEv and C57BL/6). Isolation had no effect on the expression levels of Lsamp. Environmental enrichment elevated the expression levels of Lsamp 1b transcript specifically in the hippocampus in B6 mice, and the same tendency existed across both mouse lines and both transcripts. Furthermore, we showed that the density of cells exhibiting 1b promoter activity is remarkably higher in the subgranular zone of the dentate gyrus in the hippocampal formation which is a specific area of enrichment-induced neurogenesis in adult rodents. On the contrary to 1b, 1a promoter is selectively active in the pyramidal and granule cell layers. We provide evidence that Lsamp modulates enrichment-induced activation of Bdnf as the enrichment-induced elevation of Bdnf in the hippocampus is significantly diminished in Lsamp-deficient mice; furthermore, a significant correlation was found between the expression levels of Lsamp and Bdnf transcripts in the hippocampus and frontal cortex. Significant strain differences in Lsamp expression were detected in the hippocampus, frontal cortex and thalamus that could be related to the different behavioral phenotype of B6 and 129Sv mice. Our data provides further evidence that LSAMP is implicated in the hippocampal connectivity and plasticity thereby modulating adaptability in changing environments.
Collapse
Affiliation(s)
- Indrek Heinla
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Este Leidmaa
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia ; Stress Neurobiology and Neurogenetics, Max Planck Institute of Psychiatry Munich, Germany
| | - Karina Kongi
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Airi Pennert
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Jürgen Innos
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Kaarel Nurk
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Triin Tekko
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Katyayani Singh
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Taavi Vanaveski
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Riin Reimets
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Merle Mandel
- Department of Pharmacology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Aavo Lang
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Kersti Lilleväli
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Allen Kaasik
- Department of Pharmacology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Eero Vasar
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| | - Mari-Anne Philips
- Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu Tartu, Estonia
| |
Collapse
|
30
|
Abstract
Patient-reported outcome measures (PRO) can provide reliable and valid estimates of patient status and response to interventions to complete the final step in an evidence-based patient interaction. A variety of PRO are relevant to upper extremity surgery and rehabilitation outcomes. PRO provide feasible tools for clinical research or practice, although use in clinical decision making lags behind research applications. Recent trends in clinical measurement include better integration of International Classification of Functioning, Disability and Health in content validation, more modern methods of evaluating scaling properties (Rasch analysis), consensus exercise on establishing core measures, electronic data collection, and computer-adaptive testing.
Collapse
|