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Sirucek L, De Schoenmacker I, Scheuren PS, Lütolf R, Gorrell LM, Langenfeld A, Baechler M, Rosner J, Wirth B, Hubli M, Schweinhardt P. Indication for spinal sensitization in chronic low back pain: mechanical hyperalgesia adjacent to but not within the most painful body area. Pain Rep 2024; 9:e1166. [PMID: 38910867 PMCID: PMC11191021 DOI: 10.1097/pr9.0000000000001166] [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: 07/10/2023] [Revised: 03/29/2024] [Accepted: 04/07/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction In 85% of patients with chronic low back pain (CLBP), no specific pathoanatomical cause can be identified. Besides primary peripheral drivers within the lower back, spinal or supraspinal sensitization processes might contribute to the patients' pain. Objectives The present study conceptualized the most painful area (MP) of patients with nonspecific CLBP as primarily affected area and assessed signs of peripheral, spinal, and supraspinal sensitization using quantitative sensory testing (QST) in MP, a pain-free area adjacent to MP (AD), and a remote, pain-free control area (CON). Methods Fifty-nine patients with CLBP (51 years, SD = 16.6, 22 female patients) and 35 pain-free control participants individually matched for age, sex, and testing areas (49 years, SD = 17.5, 19 female participants) underwent a full QST protocol in MP and a reduced QST protocol assessing sensory gain in AD and CON. Quantitative sensory testing measures, except paradoxical heat sensations and dynamic mechanical allodynia (DMA), were Z-transformed to the matched control participants and tested for significance using Z-tests (α = 0.001). Paradoxical heat sensations and DMA occurrence were compared between cohorts using Fisher's exact tests (α = 0.05). The same analyses were performed with a high-pain and a low-pain CLBP subsample (50% quantile). Results Patients showed cold and vibration hypoesthesia in MP (all Ps < 0.001) and mechanical hyperalgesia (P < 0.001) and more frequent DMA (P = 0.044) in AD. The results were mainly driven by the high-pain CLBP subsample. In CON, no sensory alterations were observed. Conclusion Mechanical hyperalgesia and DMA adjacent to but not within MP, the supposedly primarily affected area, might reflect secondary hyperalgesia originating from spinal sensitization in patients with CLBP.
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Affiliation(s)
- Laura Sirucek
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Iara De Schoenmacker
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Biomedical Data Science Lab, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Paulina Simonne Scheuren
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Robin Lütolf
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lindsay Mary Gorrell
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Anke Langenfeld
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mirjam Baechler
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - 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
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Brigitte Wirth
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Michèle Hubli
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
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Rosner J, de Andrade DC, Davis KD, Gustin SM, Kramer JLK, Seal RP, Finnerup NB. Central neuropathic pain. Nat Rev Dis Primers 2023; 9:73. [PMID: 38129427 DOI: 10.1038/s41572-023-00484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Central neuropathic pain arises from a lesion or disease of the central somatosensory nervous system such as brain injury, spinal cord injury, stroke, multiple sclerosis or related neuroinflammatory conditions. The incidence of central neuropathic pain differs based on its underlying cause. Individuals with spinal cord injury are at the highest risk; however, central post-stroke pain is the most prevalent form of central neuropathic pain worldwide. The mechanisms that underlie central neuropathic pain are not fully understood, but the pathophysiology likely involves intricate interactions and maladaptive plasticity within spinal circuits and brain circuits associated with nociception and antinociception coupled with neuronal hyperexcitability. Modulation of neuronal activity, neuron-glia and neuro-immune interactions and targeting pain-related alterations in brain connectivity, represent potential therapeutic approaches. Current evidence-based pharmacological treatments include antidepressants and gabapentinoids as first-line options. Non-pharmacological pain management options include self-management strategies, exercise and neuromodulation. A comprehensive pain history and clinical examination form the foundation of central neuropathic pain classification, identification of potential risk factors and stratification of patients for clinical trials. Advanced neurophysiological and neuroimaging techniques hold promise to improve the understanding of mechanisms that underlie central neuropathic pain and as predictive biomarkers of treatment outcome.
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Affiliation(s)
- Jan Rosner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel C de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Karen D Davis
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - John L K Kramer
- International Collaboration on Repair Discoveries, ICORD, University of British Columbia, Vancouver, Canada
- Department of Anaesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rebecca P Seal
- Pittsburgh Center for Pain Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Departments of Neurobiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
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Leone C, Di Pietro G, Salman Y, Galosi E, Di Stefano G, Caspani O, Garcia-Larrea L, Mouraux A, Treede RD, Truini A. Modulation of the spinal N13 SEP component by high- and low-frequency electrical stimulation. Experimental pain models matter. Clin Neurophysiol 2023; 156:28-37. [PMID: 37856896 DOI: 10.1016/j.clinph.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/15/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE The N13 component of somatosensory evoked potential (N13 SEP) represents the segmental response of cervical dorsal horn neurons. Neurophysiological studies in healthy participants showed that capsaicin-induced central sensitization causes an increase of the N13 SEP amplitude. Consequently, in human research, this spinal component may serve as a valuable readout of central sensitization. In this study, we wanted to verify if the sensitivity of the N13 SEP for detecting central sensitization is consistent across different experimental pain models inducing central sensitization and secondary hyperalgesia, namely high and low-frequency electrical stimulation (HFS and LFS). METHODS In 18 healthy participants, we recorded SEP after bilateral ulnar nerve stimulation before and after secondary hyperalgesia was induced through HFS and LFS applied on the ulnar nerve territory of the hand of one side. The area of secondary hyperalgesia was mapped with a calibrated 128-mN pinprick probe, and the mechanical pain sensitivity with three calibrated 16-64-256-mN pinprick probes. RESULTS Although both HFS and LFS successfully induced secondary hyperalgesia only LFS increased the amplitude of the N13 SEP. CONCLUSIONS These findings suggest that the sensitivity of the N13 SEP for detecting dorsal horn excitability changes may critically depend on the different experimental pain models. SIGNIFICANCE Our results indicate that LFS and HFS could trigger central sensitization at the dorsal horn level through distinct mechanisms, however this still needs confirmation by replication studies.
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Affiliation(s)
- C Leone
- Department of Human Neuroscience, Sapienza University of Rome, Italy.
| | - G Di Pietro
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Y Salman
- Université Catholique de Louvain, Institute of Neuroscience (IoNS), Faculty of Medicine, Bruxelles, Belgium
| | - E Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - G Di Stefano
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - O Caspani
- Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - L Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - A Mouraux
- Université Catholique de Louvain, Institute of Neuroscience (IoNS), Faculty of Medicine, Bruxelles, Belgium
| | - R-D Treede
- Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - A Truini
- Department of Human Neuroscience, Sapienza University of Rome, Italy
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Tsujinaka R, Oda H, Fukuda S, Hamada N, Matsuoka M, Hiraoka K. Afferent volley from the digital nerve induces short-latency facilitation of perceptual sensitivity and primary sensory cortex excitability. Exp Brain Res 2023; 241:1339-1351. [PMID: 37012374 DOI: 10.1007/s00221-023-06611-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
The present study examined whether the perceptual sensitivity and excitability of the primary sensory cortex are modulated by the afferent volley from the digital nerve of a conditioned finger within a short period of time. The perceptual threshold of an electrical stimulus to the index finger (test stimulus) was decreased by a conditioning stimulus to the index finger 4 or 6 ms before the test stimulus, or by a stimulus to the middle or ring finger 2 ms before that. This is explained by the view that the afferent volleys from the digital nerves of the fingers converge in the somatosensory areas, causing spatial summation of the afferent inputs through a small number of synaptic relays, leading to the facilitation of perceptual sensitivity. The N20 component of the somatosensory-evoked potential was facilitated by a conditioning stimulus to the middle finger 4 ms before a test stimulus or to the thumb 2 ms before the test stimulus. This is explained by the view that the afferent volley from the digital nerve of the finger adjacent to the tested finger induces lateral facilitation of the representation of the tested finger in the primary sensory cortex through a small number of synaptic relays.
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Affiliation(s)
- Ryo Tsujinaka
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Japan
| | - Hitoshi Oda
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Japan
| | - Shiho Fukuda
- Department of Rehabilitation Science, School of Medicine, Osaka Metropolitan University, Habikino City, Japan
| | - Naoki Hamada
- Department of Rehabilitation Science, School of Medicine, Osaka Metropolitan University, Habikino City, Japan
| | - Masakazu Matsuoka
- Department of Rehabilitation Science, School of Medicine, Osaka Metropolitan University, Habikino City, Japan
| | - Koichi Hiraoka
- Department of Rehabilitation Science, School of Medicine, Osaka Metropolitan University, Habikino City, Japan.
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van Niel J, Bloms-Funke P, Caspani O, Cendros JM, Garcia-Larrea L, Truini A, Tracey I, Chapman SC, Marco-Ariño N, Troconiz IF, Phillips K, Finnerup NB, Mouraux A, Treede RD. Pharmacological Probes to Validate Biomarkers for Analgesic Drug Development. Int J Mol Sci 2022; 23:ijms23158295. [PMID: 35955432 PMCID: PMC9368481 DOI: 10.3390/ijms23158295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 12/10/2022] Open
Abstract
There is an urgent need for analgesics with improved efficacy, especially in neuropathic and other chronic pain conditions. Unfortunately, in recent decades, many candidate analgesics have failed in clinical phase II or III trials despite promising preclinical results. Translational assessment tools to verify engagement of pharmacological targets and actions on compartments of the nociceptive system are missing in both rodents and humans. Through the Innovative Medicines Initiative of the European Union and EFPIA, a consortium of researchers from academia and the pharmaceutical industry was established to identify and validate a set of functional biomarkers to assess drug-induced effects on nociceptive processing at peripheral, spinal and supraspinal levels using electrophysiological and functional neuroimaging techniques. Here, we report the results of a systematic literature search for pharmacological probes that allow for validation of these biomarkers. Of 26 candidate substances, only 7 met the inclusion criteria: evidence for nociceptive system modulation, tolerability, availability in oral form for human use and absence of active metabolites. Based on pharmacokinetic characteristics, three were selected for a set of crossover studies in rodents and healthy humans. All currently available probes act on more than one compartment of the nociceptive system. Once validated, biomarkers of nociceptive signal processing, combined with a pharmacometric modelling, will enable a more rational approach to selecting dose ranges and verifying target engagement. Combined with advances in classification of chronic pain conditions, these biomarkers are expected to accelerate analgesic drug development.
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Affiliation(s)
| | - Petra Bloms-Funke
- Translational Science & Intelligence, Grünenthal GmbH, 52099 Aachen, Germany;
| | - Ombretta Caspani
- Mannheim Center for Translational Neurosciences (MCTN), Department of Neurophysiology, University of Heidelberg, 69120 Mannheim, Germany; (O.C.); (R.-D.T.)
| | | | - Luis Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, 69100 Lyon, France;
| | - Andrea Truini
- Department of Human Neuroscience, Sapienzia University, 00185 Rome, Italy;
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK;
| | - Sonya C. Chapman
- Eli Lilly and Company, Arlington Square, Bracknell RG12 1PU, UK;
| | - Nicolás Marco-Ariño
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, 31009 Pamplona, Spain; (N.M.-A.); (I.F.T.)
| | - Iñaki F. Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, 31009 Pamplona, Spain; (N.M.-A.); (I.F.T.)
| | - Keith Phillips
- Eli Lilly and Company, Erl Wood, Bracknell GU20 6PH, UK;
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark;
| | - André Mouraux
- Institute of Neuroscience (IoNS), UCLouvain, B-1200 Brussels, Belgium
- Correspondence:
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neurosciences (MCTN), Department of Neurophysiology, University of Heidelberg, 69120 Mannheim, Germany; (O.C.); (R.-D.T.)
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Central sensitization: clinical utility of a physiological concept for the International Statistical Classification of Diseases and Related Health Problems and for nociplastic pain. Pain 2022; 163:S99-S107. [PMID: 36099342 DOI: 10.1097/j.pain.0000000000002740] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/14/2022] [Indexed: 01/14/2023]
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