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Diekman CO, Thomas PJ, Wilson CG. COVID-19 and silent hypoxemia in a minimal closed-loop model of the respiratory rhythm generator. BIOLOGICAL CYBERNETICS 2024:10.1007/s00422-024-00989-w. [PMID: 38884785 DOI: 10.1007/s00422-024-00989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 03/28/2024] [Indexed: 06/18/2024]
Abstract
Silent hypoxemia, or "happy hypoxia," is a puzzling phenomenon in which patients who have contracted COVID-19 exhibit very low oxygen saturation ( SaO 2 < 80%) but do not experience discomfort in breathing. The mechanism by which this blunted response to hypoxia occurs is unknown. We have previously shown that a computational model of the respiratory neural network (Diekman et al. in J Neurophysiol 118(4):2194-2215, 2017) can be used to test hypotheses focused on changes in chemosensory inputs to the central pattern generator (CPG). We hypothesize that altered chemosensory function at the level of the carotid bodies and/or the nucleus tractus solitarii are responsible for the blunted response to hypoxia. Here, we use our model to explore this hypothesis by altering the properties of the gain function representing oxygen sensing inputs to the CPG. We then vary other parameters in the model and show that oxygen carrying capacity is the most salient factor for producing silent hypoxemia. We call for clinicians to measure hematocrit as a clinical index of altered physiology in response to COVID-19 infection.
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Affiliation(s)
- Casey O Diekman
- Department of Mathematical Sciences, New Jersey Institute of Technology, University Heights, Newark, NJ, 07102, USA.
| | - Peter J Thomas
- Department of Mathematics, Applied Mathematics and Statistics, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Christopher G Wilson
- Department of Pediatrics and Basic Sciences, Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University, 11223 Campus St, Loma Linda, CA, 92350, USA
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Chen L, Zhang S, Tan Y, Zheng Y, Fang S, Yi Y, Xiong X. Anxiety mediates association between sex and jaw function limitation in temporomandibular disorder patients from China. Front Neurol 2024; 15:1398788. [PMID: 38803643 PMCID: PMC11128587 DOI: 10.3389/fneur.2024.1398788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Aim The objective of this study is to explore the relationship between sex and jaw function and to test whether anxiety mediates the causal relationship between sex and jaw function in temporomandibular disorders (TMDs) patients. Methods A total of 488 participants with TMD were included in the analysis. Demographic data were collected. Generalized anxiety symptoms and anxiety severity were initially assessed using the GAD-7 questionnaire. And jaw function limitation was measured using the JFLS-8 scale. A directed acyclic graph (DAG) was used in this study to evaluate the hypotheses. Mediation analysis was conducted to explore causality and to calculate the total effect, natural direct effect (NDE) and natural indirect effect (NIE). Results In TMD patients, there was a significant association between female and jaw function (r = 0.17, p < 0.001), female and anxiety (r = 0.15, p = 0.002), anxiety and jaw function (r = 0.35, p < 0.001). In addition, sex can directly lead to differences in impaired jaw function (NDE: 3.719, 95% CI: 1.619-5.828, p < 0.001), and can also be causally related to jaw function through anxiety (NIE: 1.146, 95% CI: 0.267-2.024, p = 0.011). And the total effect was 4.865 (95% CI, 2.709-7.029, p < 0.001). Conclusion A causal mechanism was found that anxiety acts as a mediator of sex effects on jaw function. Therefore, psychological factors need to be taken into account in the treatment of female TMD patients. Further clinical trials are needed to explore whether psychotherapy is more beneficial to improve jaw function in female TMD patients.
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Affiliation(s)
- Li Chen
- State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shuyuan Zhang
- West China Hospital of Sichuan University, Chengdu, China
| | - Yanyue Tan
- State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yunhao Zheng
- West China Hospital of Sichuan University, Chengdu, China
| | - Shanbao Fang
- Department of Orthodontics, College and Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Yating Yi
- State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xiong
- State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Nahman-Averbuch H, Li R, Boerner KE, Lewis C, Garwood S, Palermo TM, Jordan A. Alterations in pain during adolescence and puberty. Trends Neurosci 2023; 46:307-317. [PMID: 36842946 DOI: 10.1016/j.tins.2023.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 02/26/2023]
Abstract
During adolescence and puberty, alterations in pain, both experimental and clinical, are observed. In addition, adolescents undergo extensive biopsychosocial changes as they transition from childhood to adulthood. However, a better understanding of how the biopsychosocial changes during adolescence impact pain is needed to improve pain management and develop targeted pain interventions for adolescents. This review synthesizes the literature on alterations in pain during adolescence in humans, describes the potential biopsychosocial factors impacting pain during adolescence, and suggests future research directions to advance the understanding of the impact of adolescent development on pain.
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Affiliation(s)
- Hadas Nahman-Averbuch
- Washington University Pain Center and Division of Clinical and Translational Research, Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, MO, USA.
| | - Rui Li
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Christopher Lewis
- Division of Endocrinology and Diabetes, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA; Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah Garwood
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, United Kingdom
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Souza TCDM, Goston JL, Martins-Costa HC, Minighin EC, Anastácio LR. Can Anthocyanins Reduce Delayed Onset Muscle Soreness or Are We Barking Up the Wrong Tree? Prev Nutr Food Sci 2022; 27:265-275. [PMID: 36313058 PMCID: PMC9585400 DOI: 10.3746/pnf.2022.27.3.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Exercise-induced muscular overload can trigger delayed onset muscle soreness (DOMS). DOMS is related to the indiscriminate use of analgesics and nonsteroidal anti-inflammatory drugs without proper guidance, decreased physical exercise adherence and degenerating sports performance, increased risk of injury, and reduced muscle strength and function. Dietary anthocyanins have been extensively studied as potential natural treatments for DOMS, but the indication, dosage, and form of use remain highly variable. Therefore, this review aims to synergize and present evidence relating to the effect of anthocyanins on DOMS in clinical studies. Notably, the results of anthocyanin supplementation for DOMS were found to be inconclusive. The use of protocols with lower anthocyanin doses yielded better results than those with high-dose supplements, suggesting that anthocyanin-rich foods are more accessible as therapeutic tools, leading to the conclusion that these foods could be used to prevent and treat DOMS. However, consumption protocols for this purpose are not yet well established, and the answer is dependent on the methodological quality of future studies.
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Affiliation(s)
| | - Janaina Lavalli Goston
- Department of Physical Education, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG 30535-610, Brazil
| | - Hugo César Martins-Costa
- Department of Physical Education, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG 30535-610, Brazil
| | - Elaine Carvalho Minighin
- Department of Food Science, Federal University of Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Lucilene Rezende Anastácio
- Department of Food Science, Federal University of Minas Gerais, Belo Horizonte, MG 31270-901, Brazil,
Correspondence to Lucilene Rezende Anastácio, E-mail:
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Leitão AWA, Borges MMF, Martins JODL, Coelho AA, Carlos ACAM, Alves APNN, Silva PGDB, Sousa FB. Celecoxib in the treatment of orofacial pain and discomfort in rats subjected to a dental occlusal interference model. Acta Cir Bras 2022; 37:e370506. [PMID: 35976283 PMCID: PMC9377653 DOI: 10.1590/acb370506] [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: 01/09/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate the effect of a selective cyclooxygenase 2 (COX-2) inhibitor on trigeminal ganglion changes and orofacial discomfort/nociception in rats submitted to an experimental model of dental occlusal interference (DOI). Methods: Female Wistar rats (180-200 g) were divided into five groups: a sham group (without DOI) (n=15); and four experimental groups with DOI treated daily with 0.1 mL/kg saline (DOI+SAL), 8, 16, or 32 mg/kg celecoxib (DOI+cel -8, -16, -32) (n=30/group). The animals were euthanized after one, three, and seven days. The bilateral trigeminal ganglia were analyzed histomorphometrically (neuron cell body area) and immunohistochemically (COX-2, nuclear factor-kappa B [NFkB], and peroxisome proliferator-activated receptor-y [PPARy]). A bilateral nociception assay of the masseter muscle was performed. The number of bites/scratches, weight, and grimace scale scores were determined daily. One-way/two-way analysis of variance (ANOVA)/Bonferroni post hoc tests were used (P < .05, GraphPad Prism 5.0). Results: DOI+SAL showed a reduction in neuron cell body area bilaterally, whereas DOI+cel-32 exhibited a significative increase in neuron cell body area compared with DOI+SAL group (P < 0.05). The ipsilateral (P=0.007 and P=0.039) and contralateral (P < 0.001 and P=0.005) overexpression of COX-2 and NFkB and downregulation of PPARy (P=0.016 and P < 0.001) occurred in DOI+SAL, but DOI+cel-32 reverted this alteration. DOI+SAL showed increase in isplateral (P < 0.001) and contralateral (P < 0.001) nociception, an increased number of bites (P=0.010), scratches (P < 0.001), and grimace scores (P=0.032). In the group of DOI+cel-32, these parameters were reduced. Conclusions: Celecoxib attenuated DOI-induced transitory nociception/orofacial discomfort resulting from trigeminal COX-2 overexpression.
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Affiliation(s)
- Andrea Whitehurst Ary Leitão
- Master. Centro Univeristário Christus - Department of Dentistry - Laboratory of Oral Pathology - Fortaleza (CE), Brazil
| | - Marcela Maria Fontes Borges
- Fellow Master degree. Universidade Federal do Ceará - Faculty of Pharmacy, Dentistry and Nursing - Division of Oral Pathology - Fortaleza (CE), Brazil
| | - Joyce Ohana de Lima Martins
- Fellow Master degree. Universidade Federal do Ceará - Faculty of Pharmacy, Dentistry and Nursing - Division of Oral Pathology - Fortaleza (CE), Brazil
| | - Antônio Alexandre Coelho
- Graduate student. Centro Univeristário Christus - Department of Dentistry - Fortaleza (CE), Brazil
| | | | - Ana Paula Negreiros Nunes Alves
- PhD, Full Professor. Universidade Federal do Ceará - Faculty of Pharmacy, Dentistry and Nursing - Division of Oral Pathology - Fortaleza (CE), Brazil
| | - Paulo Goberlânio de Barros Silva
- PhD, Full Professor. Centro Univeristário Christus - Department of Dentistry - Laboratory of Oral Pathology - Fortaleza (CE), Brazil
| | - Fabrício Bitu Sousa
- PhD, Full Professor. Centro Univeristário Christus - Department of Dentistry - Laboratory of Oral Pathology - Fortaleza (CE), Brazil
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Li J, Li S, Yu L, Wei J, Li S, Tan H. The Effects of Resistin Gene Polymorphism on Pain Thresholds and Postoperative Sufentanil Consumption in Gastric Cancer Patients. J Pain Res 2022; 15:1995-2004. [PMID: 35873952 PMCID: PMC9304898 DOI: 10.2147/jpr.s372845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose As an adipocyte-secreted hormone, resistin is linked to inflammation, insulin resistance and atherosclerosis. Currently, resistin is proposed as a novel biomarker for postoperative pain intensity. However, due to the various types of surgery and limited numbers of studies, previous conclusions should be validated. This study aimed to explore the effect of resistin polymorphism (rs3745367) on pain thresholds and sufentanil consumption in gastric cancer patients. Patients and Methods A total of 148 gastric cancer patients enrolled in this study had their pain thresholds measured before surgery. After the exclusion of 16 patients, the characteristics of demography and clinic, numerical rating scale (NRS) and sufentanil consumption of 132 patients were recorded. Rs3745367 of resistin was identified by Sanger sequencing. Multivariate linear regression analysis was performed for sufentanil consumption and mechanical pain threshold. Results The distributions of the GG, AG, and AA genotypes of rs3745367 among the participants were 54 (40.9%), 65 (49.2%), and 13 (9.9%), respectively. The mechanical pain threshold (P=0.04) and postoperative sufentanil consumption in the 1st 24 h (P=0.03) were significantly different among GG, AG, and AA genotype carriers. There was no significant difference among the three genotypes for the heat pain threshold and cold pain threshold. Regarding the NRS, no statistically significant difference among the three different genotypes was found 24 h postoperatively. Conclusion Rs3745367 of resistin is associated with the mechanical pain threshold and postoperative sufentanil consumption in gastric cancer patients. Patients with the AA genotype of rs3745367 present an increased mechanical pain threshold and decreased postoperative sufentanil consumption.
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Affiliation(s)
- Jianing Li
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Shuo Li
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Ling Yu
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jin Wei
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Shuang Li
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Hongyu Tan
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
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7
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Colorectal cancer chemotherapy: can sex-specific disparities impact on drug toxicities? Eur J Clin Pharmacol 2022; 78:1029-1038. [PMID: 35192004 PMCID: PMC9107437 DOI: 10.1007/s00228-022-03298-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/01/2022] [Indexed: 01/13/2023]
Abstract
Purpose Given the biological differences between females and males, sex-specific evaluations should be carried out to obtain better cancer prevention, diagnosis, and treatment strategies. To this purpose, our aim was to evaluate sex differences for toxicity in a cohort of colorectal cancer (CRC) patients undergoing chemotherapy. Methods We performed a retrospective study in 329 CRC patients. Differences between males and females were tested performing the Mann-Whitney U test or the Fisher exact test. Multivariate logistic regression models were computed to evaluate the association between sex and risk of chemotherapy agent-related toxicity. Results According association sex toxicity, significant differences were observed in the median number of episodes of nausea (p = 0.044), vomit (p = 0.007), heartburn (p = 0.022), thrombocytopenia (p = 0.005), mucositis (p = 0.024). Moreover, statistically significant differences between males and females were observed in the distribution of the highest toxicity grades of nausea (p = 0.024), heartburn (p = 0.016), and thrombocytopenia (p = 0.034). Females have an increased risk of vomit (p = 0.002), alopecia (p = 0.035), heartburn (p = 0.005), mucositis (p = 0.003), and lower risk for thrombocytopenia (p = 0.005). Conclusion According to the association of sex chemotherapy agent-related toxicities, females resulted on average at a significant increased risk of more common adverse events (constipation, dysgeusia, alopecia, heartburn, vomit, asthenia, nausea, pain events, and mucositis). Sex-tailored CRC chemotherapy treatment is necessary to obtain efficacy avoiding toxicity, based on patients’ biological and genetic characteristics, a vision that would change CRC setting, a stable disease but still orphan of a real tailored approach. Supplementary information The online version contains supplementary material available at 10.1007/s00228-022-03298-y.
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Lima RF, Magalhães MBP, Oliveira DV, Freitas DAS, Ferreira EF, Martins RC. Pain Perception Before Endodontic Treatment: from Primary Care to Specialized Care. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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McHann MC, Blanton HL, Guindon J. Role of sex hormones in modulating breast and ovarian cancer associated pain. Mol Cell Endocrinol 2021; 533:111320. [PMID: 34033890 PMCID: PMC8263503 DOI: 10.1016/j.mce.2021.111320] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/16/2021] [Accepted: 05/09/2021] [Indexed: 01/18/2023]
Abstract
According to the National Cancer Institute in 2020 there will be an estimated 21,750 new ovarian cancer cases and 276,480 new breast cancer cases. Both breast and ovarian cancer are hormone dependent cancers, meaning they cannot grow without the presence of hormones. The two most studied hormones in these two cancers are estrogen and progesterone, which are also involved in the modulation of pain. The incidence of pain in breast and ovarian cancer is very high. Research about mechanisms involved in modulation of pain by hormones are still being debated, as some studies find estrogen to be anti-nociceptive and others pro-nociceptive in pain studies. Moreover, analgesic treatments for breast and ovarian cancer-associated pain are limited and often ineffective. In this review, we will focus on estrogen and progesterone mechanisms of action in modulation of pain and cancer. We will also discuss new treatment options for these types of cancer and associated-pain.
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Affiliation(s)
- Melissa C McHann
- Department of Pharmacology and Neuroscience at Texas Tech University Health Sciences Center, USA
| | - Henry L Blanton
- Department of Pharmacology and Neuroscience at Texas Tech University Health Sciences Center, USA
| | - Josée Guindon
- Department of Pharmacology and Neuroscience at Texas Tech University Health Sciences Center, USA.
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Chang WS, Hsieh YT, Chen MC, Chang SC, Chen TS, Chang YC, Tsai YC, Lam CF. Characterization of self-anticipated pain score prior to elective surgery - a prospective observational study. BMC Anesthesiol 2021; 21:85. [PMID: 33740887 PMCID: PMC7977573 DOI: 10.1186/s12871-021-01303-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0–10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0–10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126–2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period. Conclusion This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01303-y.
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Affiliation(s)
- Wei-Shu Chang
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Yi-Ting Hsieh
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Moa-Chu Chen
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Shu-Ching Chang
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Tzu-Shan Chen
- Department of Medical Research, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yun-Chi Chang
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Yu-Chuan Tsai
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Chen-Fuh Lam
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan. .,School of Medicine, I-Shou University College of Medicine, Kaohsiung, Taiwan.
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FLOX (5-fluorouracil + leucovorin + oxaliplatin) chemotherapy for colorectal cancer leads to long-term orofacial neurotoxicity: a STROBE-guided longitudinal prospective study. Int J Clin Oncol 2020; 25:2066-2074. [PMID: 32761281 DOI: 10.1007/s10147-020-01757-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Colorectal carcinoma (CRC) is widely treated by chemotherapy based on an intensely neurotoxic drug: oxaliplatin (OXL). We objective to evaluate prospectively the orofacial neurotoxicity during FLOX (fluorouracil + leucovorin + OXL) chemotherapy. METHODS So, 46 patients with CRC were prospectively evaluated during FLOX chemotherapy by 3 cycles (C) of 6 weeks (W) each. We weekly applied the orofacial section of the Acute and Chronic Neuropathy Questionnaire of Common Toxicity Criteria for Adverse Events of the National Cancer Institute of the United States of America (Oxaliplatin-specific neurotoxicity scale). Patients were asked the following concerning the severity (scores 0-5) of orofacial symptoms: jaw pain, eyelids drooping, throat discomfort, ear pain, tingling in mouth, difficulty with speech, burning or discomfort of the eyes, loss of any vision, feeling shock/pain down back and problems breathing. We summed the scores (0-50) and evaluated the clinicopathological data. Friedman/Dunn, Chi square and multinomial regression logistic tests were used (SPSS 20.0, p < 0.05). RESULTS There was a significant increase in sum of orofacial neurotoxicity from baseline to C1.W3, C2.W1 and C3.W5 (p < 0.001) due increase in scores of jaw pain (p < 0.001), eyelids drooping (p = 0.034), throat discomfort (p < 0.001), ear pain (p = 0.034), tingling in mouth (p = 0.015), burning/discomfort of your eyes (p < 0.001), loss of any vision (p < 0.001), feeling shock/pain down back (p < 0.001), problems with breathing (p = 0.045), but not difficulty with speech (p = 0.087). Women (p = 0.021) and young patients (p = 0.027) had significant higher prevalence of orofacial neurotoxicity. CONCLUSIONS FLOX-related orofacial neurotoxicity begins acutely and remains long term with increased incidence in women and younger patients.
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Sedrez EDS, Monteiro JK. Pain assessment in pediatrics. Rev Bras Enferm 2020; 73 Suppl 4:e20190109. [PMID: 32756756 DOI: 10.1590/0034-7167-2019-0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to investigate how the pain assessment and management process in pediatric patients is performed and suggestions for its improvement. METHODS exploratory, qualitative study. Nine professionals from the nursing team of a pediatric hospital unit in Porto Alegre/RS participated in the study. A sociodemographic questionnaire and semi-structured interviews were used with content analysis. RESULTS the results reinforced the importance of pain assessment with family participation and the need to use tools and process improvements in the training and sensitization of professionals. Final Considerations: after the study was concluded, there was a clear need to address the issue, highlighting its relevance for pain resolution in pediatric patients.
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Silva PGDB, de Lima Martins JO, de Lima Praxedes Neto RA, Mota Lemos JV, Machado LC, Matos Carlos ACA, Alves APNN, Lima RA. Tumor necrosis factor alpha mediates orofacial discomfort in an occlusal dental interference model in rats: The role of trigeminal ganglion inflammation. J Oral Pathol Med 2019; 49:169-176. [PMID: 31829463 DOI: 10.1111/jop.12984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Tumor necrosis factor alpha (TNF-α) is a proinflammatory cytokine that plays an important role in the early stages of inflammation. In this study, we investigated its role in orofacial discomfort in rats subjected to occlusal dental interference (ODI). METHODS Female Wistar rats (180-200 g) were divided in three groups (n = 30/group): sham group, without ODI, and two experimental groups with ODI pre-treated with 0.1 mL/kg saline (ODI + SAL) or 5 mg/kg infliximab (ODI + INF) and treated every 3 days. The animals were euthanized after 1, 3, and 7 days. The number of bites and scratches and grimace scale scores were determined daily, and the bilateral trigeminal ganglion was histomorphometrically (neuronal body area) analyzed and submitted for immunohistochemistry for TNF-α, nitric oxide synthesis (NOS) neuronal (nNOS) and inducible (iNOS), peroxisome proliferator-activated receptors (PPAR) y (PPARy) and δ/β (PPARδ/β), and glial fibrillary acidic protein (GFAP). One-way/two-way ANOVA/Bonferroni tests were used (P < .05, GraphPad Prism 5.0). RESULTS ODI + SAL showed a large number of bites (P = .002), scratches (P = .002), and grimace scores (P < .001) in the firsts days, and ODI + INF partially reduced these parameters. The contralateral and ipsilateral neuronal body area was significantly reduced on day 1 in ODI + SAL, but returned to the basal size on days 3 and 7, by increase in TNF-α, nNOS, PPARy, PPARδ/β, and GFAP immunostaining. The infliximab treatment attenuated these alterations (P < .05). There was no iNOS immunostaining. CONCLUSION Occlusal dental interference induced transitory orofacial discomfort by trigeminal inflammatory mediator overexpression, and TNF-α blockage attenuated these processes.
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Affiliation(s)
| | | | | | | | | | | | - Ana Paula Negreiros Nunes Alves
- Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceara, Fortaleza, Brazil
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Smith JC. A Review of Strain and Sex Differences in Response to Pain and Analgesia in Mice. Comp Med 2019; 69:490-500. [PMID: 31822324 DOI: 10.30802/aalas-cm-19-000066] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pain and its alleviation are currently a highly studied issue in human health. Research on pain and response to analgesia has evolved to include the effects of genetics, heritability, and sex as important components in both humans and animals. The laboratory mouse is the major animal studied in the field of pain and analgesia. Studying the inbred mouse to understand how genetic heritable traits and/or sex influence pain and analgesia has added valuable information to the complex nature of pain as a human disease. In the context of biomedical research, identifying pain and ensuring its control through analgesia in research animals remains one of the hallmark responsibilities of the research community. Advancements in both human and mouse genomic research shed light not only on the need to understand how both strain and sex affect the mouse pain response but also on how these research achievements can be used to improve the humane use of all research animal species. A better understanding of how strain and sex affect the response to pain may allow researchers to improve study design and thereby the reproducibility of animal research studies. The need to use both sexes, along with an improved understanding of how genetic heritability affects nociception and analgesic sensitivity, remains a key priority for pain researchers working with mice. This review summarizes the current literature on how strain and sex alter the response to pain and analgesia in the modern research mouse, and highlights the importance of both strain and sex selection in pain research.
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Affiliation(s)
- Jennifer C Smith
- Department of Bioresources, Henry Ford Health System, Detroit, Michigan;,
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Hernandez-Avalos I, Mota-Rojas D, Mora-Medina P, Martínez-Burnes J, Casas Alvarado A, Verduzco-Mendoza A, Lezama-García K, Olmos-Hernandez A. Review of different methods used for clinical recognition and assessment of pain in dogs and cats. Int J Vet Sci Med 2019; 7:43-54. [PMID: 31819890 PMCID: PMC6882480 DOI: 10.1080/23144599.2019.1680044] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022] Open
Abstract
In light of the need to perform surgical techniques and the importance of animal welfare because of acute pain, the objectives of the veterinary anaesthetists are to manage muscle relaxation and adequate analgesia in order to conserve a balance in the autonomic nervous system, enhance the action of the parasympathetic system in the face of the emerging action of the sympathetic portion provoked by the surgeon, and maintain a balance among them. The aim of the present review is to describe different evaluation criteria for acute pain using unidimensional and multidimensional scales, correlating these findings to parasympathetic tone activity (PTA) and bispectral index (BIS) assessment, to conduct an objective evaluation of pain that patients (dog or cat) perceives, in order to administrate an adequate analgesic treatment in each case. In conclusion, this integral, objective evaluation will allow veterinarians – especially anaesthesiologists – to improve the management of pain in the patients.
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Affiliation(s)
| | - Daniel Mota-Rojas
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Patricia Mora-Medina
- Livestock Science Department, Universidad Nacional Autónoma de México (UNAM), FESC, Mexico
| | - Julio Martínez-Burnes
- Graduate and Research Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City, Tamaulipas, Mexico
| | - Alejandro Casas Alvarado
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Antonio Verduzco-Mendoza
- Departamento Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
| | - Karina Lezama-García
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Adriana Olmos-Hernandez
- Departamento Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
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Yao Y, Su Z, Chen Y, Ye Y, Lu L, Zhong C, Chen X, Tang C, Li S. Safety and efficacy of sufentanil combined with midazolam in bronchoscopy under conscious sedation: retrospective study of 11,158 cases. J Thorac Dis 2019; 11:4127-4134. [PMID: 31737295 DOI: 10.21037/jtd.2019.10.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The recommended conscious sedation for bronchoscopy is still lacking. The safety and efficacy of sufentanil combined with midazolam in bronchoscopy under conscious sedation is not well elucidated. Methods A retrospective analysis was conducted on patients who received bronchoscopy in the First Affiliated Hospital of Guangzhou Medical University from September 2013 to July 2017. Sufentanil and midazolam were administrated for conscious sedation. The drug dosage, sedating effect and adverse event were collected and analyzed. Results Totally, 7,089 males and 4,069 females aged 54±16 years (ranged from 4 to 94 years) were enrolled in this study. The dosage of sufentanil and midazolam were 5.25±1.28 mcg (2-13 mcg) and 2.03±0.51 mg (0.5-4.5 mg), respectively. Ninety-eight point six percent (10,998/11,158) of bronchoscopies were successfully completed, while 68.7% (7,670/11,158) procedures were performed with initial dose of 5 mcg sufentanil and 2 mg midazolam. Endobronchial biopsy, transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA), therapeutic procedure and asthma were predictors of giving incremental doses of sufentanil and midazolam (all OR >1, P<0.05), whereas, the age was associated with lower incidence of adding dose of sufentanil and midazolam (both OR <1, P<0.05). Patients with chronic obstructive lung disease (COPD) had lower incidence of adding dose of midazolam alone (OR =0.597, P=0.003). Whereas, female and pulmonary infection were predictors of adding dose of sufentanil alone (OR >1, P<0.05). The conscious sedation related adverse events were not observed. Conclusions Sufentanil combined with midazolam was safe and effective for bronchoscopy under conscious sedation.
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Affiliation(s)
- Yao Yao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Zhuquan Su
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yongshun Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Liya Lu
- Anesthesiology Department, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Changhao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiaobo Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Chunli Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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de Freitas Rodrigues A, de Oliveira Martins D, Chacur M, Luz JGC. The effectiveness of photobiomodulation in the management of temporomandibular pain sensitivity in rats: behavioral and neurochemical effects. Lasers Med Sci 2019; 35:447-453. [PMID: 31292820 DOI: 10.1007/s10103-019-02842-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 07/04/2019] [Indexed: 12/14/2022]
Abstract
This study analyzed the effects of photobiomodulation (PBM) with low-level laser therapy on nociceptive behavior and neuronal activity in the trigeminal nucleus after experimental unilateral temporomandibular joint (TMJ) disc injury. The animals were divided into 4 groups (n = 10 each): group 1, surgical injury of the articular disc and PBM; group 2, sham-operated subjected to PBM; group 3, surgical injury of the articular disc; and group 4, control (Naïve). Ten sessions of PBM were performed using GaAs laser with a wavelength of 904 nm, power of 75 W pico, average power of 0.043 W, area of the beam of 0.13 cm2, duration of the pulses of 60 nseg (in the frequency of 9500 Hz), energy density of 5.95 J/cm2, energy per point of 0.7 J, and power density of 333.8 mW/cm2, and the irradiation was done for 18 s per point. Neuropathic symptoms were evaluated using the von Frey test. Trigeminal ganglion samples underwent immunoblotting to examine the expression of substance P, vanilloid transient potential receptor of subtype-1 (TRPV-1), and peptide related to the calcitonin gene (CGRP). There was a total decrease in pain sensitivity after the second session of PBM in operated animals, and this decrease remains until the last session. There was a significant decrease in the expression of SP, TRPV-1, and CGRP after PBM. Photobiomodulation therapy was effective in reducing nociceptive behavior and trigeminal nucleus neuronal activity after TMJ disc injury.
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Affiliation(s)
- Alex de Freitas Rodrigues
- Laboratory of Functional Neuroanatomy of Pain, Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - Daniel de Oliveira Martins
- Laboratory of Functional Neuroanatomy of Pain, Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marucia Chacur
- Laboratory of Functional Neuroanatomy of Pain, Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - João Gualberto C Luz
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, São Paulo, SP, 05508-000, Brazil.
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Stinson C, Logan SM, Bellinger LL, Rao M, Kinchington PR, Kramer PR. Estradiol Acts in Lateral Thalamic Region to Attenuate Varicella Zoster Virus Associated Affective Pain. Neuroscience 2019; 414:99-111. [PMID: 31271831 DOI: 10.1016/j.neuroscience.2019.06.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023]
Abstract
Varicella zoster virus (VZV) results in chicken pox and herpes zoster. Female rats show a higher level of herpes zoster associated pain than males, consistent with human studies. In this study, we addressed the novel hypothesis that sex difference in herpes zoster associated pain is due, in part, to estradiol modulating activity in the thalamus. To test this hypothesis a high and low physiological dose of estradiol was administered to castrated and ovariectomized rats and the affective pain response was measured after injection of VZV into the whisker pad. Thalamic infusion of the estrogen receptor antagonist ICI 182,780 concomitant with a high dose of estradiol addressed the role of estradiol binding to its receptor to effect pain. Phosphorylated extracellular signal-regulated protein kinase (pERK) positive cells were measured in excitatory (glutaminase positive) and inhibitory (glutamate decarboxylase 67 positive) cells of the lateral thalamic region. Our results show that a high dose of estradiol significantly reduced the pain response in both males and females. pERK significantly increased in excitatory cells after treatment with a low dose of estradiol and increased in inhibitory cells after treatment with a high dose of estradiol. Administration of ICI 182,780 significantly increased the pain response, reduced expression of GABA related genes in the thalamic region and significantly reduced the number of inhibitory cells expressing pERK. The results suggest that estradiol attenuates herpes zoster pain by increasing the activity of inhibitory neurons within the thalamus and that this reduction includes an estrogen receptor dependent mechanism.
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Affiliation(s)
- Crystal Stinson
- Texas A&M University College of Dentistry, Dallas, TX 75246, United States of America
| | - Shaun M Logan
- Texas A&M University College of Dentistry, Dallas, TX 75246, United States of America
| | - Larry L Bellinger
- Texas A&M University College of Dentistry, Dallas, TX 75246, United States of America
| | - Mahesh Rao
- Texas A&M University College of Dentistry, Dallas, TX 75246, United States of America
| | - Paul R Kinchington
- Department of Ophthalmology and Department of Microbiology and Molecular Genetics, University of Pittsburgh, Room 1020 EEI building 203 Lothrop Street, Pittsburgh, PA 15213, United States of America
| | - Phillip R Kramer
- Texas A&M University College of Dentistry, Dallas, TX 75246, United States of America.
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Christensen J, Noel M, Mychasiuk R. Neurobiological mechanisms underlying the sleep-pain relationship in adolescence: A review. Neurosci Biobehav Rev 2019; 96:401-413. [PMID: 30621863 DOI: 10.1016/j.neubiorev.2018.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/20/2022]
Abstract
Adolescence characterizes a period of significant change in brain structure and function, causing the neural circuitry to be particularly susceptible to the environment and various other experiences. Chronic pain and sleep deprivation represent major health issues that plague adolescence. A bidirectional relationship exists between sleep and pain; however, emerging evidence suggests that sleep disturbances have a stronger influence on subsequent pain than vice versa. The neurobiological underpinnings of this relationship, particularly during adolescence, are poorly understood. This review examines the current literature regarding sleep and pain in adolescence, with a particular focus on the neurobiological mechanisms underlying pain, sleep problems, and the neural circuitry that potentially links the two. Finally, a research agenda is outlined to stimulate future research on this topic. Given the high prevalence of these health issues during adolescence and the debilitating effects they inflict on nearly every domain of development, it is crucial that we determine the neurobiological mechanisms fundamental to this relationship and identify potential therapeutic strategies.
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Affiliation(s)
- Jennaya Christensen
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Hotchkiss Brain Institute, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Hotchkiss Brain Institute, Canada
| | - Richelle Mychasiuk
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Canada; Hotchkiss Brain Institute, Canada.
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20
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Zhang N, Chen CF. Clinical observation of the effect of prophylaxis on allodynia in patients with migraine. J Pain Res 2018; 11:2721-2728. [PMID: 30519076 PMCID: PMC6233946 DOI: 10.2147/jpr.s172976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective The clinical characteristics of migraine with and without allodynia were compared to evaluate the risk factors of cutaneous allodynia in migraine. The effects of prophylactic therapy on allodynia in patients with migraine were assessed based on the change in pain threshold after therapy. Patients and methods A total of 71 patients with migraine admitted to the Department of Neurology of Shandong Provincial Hospital were recruited in this study. The included patients were aged 18–70 years and did not present positive symptoms according to the nervous system examination. The variation in cutaneous allodynia was assessed for the role of classic prophylactic therapy in migraine-related allodynia, also termed as central sensitization (CS). Patients with migraine were randomized into two groups (topiramate and flunarizine groups), and the effect of drugs was evaluated by the change in cutaneous pain threshold between the two groups. Fifty-five patients were tested for pain threshold due to instrument failure. Pressure allodynia was measured with a force gage, and pricking was measured with Electronic von Frey Anesthesiometer. The pain threshold was measured every 3 months for 6 months. The variations in pain threshold after treatment were compared using t-test and χ2 test. Results Allodynia was seen in 70.4% of the patients; of these, 76.3% were females. Female gender, duration of illness, and frequency of migraine attacks per month were significantly associated with allodynia. The rate of allodynia and frequency of headache declined significantly, the number of patients with allodynia was reduced, and the pain threshold improved dramatically after treatment. The composite adverse events were low after treatment with topiramate and flunarizine. Conclusion Allodynia was observed, especially in females who experienced frequent migraine attacks for a prolonged period. Gender, duration of illness, and number of migraine attacks per month were the major predictors of allodynia. Topiramate and flunarizine administered orally for a short duration can effectively improve the pain threshold and CS of patients with migraine, and efficiently relieve allodynia.
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Affiliation(s)
- Na Zhang
- Department of Emergency Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China,
| | - Chun-Fu Chen
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan 250021, China,
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21
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Kramer PR, Rao M, Stinson C, Bellinger LL, Kinchington PR, Yee MB. Aromatase Derived Estradiol Within the Thalamus Modulates Pain Induced by Varicella Zoster Virus. Front Integr Neurosci 2018; 12:46. [PMID: 30369871 PMCID: PMC6194186 DOI: 10.3389/fnint.2018.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/14/2018] [Indexed: 12/18/2022] Open
Abstract
Herpes zoster or shingles is the result of varicella zoster virus (VZV) infection and often results in chronic pain that lasts for months after visible symptoms subside. Testosterone often attenuates pain in males. Previous work demonstrates ovarian estrogen effects γ-aminobutyric acid (GABA) signaling in the thalamus, reducing pain but the role of testosterone within the thalamus is currently unknown. Because aromatase affects pain and is present in the thalamus we tested a hypothesis that testosterone converted to estrogen in the thalamus attenuates herpes zoster induced pain. To address this hypothesis, male Sprague-Dawley rats received whisker pad injection of either MeWo cells or MeWo cells containing VZV. To reduce aromatase derived estrogen in these animals we injected aromatase inhibitor letrozole systemically or infused it into the thalamus. To test if estrogen was working through the estrogen receptor (ER) agonist, 4, 4′, 4″-(4-Propyl-[1H]-pyrazole-1,3,5-triyl)trisphenol (PPT) was infused concomitant with letrozole. Motivational and affective pain was measured after letrozole and/or PPT treatment. Vesicular GABA transporter (VGAT) is important in pain signaling. Because estrogen effects VGAT expression we measured its transcript and protein levels after letrozole treatment. Virus injection and letrozole significantly increased the pain response but thalamic infusion of PPT reduced zoster pain. Letrozole increased the number of thalamic neurons staining for phosphorylated ERK (pERK) but decreased VGAT expression. The results suggest in male rats aromatase derived estradiol interacts with the ER to increase VGAT expression and increase neuronal inhibition in the thalamus to attenuate VZV induced pain.
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Affiliation(s)
- Phillip R Kramer
- Department of Biomedical Science, Texas A&M University College of Dentistry, Dallas, TX, United States
| | - Mahesh Rao
- Department of Biomedical Science, Texas A&M University College of Dentistry, Dallas, TX, United States
| | - Crystal Stinson
- Department of Biomedical Science, Texas A&M University College of Dentistry, Dallas, TX, United States
| | - Larry L Bellinger
- Department of Biomedical Science, Texas A&M University College of Dentistry, Dallas, TX, United States
| | - Paul R Kinchington
- Department of Ophthalmology and of Molecular Microbiology and Genetics, Eye and Ear Foundation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael B Yee
- Department of Ophthalmology and of Molecular Microbiology and Genetics, Eye and Ear Foundation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Levinsky Y, Zeharia A, Eidlitz-Markus T. Cephalic cutaneous allodynia in children and adolescents with migraine of short duration: A retrospective cohort study. Cephalalgia 2018; 39:61-67. [PMID: 29732930 DOI: 10.1177/0333102418776018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Allodynia is prevalent in adults with migraine and has been associated with long disease duration and severe course. Studies of the pediatric population are sparse. The aim of this study was to evaluate the rate of cephalic cutaneous allodynia in children and adolescents within the first 6 months of migraine onset and to identify associated clinical and migraine-related parameters. METHODS The electronic database of a tertiary pediatric headache clinic from 2014 to 2017 was retrospectively searched for all children and adolescents diagnosed with migraine headache within 6 months or less of symptom onset. Cephalic cutaneous allodynia was identified by validated questionnaire. Demographics, symptoms, and headache-related parameters were compared between patients with and without allodynia. RESULTS The cohort included 119 patients, 69 girls (58.0%) and 50 (42.0%) boys, of mean age 11.6 ± 3.6 years. Mean time since onset of migraine disease was 3.6 ± 1.8 months. Cephalic cutaneous allodynia was reported by 31.1% of patients. It was significantly associated with female gender ( p = 0.03), older age at admission ( p = 0.037), older age at onset ( p = 0.042) migraine with aura ( p = 0.002), and higher rate of awakening pain ( p = 0.017). CONCLUSIONS Cephalic cutaneous allodynia may occur in children and adolescents already in the first 6 months of migraine onset. Contrary to adult studies, we found no association of allodynia with migraine frequency or long disease duration. Allodynia was significantly associated with migraine with aura, female gender, and awakening pain. A genetic tendency may contribute to the appearance of allodynia in the pediatric age group.
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Affiliation(s)
- Yoel Levinsky
- Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva; affiliated; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Zeharia
- Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva; affiliated; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Eidlitz-Markus
- Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva; affiliated; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Alijani A, Parandin R, Yousofvand N, Oryan SH. Effects of Testosterone on Analgesia in Formalin-Treated Mice. JOURNAL OF ARDABIL UNIVERSITY OF MEDICAL SCIENCES 2018. [DOI: 10.29252/jarums.18.1.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Effects of Chronic Musculoskeletal Pain on Fertility Potential in Lean and Overweight Male Patients. Pain Res Manag 2018; 2017:4628627. [PMID: 29375246 PMCID: PMC5757111 DOI: 10.1155/2017/4628627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/03/2017] [Accepted: 11/13/2017] [Indexed: 11/30/2022]
Abstract
Both chronic pain and obesity are known to affect reproductive hormone profiles in male patients. However, the effect of these conditions, alone or in combination, on male fertility potential has received less attention. 20 chronic musculoskeletal pain patients and 20 healthy controls were divided into lean and overweight subgroups according to their BMI. Current level of chronic pain (visual analogue scale) and pressure pain thresholds (PPTs) in 16 predefined sites, classically described and tested as painful points on the lower body, were measured. Levels of reproductive hormone and lipid profiles were assessed by ELISA. Sperm concentration and motility parameters were analyzed using a computer-aided sperm analysis system. Sperm concentration, progressive motility, and percentage of hyperactivated sperm were generally lower in the chronic pain patients in both lean and overweight groups. The overweight control and the lean chronic pain groups demonstrated a significantly lower percentage of progressively motile sperm compared with the lean control group, suggesting that musculoskeletal chronic pain may have a negative influence on sperm quality in lean patients. However, due to the potential great negative influence of obesity on the sperm parameters, it is difficult to propose if musculoskeletal chronic pain also influenced sperm quality in overweight patients. Further research in chronic pain patients is required to test this hypothesis.
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Abdelfattah AAM, Rizk F, Hawash N, Hanafy A, El-kalla F, Abd-Elsalam S. Randomized trial of preoperative administration of oral pregabalin for postoperative analgesia in patients scheduled for radiofrequency ablation of focal lesions in the liver. Int J Hyperthermia 2018; 34:1367-1371. [PMID: 29308685 DOI: 10.1080/02656736.2018.1424946] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Fatma Rizk
- Department of Physiology, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Nehad Hawash
- Department of Tropical Medicine, Tanta University, Tanta, Egypt
| | - Amr Hanafy
- Department of Internal Medicine, Zagazig University Faculty of Human Medicine, Zagazig, Egypt
| | - Ferial El-kalla
- Department of Tropical Medicine, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Sherief Abd-Elsalam
- Department of Tropical Medicine, Tanta University Faculty of Medicine, Tanta, Egypt
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Nierula B, Martini M, Matamala-Gomez M, Slater M, Sanchez-Vives MV. Seeing an Embodied Virtual Hand is Analgesic Contingent on Colocation. THE JOURNAL OF PAIN 2017; 18:645-655. [DOI: 10.1016/j.jpain.2017.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Zhu Q, Sun Y, Mao L, Liu C, Jiang B, Zhang W, Li JX. Antinociceptive effects of sinomenine in a rat model of postoperative pain. Br J Pharmacol 2016; 173:1693-702. [PMID: 26915970 DOI: 10.1111/bph.13470] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/30/2016] [Accepted: 02/17/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE This study examined the antinociceptive effects of sinomenine in a rat model of postoperative pain. EXPERIMENTAL APPROACH Male and female rats were subjected to a surgical incision in the right hind paw, and the von Frey filament test was used to measure mechanical hypersensitivity after drug or vehicle treatment (p.o. or i.p.). Rats were treated daily with sinomenine before or after the surgery and the AUCs of the antinociceptive effects measured during a 4 h period were calculated to determine the ED50 values of sinomenine. The anti-hyperalgesic effects of different doses of a combination of sinomenine and acetaminophen (paracetamol) were assessed in another group of rats. Dose combinations were determined by using a fixed ratio dose-addition analysis method. KEY RESULTS Sinomenine (5-80 mg·kg(-1) ) produced dose-dependent antinociceptive effects in rats that had been subjected to surgery and this effect lasted for 4 h. The potency of sinomenine, given i.p. or p.o., did not differ between male and female rats. However, sinomenine was fourfold more potent when given i.p. than p.o. The GABAA receptor antagonist bicuculline blocked the antinociceptive effects of sinomenine. The antinociceptive effect of a daily treatment with sinomenine remained stable throughout the course of postoperative pain. Pretreatment with sinomenine did not alter the mechanical hypersensitivity post-surgery. The combination of sinomenine with acetaminophen produced an infra-additive interaction. CONCLUSIONS AND IMPLICATIONS Sinomenine demonstrated significant antinociceptive activity against postoperative pain and may be a useful novel pharmacotherapy for the management of postoperative pain.
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Affiliation(s)
- Qing Zhu
- School of Pharmacy, Nantong University, Nantong, Jiangsu Province, China
| | - Yuehua Sun
- School of Pharmacy, Nantong University, Nantong, Jiangsu Province, China
| | - Lina Mao
- School of Pharmacy, Nantong University, Nantong, Jiangsu Province, China
| | - Chengpeng Liu
- School of Pharmacy, Nantong University, Nantong, Jiangsu Province, China
| | - Bo Jiang
- School of Pharmacy, Nantong University, Nantong, Jiangsu Province, China
| | - Wei Zhang
- School of Pharmacy, Nantong University, Nantong, Jiangsu Province, China
| | - Jun-Xu Li
- School of Pharmacy, Nantong University, Nantong, Jiangsu Province, China
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Ribeiro I, Camargo P, Alburquerque-Sendín F, Madeleine P, Fernández-de-las-Peñas C, Salvini T. Topographical pressure pain sensitivity maps of the shoulder region in individuals with subacromial pain syndrome. ACTA ACUST UNITED AC 2016; 21:134-43. [DOI: 10.1016/j.math.2015.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/10/2015] [Accepted: 07/07/2015] [Indexed: 11/25/2022]
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da Silva OM, Rigon E, Corradi Dalazen JV, Bissoloti A, Rabelo-Silva ER. Pain during Arteriovenous Fistula Cannulation in Chronic Renal Patients on Hemodialysis. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.612098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bahorski JS, Hauber RP, Hanks C, Johnson M, Mundy K, Ranner D, Stoutamire B, Gordon G. Mitigating procedural pain during venipuncture in a pediatric population: A randomized factorial study. Int J Nurs Stud 2015; 52:1553-64. [DOI: 10.1016/j.ijnurstu.2015.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/12/2015] [Accepted: 05/14/2015] [Indexed: 12/23/2022]
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Qu CL, Dang YH, Tang JS. Administration of somatostatin analog octreotide in the ventrolateral orbital cortex produces sex-related antinociceptive effects on acute and formalin-induced nociceptive behavior in rats. Neurochem Int 2015; 87:77-84. [PMID: 26055971 DOI: 10.1016/j.neuint.2015.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/10/2015] [Accepted: 06/02/2015] [Indexed: 12/23/2022]
Abstract
The present study was designed to examine whether somatostatin analog octreotide (OCT) was involved in antinociception in the ventrolateral orbital cortex (VLO) and determine whether this effect had a sex difference between male and female rats. The radiant heat-evoked tail flick (TF) reflex was used as an index of acute nociceptive response in lightly anesthetized rats. The number of flinches evoked by formalin injection into the hindpaw was used to evaluate inflammatory persistent pain in conscious rats. Administration of OCT (2.0, 5.0 10.0 ng in 0.5 µl) into the VLO depressed the TF reflex in a dose-dependent manner only in female rats, but not male rats. Pretreatment with a nonselective somatostatin receptor antagonist cyclo-somatostatin (c-SOM) (25.0 µg in 0.5 µl) into the VLO antagonized 10.0 ng OCT-induced inhibition of the TF reflex in female rats. Similarly, application of high dose of OCT (10.0 ng in 0.5 µl) into the VLO depressed formalin-induced flinching response in the early and late phases only in female rats, and had no any effects in male rats. Pretreatment with c-SOM (25.0 µg in 0.5 µl) into the VLO totally antagonized the 10 ng OCT-induced inhibition of the flinches in both phases in female rats. Additionally, single administration of c-SOM into the VLO failed to alter tail reflex latencies and formalin-induced nociceptive behaviors in female rats. The results provide the first valuable evidence that somatostatin and its receptors are involved in antinociception in acute heat-evoked nociception and inflammatory persistent pain only in female rats, not male rats, in the VLO.
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Affiliation(s)
- Chao-Ling Qu
- Department of Physiology and Pathophysiology, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China.
| | - Yong-Hui Dang
- Department of Forensic Medicine, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University School of Medicine, Yanta Road West 76#, Xi'an, Shaanxi 710061, China
| | - Jing-Shi Tang
- Department of Physiology and Pathophysiology, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China
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Gomes ADO, Silvestre AC, Silva CFD, Gomes MR, Bonfleur ML, Bertolini GRF. Influence of different frequencies of transcutaneous electrical nerve stimulation on the threshold and pain intensity in young subjects. EINSTEIN-SAO PAULO 2015; 12:318-22. [PMID: 25295453 PMCID: PMC4872943 DOI: 10.1590/s1679-45082014ao3092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/21/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effects of different transcutaneous electrical nerve stimulation frequencies in nociception front of a pressure pain threshold and cold in healthy individuals. Methods Twenty healthy subjects were divided into four groups, all of which have gone through all forms of electrical stimulation at different weeks. Assessments were pre and post-therapy, 20 and 60 minutes after stimulation. To evaluate the pressure pain threshold, an algometer was used with one tapered tip, pressing the hypothenar region until voluntary report the word “pain”. Cold pain intensity was assessed by immersion in water at 5°C for 30 seconds; at the end, the subject was asked to quantify the pain intensity on a Visual Analog Scale for Pain. For electrical stimulation, two electrodes were used near the elbow, for 20 minutes, with an intensity strong, but not painful. The frequency was in accordance with the group: 0Hz (placebo); 7Hz; 100Hz; and 255Hz. Results Both for the assessment of pressure pain threshold as the cold pain intensity, there was no significant difference (p>0.05). Conclusion We conclude that the use of transcutaneous electrical nerve stimulation on dermatomes C6 to C8 produced no significant change in pressure pain threshold or cold discomfort.
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Fingleton CP, Dempsey L, Smart K, Doody CM. Intraexaminer and Interexaminer Reliability of Manual Palpation and Pressure Algometry of the Lower Limb Nerves in Asymptomatic Subjects. J Manipulative Physiol Ther 2014; 37:97-104. [DOI: 10.1016/j.jmpt.2013.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/24/2013] [Accepted: 11/01/2013] [Indexed: 12/26/2022]
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Seccia V, Dallan I, Massimetti G, Segnini G, Navari E, Fortunato S, Bajraktari A, Lenzi R, Muscatello L, Sellari-Franceschini S. Patient-related and ENT-related predictive factors based on the pain experienced during flexible nasendoscopy. Laryngoscope 2014; 124:1648-52. [PMID: 24272788 DOI: 10.1002/lary.24535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 11/14/2013] [Accepted: 11/20/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective was to explore the role of specific patient-related and operator-related factors in pain perception during flexible laryngoscopy, which is one of the most common ENT procedures. STUDY DESIGN Monocentric, randomized, individual prospective study. METHODS A total of 532 patients (145 men and 387 women), without any relevant ENT diseases, underwent laryngoscopy performed by otolaryngologists with various degrees of experience. Patient discomfort was reported using visual analog scores, and willingness to repeat the experience was also recorded. RESULTS Statistical analysis showed that greater pain was significantly associated with female patients and female otolaryngologists, whereas the pain was less severe in the cases of experienced laryngologists and older patients. Pain plays an important role in determining the willingness to repeat the examination; in fact, patients who experienced lower levels of pain during laryngoscopy were more prone to repeat the experience. CONCLUSION This article explores the importance of the extrinsic factors that are related to the patient and the otolaryngologist in determining the level of pain associated with laryngoscopy. Our study indicated that laryngoscopy is generally a well-tolerated procedure, causing little overall discomfort, but that a subgroup of patients may experience more pain than others, which may affect the patient's perspective toward undergoing a similar future experience. Our analysis may be helpful for clinicians in understanding pain perception during a routine procedure, enabling them to focus more on that subgroup of patients who are more prone to pain. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Veronica Seccia
- 1st ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Aloisi AM, Vodo S, Buonocore M. Pain and thyroid hormones. Neurol Sci 2013; 34:1501-8. [PMID: 23609461 DOI: 10.1007/s10072-013-1440-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/10/2013] [Indexed: 12/31/2022]
Abstract
The role of endocrine systems in chronic pain mechanisms is slowly getting increasing experimental and clinical consideration. Many painful conditions appear to be directly and/or indirectly induced, reduced or, in some cases, modulated by hormones. We have done much work in trying to understand the relationship between hormones and pain, with particular attention to the hypothalamus-pituitary-gonadal axis. To expand our knowledge of this field, we have directed our attention to another axis, the hypothalamus-pituitary-thyroid (HPT). The literature on thyroid functions is vast but very few studies have focused on the HPT axis and pain. The few available data are considered in the present review to stimulate interest in the possible interactions between the HPT axis and pain.
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Affiliation(s)
- Anna Maria Aloisi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Via Aldo Moro 2, 53100, Siena, Italy,
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Abstract
Cutaneous allodynia may be observed in patients with migraine and this reflects the central sensitization of the trigeminal neurons. We aimed to investigate the frequency of cutaneous allodynia in patients with episodic migraine and to compare clinical characteristics of migraine patients with and without allodynia. One hundred and eighty-six consecutive patients with episodic migraine attacks were prospectively included in the study. The cutaneous allodynia symptoms that occurred during headache attacks were documented using a questionnaire for assessing cephalic and extracephalic cutaneous allodynia. One hundred and fourteen patients (61.3 %) were observed to develop allodynia during migraine attacks and the ratio of the female gender was found higher among the patients with allodynia (p < 0.001). Migraine disease duration was longer (p = 0.004) and accompanying nausea and phonophobia were more common (p = 0.003 and p = 0.005, respectively) in the patients with allodynia. Menstrually related migraine was found to be associated with both allodynia (p = 0.049) and its severity (p = 0.003). The results of present study revealed that cutaneous allodynia was rather frequent in episodic migraine, particularly in patients having longer disease duration. Higher frequency of allodynia in women and its association with menstrually related migraine may be related to the effects of hormonal factors on cutaneous pain thresholds and central sensitization. Association of nausea and phonophobia with allodynia may be interpreted as the common pathways are shared in the development of these symptoms.
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Hendrich J, Alvarez P, Joseph EK, Ferrari LF, Chen X, Levine JD. In vivo and in vitro comparison of female and male nociceptors. THE JOURNAL OF PAIN 2012; 13:1224-31. [PMID: 23146406 DOI: 10.1016/j.jpain.2012.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 09/17/2012] [Accepted: 09/20/2012] [Indexed: 12/19/2022]
Abstract
UNLABELLED While it is generally accepted that women have lower pain thresholds for diverse forms of noxious stimuli, the mechanistic basis for this sexual dimorphism in nociceptive pain remains to be elucidated. We confirmed, in the rat, that females have lower cutaneous mechanical nociceptive thresholds and established a similar sexual dimorphism in muscle. To determine if a peripheral mechanism underlies this sexual dimorphism in pain threshold, we compared biophysical properties of cultured dorsal root ganglion (DRG) neurons that innervated the gastrocnemius muscle in female and male rats. DRG neurons from female rats, which innervated the gastrocnemius muscle, had a more hyperpolarized resting membrane potential. To determine if this was associated with a higher mechanical nociceptive threshold, in contradiction to our working hypothesis, we compared the function, in vivo, of nociceptive afferents innervating the gastrocnemius muscle in male and female rats. C-fiber nociceptors innervating muscle in female rats had higher mechanical thresholds than those in males. Other response characteristics of these nociceptors were not significantly different. Thus, both in vitro and in vivo electrophysiology experiments support the idea that lower mechanical nociceptive threshold in females may be due to sexual dimorphism in central nervous system mechanisms, a difference large enough to overcome an opposing difference in peripheral pain mechanisms. PERSPECTIVE This article unifies in vivo and in vitro electrophysiology with behavioral data examining the differences in mechanical nociceptive threshold between male and female rats. The data provide a novel perspective on the peripheral and behavioral outcomes of noxious mechanical stimulation.
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Affiliation(s)
- Jan Hendrich
- Department of Oral and Maxillofacial Surgery, University of California at San Francisco, San Francisco, CA, USA
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