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Richardson EJ, McKinley EC, Richards JS. Perceived stress and pain interference in acute rehabilitation following spinal cord injury: Resilience as a moderator. Rehabil Psychol 2024; 69:85-93. [PMID: 38127538 PMCID: PMC11058032 DOI: 10.1037/rep0000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE/OBJECTIVE Higher levels of resilience is associated with improved pain outcomes in chronic pain and other neurological populations, but the role of resilience in pain following spinal cord injury (SCI) remains unclear. This study examined resilience as a moderator in the relationship between perceived stress and both pain intensity and interference during acute rehabilitation for SCI. RESEARCH METHOD/DESIGN Individuals admitted to inpatient rehabilitation acutely following SCI (N = 57) completed measures of perceived stress, resilience, pain intensity, and interference. The Johnson-Neyman procedure was used to examine significance of conditional relationships that emerged. RESULTS Resilience was found to moderate the relationship between perceived stress and pain interference, but not pain intensity, during inpatient rehabilitation. CONCLUSIONS/IMPLICATIONS When resilience is low, perceived stress has a more profound and adverse impact on pain interference during inpatient rehabilitation, suggesting therapeutic strategies that build components of resilience are needed during acute rehabilitation following SCI. The relationship between stress, resilience, and pain may differ postinpatient rehabilitation for SCI and warrants further investigation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Elizabeth J. Richardson
- Department of Behavioral and Social Sciences, University of Montevallo
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham
| | | | - J. Scott Richards
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham
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Kang K, Fleming K, Sathe A, Muller J, Harrop J, Middleton D, Heller J, Sharan A, Mohamed F, Krisa L, Alizadeh M. Microstructural alterations of major thalamic nuclei in the chronic pediatric spinal cord injured population. World Neurosurg X 2024; 21:100268. [PMID: 38187507 PMCID: PMC10767188 DOI: 10.1016/j.wnsx.2023.100268] [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: 01/21/2023] [Revised: 07/12/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Background The brain undergoes reorganization following spinal cord injury (SCI), but little is known about how the thalamus is affected in pediatric SCIs. Purpose To characterize microstructural alterations in the thalamus after SCI with diffusion tensor imaging (DTI) metrics. Methods 18 pediatric participants with chronic SCI (8-20 years) were stratified using the American Spinal Injury Association Impairment Scale (AIS) into groups: A, B, and C/D. DTI of the brain used a 3 T Siemens Verio MRI using the parameters: 20 directions, number of averages = 3, b = 1000 s/mm2, voxel size = 1.8 mm × 1.8 mm, slice thickness = 5 mm, TE = 95 ms, TR = 4300 ms, 30 slices, FOV = 230 × 230 mm2, matrix = 128 × 128, acquisition time = 4:45 min. Diffusion data was processed to generate DTI metrics FA, MD, AD, and RD. Data analysis DTI metrics were acquired by superimposing the AAL3 thalamic atlas onto participant diffusion images registered to MNI152 space. We utilized a multiple Mann-Whitney U-test to compare between AIS groups, considering values of p ≤ 0.05 as significant. Results FA, AD, RD, and MD significantly differed in thalamic nuclei between AIS groups A vs B and B vs C/D. Significant nuclei include the right ventral anterior, left intralaminar, bilateral lateral pulvinar, and right lateral geniculate. Conclusion Our findings suggest the presence of microstructural alterations based on SCI severity in pediatric patients. These results are encouraging and warrant further study.
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Affiliation(s)
- K. Kang
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St., Philadelphia, PA, 19107, USA
| | - K. Fleming
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St., Philadelphia, PA, 19107, USA
| | - A. Sathe
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St., Philadelphia, PA, 19107, USA
| | - J. Muller
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St., Philadelphia, PA, 19107, USA
| | - J. Harrop
- Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, 19107, USA
| | - D. Middleton
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St., Philadelphia, PA, 19107, USA
| | - J.E. Heller
- Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, 19107, USA
| | - A. Sharan
- Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, 19107, USA
| | - F. Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St., Philadelphia, PA, 19107, USA
| | - L. Krisa
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St., Philadelphia, PA, 19107, USA
| | - M. Alizadeh
- Department of Neurosurgery, Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St., Philadelphia, PA, 19107, USA
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Widerström-Noga E, Biering-Sørensen F, Bryce TN, Cardenas DD, Finnerup NB, Jensen MP, Richards JS, Rosner J, Taylor J. The international spinal cord injury pain basic data set (version 3.0). Spinal Cord 2023; 61:536-540. [PMID: 37491608 DOI: 10.1038/s41393-023-00919-w] [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: 11/29/2022] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
STUDY DESIGN Expert opinion, feedback, revisions, and final consensus. OBJECTIVES To update the International Spinal Cord Injury Pain Basic Data Set (ISCIPBDS version 2.0) and incorporate suggestions from the SCI pain clinical and research community with respect to overall utility. SETTING International. METHODS The ISCIPBDS working group evaluated these suggestions and made modifications. The revised ISCIPBDS (Version 3.0) was then reviewed by members of the International SCI Data Sets Committee, the American Spinal Injury Association (ASIA) Board, the International Spinal Cord Society (ISCoS) Executive and Scientific Committees, individual reviewers and societies, and posted on the ASIA and ISCoS websites for 1 month to elicit comments before final approval by ASIA and ISCoS. RESULTS The ISCIPBDS (Version 3.0) was updated to make the dataset more flexible and useful: 1. The assessment can be based on the patient's perception of several of his/her "worst" pain(s) or based on the International SCI Pain (ISCIP) Classification-defined or other pain types, depending on the specific research questions or clinical needs. 2. Pain interference should usually be rated for overall pain but may also be used for specific pain problems if needed. 3. An optional pain drawing was added to complement the check box documentation of pain location. 4. Data categories consistent with the Extended Pain Dataset list of current treatments were added. 5. Several new training cases were added.
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Affiliation(s)
- Eva Widerström-Noga
- Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, FL, USA.
- Department of Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | - Fin Biering-Sørensen
- Department for Brain and Spinal Cord Injuries, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas N Bryce
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Diana D Cardenas
- Department of Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical medicine, Aarhus University, Aarhus, Denmark
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - J Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, Servicio de Salud Castilla-La Mancha (SESCAM), Toledo, Spain
- Harris Manchester College, University of Oxford, Oxford, UK
- Instituto de Investigación Sanitaria de Castilla-La Mancha (SESCAM), Hospital Nacional de Parapléjicos, Toledo, Spain
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Van de Winckel A, Carpentier S, Deng W, Zhang L, Battaglino R, Morse L. Using remotely delivered Spring Forest Qigong™ to reduce neuropathic pain in adults with spinal cord injury: protocol of a quasi-experimental feasibility clinical trial. Pilot Feasibility Stud 2023; 9:145. [PMID: 37608389 PMCID: PMC10464017 DOI: 10.1186/s40814-023-01374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND About 69% of Americans living with spinal cord injury (SCI) suffer from long-term debilitating neuropathic pain, interfering with the quality of daily life. Neuropathic pain is refractory to many available treatments-some carrying a risk for opioid addiction-highlighting an urgent need for new treatments. In this study, we will test our hypothesis that Spring Forest Qigong™ will reduce SCI-related neuropathic pain by improving body awareness. We will determine whether remotely delivered Qigong is feasible and we will collect data on neuropathic pain, and other reported associations with pain such as spasms frequency and/or severity, functional performance, mood, and body awareness. METHODS In this quasi-experimental pilot clinical trial study, adults with SCI will practice Qigong at home with a 45-min video, at least 3 × /week for 12 weeks. The Qigong practice includes movements with guided breathing and is individualized based on functional abilities, i.e., the participants follow along with the Qigong movements to the level of their ability, with guided breathing, and perform kinesthetic imagery by focusing on the feeling in the whole body as if doing the whole-body Qigong movement while standing. The highest, average, and lowest neuropathic pain ratings perceived in the prior week will be recorded weekly until the 6-week follow-up. The other outcomes will be collected at 5 time points: at baseline, midway during the Qigong intervention (6 weeks), after the Qigong intervention (12 weeks), after a 6-week and 1-year follow-up. Rate parameters for the feasibility markers will be estimated based on the participants who achieved each benchmark. DISCUSSION The University of Minnesota (UMN)'s Institutional Review Board (IRB) approved the study (IRB #STUDY00011997). All participants will sign electronic informed consent on the secure UMN REDCap platform. The results will be presented at academic conferences and published in peer-reviewed publications. TRIAL REGISTRATION ClinicalTrial.gov registration number: NCT04917107 , (this protocol paper refers to the substudy), first registered 6/8/2021.
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, 420 Delaware St SE (MMC 388), Rm 311, Minneapolis, 55455, USA.
| | - Sydney Carpentier
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, USA
| | - Wei Deng
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, USA
| | - Lin Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Ricardo Battaglino
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, USA
| | - Leslie Morse
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, USA
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Starosta AJ, Wright KS, Bombardier CH, Kahlia F, Barber J, Accardi-Ravid MC, Wiechman SA, Crane DA, Jensen MP. A Case Study of Hypnosis Enhanced Cognitive Therapy for Pain in a Ventilator Dependent Patient during Inpatient Rehabilitation for Spinal Cord Injury. J Clin Med 2023; 12:4539. [PMID: 37445573 DOI: 10.3390/jcm12134539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Early, acute pain following spinal cord injury (SCI) is common, can negatively impact SCI rehabilitation, and is frequently not responsive to biomedical treatment. Nonpharmacological interventions show promise in reducing pain for individuals with SCI. However, most psychological interventions rely heavily on verbal interaction between the individual being treated and the clinician, making them inaccessible for individuals with impaired verbal output due to mechanical ventilation. This case study aims to describe the adaptation and implementation of hypnotic cognitive therapy (HYP-CT) intervention for early SCI pain in the context of mechanical ventilation dependence and weaning. The participant was a 54-year-old male with C2 AIS A SCI requiring mechanical ventilation. Four sessions of HYP-CT were provided during inpatient rehabilitation with assessment prior to intervention, after the intervention sessions, and prior to discharge. The participant reported immediate reductions in pain intensity following each intervention session. Overall, he reported increases in self-efficacy and pain acceptance. He did not report any negative treatment effects and thought the intervention provided support during mechanical ventilation weaning. During treatment, he discontinued opioid pain medications and reported actively using intervention strategies. Our results support the potential for early, hypnotic cognitive therapy for individuals with SCI experiencing pain or distress while dependent on mechanical ventilation.
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Affiliation(s)
- Amy J Starosta
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Katherine S Wright
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Faran Kahlia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195, USA
| | - Michelle C Accardi-Ravid
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT 84132, USA
| | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Deborah A Crane
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
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6
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Olusanya A, Yearsley A, Brown N, Braun S, Hayes C, Rose E, Connolly B, Dicks M, Beal C, Helmonds B, Peace W, Kirkman B, Nguyen C, Erickson J, Nguyen G, Lukose E, Koek W, Nagpal AS, Trbovich M. Capsaicin 8% Patch for Spinal Cord Injury Focal Neuropathic Pain, a Randomized Controlled Trial. PAIN MEDICINE 2023; 24:71-78. [PMID: 35799365 DOI: 10.1093/pm/pnac104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neuropathic pain (NP) after spinal cord injury (SCI) exacerbates disability, decreases quality of life (QOL), and is often refractory to available therapies. Patients report willingness to trade potential recovery of strength, bowel, bladder, or sexual function for pain relief. One proposed mechanism causing NP is up-regulation of transient receptor potential vanilloid 1 (TRPV 1) proteins in uninjured C fibers and dorsal root ganglia causing neuronal excitability. Recent studies have found up-regulation of TRPV 1 proteins after SCI. OBJECTIVE We hypothesize the application of capsaicin 8% patch (C8P), FDA approved for NP in diabetic peripheral neuropathy and post-herpetic neuralgia, will improve pain, function and QOL in persons with SCI. METHODS Randomized single-blind crossover design in which 11 persons with SCI and NP refractory to two oral pain medications received C8P or a control low dose Capsaicin 0.025% patch (CON) over two 12-week periods. Pain (VAS, MPI-SCI), quality of life (WHO-QOL), and functional status (SCIM) were measured at 2-4-week intervals. RESULTS There was a main treatment effect of C8P over CON on VAS and MPI-SCI outcomes with pain reduction of 35% and 29% at weeks 2 and 4, respectively. C8P also demonstrated a main treatment effect over CON on the SCIM mobility subscale. WHO-QOL scores did not improve with C8P. CONCLUSIONS C8P improves pain and mobility for patients with SCI and refractory NP. Larger studies should be performed to evaluate impact of repeat applications and QOL outcomes.
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Affiliation(s)
- Adedeji Olusanya
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Aaron Yearsley
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Nicholas Brown
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Samantha Braun
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Corey Hayes
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Evon Rose
- University of the Incarnate World Osteopathic Medical School, San Antonio, Texas, USA
| | - Brian Connolly
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Madeline Dicks
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Colby Beal
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Brett Helmonds
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Wesley Peace
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Bryce Kirkman
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Christina Nguyen
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jacob Erickson
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Gabby Nguyen
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Esha Lukose
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Wouter Koek
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ameet S Nagpal
- Department of Orthopedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle Trbovich
- Physical Medicine and Rehabilitation, UTHSC at San Antonio, San Antonio, Texas, USA
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Shnawa A, Lee S, Papatheodorou A, Gibbs K, Stein A, Morrison D, Bloom O. Elevated levels of IgA and IgG2 in individuals with chronic spinal cord injury. J Spinal Cord Med 2022; 45:728-738. [PMID: 33443466 PMCID: PMC9542629 DOI: 10.1080/10790268.2020.1854550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine circulating levels of antibodies (IgA, IgM, IgG1-4) in individuals with SCI as compared to uninjured individuals. STUDY DESIGN Prospective, observational study. SETTING Outpatient clinic of a Department of Physical Medicine and Rehabilitation and research institute in an academic medical center. PARTICIPANTS Individuals with chronic (≥ 1 year from injury) SCI and uninjured individuals. OUTCOME MEASURES Serum antibody titers were determined by commercial multiplex ELISA. RESULTS Blood samples were collected from individuals with chronic SCI (N = 29, 83% males) and uninjured individuals (N = 25, 64% males). Among participants with SCI, the distribution of American Spinal Injury Association Impairment Scale (AIS) grades was: A (n = 15), B (n = 2), C (n = 4), D (n = 8). Neurological levels of injury were: cervical (n = 17), thoracic (n = 10), and lumbar (n = 2). IgA levels were significantly elevated in participants with SCI compared to uninjured participants (median: 1.98 vs. 1.21 mg/ml, P < 0.0001), with levels most elevated in individuals with motor complete injuries compared to uninjured participants (P < 0.0003). IgG2 antibodies were also significantly elevated in participants with SCI compared to uninjured participants (median: 5.98 vs. 4.37 mg/ml, P < 0.018). CONCLUSIONS To our knowledge, this study provides the first evidence of elevated IgA, the antibody type most prevalent at respiratory, genitourinary and gastrointestinal tracts, common sites of infections in individuals with SCI. IgG2 levels were also elevated in individuals with SCI. These data support further investigations of IgA and other antibody types in individuals with chronic SCI, which may be increasingly important in the context of emerging novel infectious diseases such as SARS-CoV-2.
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Affiliation(s)
- Aya Shnawa
- Laboratory of Spinal Cord Injury Research, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Samuel Lee
- Laboratory of Spinal Cord Injury Research, The Feinstein Institutes for Medical Research, Manhasset, New York, USA,Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Angelos Papatheodorou
- Laboratory of Spinal Cord Injury Research, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Katie Gibbs
- Laboratory of Spinal Cord Injury Research, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Adam Stein
- Department of Physical Medicine and Rehabilitation, Zucker School of Medicine at Hofstra Northwell, Northwell Health, Great Neck, New York, USA
| | - Debra Morrison
- Laboratory of Spinal Cord Injury Research, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Ona Bloom
- Laboratory of Spinal Cord Injury Research, The Feinstein Institutes for Medical Research, Manhasset, New York, USA,Department of Physical Medicine and Rehabilitation, Zucker School of Medicine at Hofstra Northwell, Northwell Health, Great Neck, New York, USA,Correspondence to: Ona Bloom, Laboratory of Spinal Cord Injury Research, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, New York, USA; Department of Physical Medicine and Rehabilitation, Zucker School of Medicine at Hofstra Northwell, Northwell Health, 1554 Northern Boulevard, Great Neck, New York, USA.
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Karran EL, Wiles LK, Wilson DJ, Moseley GL. Best practice care for persistent pain in adults with spinal cord injuries: a systematic review and narrative synthesis of clinical practice guideline recommendations. Disabil Rehabil 2022:1-10. [DOI: 10.1080/09638288.2022.2093998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Emma L. Karran
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - Louise K. Wiles
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - Dianne J. Wilson
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - G. Lorimer Moseley
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
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9
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Kowalski JL, Nguyen N, Battaglino RA, Falci SP, Charlifue S, Morse LR. miR-338-5p Levels and Cigarette Smoking are Associated With Neuropathic Pain Severity in Individuals With Spinal Cord Injury: Preliminary Findings From a Genome-Wide microRNA Expression Profiling Screen. Arch Phys Med Rehabil 2022; 103:738-746. [PMID: 34717922 DOI: 10.1016/j.apmr.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To identify microRNA biomarkers and clinical factors associated with neuropathic pain after spinal cord injury. DESIGN Cross-sectional, secondary analysis of baseline data collected from ongoing clinical studies. Using a genome-wide microRNA screening approach, we studied differential microRNA expression in serum from 43 adults with spinal cord injury enrolled in ongoing clinical studies. Least squares regression was used to identify associations between microRNA expression, clinical factors, and neuropathic pain severity. SETTING Community-dwelling individuals with spinal cord injury. PARTICIPANTS Participants (N=43) were at least 18 years old with spinal cord injury, with 28 reporting neuropathic pain and 15 reporting no neuropathic pain. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain presence, type, and intensity were assessed with the International Spinal Cord Injury Pain Basic Data Set. Serum microRNA normalized deep sequencing counts were quantified from blood samples. Participant demographic factors, injury characteristics, medication use, and health habits were collected via questionnaire. RESULTS miR-338-5p expression and history of cigarette smoking were associated with and explained 37% of the variance in neuropathic pain severity (R2=0.37, F2,18=5.31, P=.02) independent of other clinical factors. No association was identified between miR-338-5p levels and nociceptive pain severity. CONCLUSIONS Our findings suggest that miR-338-5p and cigarette smoking may both play a role in the development or maintenance of neuropathic pain after spinal cord injury. While additional work is needed to confirm these findings, validated target analysis suggests a neuroprotective role of miR-338-5p in modulating neuroinflammation and neuronal apoptosis and that its downregulation may result in maladaptive neuroplastic mechanisms contributing to neuropathic pain after spinal cord injury.
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Affiliation(s)
- Jesse L Kowalski
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Nguyen Nguyen
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Ricardo A Battaglino
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Scott P Falci
- Department of Neurosurgery, Swedish Medical Center, Englewood, Colorado; Research Department, Craig Hospital, Englewood, Colorado
| | | | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota.
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Asgari P, Zolfaghari M, Bit-Lian Y, Abdi AH, Mohammadi Y, Bahramnezhad F. Comparison of Hydrocolloid Dressings and Silver Nanoparticles in Treatment of Pressure Ulcers in Patients with Spinal Cord Injuries: A Randomized Clinical Trial. J Caring Sci 2022; 11:1-6. [PMID: 35603087 PMCID: PMC9012899 DOI: 10.34172/jcs.2022.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/20/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction: There are numerous dressings used to treat pressure ulcers (PUs), depending on their advantages to achieve optimum patient outcomes. This study aimed to compare hydrocolloid dressings and silver nanoparticles in treating PUs among patients with spinal cord injury (SCI). Methods: This randomized clinical trial was conducted on 70 patients with SCI in Iran. Participants were randomly divided into two equal groups (n=35) receiving silver nanoparticle dressing and hydrocolloid dressing, respectively. The groups were evaluated in four assessment periods using the Bates-Jensen Wound Assessment Tool (BWAT). Data analysis was performed using SPSS software version 13, repeated measures ANOVA, non-parametric tests, and chi-square. Results: Chi-square test was used to investigate the difference between the scores before the intervention, the results of which were not statistically significant. In repetitive measurements, the results of the analysis of variance showed that the average assessment score in both groups decreased and both dressings were effective in the treatment process. Although PU improvement status in the group that received silver nanoparticles was better, between-group analysis of variance did not show any statistically significant difference between the two groups. Conclusion: Our results indicated that silver nanoparticles and hydrocolloid dressings can be used interchangeably in the treatment of PUs.
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Affiliation(s)
- Parvaneh Asgari
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Zolfaghari
- Department of E-learning in Medical Education, Nursing and Midwifery Care Research Center, Virtual School, Tehran University of Medical Sciences, Tehran, Iran
| | - Yee Bit-Lian
- Cluster of Applied Sciences, Petaling Jaya Learning Centre, Open University Malaysia, 46350 Petaling Jaya, Malaysia
| | - Amir Hossien Abdi
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Younes Mohammadi
- Department of Epidemiology, School of heath, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Bahramnezhad
- Department of Critical Care Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran
- Spiritual Health Group, Research Center of Quran, Hadith and Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Internal consistency and convergent validity of the International Spinal Cord Injury Quality of Life Basic Data Set at discharge from first rehabilitation. Spinal Cord 2021; 60:261-267. [PMID: 34446839 DOI: 10.1038/s41393-021-00696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This study is a cross-sectional analysis using data from the Swiss Spinal Cord Injury Cohort Study. OBJECTIVES To examine internal consistency and convergent validity of the International Spinal Cord Injury Quality of Life Basic Data Set (QoL-BDS) at discharge from first inpatient rehabilitation. SETTING The study was performed at four rehabilitation centers in Switzerland. METHODS Participants were Swiss residents aged over 16 years newly diagnosed with traumatic or non-traumatic spinal cord injury (SCI). Measures included the QoL-BDS, World Health Organization Quality of Life (WHOQOL) items, Hospital Anxiety and Depression Scale (HADS), and Spinal Cord Independence Measure III (SCIM). RESULTS A total of 495 participants were included. In all, 57% had a traumatic SCI, 71.1% a motor complete SCI, and 33.3% had tetraplegia. Mean age was 53 (SD = 16.4) years and 68% were male. No floor or ceiling effects were found. Inter-correlations were strong (0.73-0.80) and Cronbach's alpha was good (0.88). QoL-BDS mean scores were 6.4 (SD = 2.2) for life satisfaction, 5.8 (SD = 2.4) for physical health, 6.9 (SD = 2.4) for psychological health, and 6.4 (SD = 2.1) for total QoL. Correlations with reference measures were strongest for QoL-BDS total and WHOQOL general quality of life (r = 0.67), QoL-BDS physical health and WHOQOL health and daily activities (r = 0.64 and 0.53), and QoL-BDS psychological health and HADS depression and anxiety (r = -0.64 and -0.69). SCIM correlated weakly with all QoL-BDS items. CONCLUSIONS The QoL-BDS revealed no floor or ceiling effects and demonstrated good internal consistency and convergent validity in individuals with SCI assessed at discharge from first rehabilitation. This study supports the clinical routine use of the QoL-BDS.
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Sturm C, Gutenbrunner CM, Egen C, Geng V, Lemhöfer C, Kalke YB, Korallus C, Thietje R, Liebscher T, Abel R, Bökel A. Which factors have an association to the Quality of Life (QoL) of people with acquired Spinal Cord Injury (SCI)? A cross-sectional explorative observational study. Spinal Cord 2021; 59:925-932. [PMID: 34239041 PMCID: PMC8338547 DOI: 10.1038/s41393-021-00663-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional explorative observational study. OBJECTIVES To identify factors which have an association to the self-perceived Quality of Life (QoL) for persons with acquired spinal cord injury (SCI). SETTING Eight specialized SCI-centers in Germany. The GerSCI survey is the German part of the International Spinal Cord Injury Survey (InSCI). METHODS Self-disclosure questionnaire, created from the InSCI group, translated and adapted for Germany. The questionnaire collects a very broad range of data and, and due to its design as a self-report, is particularly suitable for the analysis on QoL. Because of the content, which is binding for all participating states, it allows a direct comparability of the results. Included in Germany were 1479 persons with acquired SCI aged 18 years and older. RESULTS Various factors were identified with high associations to QoL, including changeable and unchangeable ones, such as those of particular importance: pain, sleep problems, sexual dysfunction, age, and time since onset of SCI. Some results confirmed reports of previous studies, others were surprising. CONCLUSION this study provides an important basis for the planned analysis of the InSCI participating countries in the 6 WHO regions. Germany was able to contribute the largest study population. The concrete study design of InSCI allows us to directly compare data and helps us to improve ourselves within the framework of a "learning health system". Medical measures can be orientated towards the found results, in order to ensure the best possible care and support by the therapeutic team, individually adapted to the person, place of residence and impairment.
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Affiliation(s)
- Christian Sturm
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany.
| | | | - Christoph Egen
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | | | | | - Yorck B Kalke
- RKU - University and Rehabilitation Clinics Ulm, Ulm, Germany
| | - Christoph Korallus
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | - Roland Thietje
- Center for spinal injuries, Trauma Hospital Hamburg, Hamburg, Germany
| | - Thomas Liebscher
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, Germany
| | - Rainer Abel
- SCI Unit, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Andrea Bökel
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
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Cheng L, Sami A, Ghosh B, Goudsward HJ, Smith GM, Wright MC, Li S, Lepore AC. Respiratory axon regeneration in the chronically injured spinal cord. Neurobiol Dis 2021; 155:105389. [PMID: 33975016 DOI: 10.1016/j.nbd.2021.105389] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/19/2021] [Accepted: 05/05/2021] [Indexed: 02/01/2023] Open
Abstract
Promoting the combination of robust regeneration of damaged axons and synaptic reconnection of these growing axon populations with appropriate neuronal targets represents a major therapeutic goal following spinal cord injury (SCI). A key impediment to achieving this important aim includes an intrinsic inability of neurons to extend axons in adult CNS, particularly in the context of the chronically-injured spinal cord. We tested whether an inhibitory peptide directed against phosphatase and tensin homolog (PTEN: a central inhibitor of neuron-intrinsic axon growth potential) could restore inspiratory diaphragm function by reconnecting critical respiratory neural circuitry in a rat model of chronic cervical level 2 (C2) hemisection SCI. We found that systemic delivery of PTEN antagonist peptide 4 (PAP4) starting at 8 weeks after C2 hemisection promoted substantial, long-distance regeneration of injured bulbospinal rostral Ventral Respiratory Group (rVRG) axons into and through the lesion and back toward phrenic motor neurons (PhMNs) located in intact caudal C3-C5 spinal cord. Despite this robust rVRG axon regeneration, PAP4 stimulated only minimal recovery of diaphragm function. Furthermore, re-lesion through the hemisection site completely removed PAP4-induced functional improvement, demonstrating that axon regeneration through the lesion was responsible for this partial functional recovery. Interestingly, there was minimal formation of putative excitatory monosynaptic connections between regrowing rVRG axons and PhMN targets, suggesting that (1) limited rVRG-PhMN synaptic reconnectivity was responsible at least in part for the lack of a significant functional effect, (2) chronically-injured spinal cord presents an obstacle to achieving synaptogenesis between regenerating axons and post-synaptic targets, and (3) addressing this challenge is a potentially-powerful strategy to enhance therapeutic efficacy in the chronic SCI setting. In conclusion, our study demonstrates a non-invasive and transient pharmacological approach in chronic SCI to repair the critically-important neural circuitry controlling diaphragmatic respiratory function, but also sheds light on obstacles to circuit plasticity presented by the chronically-injured spinal cord.
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Affiliation(s)
- Lan Cheng
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Armin Sami
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Biswarup Ghosh
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Hannah J Goudsward
- Department of Biology, Arcadia University, 450 S. Easton Rd., 220 Boyer Hall, Glenside, PA 19038, USA
| | - George M Smith
- Department of Neuroscience, Shriners Hospitals for Pediatric Research Center, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140-5104, USA
| | - Megan C Wright
- Department of Biology, Arcadia University, 450 S. Easton Rd., 220 Boyer Hall, Glenside, PA 19038, USA
| | - Shuxin Li
- Department of Neuroscience, Shriners Hospitals for Pediatric Research Center, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140-5104, USA
| | - Angelo C Lepore
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Morrison D, Arcese AA, Parrish J, Gibbs K, Beaufort A, Herman P, Stein AB, Bloom O. Systemic gene expression profiles according to pain types in individuals with chronic spinal cord injury. Mol Pain 2021; 17:17448069211007289. [PMID: 33853401 PMCID: PMC8053765 DOI: 10.1177/17448069211007289] [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] [Indexed: 01/18/2023] Open
Abstract
Pain affects most individuals with traumatic spinal cord injury (SCI). Major pain types after SCI are neuropathic or nociceptive, often experienced concurrently. Pain after SCI may be refractory to treatments and negatively affects quality of life. Previously, we analyzed whole blood gene expression in individuals with chronic SCI compared to able-bodied (AB) individuals. Most participants with SCI reported pain (N = 19/28). Here, we examined gene expression of participants with SCI by pain status. Compared to AB, participants with SCI with pain had 468 differentially expressed (DE) genes; participants without pain had 564 DE genes (FDR < 0.05). Among DE genes distinct to participants with SCI with pain, Gene Ontology Biological Process (GOBP) analysis showed upregulated genes were enriched in categories related to T cell activation or inflammation; downregulated genes were enriched in categories related to protein proteolysis and catabolism. Although most participants with pain reported multiple pain types concurrently, we performed a preliminary comparison of gene expression by worst pain problem type. Compared to AB, participants with SCI who ranked neuropathic (N = 9) as worst had one distinct DE gene (TMEM156); participants who ranked nociceptive (N = 10) as worst had 61 distinct DE genes (FDR < 0.05). In the nociceptive group, the GOBP category with the lowest P-value identified among upregulated genes was “positive regulation of T cell activation”; among downregulated genes it was “receptor tyrosine kinase binding”. An exploratory comparison of pain groups by principal components analysis also showed that the nociceptive group was enriched in T-cell related genes. A correlation analysis identified genes significantly correlated with pain intensity in the neuropathic or nociceptive groups (N = 145, 65, respectively, Pearson’s correlation r > 0.8). While this pilot study highlights challenges of identifying gene expression profiles that correlate with specific types of pain in individuals with SCI, it suggests that T-cell signaling should be further investigated in this context.
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Affiliation(s)
- Debra Morrison
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Anthony A Arcese
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Janay Parrish
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
| | - Katie Gibbs
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Department of Physical Medicine and Rehabilitation, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
| | - Andrew Beaufort
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Paige Herman
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Adam B Stein
- Department of Physical Medicine and Rehabilitation, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
| | - Ona Bloom
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Department of Physical Medicine and Rehabilitation, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA.,Department of Molecular Medicine, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
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Suwito J, Putra ST, Sulistyono A. The Affirmation – Tapping on Pain Perception and Serotonin Serum Level of Post – Caesarian Section patients. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i2.16421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Affirmation - tapping interventions have been shown to reduce pain complaints in post-operative patients completing conventional treatment. This is thought to be due to serotonin performance but clinical studies have not been conducted. The aim was to compare the mean perception of the pain reported by post-operative patients given affirmation- tapping treatment with another treatment as a complementary nursing intervention. This was to see if the performance of the serotonin serum level is different from in other treatments.Methods: We used a randomized post-test only control group design carried out in parallel in post-caesarean section patients. The sample totaled 40 patients divided into four groups (10 in affirmation, 10 in tapping, 10 in affirmation-tapping and 10 in the control). They were obtained through simple random sampling. The instruments included affirmation-tapping guidelines, Elisa kits and the McGill - Melzack Pain Questionnaire short-form (MPQsf). The independent variable was the intervention of affirmation-tapping and the dependent variables were pain perception and serotonin level. The data was analyzed using simple linear regression.Results: The average variant of the serotonin levels in the affirmation-tapping treatment group was higher and thus differed significantly from the other groups.Conclusion: Affirmation-tapping as a complementary nursing intervention can increase the serotonin serum levels of the post-caesarean section patients by complementing conventional treatments. Participant pain complaints were lowest in the affirmation-tapping group with the highest serotonin levels present and these were significantly different to the other groups. Affirmation – tapping was recommended as a complementary intervention in nursing post-operative patients that complements conventional treatment.
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Systemic inflammation in traumatic spinal cord injury. Exp Neurol 2019; 325:113143. [PMID: 31843491 DOI: 10.1016/j.expneurol.2019.113143] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 01/08/2023]
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