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Mountford R, Adler BL, Andersson D, Bashford-Rogers R, Berwick R, Bevan S, Caro X, Chung TH, Clark JD, Dawes JM, Dong X, Helyes Z, Kingery W, van Middendorp JJ, Neiland H, Maurer M, Scheibenbogen C, Schmack K, Schreiner T, Svensson CI, Tékus V, Goebel A. Antibody-mediated autoimmunity in symptom-based disorders: position statement and proceedings from an international workshop. Pain Rep 2024; 9:e1167. [PMID: 38873615 PMCID: PMC11175924 DOI: 10.1097/pr9.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 06/15/2024] Open
Abstract
A 2-day closed workshop was held in Liverpool, United Kingdom, to discuss the results of research concerning symptom-based disorders (SBDs) caused by autoantibodies, share technical knowledge, and consider future plans. Twenty-two speakers and 14 additional participants attended. This workshop set out to consolidate knowledge about the contribution of autoantibodies to SBDs. Persuasive evidence for a causative role of autoantibodies in disease often derives from experimental "passive transfer" approaches, as first established in neurological research. Here, serum immunoglobulin (IgM or IgG) is purified from donated blood and transferred to rodents, either systemically or intrathecally. Rodents are then assessed for the expression of phenotypes resembling the human condition; successful phenotype transfer is considered supportive of or proof for autoimmune pathology. Workshop participants discussed passive transfer models and wider evidence for autoantibody contribution to a range of SBDs. Clinical trials testing autoantibody reduction were presented. Cornerstones of both experimental approaches and clinical trial parameters in this field were distilled and presented in this article. Mounting evidence suggests that immunoglobulin transfer from patient donors often induces the respective SBD phenotype in rodents. Understanding antibody binding epitopes and downstream mechanisms will require substantial research efforts, but treatments to reduce antibody titres can already now be evaluated.
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Affiliation(s)
- Rebecca Mountford
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Brittany L. Adler
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - David Andersson
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | | | - Richard Berwick
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Stuart Bevan
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Xavier Caro
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Tae Hwan Chung
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - J. David Clark
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - John M. Dawes
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Xinzhong Dong
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Zsuzsanna Helyes
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Wade Kingery
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | | | - Harvey Neiland
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Margot Maurer
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | | | - Katharina Schmack
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Thomas Schreiner
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | | | - Valéria Tékus
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
| | - Andreas Goebel
- Pain Research Institute, University of Liverpool, Liverpool, United Kingdom
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Jessen J, Höffken O, Schwenkreis P, Tegenthoff M, Özgül ÖS, Enax-Krumova E. Posttraumatic headache: pain related evoked potentials (PREP) and conditioned pain modulation (CPM) to assess the pain modulatory function. Sci Rep 2024; 14:16306. [PMID: 39009744 PMCID: PMC11251016 DOI: 10.1038/s41598-024-67288-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
Posttraumatic headache (PTH) is common following traumatic brain injury and impacts quality of life. We investigated descending pain modulation as one possible mechanism for PTH and correlated it to clinical measures. Pain-related evoked potentials (PREP) were recorded in 26 PTH-patients and 20 controls after electrical stimulation at the right hand and forehead with concentric surface electrodes. Conditioned pain modulation (CPM) was assessed using painful cutaneous electric stimulation (PCES) on the right hand as test stimulus and immersion of the left hand into 10 °C-cold water bath as conditioning stimulus based on changes in pain intensity and in amplitudes of PCES-evoked potentials. All participants completed questionnaires assessing depression, anxiety, and pain catastrophising. PTH-patients reported significantly higher pain ratings during PREP-recording in both areas despite similar stimulus intensity at pain threshold. N1P1-amplitudes during PREP and CPM-assessment were lower in patients in both areas, but statistically significant only on the hand. Both, PREP-N1-latencies and CPM-effects (based on the N1P1-amplitudes and pain ratings) were similar in both groups. Patients showed significantly higher ratings for anxiety and depression, which did not correlate with the CPM-effect. Our results indicate generalized hyperalgesia for electrical stimuli in both hand and face in PTH. The lacking correlation between pain ratings and EEG parameters indicates different mechanisms of pain perception and nociception.
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Affiliation(s)
- Julia Jessen
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Oliver Höffken
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Peter Schwenkreis
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Özüm Simal Özgül
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
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Buzza AS, Cousins H, Tapas KE, Anders JJ, Lewis SJ, Jenkins MW, Moffitt MA. Direct Photobiomodulation Therapy on the Sciatic Nerve Significantly Attenuates Acute Nociceptive Sensitivity Without Affecting Motor Output. Neuromodulation 2024:S1094-7159(24)00113-2. [PMID: 38958630 DOI: 10.1016/j.neurom.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/14/2024] [Accepted: 04/30/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Pharmacologic pain treatments lack specific targeting and often produce unwanted side effects (eg, addiction, additional hyperalgesia). We previously established that the direct application of laser irradiation (direct photobiomodulation [PBM]) of the sural nerve reduces thermal hypersensitivity in a rodent model of chronic pain, but not mechanical hypersensitivity. These observations were consistent with a selective reduction in the small-diameter fiber contribution to electrophysiologically measured evoked response after direct PBM of a sensory nerve (saphenous). However, to our knowledge, direct application of laser irradiation has never been performed in an animal model of acute nociceptive pain or on a mixed nerve in which sensory and motor outcomes can be observed. MATERIALS AND METHODS In this study, we describe the effects of direct application of laser irradiation (808 nm, 60 mW, 4 minutes) on a mixed nerve (sciatic nerve) in an acute nociceptive pain model (intradermal capsaicin injection) in rats over the course of two weeks. To investigate whether laser irradiation of a mixed nerve alters motor function, in separate experiments, we applied laser irradiation to the sciatic nerve (using the same parameters as in the chronic pain experiments), and force generation of the gastrocnemius was measured. RESULTS Capsaicin-induced hypersensitivities to mechanical (pin prick) and thermal (Hargreaves) noxious stimuli, associated with Aδ- and C-fibers, showed a maximal reduction of 70% and 56.2%, respectively, by direct PBM, when compared with a control group (vehicle injection, no PBM) on the same day. This reduction was determined to be significant using a mixed-design analysis of variance with a p value < 0.05. Force generation remained unchanged for up to 120 minutes after laser irradiation. In summary, direct PBM selectively inhibits C- and Aδ-fiber transmission while leaving Aɑ-, Aβ-, and motor-fiber activity intact. CONCLUSIONS These results, in conjunction with our previous analyses of laser irradiation effects on the sural nerve in a chronic spared nerve injury pain model, suggest that direct PBM is a promising candidate for treating pain induced by small-diameter fiber activity.
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Affiliation(s)
- Andrew S Buzza
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Hannah Cousins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Kalista E Tapas
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Juanita J Anders
- Department of Anatomy, Physiology, and Genetics, Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stephen J Lewis
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, USA; Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Michael W Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Michael A Moffitt
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
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Taub DG, Woolf CJ. Age-dependent small fiber neuropathy: Mechanistic insights from animal models. Exp Neurol 2024; 377:114811. [PMID: 38723859 PMCID: PMC11131160 DOI: 10.1016/j.expneurol.2024.114811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/07/2024] [Accepted: 05/05/2024] [Indexed: 05/28/2024]
Abstract
Small fiber neuropathy (SFN) is a common and debilitating disease in which the terminals of small diameter sensory axons degenerate, producing sensory loss, and in many patients neuropathic pain. While a substantial number of cases are attributable to diabetes, almost 50% are idiopathic. An underappreciated aspect of the disease is its late onset in most patients. Animal models of human genetic mutations that produce SFN also display age-dependent phenotypes suggesting that aging is an important contributor to the risk of development of the disease. In this review we define how particular sensory neurons are affected in SFN and discuss how aging may drive the disease. We also evaluate how animal models of SFN can define disease mechanisms that will provide insight into early risk detection and suggest novel therapeutic interventions.
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Affiliation(s)
- Daniel G Taub
- F. M. Kirby Neurobiology Center and Department of Neurology, Boston Children's Hospital, Boston, MA, USA; Department of Neurobiology, Harvard Medical School, Boston, MA, USA.
| | - Clifford J Woolf
- F. M. Kirby Neurobiology Center and Department of Neurology, Boston Children's Hospital, Boston, MA, USA; Department of Neurobiology, Harvard Medical School, Boston, MA, USA
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5
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Luebke L, Lopes CG, Myka Y, Lumma A, Adamczyk WM, Carvalho GF, Scholten-Peeters GGM, Luedtke K, Szikszay TM. Assessing the influence of non-ischaemic A-fiber conduction blockade on offset analgesia: an experimental study. THE JOURNAL OF PAIN 2024:104611. [PMID: 38908497 DOI: 10.1016/j.jpain.2024.104611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/31/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
Offset analgesia (OA) is believed to reflect the efficiency of the endogenous pain modulatory system. However, the underlying mechanisms are still being debated. Previous research suggested both, central and peripheral mechanisms, with the latter involving the influence of specific A-delta-fibers. Therefore, this study aimed to investigate the influence of a non-ischaemic A-fiber conduction blockade on the OA response in healthy participants. A total of 52 participants were recruited for an A-fiber conduction blockade via compression of the superficial radial nerve. To monitor fiber-specific peripheral nerve conduction capacity, quantitative sensory testing was performed continuously. Before, during and after the A-fiber block, an individualized OA-paradigm was applied to the dorsum of both hands (blocked and control side were randomized). Pain intensity of each heat stimulus was evaluated by an electronic visual analogue scale. A successful A-fiber conduction blockade was achieved in thirty participants. Offset analgesia has been verified within time (before, during, after blockade), and condition (blocked and control side) (p < 0.01, d > 0.5). Repeated measurements ANOVA showed no significant interaction effects between OA within condition and time (p = 0.24, η²p = 0.05). Hence, no significant effect of A-fiber blockade was detected on OA during noxious heat stimulation. The results suggest that peripheral A-fiber afferents may play a minor role in OA compared to alternative central mechanisms or other fibers. However, further studies are needed to substantiate a central rather than peripheral influence on OA. PERSPECTIVE: This article presents the observation of offset analgesia before, during and after a successful A-fiber conduction blockade in healthy volunteers. A better understanding of the mechanisms of offset analgesia and endogenous pain modulation in general may help to explain the underlying aspects of pain disorders.
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Affiliation(s)
- Luisa Luebke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany.
| | - Clara Gieseke Lopes
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Amsterdam, the Netherlands
| | - Yasmin Myka
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Germany
| | - Annika Lumma
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Germany
| | - Wacław M Adamczyk
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany; Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Gabriela F Carvalho
- Department of Physiotherapy, Faculty of Health, Safety and Society, Furtwangen University, Furtwangen, Germany
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Amsterdam, the Netherlands
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany
| | - Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany
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6
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Kaplan CM, Kelleher E, Irani A, Schrepf A, Clauw DJ, Harte SE. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nat Rev Neurol 2024; 20:347-363. [PMID: 38755449 DOI: 10.1038/s41582-024-00966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Nociplastic pain is a mechanistic term used to describe pain that arises or is sustained by altered nociception, despite the absence of tissue damage. Although nociplastic pain has distinct pathophysiology from nociceptive and neuropathic pain, these pain mechanisms often coincide within individuals, which contributes to the intractability of chronic pain. Key symptoms of nociplastic pain include pain in multiple body regions, fatigue, sleep disturbances, cognitive dysfunction, depression and anxiety. Individuals with nociplastic pain are often diffusely tender - indicative of hyperalgesia and/or allodynia - and are often more sensitive than others to non-painful sensory stimuli such as lights, odours and noises. This Review summarizes the risk factors, clinical presentation and treatment of nociplastic pain, and describes how alterations in brain function and structure, immune processing and peripheral factors might contribute to the nociplastic pain phenotype. This article concludes with a discussion of two proposed subtypes of nociplastic pain that reflect distinct neurobiological features and treatment responsivity.
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Affiliation(s)
- Chelsea M Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Eoin Kelleher
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anushka Irani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Division of Rheumatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
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Minhas D. Pain mechanisms for the practicing rheumatologist. Best Pract Res Clin Rheumatol 2024:101942. [PMID: 38521633 DOI: 10.1016/j.berh.2024.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
Pain in rheumatic diseases transcends the traditional nociceptive paradigm, incorporating complex interactions between nociceptive, neuropathic, and nociplastic mechanisms, as well as significant psychosocial factors. Advances in understanding chronic pain highlight the role of peripheral and central sensitization, and the emergence of nociplastic pain-a result of altered central nervous system processing. This modern perspective acknowledges the influence of mood disorders, environmental stressors, and cognitive patterns like catastrophizing, revealing the intricate interplay between biological, psychological, and social determinants of pain. Research emphasizes the brain's pivotal role in pain perception, underscoring the importance of comprehensive approaches that integrate medical, psychological, and social interventions to address the multifaceted nature of chronic pain in rheumatic diseases effectively.
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Affiliation(s)
- Deeba Minhas
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
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Marshall A, Rapteas L, Burgess J, Riley D, Anson M, Matsumoto K, Bennett A, Kaye S, Marshall A, Dunham J, Fallon N, Zhao SS, Pritchard A, Goodson N, Malik RA, Goebel A, Frank B, Alam U. Small fibre pathology, small fibre symptoms and pain in fibromyalgia syndrome. Sci Rep 2024; 14:3947. [PMID: 38365860 PMCID: PMC10873371 DOI: 10.1038/s41598-024-54365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
A proportion of people with fibromyalgia demonstrate small fibre pathology (SFP). However, it is unclear how SFP directly relates to pain phenomenology. Thirty-three individuals with FMS and ten healthy volunteers underwent assessment of SFP and sensory phenotyping using corneal confocal microscopy, validated questionnaires and quantitative sensory testing (QST). Corneal nerve fibre length was used to stratify participants with fibromyalgia into with SFP [SFP+] and without SFP [SFP-]. SFP was detected in 50% of the fibromyalgia cohort. Current pain score and QST parameters did not differ between SFP+ and SFP-. Mechanical pain sensitivity (MPS) demonstrated a significant gain-of-function in the SFP- cohort compared to healthy-volunteers (p = 0.014, F = 4.806, η2 = 0.22). Further stratification revealed a cohort without structural SFP but with symptoms compatible with small fibre neuropathy symptoms and a significant gain in function in MPS (p = 0.020 Chi-square). Additionally, this cohort reported higher scores for both depression (p = 0.039, H = 8.483, η2 = 0.312) and anxiety (p = 0.022, F = 3.587, η2 = 0.293). This study confirms that SFP is present in a proportion of people with fibromyalgia. We also show that in a proportion of people with fibromyalgia, small fibre neuropathy symptoms are present in the absence of structural SFP. Greater mechanical pain sensitivity, depression and anxiety are seen in these individuals.
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Affiliation(s)
- Anne Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Leandros Rapteas
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Jamie Burgess
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - David Riley
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Matthew Anson
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Kohei Matsumoto
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Amanda Bennett
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Stephen Kaye
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Andrew Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - James Dunham
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Nicholas Fallon
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Sizheng S Zhao
- Faculty of Biological Medicine and Health, Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Anne Pritchard
- Fibromates, North West Fibromyalgia Support Group, Liverpool, UK
| | - Nicola Goodson
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Rayaz A Malik
- Research Division, Weill Cornell Medicine-Qatar, Qatar Foundation, 24144, Doha, Qatar
| | - Andreas Goebel
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Bernhard Frank
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Uazman Alam
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK.
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9
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Erbacher C, Britz S, Dinkel P, Klein T, Sauer M, Stigloher C, Üçeyler N. Interaction of human keratinocytes and nerve fiber terminals at the neuro-cutaneous unit. eLife 2024; 13:e77761. [PMID: 38225894 PMCID: PMC10791129 DOI: 10.7554/elife.77761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 12/19/2023] [Indexed: 01/17/2024] Open
Abstract
Traditionally, peripheral sensory neurons are assumed as the exclusive transducers of external stimuli. Current research moves epidermal keratinocytes into focus as sensors and transmitters of nociceptive and non-nociceptive sensations, tightly interacting with intraepidermal nerve fibers at the neuro-cutaneous unit. In animal models, epidermal cells establish close contacts and ensheath sensory neurites. However, ultrastructural morphological and mechanistic data examining the human keratinocyte-nerve fiber interface are sparse. We investigated this exact interface in human skin applying super-resolution array tomography, expansion microscopy, and structured illumination microscopy. We show keratinocyte ensheathment of afferents and adjacent connexin 43 contacts in native skin and have applied a pipeline based on expansion microscopy to quantify these parameter in skin sections of healthy participants versus patients with small fiber neuropathy. We further derived a fully human co-culture system, visualizing ensheathment and connexin 43 plaques in vitro. Unraveling human intraepidermal nerve fiber ensheathment and potential interaction sites advances research at the neuro-cutaneous unit. These findings are crucial on the way to decipher the mechanisms of cutaneous nociception.
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Affiliation(s)
| | - Sebastian Britz
- Imaging Core Facility, Biocenter, University of WürzburgWürzburgGermany
| | - Philine Dinkel
- Department of Neurology, University Hospital of WürzburgWürzburgGermany
| | - Thomas Klein
- Department of Neurology, University Hospital of WürzburgWürzburgGermany
| | - Markus Sauer
- Department of Biotechnology and Biophysics, University of WürzburgWürzburgGermany
| | | | - Nurcan Üçeyler
- Department of Neurology, University Hospital of WürzburgWürzburgGermany
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10
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Falco P, Galosi E, Di Stefano G, Leone C, Di Pietro G, Tramontana L, De Stefano G, Litewczuk D, Esposito N, Truini A. Autonomic Small-Fiber Pathology in Patients With Fibromyalgia. THE JOURNAL OF PAIN 2024; 25:64-72. [PMID: 37524221 DOI: 10.1016/j.jpain.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
In this clinical and skin biopsy study, we aimed to investigate whether fibromyalgia-associated small-fiber pathology (SFP), consisting of an intraepidermal nerve fiber loss, implies damage of dermal autonomic nerve fibers and how this damage is associated with autonomic symptoms that patients with fibromyalgia syndrome experience. Using skin biopsy, we investigated intraepidermal nerve fiber density, piloerector muscle, and sweat gland nerve fiber density (SGNFD) in 138 participants, that is, 58 patients with fibromyalgia syndrome, 48 healthy subjects, and 32 patients with small-fiber neuropathy. In patients with fibromyalgia-associated SFP, we also investigated how the different skin biopsy variables correlated with autonomic symptoms, as assessed with the Composite Autonomic Symptom Score 31 questionnaire. We found that in patients with fibromyalgia-associated SFP, the piloerector muscle and SGNFD were lower than that in healthy subjects. However, the autonomic small-fiber damage had no correlation with autonomic symptoms severity. In patients with SFP, the intraepidermal, piloerector muscle, and SGNFD were higher than that in patients with small-fiber neuropathy. Our clinical and skin biopsy study shows that patients with fibromyalgia have a reduction of dermal autonomic small fibers paralleling the intraepidermal nerve fiber loss, thus indicating that SFP also implies autonomic small nerve fiber damage. However, the autonomic small-fiber damage we found had no correlation with the severity of autonomic symptoms, and thus its clinical impact is still undetermined. PERSPECTIVE: In patients with fibromyalgia, SFP also affects autonomic fibers. These novel data provide additional insights into the pathophysiology of fibromyalgia syndrome, highlighting the complex role of small-fiber damage in the clinical picture of fibromyalgia.
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Affiliation(s)
- Pietro Falco
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Eleonora Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | - Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | | | | | - Daniel Litewczuk
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
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11
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Jänsch S, Evdokimov D, Egenolf N, Meyer zu Altenschildesche C, Kreß L, Üçeyler N. Distinguishing fibromyalgia syndrome from small fiber neuropathy: a clinical guide. Pain Rep 2024; 9:e1136. [PMID: 38283649 PMCID: PMC10811691 DOI: 10.1097/pr9.0000000000001136] [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: 08/14/2023] [Revised: 11/04/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Fibromyalgia syndrome (FMS) and small fiber neuropathy (SFN) are distinct pain conditions that share commonalities and may be challenging as for differential diagnosis. Objective To comprehensively investigate clinical characteristics of women with FMS and SFN to determine clinically applicable parameters for differentiation. Methods We retrospectively analyzed medical records of 158 women with FMS and 53 with SFN focusing on pain-specific medical and family history, accompanying symptoms, additional diseases, and treatment. We investigated data obtained using standardized pain, depression, and anxiety questionnaires. We further analyzed test results and findings obtained in standardized small fiber tests. Results FMS patients were on average ten years younger at symptom onset, described higher pain intensities requiring frequent change of pharmaceutics, and reported generalized pain compared to SFN. Pain in FMS was accompanied by irritable bowel or sleep disturbances, and in SFN by paresthesias, numbness, and impaired glucose metabolism (P < 0.01 each). Family history was informative for chronic pain and affective disorders in FMS (P < 0.001) and for neurological disorders in SFN patients (P < 0.001). Small fiber pathology in terms of skin denervation and/or thermal sensory threshold elevation was present in 110/158 (69.7 %) FMS patients and 39/53 (73.6 %) SFN patients. FMS patients mainly showed proximally reduced skin innervation and higher corneal nerve branch densities (p<0.001) whereas SFN patients were characterized by reduced cold detection and prolonged electrical A-delta conduction latencies (P < 0.05). Conclusions Our data show that FMS and SFN differ substantially. Detailed pain, drug and family history, investigating blood glucose metabolism, and applying differential small fiber tests may help to improve diagnostic differentiation and targeted therapy.
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Affiliation(s)
- Sarah Jänsch
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany. Meyer zu Altenschildesche is now with the Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - Dimitar Evdokimov
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany. Meyer zu Altenschildesche is now with the Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - Nadine Egenolf
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany. Meyer zu Altenschildesche is now with the Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - Caren Meyer zu Altenschildesche
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany. Meyer zu Altenschildesche is now with the Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - Luisa Kreß
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany. Meyer zu Altenschildesche is now with the Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany. Meyer zu Altenschildesche is now with the Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
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12
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Ueda H, Neyama H. Fibromyalgia Animal Models Using Intermittent Cold and Psychological Stress. Biomedicines 2023; 12:56. [PMID: 38255163 PMCID: PMC10813244 DOI: 10.3390/biomedicines12010056] [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: 11/14/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Fibromyalgia (FM) is a chronic pain condition characterized by widespread musculoskeletal pain and other frequent symptoms such as fatigue, sleep disturbance, cognitive impairment, and mood disorder. Based on the view that intermittent stress would be the most probable etiology for FM, intermittent cold- and intermittent psychological stress-induced generalized pain (ICGP and IPGP) models in mice have been developed and validated as FM-like pain models in terms of the patho-physiological and pharmacotherapeutic features that are shared with clinical versions. Both models show long-lasting and generalized pain and female-predominant sex differences after gonadectomy. Like many other neuropathic pain models, ICGP and IPGP were abolished in lysophosphatidic acid receptor 1 (LPAR1) knock-out mice or by LPAR1 antagonist treatments, although deciding the clinical importance of this mechanism depends on waiting for the development of a clinically available LPAR1 antagonist. On the other hand, the nonsteroidal anti-inflammatory drug diclofenac with morphine did not suppress hyperalgesia in these models, and this is consistent with the clinical findings. Pharmacological studies suggest that the lack of morphine analgesia is associated with opioid tolerance upon the stress-induced release of endorphins and subsequent counterbalance through anti-opioid NMDA receptor mechanisms. Regarding pharmacotherapy, hyperalgesia in both models was suppressed by pregabalin and duloxetine, which have been approved for FM treatment in clinic. Notably, repeated treatments with mirtazapine, an α2 adrenergic receptor antagonist-type antidepressant, and donepezil, a drug for treating Alzheimer's disease, showed potent therapeutic actions in these models. However, the pharmacotherapeutic treatment should be carried out 3 months after stress, which is stated in the FM guideline, and many preclinical studies, such as those analyzing molecular and cellular mechanisms, as well as additional evidence using different animal models, are required. Thus, the ICGP and IPGP models have the potential to help discover and characterize new therapeutic medicines that might be used for the radical treatment of FM, although there are several limitations to be overcome.
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Affiliation(s)
- Hiroshi Ueda
- Department of Pharmacology and Therapeutic Innovation, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8521, Japan;
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei 114201, Taiwan
| | - Hiroyuki Neyama
- Department of Pharmacology and Therapeutic Innovation, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8521, Japan;
- Multiomics Platform, Center for Cancer Immunotherapy and Immunobiology, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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13
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Barboza VR, Kubota GT, da Silva VA, Barbosa LM, Arnaut D, Rodrigues ALDL, Galhardoni R, Cury RG, Barbosa ER, Brunoni AR, Teixeira MJ, de Andrade DC. Parkinson's Disease-related Pains are Not Equal: Clinical, Somatosensory and Cortical Excitability Findings in Individuals With Nociceptive Pain. THE JOURNAL OF PAIN 2023; 24:2186-2198. [PMID: 37442404 DOI: 10.1016/j.jpain.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
Chronic pain is a frequent and burdensome nonmotor symptom of Parkinson's disease (PD). PD-related chronic pain can be classified as nociceptive, neuropathic, or nociplastic, the former being the most frequent subtype. However, differences in neurophysiologic profiles between these pain subtypes, and their potential prognostic and therapeutic implications have not been explored yet. This is a cross-sectional study on patients with PD (PwP)-related chronic pain (ie, started with or was aggravated by PD). Subjects were assessed for clinical and pain characteristics through questionnaires and underwent quantitative sensory tests and motor corticospinal excitability (CE) evaluations. Data were then compared between individuals with nociceptive and non-nociceptive (ie, neuropathic or nociplastic) pains. Thirty-five patients were included (51.4% male, 55.7 ± 11.0 years old), 20 of which had nociceptive pain. Patients with nociceptive PD-related pain had lower warm detection threshold (WDT, 33.34 ± 1.39 vs 34.34 ± 1.72, P = .019) and mechanical detection threshold (MDT, 2.55 ± 1.54 vs 3.86 ± .97, P = .007) compared to those with non-nociceptive pains. They also presented a higher proportion of low rest motor threshold values than the non-nociceptive pain ones (64.7% vs 26.6%, P = .048). In non-nociceptive pain patients, there was a negative correlation between WDT and non-motor symptoms scores (r = -.612, P = .045) and a positive correlation between MDT and average pain intensity (r = .629, P = .038), along with neuropathic pain symptom scores (r = .604, P = .049). It is possible to conclude that PD-related chronic pain subtypes have distinctive somatosensory and CE profiles. These preliminary data may help better frame previous contradictory findings in PwP and may have implications for future trial designs aiming at developing individually-tailored therapies. PERSPECTIVE: This work showed that PwP-related nociceptive chronic pain may have distinctive somatosensory and CE profiles than those with non-nociceptive pain subtypes. These data may help shed light on previous contradictory findings in PwP and guide future trials aiming at developing individually-tailored management strategies.
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Affiliation(s)
| | | | | | | | - Debora Arnaut
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Ricardo Galhardoni
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Andre Russowsky Brunoni
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil; Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg E, Denmark
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14
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Öznur Ö, Schlee C, Utz S, Langhorst J. Investigating the Influential Factors of Mild Water-Filtered Infrared-A Whole-Body Hyperthermia for Pain Relief in Fibromyalgia: A Mixed-Methods Approach Focusing on Predictors and Patient Perspectives. Biomedicines 2023; 11:2949. [PMID: 38001951 PMCID: PMC10669402 DOI: 10.3390/biomedicines11112949] [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: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Fibromyalgia syndrome (FMS) is a chronic condition characterized by chronic widespread pain, persistent fatigue, and disrupted sleep, significantly impacting well-being. Mild water-filtered infrared-A (wIRA) whole-body hyperthermia (WBH) is emerging as a promising pain management approach to FMS. Within the present randomized controlled trial (ClinicalTrials ID: NCT05135936), FMS patients underwent six sessions of mild wIRA-WBH over 3 weeks. Their pain levels were assessed at baseline and at week 12, while body core temperature and plateau phase duration were monitored during WBH. Qualitative interviews were conducted at week 12. Results from this mixed-methods study revealed that baseline pain intensity and plateau phase duration significantly predicted pain intensity at week 12. Thematic analysis of the interviews revealed diverse patient experiences with the treatment, with all patients reporting improvements in perceived pain and overall well-being. The onset and duration of pain relief varied among individuals. Overall, the findings suggest that the duration of the plateau phase may serve as an indicator for long-term pain reduction, although individual factors may influence treatment outcomes. Despite varying experiences, a prevailing trend of positive patient evaluations emerged. This study sheds light on the potential of wIRA-WBH as a therapeutic option for alleviating pain for and enhancing the well-being of FMS patients.
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Affiliation(s)
- Özlem Öznur
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Christoph Schlee
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
- Department of Sociology, University of Bamberg, 96052 Bamberg, Germany
| | - Sandra Utz
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany; (Ö.Ö.); (C.S.); (S.U.)
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
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15
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Fanton S, Menezes J, Krock E, Sandström A, Tour J, Sandor K, Jurczak A, Hunt M, Baharpoor A, Kadetoff D, Jensen KB, Fransson P, Ellerbrock I, Sitnikov R, Svensson CI, Kosek E. Anti-satellite glia cell IgG antibodies in fibromyalgia patients are related to symptom severity and to metabolite concentrations in thalamus and rostral anterior cingulate cortex. Brain Behav Immun 2023; 114:371-382. [PMID: 37683961 DOI: 10.1016/j.bbi.2023.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023] Open
Abstract
Recent translational work has shown that fibromyalgia might be an autoimmune condition with pathogenic mechanisms mediated by a peripheral, pain-inducing action of immunoglobulin G (IgG) antibodies binding to satellite glia cells (SGC) in the dorsal root ganglia. A first clinical assessment of the postulated autoimmunity showed that fibromyalgia subjects (FMS) had elevated levels of antibodies against SGC (termed anti-SGC IgG) compared to healthy controls and that anti-SGC IgG were associated with a more severe disease status. The overarching aim of the current study was to determine whether the role of anti-SGC IgG in driving pain is exclusively through peripheral mechanisms, as indirectly shown so far, or could be attributed also to central mechanisms. To this end, we wanted to first confirm, in a larger cohort of FMS, the relation between anti-SGC IgG and pain-related clinical measures. Secondly, we explored the associations of these autoantibodies with brain metabolite concentrations (assessed via magnetic resonance spectroscopy, MRS) and pressure-evoked cerebral pain processing (assessed via functional magnetic resonance imaging, fMRI) in FMS. Proton MRS was performed in the thalamus and rostral anterior cingulate cortex (rACC) of FMS and concentrations of a wide spectrum of metabolites were assessed. During fMRI, FMS received individually calibrated painful pressure stimuli corresponding to low and high pain intensities. Our results confirmed a positive correlation between anti-SGC IgG and clinical measures assessing condition severity. Additionally, FMS with high anti-SGC IgG levels had higher pain intensity and a worse disease status than FMS with low anti-SGC IgG levels. Further, anti-SGC IgG levels negatively correlated with metabolites such as scyllo-inositol in thalamus and rACC as well as with total choline and macromolecule 12 in thalamus, thus linking anti-SGC IgG levels to the concentration of metabolites in the brain of FMS. However, anti-SGC IgG levels in FMS were not associated with the sensitivity to pressure pain or the cerebral processing of evoked pressure pain. Taken together, our results suggest that anti-SGC IgG might be clinically relevant for spontaneous, non-evoked pain. Our current and previous translational and clinical findings could provide a rationale to try new antibody-related treatments in FMS.
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Affiliation(s)
- Silvia Fanton
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Joana Menezes
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Emerson Krock
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Faculty of Dental Medicine and Oral Health Sciences, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| | - Angelica Sandström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Radiology, Massachusetts General Hospital, A.A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA
| | - Jeanette Tour
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Katalin Sandor
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alexandra Jurczak
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matthew Hunt
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Azar Baharpoor
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Diana Kadetoff
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Stockholm Spine Center, Löwenströmska Hospital, Upplands Väsby, Sweden
| | - Karin B Jensen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Fransson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Isabel Ellerbrock
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Rouslan Sitnikov
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; MRI Research Center, Karolinska University Hospital, Stockholm, Sweden
| | - Camilla I Svensson
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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16
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Bäumler P, Brenske A, Winkelmann A, Irnich D, Averbeck B. Strong and aversive cold processing and pain facilitation in fibromyalgia patients relates to augmented thermal grill illusion. Sci Rep 2023; 13:15982. [PMID: 37749154 PMCID: PMC10520026 DOI: 10.1038/s41598-023-42288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/07/2023] [Indexed: 09/27/2023] Open
Abstract
The thermal grill illusion (TGI) is assumed to result from crosstalk between the thermoreceptive and nociceptive pathways. To elucidate this further, we compared 40 female fibromyalgia patients to 20 healthy women in an exploratory cross-sectional study. Sensations (cold, warm/heat, unpleasantness, pain and burning) evoked by 20 °C, 40 °C and alternating 20 °C/40 °C (TGI) and somatosensory profiles according to standardized quantitative sensory testing (QST) were assessed on the palm of the dominant hand. Compared to healthy controls, fibromyalgia patients reported stronger thermal grill-evoked cold, warm, unpleasantness and pain as well as stronger and more aversive 20 °C- and 40 °C-evoked sensations. They showed a loss in warm, mechanical and vibration detection, a gain in thermal pain thresholds and higher temporal summation (TS). Among QST parameters higher TS in fibromyalgia patients was most consistently associated with an augmented TGI. Independently, an increased TGI was linked to cold (20 °C) but less to warm (40 °C) perception. In fibromyalgia patients all thermal grill-evoked sensations were positively related to a higher 20 °C-evoked cold sensation and/or 20 °C-evoked unpleasantness. In conclusion, the TGI appears to be driven mainly by the cold-input. Aversive cold processing and central pain facilitation in fibromyalgia patients seem to independently augment the activation of the pain pathway.
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Affiliation(s)
- Petra Bäumler
- Multidisciplinary Pain Center, Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Brenske
- Multidisciplinary Pain Center, Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
- Walter Brendel Center of Experimental Medicine (WBex), Biomedical Center Munich (BMC), LMU Munich, Großhaderner Str. 9, 82152, Planegg-Martinsried, Germany
| | - Andreas Winkelmann
- Multidisciplinary Pain Center, Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Dominik Irnich
- Multidisciplinary Pain Center, Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Beate Averbeck
- Walter Brendel Center of Experimental Medicine (WBex), Biomedical Center Munich (BMC), LMU Munich, Großhaderner Str. 9, 82152, Planegg-Martinsried, Germany.
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17
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Daifallah O, Farah A, Dawes JM. A role for pathogenic autoantibodies in small fiber neuropathy? Front Mol Neurosci 2023; 16:1254854. [PMID: 37799730 PMCID: PMC10547903 DOI: 10.3389/fnmol.2023.1254854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
The immune system has a role in neuropathic pain which includes autoimmune mechanisms (e.g., autoantibodies). Clinical studies have identified a number of conditions where neuropathic pain is common and that are associated with autoantibodies targeting antigens within the nervous system. Interestingly sensory symptoms can be relieved with immunotherapies or plasma exchange, suggesting that pain in these patients is antibody-mediated. Recent preclinical studies have directly addressed this. For example, passive transfer of CASPR2 autoantibodies from patients cause increased pain sensitivity and enhanced sensory neuron excitability in mice confirming pathogenicity and demonstrating that patient autoantibodies are a mechanism to cause neuropathic pain. Small fiber neuropathy (SFN) exclusively affects small sensory fibers (typically nociceptors) and is characterized by severe neuropathic pain. Known causes include diabetes, B12 deficiency and rare variants in sodium channel genes, although around 50% of cases are idiopathic. SFN is associated with autoimmune conditions such as Sjorgen's syndrome, Sarcoidosis and Celiac disease and immunotherapy in the form of Intravenous immunoglobulin (IVIG) has proved an effective treatment. Autoantibodies have been identified and, in some cases, passive transfer of SFN patient IgG in mice can recapitulate neuropathic pain-like behavior. Here we will discuss clinical and preclinical data relating to the idea that pathogenic autoantibodies contribute to SNF. We discuss putative pathogenic antibodies, cellular targets and the molecular mechanisms by which they cause sensory neuron damage and the development of neuropathic pain. Finally, we will comment on future directions which may provide further insights into the mechanisms underlying SFN in patients.
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Affiliation(s)
- Omar Daifallah
- Department of Zoology, King Saud University, Riyadh, Saudi Arabia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Adham Farah
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - John M. Dawes
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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18
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Bubenzer LJ, Konsolke L, Enax-Krumova E, Eberhardt F, Tegenthoff M, Höffken O, Özgül ÖS. Pain-related evoked potentials with concentric surface electrodes in patients and healthy subjects: a systematic review. Brain Struct Funct 2023; 228:1581-1594. [PMID: 37555924 PMCID: PMC10471670 DOI: 10.1007/s00429-023-02690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
Pain-related evoked potentials with concentric surface electrodes (PREP with CE) have been increasingly used in the diagnostics of polyneuropathies as well as in pain research. However, the study results are partly inconsistent regarding their utility to distinguish between normal and abnormal findings. The present systematic review aimed to summarise and compare study results, where PREP with CE were used in healthy subjects or patients and to identify possible influencing factors. We found 36 research articles, of which 21 investigated disorders in patients compared to healthy controls, while the other 15 focussed on basic research in healthy subjects. Patients with polyneuropathies showed the most consistent PREP results with similar prolonged latencies and reduced amplitude values. Findings in other patient groups or in healthy subjects were more heterogeneous. There was evidence for an influence by age and height as well as by central effects like emotions, which should be considered in further studies. Further systematic research analysing PREP results depending on individual and disease-specific factors is needed to develop optimal normative values.
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Affiliation(s)
- Laura Josephine Bubenzer
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle de La Camp-Platz 1, 44789, Bochum, Germany
| | - Lena Konsolke
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle de La Camp-Platz 1, 44789, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle de La Camp-Platz 1, 44789, Bochum, Germany
| | - Frederic Eberhardt
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle de La Camp-Platz 1, 44789, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle de La Camp-Platz 1, 44789, Bochum, Germany
| | - Oliver Höffken
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle de La Camp-Platz 1, 44789, Bochum, Germany
| | - Özüm Simal Özgül
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle de La Camp-Platz 1, 44789, Bochum, Germany.
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19
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Di Stefano G, Falco P, Galosi E, De Stefano G, Di Pietro G, Leone C, Litewczuk D, Tramontana L, Strano S, Truini A. Pain associated with COVID-19 vaccination is unrelated to skin biopsy abnormalities. Pain Rep 2023; 8:e1089. [PMID: 38225959 PMCID: PMC10789449 DOI: 10.1097/pr9.0000000000001089] [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: 12/18/2022] [Revised: 04/07/2023] [Accepted: 05/05/2023] [Indexed: 01/17/2024] Open
Abstract
Introduction Previous clinical observations raised the possibility that COVID-19 vaccination might trigger a small-fibre neuropathy. Objectives In this uncontrolled observational study, we aimed to identify small fibre damage in patients complaining of generalized sensory symptoms and pain after COVID-19 vaccination. Methods We collected clinical data, including a questionnaire for assessing autonomic symptoms (Composite Autonomic Symptom Score-31), and investigated quantitative sensory testing (QST) and skin biopsy in 15 prospectively enrolled patients with generalized sensory symptoms and pain after COVID-19 vaccination. Nine patients complaining of orthostatic intolerance also underwent cardiovascular autonomic tests. Results We found that all patients experienced widespread pain, and most of them (11 of 15) had a fibromyalgia syndrome. All patients had normal skin biopsy findings, and in the 9 patients with orthostatic intolerance, cardiovascular autonomic tests showed normal findings. Nevertheless, 5 patients had cold and warm detection abnormalities at the QST investigation. Conclusions In our study, most patients complaining of generalized sensory symptoms and pain after COVID-19 vaccination had clinical and diagnostic test findings compatible with a fibromyalgia syndrome. Although the abnormal QST findings we found in 5 patients might be compatible with a small-fibre neuropathy, they should be cautiously interpreted given the psychophysical characteristics of this diagnostic test. Further larger controlled studies are needed to define precisely the association between small fibre damage and COVID-19 vaccination.
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Affiliation(s)
| | - Pietro Falco
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Eleonora Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | | | - Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Daniel Litewczuk
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | - Stefano Strano
- Dipartimento Cuore e Grossi Vasi, Sapienza University, Rome, Italy
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
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20
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Sarı İF, İlhanlı İ, Mızrak T, Kulaklı F, Kasap Z. The Effect of Transcutaneous Posterior Tibial Nerve Stimulation on Pain and Quality of Life in Patients with Fibromyalgia: A Single-Blind, Randomized Controlled Trial. J Clin Med 2023; 12:4989. [PMID: 37568391 PMCID: PMC10420003 DOI: 10.3390/jcm12154989] [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: 07/07/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed to investigate the effectiveness of posterior tibial nerve stimulation (PTNS) in reducing pain, improving quality of life, and decreasing disease severity in patients with fibromyalgia. This prospective, single-blind, randomized controlled trial included female patients newly diagnosed with fibromyalgia who had started duloxetine treatment (30 mg/day). The patients in the study group received six sessions of posterior tibial nerve stimulation, twice weekly, 3-4 days apart, in addition to duloxetine; the controls received duloxetine only. The patients were evaluated three times (at baseline, 1st month, and 3rd month). Pain was evaluated using a numeric rating scale, the short-form McGill Pain Questionnaire, and quality of life with a 36-item short-form health survey (SF-36). Patient functional status and disease severity were evaluated using the fibromyalgia impact questionnaire (FIQ). A total of 64 patients met the inclusion criteria: 22 were ultimately included in the study group and 30 in the control group. Statistical improvements in pain and FIQ scores were observed after treatment in both groups. The SF-36 scores indicated improved vitality only in the 1st month in both groups, with no significant changes in the other quality-of-life subscales in either group. There was no statistical difference between the two groups in terms of changes in pain, FIQ, and SF-36 scores compared with baseline at the 1st month and 3rd month. The addition of PTNS to pharmacological treatment did not contribute to the reduction in pain or improvement in quality of life in fibromyalgia either in the 1st or 3rd month. NIH Clinical Trial Registration Number NCT05937711.
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Affiliation(s)
- İlker Fatih Sarı
- The Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Gazipaşa Yerleşkesi Debboy Mevki Giresun/Türkiye, Giresun 28200, Turkey; (F.K.); (Z.K.)
| | - İlker İlhanlı
- The Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ondokuz Mayıs University, Samsun 55139, Turkey;
| | - Tuba Mızrak
- Havza Physical Therapy and Rehabilitation Center, Ondokuz Mayıs University, Samsun 55700, Turkey;
| | - Fazıl Kulaklı
- The Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Gazipaşa Yerleşkesi Debboy Mevki Giresun/Türkiye, Giresun 28200, Turkey; (F.K.); (Z.K.)
| | - Zerrin Kasap
- The Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Giresun University, Gazipaşa Yerleşkesi Debboy Mevki Giresun/Türkiye, Giresun 28200, Turkey; (F.K.); (Z.K.)
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21
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Favretti M, Iannuccelli C, Di Franco M. Pain Biomarkers in Fibromyalgia Syndrome: Current Understanding and Future Directions. Int J Mol Sci 2023; 24:10443. [PMID: 37445618 DOI: 10.3390/ijms241310443] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
Fibromyalgia is a complex and heterogeneous clinical syndrome, mainly characterized by the presence of widespread pain, possibly associated with a variety of other symptoms. Fibromyalgia can have an extremely negative impact on the psychological, physical and social lives of people affected, sometimes causing patients to experience dramatically impaired quality of life. Nowadays, the diagnosis of fibromyalgia is still clinical, thus favoring diagnostic uncertainties and making its clear identification challenging to establish, especially in primary care centers. These difficulties lead patients to undergo innumerable clinical visits, investigations and specialist consultations, thus increasing their stress, frustration and even dissatisfaction. Unfortunately, research over the last 25 years regarding a specific biomarker for the diagnosis of fibromyalgia has been fruitless. The discovery of a reliable biomarker for fibromyalgia syndrome would be a critical step towards the early identification of this condition, not only reducing patient healthcare utilization and diagnostic test execution but also providing early intervention with guideline-based treatments. This narrative article reviews different metabolite alterations proposed as possible biomarkers for fibromyalgia, focusing on their associations with clinical evidence of pain, and highlights some new, promising areas of research in this context. Nevertheless, none of the analyzed metabolites emerge as sufficiently reliable to be validated as a diagnostic biomarker. Given the complexity of this syndrome, in the future, a panel of biomarkers, including subtype-specific biomarkers, could be considered as an interesting alternative research area.
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Affiliation(s)
- Martina Favretti
- Rheumatology Unit, Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristina Iannuccelli
- Rheumatology Unit, Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Manuela Di Franco
- Rheumatology Unit, Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
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22
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Devigili G, Di Stefano G, Donadio V, Frattale I, Mantovani E, Nolano M, Occhipinti G, Provitera V, Quitadamo S, Tamburin S, Toscano A, Tozza S, Truini A, Valeriani M, de Tommaso M. Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group. Neurol Sci 2023:10.1007/s10072-023-06836-3. [PMID: 37222872 DOI: 10.1007/s10072-023-06836-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/25/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia. AIM The aim of this position statement on behalf of the Neuropathic Pain Study Group of the Italian Society of Neurology is to give practical guidelines for the clinical and instrumental assessment of fibromyalgia (FM) in the neurological clinical practice, taking into consideration recent studies. METHODS Criteria for study selection and consideration were original studies, case-controls design, use of standardized methodologies for clinical practice, and FM diagnosis with ACR criteria (2010, 2011, 2016). RESULTS ACR criteria were revised. For diagnostic procedure of small-fiber pathology, 47 studies were totally considered. Recent diagnostic criteria should be applied (ACR, 2016). A rheumatologic visit seems mandatory. The involvement of small fibers should request at least 2 among HRV + SSR and/or laser-evoked responses and/or skin biopsy and/or corneal confocal microscopy, eventually followed by monitoring of metabolic and/or immunological/ and or/paraneoplastic basis, to be repeated at 1-year follow-up. CONCLUSIONS The correct diagnostic approach to FM could promote the exclusion of the known causes of small-fiber impairment. The research toward common genetic factors would be useful to promote a more specific therapeutic approach.
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Affiliation(s)
- G Devigili
- UOC Neurologia IIRCCS Carlo Besta, Milan, Italy
| | - G Di Stefano
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - V Donadio
- Clinica Neurologica Bellaria Hospital, Bologna, Italy
| | - I Frattale
- Child Neurology and Psychiatric Unit, Tor Vergata University, Rome, Italy
| | - E Mantovani
- Neurosciences, Biomedicine and Movement Sciences Department, Verona University, Verona, Italy
| | - M Nolano
- Skin Biopsy Laboratory, Department of Neurology, Instituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, 80100, Naples, Italy
| | - G Occhipinti
- UOC Neurologia E Malattie Neuromuscolari, AUO Martino Messina, Messina, Italy
| | - V Provitera
- Skin Biopsy Laboratory, Department of Neurology, Instituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
| | - S Quitadamo
- Neurophysiopathology Unit, DiBraiN Department, Policlinico General Hospital, Bari Aldo Moro University, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - S Tamburin
- Neurosciences, Biomedicine and Movement Sciences Department, Verona University, Verona, Italy
| | - A Toscano
- EURO-ERN NMD, AOU Martino University of Messina, Messina, Italy
| | - S Tozza
- UOC Neurologia E Malattie Neuromuscolari, AUO Martino Messina, Messina, Italy
| | - A Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - M Valeriani
- Developmental Neurology Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - M de Tommaso
- Neurophysiopathology Unit, DiBraiN Department, Policlinico General Hospital, Bari Aldo Moro University, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
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23
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Pinto AM, Luís M, Geenen R, Palavra F, Lumley MA, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, Häuser W, Kosek E, López-Solà M, Mease P, Marques TR, Jacobs JWG, Castilho P, da Silva JAP. Neurophysiological and Psychosocial Mechanisms of Fibromyalgia: A Comprehensive Review and Call for An Integrative Model. Neurosci Biobehav Rev 2023:105235. [PMID: 37207842 DOI: 10.1016/j.neubiorev.2023.105235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023]
Abstract
Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fibromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the understanding, assessment, and intervention for fibromyalgia.
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Affiliation(s)
- Ana Margarida Pinto
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal; University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal.
| | - Mariana Luís
- Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal.
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Martinus J. Langeveldgebouw, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, the Netherlands.
| | - Filipe Palavra
- Centre for Child Development, Neuropediatric Unit. Pediatric Hospital, Coimbra Hospital and University Centre, Avenida Afonso Romão, 3000-602 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7908, Detroit, MI 48202, USA.
| | - Jacob N Ablin
- Internal Medicine H, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
| | - Kirstine Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Jaime Branco
- Rheumatology Department, Egas Moniz Hospital - Lisboa Ocidental Hospital Centre (CHLO-EPE), R. da Junqueira 126, 1349-019 Lisbon, Portugal; Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal.
| | - Dan Buskila
- Ben Gurion University of the Negev Beer-Sheba, Israel.
| | - João Castelhano
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, Department of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec, Canada, H3G 1A4.
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm 171 77, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA.
| | - Tiago Reis Marques
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, South Kensington, London SW7 2BU, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London WC2R 2LS, UK.
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
| | - Paula Castilho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal.
| | - José A P da Silva
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
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24
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Caxaria S, Bharde S, Fuller AM, Evans R, Thomas B, Celik P, Dell’Accio F, Yona S, Gilroy D, Voisin MB, Wood JN, Sikandar S. Neutrophils infiltrate sensory ganglia and mediate chronic widespread pain in fibromyalgia. Proc Natl Acad Sci U S A 2023; 120:e2211631120. [PMID: 37071676 PMCID: PMC10151464 DOI: 10.1073/pnas.2211631120] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/05/2023] [Indexed: 04/19/2023] Open
Abstract
Fibromyalgia is a debilitating widespread chronic pain syndrome that occurs in 2 to 4% of the population. The prevailing view that fibromyalgia results from central nervous system dysfunction has recently been challenged with data showing changes in peripheral nervous system activity. Using a mouse model of chronic widespread pain through hyperalgesic priming of muscle, we show that neutrophils invade sensory ganglia and confer mechanical hypersensitivity on recipient mice, while adoptive transfer of immunoglobulin, serum, lymphocytes, or monocytes has no effect on pain behavior. Neutrophil depletion abolishes the establishment of chronic widespread pain in mice. Neutrophils from patients with fibromyalgia also confer pain on mice. A link between neutrophil-derived mediators and peripheral nerve sensitization is already established. Our observations suggest approaches for targeting fibromyalgia pain via mechanisms that cause altered neutrophil activity and interactions with sensory neurons.
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Affiliation(s)
- Sara Caxaria
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQLondon, United Kingdom
| | - Sabah Bharde
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQLondon, United Kingdom
| | - Alice M. Fuller
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQLondon, United Kingdom
| | - Romy Evans
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQLondon, United Kingdom
| | - Bethan Thomas
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQLondon, United Kingdom
| | - Petek Celik
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQLondon, United Kingdom
| | - Francesco Dell’Accio
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQLondon, United Kingdom
| | - Simon Yona
- Institute of Biomedical and Oral Research, Hebrew University, 9112102Jerusalem, Israel
| | - Derek Gilroy
- Division of Medicine, Molecular Nociception Group, Wolfson Institute of Biomedical Research, University College London, WC1E 6BTLondon, United Kingdom
| | - Mathieu-Benoit Voisin
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQLondon, United Kingdom
| | - John N. Wood
- Division of Medicine, Molecular Nociception Group, Wolfson Institute of Biomedical Research, University College London, WC1E 6BTLondon, United Kingdom
| | - Shafaq Sikandar
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQLondon, United Kingdom
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25
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Langhorst J, Koch AK, Kehm C, Öznur Ö, Engler H, Häuser W. Mild Water-Filtered Infrared-A Whole-Body Hyperthermia Reduces Pain in Patients with Fibromyalgia Syndrome-A Randomized Sham-Controlled Trial. J Clin Med 2023; 12:jcm12082945. [PMID: 37109279 PMCID: PMC10144038 DOI: 10.3390/jcm12082945] [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: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
The challenging treatment situation of patients with fibromyalgia syndrome (FMS) requires additional therapy options. The effects of water-filtered infrared-A whole-body hyperthermia (WBH) versus sham hyperthermia on pain intensity were investigated in an outpatient setting within a two-armed randomized sham-controlled trial. n = 41 participants aged between 18 and 70 years with a medically confirmed diagnosis of FMS were randomized to WBH (intervention; n = 21) or sham hyperthermia (control; n = 20). Six treatments with mild water-filtered infrared-A WBH over a period of three weeks with at least one day in between treatments were applied. On average, the maximum temperature was 38.7 °C for a duration of approximately 15 min. The control group received exactly the same treatment except that an insulating foil between the patient and the hyperthermia device blocked most of the radiation. Primary outcome was pain intensity measured by the Brief Pain Inventory at week 4. Secondary outcomes included blood cytokine levels and FMS-related core symptoms and quality of life. Pain intensity at week 4 was significantly different between the groups in favor of WBH (p = 0.015). A statistically significant pain reduction in favor of WBH was also found at week 30 (p = 0.002). Mild water-filtered infrared-A WBH effectively reduced pain intensity at the end of treatment and follow-up.
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Affiliation(s)
- Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Anna K Koch
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany
| | - Christina Kehm
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Özlem Öznur
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, 96049 Bamberg, Germany
- Department of Integrative Medicine, Medicinal Faculty, University of Duisburg-Essen, 96049 Bamberg, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational and Behavioral Neurosciences, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, 81675 Munich, Germany
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26
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Adam F, Jouët P, Sabaté JM, Perrot S, Franchisseur C, Attal N, Bouhassira D. Thermal grill illusion of pain in patients with chronic pain: a clinical marker of central sensitization? Pain 2023; 164:638-644. [PMID: 35972466 DOI: 10.1097/j.pain.0000000000002749] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT The thermal grill illusion of pain (TGIP) is a paradoxical burning pain sensation elicited by the simultaneous application of innocuous cutaneous warm and cold stimuli with a thermode ("thermal grill") consisting of interlaced heated and cooled bars. Its neurophysiological mechanisms are unclear, but TGIP may have some mechanisms in common with pathological pain, including central sensitization in particular, through the involvement of N-methyl- d -aspartate receptors. However, few studies have investigated TGIP in patients with chronic pain and its clinical relevance is uncertain. We hypothesized that the TGIP would be increased in comparison with controls in patients with fibromyalgia or irritable bowel syndrome, which are regarded as typical "nociplastic" primary pain syndromes related to changes in central pain processing. We compared the sensations elicited by a large range of combinations of temperature differentials between the warm and cold bars of a thermal grill applied to the hand between patients with fibromyalgia (n = 30) or irritable bowel syndrome (n= 30) and controls (n = 30). The percentage of TGIP responses and the intensity and unpleasantness of TGIP were significantly greater in patients than controls. Furthermore, positive correlations were found between TGIP intensity and clinical pain intensity and between TGIP intensity and the cold pain threshold measured on the hand. These results are consistent with our working hypothesis of shared mechanisms between TGIP and clinical pain mechanisms in patients with nociplastic chronic pain syndromes and suggest that TGIP might represent a clinical marker of central sensitization in these patients.
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Affiliation(s)
- Frédéric Adam
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
- Department of Anesthesiology, Saint Joseph Hospital, Paris, France
| | - Pauline Jouët
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
- Gastroenterology and Digestive Oncology Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Jean-Marc Sabaté
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
- Gastroenterology and Digestive Oncology Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Serge Perrot
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
- Pain Clinic, Cochin Hospital, University of Paris, Paris, France
| | - Claire Franchisseur
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Nadine Attal
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
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27
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Fialho MFP, Brum ES, Oliveira SM. Could the fibromyalgia syndrome be triggered or enhanced by COVID-19? Inflammopharmacology 2023; 31:633-651. [PMID: 36849853 PMCID: PMC9970139 DOI: 10.1007/s10787-023-01160-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
Fibromyalgia (FM) is a complex disease with an uncertain aetiology and intricate pathophysiology. Although its genesis is not fully explained, potential environmental factors, such as viral infections might trigger FM or worsen patients' clinical outcomes. The SARS-CoV-2 virus may affect central and peripheral nervous systems, leading to musculoskeletal, neurological, and psychological disturbances. These symptoms might persist at least 12 months beyond the recovery, often referred to as post-COVID syndrome, which resembles FM syndrome. In this sense, we argued the potential consequences of COVID-19 exclusively on FM syndrome. First, we have described post-COVID syndrome and its painful symptoms. Afterwards, we argued whether FM syndrome could be triggered or enhanced by COVID-19 infection or by numerous and persistent stressors imposed daily by the pandemic setting (isolation, uncertainty, depression, mental stress, generalized anxiety, and fear of the virus). In addition, we have demonstrated similarities between pathophysiological mechanisms and cardinal symptoms of FM and COVID-19, speculating that SARS-CoV-2 might represent a critical mediator of FM or an exacerbator of its symptoms once both syndromes share similar mechanisms and complaints. Therefore, pharmacologic and non-pharmacological approaches commonly used to treat FM could serve as strategic therapies to attenuate painful and neurological manifestations of post-COVID syndrome. Although it is still theoretical, clinicians and researchers should be alert of patients who develop symptoms similar to FM or those who had their FM symptoms increased post-COVID to manage them better.
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Affiliation(s)
- Maria Fernanda Pessano Fialho
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Evelyne Silva Brum
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
- Department of Biochemistry and Molecular Biology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
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Herrero Babiloni A, Baril AA, Charlebois-Plante C, Jodoin M, Sanchez E, De Baets L, Arbour C, Lavigne GJ, Gosselin N, De Beaumont L. The Putative Role of Neuroinflammation in the Interaction between Traumatic Brain Injuries, Sleep, Pain and Other Neuropsychiatric Outcomes: A State-of-the-Art Review. J Clin Med 2023; 12:jcm12051793. [PMID: 36902580 PMCID: PMC10002551 DOI: 10.3390/jcm12051793] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Sleep disturbances are widely prevalent following a traumatic brain injury (TBI) and have the potential to contribute to numerous post-traumatic physiological, psychological, and cognitive difficulties developing chronically, including chronic pain. An important pathophysiological mechanism involved in the recovery of TBI is neuroinflammation, which leads to many downstream consequences. While neuroinflammation is a process that can be both beneficial and detrimental to individuals' recovery after sustaining a TBI, recent evidence suggests that neuroinflammation may worsen outcomes in traumatically injured patients, as well as exacerbate the deleterious consequences of sleep disturbances. Additionally, a bidirectional relationship between neuroinflammation and sleep has been described, where neuroinflammation plays a role in sleep regulation and, in turn, poor sleep promotes neuroinflammation. Given the complexity of this interplay, this review aims to clarify the role of neuroinflammation in the relationship between sleep and TBI, with an emphasis on long-term outcomes such as pain, mood disorders, cognitive dysfunctions, and elevated risk of Alzheimer's disease and dementia. In addition, some management strategies and novel treatment targeting sleep and neuroinflammation will be discussed in order to establish an effective approach to mitigate long-term outcomes after TBI.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, QC H3A 0C7, Canada
- CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montreal, QC H4J 1C5, Canada
- Correspondence:
| | - Andrée-Ann Baril
- Douglas Mental Health University Institute, Montreal, QC H4H 1R3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada
| | | | - Marianne Jodoin
- CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montreal, QC H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Erlan Sanchez
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Faculty of Medicine, University of Montreal, Montreal, QC H3T 1C5, Canada
- Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium
| | - Caroline Arbour
- CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montreal, QC H4J 1C5, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Gilles J. Lavigne
- Division of Experimental Medicine, McGill University, Montreal, QC H3A 0C7, Canada
- CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montreal, QC H4J 1C5, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Nadia Gosselin
- CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montreal, QC H4J 1C5, Canada
| | - Louis De Beaumont
- CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montreal, QC H4J 1C5, Canada
- Department of Surgery, University of Montreal, Montreal, QC H3T 1J4, Canada
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Chen O, He Q, Han Q, Furutani K, Gu Y, Olexa M, Ji RR. Mechanisms and treatments of neuropathic itch in a mouse model of lymphoma. J Clin Invest 2023; 133:160807. [PMID: 36520531 PMCID: PMC9927942 DOI: 10.1172/jci160807] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Our understanding of neuropathic itch is limited due to a lack of relevant animal models. Patients with cutaneous T cell lymphoma (CTCL) experience severe itching. Here, we characterize a mouse model of chronic itch with remarkable lymphoma growth, immune cell accumulation, and persistent pruritus. Intradermal CTCL inoculation produced time-dependent changes in nerve innervations in lymphoma-bearing skin. In the early phase (20 days), CTCL caused hyperinnervations in the epidermis. However, chronic itch was associated with loss of epidermal nerve fibers in the late phases (40 and 60 days). CTCL was also characterized by marked nerve innervations in mouse lymphoma. Blockade of C-fibers reduced pruritus at early and late phases, whereas blockade of A-fibers only suppressed late-phase itch. Intrathecal (i.t.) gabapentin injection reduced late-phase, but not early-phase, pruritus. IL-31 was upregulated in mouse lymphoma, whereas its receptor Il31ra was persistently upregulated in Trpv1-expressing sensory neurons in mice with CTCL. Intratumoral anti-IL-31 treatment effectively suppressed CTCL-induced scratching and alloknesis (mechanical itch). Finally, i.t. administration of a TLR4 antagonist attenuated pruritus in early and late phases and in both sexes. Collectively, we have established a mouse model of neuropathic and cancer itch with relevance to human disease. Our findings also suggest distinct mechanisms underlying acute, chronic, and neuropathic itch.
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Affiliation(s)
- Ouyang Chen
- Center for Translational Pain Medicine, Department of Anesthesiology,,Department of Cell Biology, and
| | - Qianru He
- Center for Translational Pain Medicine, Department of Anesthesiology
| | - Qingjian Han
- Center for Translational Pain Medicine, Department of Anesthesiology
| | - Kenta Furutani
- Center for Translational Pain Medicine, Department of Anesthesiology
| | - Yun Gu
- Center for Translational Pain Medicine, Department of Anesthesiology
| | - Madelynne Olexa
- Center for Translational Pain Medicine, Department of Anesthesiology
| | - Ru-Rong Ji
- Center for Translational Pain Medicine, Department of Anesthesiology,,Department of Cell Biology, and,Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
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Comparison of cutaneous silent period parameters in patients with primary Sjögren's syndrome with the healthy population and determination of ıts relationship with clinical parameters. Rheumatol Int 2023; 43:355-362. [PMID: 36048188 DOI: 10.1007/s00296-022-05198-x] [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: 07/21/2022] [Accepted: 08/23/2022] [Indexed: 02/07/2023]
Abstract
Small fiber neuropathy (SFN) is one of the main neurological manifestations in primary Sjögren's Syndrome (pSS). For the detection of SFN, cutaneous silent period (CSP) measurement is gaining popularity recently due to its non-invasiveness and practical application. Evaluating SFN involvement in patients with pSS using CSP and evaluating its relationship with clinical parameters. Patients with a diagnosis of pSS and healthy volunteers demographically homogeneous with the patient group were included in the study. The CSP responses were recorded over the abductor pollicis brevis muscle. The latency and duration values of the responses were obtained. In patient group, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Hospital Anxiety and Depression Scale (HADS), Short Form-36 (SF-36) questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Central Sensitization Inventory (CSI) were applied for the evaluation of symptom severity, mood, quality of life, presence of neuropathic pain and central sensitization, respectively. The mean CSP latency was significantly longer in patient group compared to control group (p < 0.001). Mean CSP duration was also significantly shorter in patient group (p < 0.001). There were no significant differences in CSP parameters according to patients' neuropathic pain or central sensitization profile. There were significant correlations of CSP parameters (latency and duration, respectively) with ESSPRI dryness (ρ = 0.469, p = 0.004; ρ = -0.553, p < 0.001), fatigue (ρ = 0.42, p = 0.011; ρ = -0.505, p = 0.002), pain (ρ = 0.428, p = 0.009; ρ = -0.57, p < 0.001) subscores and mean ESSPRI score (ρ = 0.631, p < 0.001; ρ = -0.749, p < 0.001). When SF-36 subscores and CSP parameters were investigated, a significant correlation was found only between "bodily pain" subscore and CSP duration (ρ = -0.395, p = 0.017). In HADS, LANSS and CSI evaluations, a significant correlation was found only between HADS anxiety score and the CSP duration (ρ = 0.364, p = 0.02). As indicated by CSP measurement, SFN is more prominent in patients with pSS than in the healthy population. It is important to investigate the presence of SFN because of its correlation with the leading symptoms in the clinical spectrum of pSS.
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Löfgren M, Sandström A, Bileviciute-Ljungar I, Mannerkorpi K, Gerdle B, Ernberg M, Fransson P, Kosek E. The effects of a 15-week physical exercise intervention on pain modulation in fibromyalgia: Increased pain-related processing within the cortico-striatal- occipital networks, but no improvement of exercise-induced hypoalgesia. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 13:100114. [PMID: 36660198 PMCID: PMC9843267 DOI: 10.1016/j.ynpai.2023.100114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
Dysfunctional top-down pain modulation is a hallmark of fibromyalgia (FM) and physical exercise is a cornerstone in FM treatment. The aim of this study was to explore the effects of a 15-week intervention of strengthening exercises, twice per week, supervised by a physiotherapist, on exercise-induced hypoalgesia (EIH) and cerebral pain processing in FM patients and healthy controls (HC). FM patients (n = 59) and HC (n = 39) who completed the exercise intervention as part of a multicenter study were examined at baseline and following the intervention. Following the exercise intervention, FM patients reported a reduction of pain intensity, fibromyalgia severity and depression. Reduced EIH was seen in FM patients compared to HC at baseline and no improvement of EIH was seen following the 15-week resistance exercise intervention in either group. Furthermore, a subsample (Stockholm site: FM n = 18; HC n = 19) was also examined with functional magnetic resonance imaging (fMRI) during subjectively calibrated thumbnail pressure pain stimulations at baseline and following intervention. A significant main effect of exercise (post > pre) was observed both in FM patients and HC, in pain-related brain activation within left dorsolateral prefrontal cortex and caudate, as well as increased functional connectivity between caudate and occipital lobe bordering cerebellum (driven by the FM patients). In conclusion, the results indicate that 15-week resistance exercise affect pain-related processing within the cortico-striatal-occipital networks (involved in motor control and cognition), rather than directly influencing top-down descending pain inhibition. In alignment with this, exercise-induced hypoalgesia remained unaltered.
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Key Words
- AAL, Automated Anatomical Labeling
- ACR, American College of Rheumatology
- CNS, central nervous system
- CPM, conditioned pain modulation
- EIH, exercise-induced hypoalgesia
- Exercise induced hypoalgesia
- Exercise intervention
- FD, Frame-wise displacement
- FEW, family-wise error
- FIQ, Fibromyalgia Impact Questionnaire
- FM, fibromyalgia
- FOV, field of view
- FWHM, full-width-half-maximum
- Fibromyalgia
- Functional connectivity
- Functional magnetic resonance imaging (fMRI)
- GLM, general linear model
- HADS, Hospital Anxiety and Depression Scale
- HC, healthy controls
- MNI, Montreal Neurological Institute
- MVC, maximum voluntary contraction force
- NSAIDs, non-steroidal anti-inflammatory drugs
- P50, pressure stimuli corresponding to a pain rating of 50mm on a 100 mm VAS
- PPI, psychophysiological interaction
- PPTs, pressure pain thresholds
- Pressure pain
- RM, repetition maximum
- SM, stimulation maximum
- SPM, Statistical Parametric Mapping
- T1, longitudinal relaxation time
- T2, transverse relaxation time
- TR/TE, time repetition/time echo
- VAS, visual analogue scale
- VOI, volume of interest
- dlPFC, dorsolateral prefrontal cortex
- fMRI, functional magnetic resonance imaging
- rACC, rostral anterior cingulate cortex
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Affiliation(s)
- Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm SE-182 88, Sweden
| | - Angelica Sandström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 77, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm SE-171 78, Sweden,Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm SE-182 88, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Physiotherapy Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg SE- 413 90, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-581 83, Sweden
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet and Scandinavian Centre for Orofacial Neurosciences, Huddinge SE-141 04, Sweden
| | - Peter Fransson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 77, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm SE-171 78, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 77, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm SE-171 78, Sweden,Department of Surgical Sciences, Uppsala University, Uppsala SE- 752 36, Sweden,Corresponding author at: Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, Stockholm SE-171 77, Sweden.
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Tagoe CE, Wang W, Barbour KE. Association of the anti-thyroid peroxidase antibody with chronic hand pain in older adults in the Third National Health and Nutrition Examination Survey: a cross-sectional study. Ther Adv Musculoskelet Dis 2023; 15:1759720X231154984. [PMID: 37063458 PMCID: PMC10102935 DOI: 10.1177/1759720x231154984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/18/2023] [Indexed: 04/18/2023] Open
Abstract
Background Autoimmune thyroid disease (AITD) is the commonest autoimmune disease. Although viewed as a classic form of single-organ autoimmunity, AITD is increasingly associated with non-thyroid sequelae including musculoskeletal manifestations and chronic pain syndromes. However, large population-based studies are needed. Objectives To examine the relationships between chronic hand pain and the AITD autoantibodies, anti-thyroid peroxidase antibody (TPOAb), and anti-thyroglobulin antibody (TgAb), in the Third National Health and Nutrition Examination Survey (NHANES III). Design This is a cross-sectional study. Methods We examined data from NHANES III on 4820 persons aged 60 years or older with respect to hand pain and its association with TPOAb and TgAb. Log-binomial regressions were fit to examine the associations between the anti-thyroid autoantibodies and hand pain. Results Positive TPOAb was associated with a higher prevalence of hand pain than negative TPOAb [prevalence ratio (PR) = 1.158, p = 0.048] in the unadjusted model. This association was no longer significant after controlling for age, body mass index, gender, and diabetes (p = 0.313). When positive TPOAb was considered as a categorical variable with four levels, the highest quartile was associated with hand pain in the unadjusted (PR = 1.489, p = 0.005) and adjusted models (PR = 1.325, p = 0.042). There was no significant association between TgAb and hand pain when covariates were controlled for. Conclusion TPOAb may be associated with the presence of chronic hand pain in persons aged over 60 years, especially at higher serum levels.
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Leone C, Galosi E, Esposito N, Falco P, Fasolino A, Di Pietro G, Di Stefano G, Camerota F, Vollert J, Truini A. Small-fibre damage is associated with distinct sensory phenotypes in patients with fibromyalgia and small-fibre neuropathy. Eur J Pain 2023; 27:163-173. [PMID: 36314856 DOI: 10.1002/ejp.2049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND In this clinical and psychophysical study, we aimed to verify whether patients with fibromyalgia with and without small-fibre pathology and patients with pure small-fibre neuropathy share common sensory phenotypes. METHODS Using an algorithm based on quantitative sensory testing variables, we grouped 64 consecutive patients with fibromyalgia (20 with small-fibre pathology, 44 without) and 30 patients with pure small-fibre neuropathy into different sensory phenotypes: sensory loss, thermal hyperalgesia, mechanical hyperalgesia and healthy phenotypes. RESULTS We found that the frequency of the different sensory phenotypes differed markedly between patients with fibromyalgia and patients with small-fibre neuropathy. In patients with fibromyalgia, with and without small-fibre pathology, healthy and hyperalgesia phenotypes (both thermal and mechanical) were similarly represented, whilst sensory loss and mechanical hyperalgesia phenotypes were the most frequent phenotypes in patients with small-fibre neuropathy. CONCLUSIONS Our findings indicate that small-fibre damage is associated with distinct sensory phenotypes in patients with fibromyalgia and in patients with small-fibre neuropathy. The lack of phenotype differences between patients with fibromyalgia with and without small-fibre pathology and the relatively high frequency of the healthy phenotype in these patients highlight a complex relationship between small-fibre pathology and pain in patients with fibromyalgia.
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Affiliation(s)
- Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Eleonora Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | - Pietro Falco
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | | | | | - Filippo Camerota
- Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer (MSK), Imperial College London, London, UK
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
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Central Sensitization and Small-fiber Neuropathy Are Associated in Patients With Fibromyalgia. Clin J Pain 2023; 39:8-14. [PMID: 36524768 DOI: 10.1097/ajp.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/16/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study the prevalence of small-fiber neuropathy (SFN) in a large cohort of patients with fibromyalgia (FM) and to better characterize the subset of patients with both FM and SFN. METHODS This 1-year, retrospective, observational cohort study included 265 patients with FM. They all performed electrochemical skin conductance (ESC) using the Sudoscan device, 1 of the simplest and most reliable technique to assess the distal autonomic nerve fibers. They completed 4 self-assessment questionnaires: (1) the Central Sensitization Inventory (CSI), (2) the Neuropathic Pain Symptom Inventory (NPSI), and (3) the Hospital Anxiety and Depression Scale (HADS), the Fibromyalgia Impact Questionnaire (FIQ). RESULTS Fifty-three patients (20%) had reduced ESC values. These patients had higher CSI and HADS scores, and a larger intake of analgesic drugs compared with patients with no ESC abnormalities. Central sensitization, which was extreme in 69% of the patients (CSI score ≥60), was 1 of the main determinants of ESC abnormalities and was associated with a higher NPSI score, even though these 2 factors were not correlated. CONCLUSION Over the past 10 years, studies have shown that a significant proportion of patients with FM have signs of small nerve fiber impairment. The possible involvement of SFN, in the occurrence and presentation of clinical symptoms in FM patients, remains however unclear. This is the first study that showed an association between central sensitization and both small nerve fiber impairment and neuropathic pain features in FM patients, rather than a direct association between SFN and neuropathic pain.
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de la Coba P, Montoro CI, Reyes Del Paso GA, Galvez-Sánchez CM. Algometry for the assessment of central sensitisation to pain in fibromyalgia patients: a systematic review. Ann Med 2022; 54:1403-1422. [PMID: 35579545 PMCID: PMC9122375 DOI: 10.1080/07853890.2022.2075560] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The pathophysiology of fibromyalgia (FM) is related to central sensitisation (CS) to pain. Algometry allows assessing CS based on dynamic evoked pain. However, current algometrýs protocols require optimising, unifying and updating. OBJECTIVES 1) identify the dynamic pain measures used most frequently to effectively assess CS processes in FM, and 2) consider the future of the algometry assessing CS in these patients. METHODS Cochrane Collaboration guidelines and PRISMA statements were followed. The protocol was registered in PROSPERO database (ID: CRD42021270135). The selected articles were evaluated using the Cochrane risk of bias (ROB) assessment tool. The PubMed, Scopus, and Web of Science databases were searched. RESULTS Thirty-four studies were selected, including measures such as temporal summation of pain (TSP), aftersensations (AS), spatial summation of pain (SSP), the noxious flexion reflex (NFR) threshold, conditioned pain modulation (CPM), cutaneous silent period (CuSP), and slowly repeated evoked pain (SREP); and evoked pain combined with neuroimaging. Each measure offered various advantages and limitations. According to ROB, 28 studies were of low quality, 3 of moderate quality, and 3 of high quality. CONCLUSIONS Several pain indicators have been demonstrated to successfully examine CS involvement in FM in the last years. Algometry, especially when it involves diverse body sites and tissues, might provide further insight into (1) the evaluation of psychological factors known to influence pain experience, (2) new dynamic pain indicators, and (3) the simultaneous use of certain neuroimaging techniques. Further research clarifying the mechanisms underlying some of these measures, and homogenisation and optimisation of the algometrýs protocols, are needed. KEY MESSAGESAlgometry allows for assessing Central Sensitisation by applying dynamic evoked pain.The future of algometry could relapse in its combination with neuroimaging.Recently-emerged pain indicators should be considered for algometrýs new protocols.
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Bourke SL, Schlag AK, O'Sullivan SE, Nutt DJ, Finn DP. Cannabinoids and the endocannabinoid system in fibromyalgia: A review of preclinical and clinical research. Pharmacol Ther 2022; 240:108216. [PMID: 35609718 DOI: 10.1016/j.pharmthera.2022.108216] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 12/14/2022]
Abstract
Characterised by chronic widespread musculoskeletal pain, generalised hyperalgesia, and psychological distress, fibromyalgia (FM) is a significant unmet clinical need. The endogenous cannabinoid system plays an important role in modulating both pain and the stress response. Here, we appraise the evidence, from preclinical and clinical studies, for a role of the endocannabinoid system in FM and the therapeutic potential of targeting the endocannabinoid system. While many animal models have been used to study FM, the reserpine-induced myalgia model has emerged as perhaps the most translatable to the clinical phenotype. Inhibition of fatty acid amide hydrolase (FAAH) has shown promise in preclinical studies, ameliorating pain- and anxiety-related behaviour . Clinically, there is evidence for alterations in the endocannabinoid system in patients with FM, including single nucleotide polymorphisms and increased levels of circulating endocannabinoids and related N-acylethanolamines. Single entity cannabinoids, cannabis, and cannabis-based medicines in patients with FM show promise therapeutically but limitations in methodology and lack of longitudinal studies to assess efficacy and tolerability preclude the current recommendation for their use in patients with FM. Gaps in the literature that warrant further investigation are discussed, particularly the need for further development of animal models with high validity for the multifaceted nature of FM, balanced studies to eliminate sex-bias in preclinical research, and ultimately, better translation between preclinical and clinical research.
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Affiliation(s)
- Stephanie L Bourke
- Pharmacology and Therapeutics, School of Medicine, Centre for Pain Research and Galway Neuroscience Centre, National University of Ireland, Galway, Ireland
| | - Anne Katrin Schlag
- Drug Science, St. Peters House, Wood Street, London, UK; Faculty of Medicine, Department of Brain Sciences, Imperial College London, UK
| | | | - David J Nutt
- Drug Science, St. Peters House, Wood Street, London, UK; Faculty of Medicine, Department of Brain Sciences, Imperial College London, UK
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, Centre for Pain Research and Galway Neuroscience Centre, National University of Ireland, Galway, Ireland.
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Ghafouri B, Ernberg M, Andréll P, Bäckryd E, Fisher MR, Freund-Levi Y, Grelz H, Gräbel O, Karlsten R, Kosek E, Löfgren M, Ringqvist Å, Rudling K, Stålnacke BM, Sörlén N, Uhlin K, Westergren H, Gerdle B. Swedish Chronic Pain Biobank: protocol for a multicentre registry and biomarker project. BMJ Open 2022; 12:e066834. [PMID: 36450421 PMCID: PMC9717004 DOI: 10.1136/bmjopen-2022-066834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION About 20% of the adult population have chronic pain, often associated with psychological distress, sick leave and poor health. There are large variations in the clinical picture. A biopsychosocial approach is used in investigation and treatment. The concept of personalised medicine, that is, optimising medication types and dosages for individual patients based on biomarkers and other patient-related factors, has received increasing attention in different diseases but used less in chronic pain. This cooperative project from all Swedish University Hospitals will investigate whether there are changes in inflammation and metabolism patterns in saliva and blood in chronic pain patients and whether the changes correlate with clinical characteristics and rehabilitation outcomes. METHODS AND ANALYSIS Patients at multidisciplinary pain centres at University Hospitals in Sweden who have chosen to participate in the Swedish Quality Registry for Pain Rehabilitation and healthy sex-matched and age-matched individuals will be included in the study. Saliva and blood samples will be collected in addition to questionnaire data obtained from the register. From the samples, proteins, lipids, metabolites and micro-RNA will be analysed in relation to, for example, diagnosis, pain characteristics, psychological distress, body weight, pharmacological treatment and clinical rehabilitation results using advanced multivariate data analysis and bioinformatics. ETHICS AND DISSEMINATION The study is approved by the Swedish Ethical Review Authority (Dnr 2021-04929) and will be conducted in accordance with the declaration of Helsinki.The results will be published in open access scientific journals and in popular scientific relevant journals such as those from patient organisations. Data will be also presented in scientific meetings, meeting with healthcare organisations and disseminated in different lecturers at the clinics and universities.
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Affiliation(s)
- Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), Karolinska Institute, Stockholm, Sweden
| | - Paulin Andréll
- Region Västra Götaland, Sahlgrenska University Hospital, Östra, department of Anaesthesiology and Intensive Care Medicine, Pain Centre, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmanuel Bäckryd
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marcelo Rivano Fisher
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Yvonne Freund-Levi
- School of Medical Sciences, Örebro University and department of Geriatrics, University Hospital Örebro, Örebro, Sweden
- Department of geriatrics, Södertälje Hospital, Södertälje, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Grelz
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Olaf Gräbel
- Region Västra Götaland, Sahlgrenska University Hospital, Östra, department of Anaesthesiology and Intensive Care Medicine, Pain Centre, Sahlgrenska Academy, Gothenburg, Sweden
| | - Rolf Karlsten
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Kosek
- Department Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karin Rudling
- Department of rehabilitation medicine, University hospital Örebro, Örebro, Sweden
| | - Britt-Marie Stålnacke
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Niklas Sörlén
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Karin Uhlin
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Hans Westergren
- Department of Neurosurgery and Pain Rehabilitation at Skåne University Hospital and Faculty of Medicine Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
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Gyorfi M, Rupp A, Abd-Elsayed A. Fibromyalgia Pathophysiology. Biomedicines 2022; 10:biomedicines10123070. [PMID: 36551826 PMCID: PMC9776089 DOI: 10.3390/biomedicines10123070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
This article examines the biological, genetic, and environmental aspects of fibromyalgia that may have an impact on its pathogenesis. Symptoms of fibromyalgia may be related to aberrations in the endogenous inhibition of pain as well as changes in the central processing of sensory input. Genetic research has revealed familial aggregation of fibromyalgia and other related disorders like major depressive disorder. Dysfunctional pain processing may also be influenced by exposure to physical or psychological stressors, abnormal biologic reactions in the autonomic nervous system, and neuroendocrine responses. With more research the pathophysiology of fibromyalgia will be better understood, leading to more logical and focused treatment options for fibromyalgia patients.
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Affiliation(s)
- Michael Gyorfi
- Department of Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
- Correspondence:
| | - Adam Rupp
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
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Üçeyler N, Schließer M, Evdokimov D, Radziwon J, Feulner B, Unterecker S, Rimmele F, Walter U. Reduced midbrain raphe echogenicity in patients with fibromyalgia syndrome. PLoS One 2022; 17:e0277316. [PMID: 36395116 PMCID: PMC9671316 DOI: 10.1371/journal.pone.0277316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The pathogenesis of fibromyalgia syndrome (FMS) is unclear. Transcranial ultrasonography revealed anechoic alteration of midbrain raphe in depression and anxiety disorders, suggesting affection of the central serotonergic system. Here, we assessed midbrain raphe echogenicity in FMS. METHODS Sixty-six patients underwent transcranial sonography, of whom 53 were patients with FMS (27 women, 26 men), 13 patients with major depression and physical pain (all women), and 14 healthy controls (11 women, 3 men). Raphe echogenicity was graded visually as normal or hypoechogenic, and quantified by digitized image analysis, each by investigators blinded to the clinical diagnosis. RESULTS Quantitative midbrain raphe echogenicity was lower in patients with FMS compared to healthy controls (p<0.05), but not different from that of patients with depression and accompanying physical pain. Pain and FMS symptom burden did not correlate with midbrain raphe echogenicity as well as the presence and severity of depressive symptoms. CONCLUSION We found reduced echogenicity of the midbrain raphe area in patients with FMS and in patients with depression and physical pain, independent of the presence or severity of pain, FMS, and depressive symptoms. Further exploration of this sonographic finding is necessary before this objective technique may enter diagnostic algorithms in FMS and depression.
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Affiliation(s)
- Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany
- * E-mail:
| | - Mira Schließer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | | | - Jakub Radziwon
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Betty Feulner
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University of Würzburg, Würzburg, Germany
| | - Florian Rimmele
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
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Fibromyalgia in women: association of inflammatory plasma proteins, muscle blood flow, and metabolism with body mass index and pain characteristics. Pain Rep 2022; 7:e1042. [PMID: 36213597 PMCID: PMC9534367 DOI: 10.1097/pr9.0000000000001042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Metabolism and inflammation interact in fibromyalgia with obesity that can lead to chronic low-grade inflammation. Introduction: Obesity is a common comorbidity in fibromyalgia (FM). Both FM and obesity have been connected to low-grade inflammation, although it is possible that previously reported inflammatory alterations in FM primarily may be linked to increased body mass index (BMI). Objective: This study aimed to investigate whether the inflammatory plasma protein profile, muscle blood flow, and metabolism and pain characteristics (clinical parameters and patient-reported outcome measurements) differed between female patients with FM with and without obesity. Methods: Patients with FM underwent clinical examinations, physical tests, and answered questionnaires. They were dichotomized according to BMI (<30 kg/m2 [n = 14]; ≥30 kg/m2 [n = 13]). Blood samples were collected and analyzed using a panel of 71 inflammatory plasma proteins. Results: There were significant (P < 0.05) differences in blood pressure, pulse, max VO2, pain intensity, physical capacity, and Fibromyalgia Impact Questionnaire between the groups; the obese group had higher blood pressure, pulse, pain intensity, and Fibromyalgia Impact Questionnaire. There were 14 proteins that contributed to the group belonging. The 4 most important proteins for the group discrimination were MIP1β, MCP4, IL1RA, and IL6, which showed higher concentrations in obese patients with FM. Significantly decreased blood flow and increased concentration of pyruvate were detected in obese patients compared with nonobese patients. There was significant correlation between inflammatory proteins and sedentary behavior and health status in obese patients with FM. Conclusions: These findings suggest that metabolism and inflammation interact in female patients with FM with obesity and might cause chronic low-grade inflammation. Screening for obesity and monitoring of BMI changes should be considered in the treatment of patients with FM.
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The Use of the Coenzyme Q 10 as a Food Supplement in the Management of Fibromyalgia: A Critical Review. Antioxidants (Basel) 2022; 11:antiox11101969. [PMID: 36290691 PMCID: PMC9598746 DOI: 10.3390/antiox11101969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
The coenzyme Q10 is a naturally occurring benzoquinone derivative widely prescribed as a food supplement for different physical conditions and pathologies. This review aims to sum up the key structural and functional characteristics of Q10, taking stock of its use in people affected by fibromyalgia. A thorough survey has been conducted, using Pubmed, Scifinder, and ClinicalTrials.gov as the reference research applications and registry database, respectively. Original articles, reviews, and editorials published within the last 15 years, as well as open clinical investigations in the field, if any, were analyzed to point out the lights and shadows of this kind of supplementation as they emerge from the literature.
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Sound-Induced Flash Illusions Support Cortex Hyperexcitability in Fibromyalgia. Pain Res Manag 2022; 2022:7355102. [PMID: 36199588 PMCID: PMC9527419 DOI: 10.1155/2022/7355102] [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: 08/13/2021] [Revised: 03/19/2022] [Accepted: 09/01/2022] [Indexed: 12/04/2022]
Abstract
Objectives Fibromyalgia (FM) is characterized by spontaneous chronic widespread pain in combination with hyperalgesia to pressure stimuli. Sound-induced flash illusions (SIFIs) reflect cross-modal interactions between senses allowing to assess a visual cortical hoerexcitability (VCH) by evaluating the fission and fusion illusions disruption. The aims of the present study were to explore whether SIFIs are perceived differently in patients with fibromyalgia as compared to healthy controls (HCs) and how migraine affects fission and fusion illusions in fibromyalgia. Methods A single flash (F) accompanied by 0 to 4 beeps (B) was presented to induce the fission illusion while multiple flash (i.e., 2 to 4) accompanied by 0 or 1 beep was presented to induce fusion illusion. The mean number of perceived flashes in fission and fusion illusion trials was compared between the groups (i.e., FM, FM with migraine, and HCs) using repeated-measures analysis of variance. Medication history was recorded along with the administration of Fibromyalgia Impact Questionnaire and Hospital Anxiety and Depression scales. Results Twenty-four patients with FM (mean age 51, 2 ± 10, 6 years; 22 females), seventeen patients with FM and migraine without aura (mean age 47.8 ± 11.4 years; 16 females; 13 chronic, 4 episodic migraine), and forty-one age- and sex-matched HCs (mean age 47.3 ± 6.9 years; 34 females) participated in the study. Fission and fusion illusory effects were detected in all the participants. However, in FM patients, the fission illusion was reduced and almost abolished as compared to HCs (1F1B, p = 0.02; 1F2B, p < 0.0001; 1F3B, p < 0.0001; 1F4B, p = 0.0001), while there were no differences between groups in fusion trials. Migraine did not affect the fission and the fusion illusions. Conclusion Results from this study confirm that patients with FM have a VCH suggesting that the pathological changes in cortical excitability might have important roles in the pathophysiology of FM. SIFI represents a noninvasive behavioral tool for the exploration of cross-sensory functional interplay.
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Fibromyalgia-associated hyperalgesia is related to psychopathological alterations but not to gut microbiome changes. PLoS One 2022; 17:e0274026. [PMID: 36149895 PMCID: PMC9506607 DOI: 10.1371/journal.pone.0274026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/20/2022] [Indexed: 11/19/2022] Open
Abstract
Fibromyalgia-syndrome (FMS) is a complex disease characterized by chronic widespread pain and additional symptoms including depression, cognitive dysfunction (“fibro-fog”) and maldigestion. Our research team examined whether FMS-related pain parameters assessed by quantitative sensory testing (QST) and psychological disturbances are accompanied by alterations of the fecal microbiome. We recruited 25 patients with FMS and 26 age- and sex-matched healthy controls. Medical background, food habits, psychopathology and quality of life were assessed through questionnaires. Stool samples were analyzed by 16S rRNA gene amplification and sequencing. QST was performed according to the protocol of the German Network for Neuropathic Pain. QST showed that both lemniscal and spinothalamic afferent pathways are altered in FMS patients relative to healthy controls and that peripheral as well as central pain sensitization processes are manifest. Psychometric assessment revealed enhanced scores of depression, anxiety and stress. In contrast, neither the composition nor the alpha- and beta-diversity of the fecal microbiome was changed in FMS patients. FMS patients segregate from healthy controls in various parameters of QST and psychopathology, but not in terms of composition and diversity of the fecal microbiome. Despite consideration of several confounding factors, we conclude that the contribution of the gut microbiome to the pathophysiology of FMS is limited.
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Analgesic Medication in Fibromyalgia Patients: A Cross-Sectional Study. Pain Res Manag 2022; 2022:1217717. [PMID: 36247103 PMCID: PMC9553668 DOI: 10.1155/2022/1217717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
There is no approved drug for fibromyalgia syndrome (FMS) in Europe. In the German S3 guideline, amitriptyline, duloxetine, and pregabalin are recommended for temporary use. The aim of this study was to cross-sectionally investigate the current practice of medication in FMS patients in Germany. We systematically interviewed 156 patients with FMS, while they were participating in a larger study. The patients had been stratified into subgroups with and without a decrease in intraepidermal nerve fiber density. The drugs most commonly used to treat FMS pain were nonsteroidal anti-inflammatory drugs (NSAIDs) (41.0% of all patients), metamizole (22.4%), and amitriptyline (12.8%). The most frequent analgesic treatment regimen was “on demand” (53.9%), during pain attacks, while 35.1% of the drugs were administered daily and the remaining in other regimens. Median pain relief as self-rated by the patients on a numerical rating scale (0–10) was 2 points for NSAIDS, 2 for metamizole, and 1 for amitriptyline. Drugs that were discontinued due to lack of efficacy rather than side effects were acetaminophen, flupirtine, and selective serotonin reuptake inhibitors. Reduction in pain severity was best achieved by NSAIDs and metamizole. Our hypothesis that a decrease in intraepidermal nerve fiber density might represent a neuropathic subtype of FMS, which would be associated with better effectiveness of drugs targeting neuropathic pain, could not be confirmed in this cohort. Many FMS patients take “on-demand” medication that is not in line with current guidelines. More randomized clinical trials are needed to assess drug effects in FMS subgroups.
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Cheng YW, Chao CC, Chen CH, Yeh TY, Jeng JS, Tang SC, Hsieh ST. Small Fiber Pathology in CADASIL: Clinical Correlation With Cognitive Impairment. Neurology 2022; 99:e583-e593. [PMID: 35584924 PMCID: PMC9442619 DOI: 10.1212/wnl.0000000000200672] [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: 12/08/2021] [Accepted: 03/16/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study investigated the cutaneous small fiber pathology of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and its clinical significance, that is, the NOTCH3 deposition in cutaneous vasculatures and CNS neurodegeneration focusing on cognitive impairment. METHODS Thirty-seven patients with CADASIL and 59 age-matched healthy controls were enrolled to evaluate cutaneous small fiber pathology by quantitative measures of intraepidermal nerve fiber density (IENFD), sweat gland innervation, and vascular innervation. Cognitive performance of patients with CADASIL was evaluated by a comprehensive neuropsychological assessment, and its association with small fiber pathology was tested using multivariable linear regression analysis adjusted for age and diabetes mellitus. We further assessed the relationships of IENFD with cutaneous vascular NOTCH3 ectodomain (NOTCH3ECD) deposition and biomarkers of neurodegeneration including structural brain MRI measures, serum neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), tau, and ubiquitin carboxy-terminal hydrolase L1. RESULTS Patients with CADASIL showed reduced IENFD (5.22 ± 2.42 vs 7.88 ± 2.89 fibers/mm, p = 0.0001) and reduced sweat gland (p < 0.0001) and vascular (p < 0.0001) innervations compared with age-matched controls. Reduced IENFD was associated with impaired global cognition measured by Mini-Mental State Examination (B = 1.062, 95% CI = 0.370-1.753, p = 0.004), and this association remained after adjustment for age and diabetes mellitus (p = 0.043). In addition, IENFD in patients with CADASIL was associated with mean cortical thickness (Pearson r = 0.565, p = 0.0023) but not white matter hyperintensity volume, total lacune count, or total microbleed count. Reduced IENFD was associated with cutaneous vascular NOTCH3ECD deposition amount among patients harboring pathogenic variants in exon 11 (mainly p.R544C) (B = -0.092, 95% CI = -0.175 to -0.009, p = 0.031). Compared with those with normal cognition, patients with CADASIL with cognitive impairment had an elevated plasma NfL level regardless of concurrent small fiber denervation, whereas only patients with both cognitive impairment and small fiber denervation showed an elevated plasma GFAP level. DISCUSSION Cutaneous small fiber pathology correlates with cognitive impairment and CNS neurodegeneration in patients with CADASIL, indicating a peripheral neurodegenerative process related to NOTCH3ECD aggregation.
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Affiliation(s)
- Yu-Wen Cheng
- From the Department of Neurology (Y.-W.C.), National Taiwan University Hospital, Hsin-Chu Branch; Graduate Institute of Clinical Medicine (Y.-W.C.), College of Medicine, National Taiwan University; Department of Neurology (C.-C.C., C.-H.C., J.-S.J., S.-C.T., S.-T.H.), National Taiwan University Hospital; Department of Anatomy and Cell Biology (T.-Y.Y., S.-T.H.), College of Medicine, National Taiwan University; Graduate Institute of Brain and Mind Sciences (S.-T.H.), College of Medicine, National Taiwan University; and Center of Precision Medicine (S.-T.H.), National Taiwan University College of Medicine, Taipei
| | - Chi-Chao Chao
- From the Department of Neurology (Y.-W.C.), National Taiwan University Hospital, Hsin-Chu Branch; Graduate Institute of Clinical Medicine (Y.-W.C.), College of Medicine, National Taiwan University; Department of Neurology (C.-C.C., C.-H.C., J.-S.J., S.-C.T., S.-T.H.), National Taiwan University Hospital; Department of Anatomy and Cell Biology (T.-Y.Y., S.-T.H.), College of Medicine, National Taiwan University; Graduate Institute of Brain and Mind Sciences (S.-T.H.), College of Medicine, National Taiwan University; and Center of Precision Medicine (S.-T.H.), National Taiwan University College of Medicine, Taipei
| | - Chih-Hao Chen
- From the Department of Neurology (Y.-W.C.), National Taiwan University Hospital, Hsin-Chu Branch; Graduate Institute of Clinical Medicine (Y.-W.C.), College of Medicine, National Taiwan University; Department of Neurology (C.-C.C., C.-H.C., J.-S.J., S.-C.T., S.-T.H.), National Taiwan University Hospital; Department of Anatomy and Cell Biology (T.-Y.Y., S.-T.H.), College of Medicine, National Taiwan University; Graduate Institute of Brain and Mind Sciences (S.-T.H.), College of Medicine, National Taiwan University; and Center of Precision Medicine (S.-T.H.), National Taiwan University College of Medicine, Taipei
| | - Ti-Yen Yeh
- From the Department of Neurology (Y.-W.C.), National Taiwan University Hospital, Hsin-Chu Branch; Graduate Institute of Clinical Medicine (Y.-W.C.), College of Medicine, National Taiwan University; Department of Neurology (C.-C.C., C.-H.C., J.-S.J., S.-C.T., S.-T.H.), National Taiwan University Hospital; Department of Anatomy and Cell Biology (T.-Y.Y., S.-T.H.), College of Medicine, National Taiwan University; Graduate Institute of Brain and Mind Sciences (S.-T.H.), College of Medicine, National Taiwan University; and Center of Precision Medicine (S.-T.H.), National Taiwan University College of Medicine, Taipei
| | - Jiann-Shing Jeng
- From the Department of Neurology (Y.-W.C.), National Taiwan University Hospital, Hsin-Chu Branch; Graduate Institute of Clinical Medicine (Y.-W.C.), College of Medicine, National Taiwan University; Department of Neurology (C.-C.C., C.-H.C., J.-S.J., S.-C.T., S.-T.H.), National Taiwan University Hospital; Department of Anatomy and Cell Biology (T.-Y.Y., S.-T.H.), College of Medicine, National Taiwan University; Graduate Institute of Brain and Mind Sciences (S.-T.H.), College of Medicine, National Taiwan University; and Center of Precision Medicine (S.-T.H.), National Taiwan University College of Medicine, Taipei
| | - Sung-Chun Tang
- From the Department of Neurology (Y.-W.C.), National Taiwan University Hospital, Hsin-Chu Branch; Graduate Institute of Clinical Medicine (Y.-W.C.), College of Medicine, National Taiwan University; Department of Neurology (C.-C.C., C.-H.C., J.-S.J., S.-C.T., S.-T.H.), National Taiwan University Hospital; Department of Anatomy and Cell Biology (T.-Y.Y., S.-T.H.), College of Medicine, National Taiwan University; Graduate Institute of Brain and Mind Sciences (S.-T.H.), College of Medicine, National Taiwan University; and Center of Precision Medicine (S.-T.H.), National Taiwan University College of Medicine, Taipei
| | - Sung-Tsang Hsieh
- From the Department of Neurology (Y.-W.C.), National Taiwan University Hospital, Hsin-Chu Branch; Graduate Institute of Clinical Medicine (Y.-W.C.), College of Medicine, National Taiwan University; Department of Neurology (C.-C.C., C.-H.C., J.-S.J., S.-C.T., S.-T.H.), National Taiwan University Hospital; Department of Anatomy and Cell Biology (T.-Y.Y., S.-T.H.), College of Medicine, National Taiwan University; Graduate Institute of Brain and Mind Sciences (S.-T.H.), College of Medicine, National Taiwan University; and Center of Precision Medicine (S.-T.H.), National Taiwan University College of Medicine, Taipei.
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Meade E, Garvey M. The Role of Neuro-Immune Interaction in Chronic Pain Conditions; Functional Somatic Syndrome, Neurogenic Inflammation, and Peripheral Neuropathy. Int J Mol Sci 2022; 23:ijms23158574. [PMID: 35955708 PMCID: PMC9369187 DOI: 10.3390/ijms23158574] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 02/01/2023] Open
Abstract
Functional somatic syndromes are increasingly diagnosed in chronically ill patients presenting with an array of symptoms not attributed to physical ailments. Conditions such as chronic fatigue syndrome, fibromyalgia syndrome, or irritable bowel syndrome are common disorders that belong in this broad category. Such syndromes are characterised by the presence of one or multiple chronic symptoms including widespread musculoskeletal pain, fatigue, sleep disorders, and abdominal pain, amongst other issues. Symptoms are believed to relate to a complex interaction of biological and psychosocial factors, where a definite aetiology has not been established. Theories suggest causative pathways between the immune and nervous systems of affected individuals with several risk factors identified in patients presenting with one or more functional syndromes. Risk factors including stress and childhood trauma are now recognised as important contributors to chronic pain conditions. Emotional, physical, and sexual abuse during childhood is considered a severe stressor having a high prevalence in functional somatic syndrome suffers. Such trauma permanently alters the biological stress response of the suffers leading to neuroexcitatory and other nerve issues associated with chronic pain in adults. Traumatic and chronic stress results in epigenetic changes in stress response genes, which ultimately leads to dysregulation of the hypothalamic-pituitary axis, the autonomic nervous system, and the immune system manifesting in a broad array of symptoms. Importantly, these systems are known to be dysregulated in patients suffering from functional somatic syndrome. Functional somatic syndromes are also highly prevalent co-morbidities of psychiatric conditions, mood disorders, and anxiety. Consequently, this review aims to provide insight into the role of the nervous system and immune system in chronic pain disorders associated with the musculoskeletal system, and central and peripheral nervous systems.
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Affiliation(s)
- Elaine Meade
- Department of Life Science, Atlantic Technological University, F91 YW50 Sligo, Ireland;
| | - Mary Garvey
- Department of Life Science, Atlantic Technological University, F91 YW50 Sligo, Ireland;
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, F91 YW50 Sligo, Ireland
- Correspondence:
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On AY, Tanigor G, Baydar DA. Relationships of autonomic dysfunction with disease severity and neuropathic pain features in fibromyalgia: is it really a sympathetically maintained neuropathic pain? Korean J Pain 2022; 35:327-335. [PMID: 35768988 PMCID: PMC9251392 DOI: 10.3344/kjp.2022.35.3.327] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/12/2022] Open
Abstract
Background The pathophysiology of fibromyalgia (FM) involves many mechanisms including central nervous system sensitization theory, autonomic nervous system (ANS) dysfunction, and recently small fiber neuropathy. While the small fiber neuropathy itself can cause ANS dysfunction and neuropathic pain (NP), it is still unknown whether ANS problems have an association with severity of disease and NP in patients with FM. The aim of this study was to evaluate ANS dysfunction in FM patients and to explore possible associations of ANS dysfunction with disease severity and NP. Methods Twenty-nine FM patients and 20 healthy controls were included in this cross-sectional study. Participants were tested using sympathetic skin responses (SSR) and R-R interval variation analyses for sympathetic and parasympathetic ANS dysfunction, respectively. Disease severity and somatic symptoms of patients with FM were evaluated using the ACR-2010 scales and Fibromyalgia Impact Questionnaire, and NP symptoms were evaluated using the Pain Detect Questionnaire and Douleur Neuropathique questionnaire. Results FM patients were found to have ANS dysfunction characterized by increased sympathetic response and decreased parasympathetic response. SSR amplitudes were found to be correlated with a more severe disease. Although non-significant, NP severity tended to be associated with a decrease in sympathetic and parasympathetic activities. Conclusions ANS dysfunction may play a role in the pathophysiology of FM. The trend of decreased ANS functions in FM patients exhibiting NP contradicts the notion that FM is a sympathetically maintained NP and may be explained with small fiber involvement.
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Affiliation(s)
- Arzu Yagiz On
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Turkey
| | - Goksel Tanigor
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Dilek Aykanat Baydar
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
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Buhck M, Achenbach J, Wiese B, Tran AT, Stuhrmann M, Jaeger B, Bernateck M, Schneider N, Karst M. The interplay of chronic stress and genetic traits discriminates between patients suffering from multisomatoform disorder with pain as the leading symptom and matched controls. J Affect Disord 2022; 308:466-472. [PMID: 35460735 DOI: 10.1016/j.jad.2022.04.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Somatoform disorders and functional somatic syndromes (FSS) with symptoms that are not sufficiently explained by physical or technical examination are among the most challenging underlying causes. Many different somatoform disorders and FSS have overlapping symptoms, often with pain as the most prevalent one, leading to a high burden of disease. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We analyzed a group of 151 patients and 149 matched controls to identify interactions of genetic and environmental factors with a possible influence on the development of MSD. DESIGN In a retrospective case-control study, we performed a statistical analysis on 151 patients and 149 matched controls using logistic regression and a Classification and Regression Tree (CART) analysis. RESULTS The logistic regression analysis of genes and environmental factors demonstrated significant differences in the results of the Trier Inventory of Chronic Stress (TICS) questionnaire, the single nucleotide polymorphism rs1800955 of the dopamine receptor D4 and the single nucleotide polymorphism rs4818 of the enzyme catechol-O-methyltransferase between patients with MSD and healthy controls. The resulting decision tree of the CART analysis determined that the TICS questionnaire was able to differentiate patients and controls most accurately, followed by certain genotypes of the 5-hydroxytryptamine receptor 2A and a single nucleotide polymorphism of the enzyme catechol-O-methyltransferase. CONCLUSIONS The results of the statistical analysis identified a gene-environmental interaction possibly leading to MSD. The resulting identifiers could be used as a reference to inform diagnostic algorithms to easier identify patients suffering from MSD.
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Affiliation(s)
- M Buhck
- Department of Child and Adolescent Psychiatry, Children's Hospital Auf der Bult Hannover, 30173 Hannover, Germany
| | - J Achenbach
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Medicine, Nordstadt Krankenhaus Hannover, 30167 Hannover, Germany.
| | - B Wiese
- Institute for General Practice and Palliative Care, Hannover Medical School, 30625 Hannover, Germany
| | - A T Tran
- Department of Neurology und Neurophysiology, Hannover Medical School, 30625 Hannover, Germany
| | - M Stuhrmann
- Institute of Human Genetics, Hannover Medical School, 30625 Hannover, Germany
| | - B Jaeger
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - M Bernateck
- Center for Pain Medicine Hannover, 30159 Hannover, Germany
| | - N Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, 30625 Hannover, Germany
| | - M Karst
- Department of Anesthesiology and Intensive Care Medicine, Pain Clinic, Hannover Medical School, 30625 Hannover, Germany
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49
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Vittersø AD, Halicka M, Buckingham G, Proulx MJ, Bultitude JH. The sensorimotor theory of pathological pain revisited. Neurosci Biobehav Rev 2022; 139:104735. [PMID: 35705110 DOI: 10.1016/j.neubiorev.2022.104735] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 01/31/2023]
Abstract
Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.
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Affiliation(s)
- Axel D Vittersø
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom; Department of Psychology, Oslo New University College, Oslo, Norway.
| | - Monika Halicka
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
| | - Gavin Buckingham
- Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom
| | - Michael J Proulx
- Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Centre for Real and Virtual Environments Augmentation Labs, Department of Computer Science, University of Bath, Bath, Somerset, United Kingdom
| | - Janet H Bultitude
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
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50
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Berwick RJ, Andersson DA, Goebel A, Marshall A. After-Sensations and Lingering Pain following Examination in Patients with Fibromyalgia Syndrome. PAIN MEDICINE 2022; 23:1928-1938. [PMID: 35652761 DOI: 10.1093/pm/pnac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/05/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic widespread pain condition with mixed peripheral and central contributions. Patients display hypersensitivities to a spectrum of stimuli. Patients' blunt pressure pain thresholds are typically reduced, and sometimes (∼15%) gentle brushstroke induces allodynia. However, after-sensations following these stimuli have not, to our knowledge, been reported. We examined the perception of blunt pressure and 'pleasant touch' in FMS. Patients were first interviewed and completed standard psychometric questionnaires. We then measured their sensitivity to blunt pressure and perception of pleasant touch including after-sensations; patients were followed for five days evaluating lingering pain from blunt pressure. We recruited 51 FMS patients and 16 pain-free controls (HC) at a UK Pain Management Centre. Forty-four patients completed the after-sensation protocol. Most patients reported pain after application of less mechanical pressure than HCs; median arm and leg thresholds were 167 kPa and 233 kPa. Eighty-four percent (31/37) of patients reported ongoing pain at the site of pressure application one day after testing, and 49% (18/37) still perceived pain at five days. After-sensations following brushstroke were common in the FMS group, reported by 77% (34/44) compared to 25% (4/16) of HCs; 34% (15/44) patients, but no HCs, perceived these after-sensations as uncomfortable. For FMS patients who experienced after-sensations, brushstroke-pleasantness ratings were reduced, and skin was often an important site of pain. Pain after blunt pressure assessment typically lingers for several days. After-sensations following brushstroke stimulation is a previously unreported FMS phenomenon. They are associated with tactile anhedonia and may identify a clinically distinct subgroup.
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Affiliation(s)
- Richard J Berwick
- Pain Research Institute, University of Liverpool, UK.,Walton Centre, Longmore Lane, Liverpool, UK
| | | | - Andreas Goebel
- Pain Research Institute, University of Liverpool, UK.,Walton Centre, Longmore Lane, Liverpool, UK
| | - Andrew Marshall
- Pain Research Institute, University of Liverpool, UK.,Walton Centre, Longmore Lane, Liverpool, UK
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