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Lyckegård Finn E, Parinder A, Nyman E, Dahlin LB. Complex Regional Pain Syndrome: a cross-sectional study of physical symptoms, disability, and psychological health in long term. Pain Rep 2024; 9:e1180. [PMID: 39315115 PMCID: PMC11419548 DOI: 10.1097/pr9.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 05/23/2024] [Accepted: 06/20/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction Knowledge about long-time residual symptoms, disabilities, and psychological health in complex regional pain syndrome (CRPS) is limited. Objectives The aim was to evaluate outcome, focusing on physical symptoms, disability, and psychological health, in individuals with CRPS through a cross-sectional survey study. Methods Individuals with a confirmed diagnosis of CRPS were identified through medical charts and sent validated survey forms (Disabilities of the Arm, Shoulder and Hand-Quick version, Specific Hand Surgery Questionnaire-8 questions, EuroQol 5 Dimensions 3 levels, Life Satisfaction Questionnaire-11, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and Sense of Coherence-29) and complementary questions. Results Responders (response rate: 99/238, 42%; CRPS type 1: 72%; CRPS type 2: 28%; time since diagnosis median: 59 [34-94] months) reported remaining symptoms and disability (Disabilities of the Arm, Shoulder and Hand-Quick version score: 45 [20-70]) and more improvement in type 1 than in type 2. Only 9% of individuals with CRPS reported no residual pain or discomfort. Approximately 60% had problems in daily activities, 49% had sleeping problems, and 90% experienced moderate-extreme pain with 23% still on sick leave. The Hospital Anxiety and Depression Scale survey revealed significantly higher scores than a Swedish reference population. Individuals with a low Sense of Coherence and high pain catastrophizing had worse disability and were less satisfied with their lives and physical and psychological health. A lower level of education and more anxiety were associated with worsened disability over time. Conclusion Individuals with CRPS suffer in the long term from pain, sleeping problems, and limitations in daily activities with occurrence of anxiety and depression, resulting in dissatisfaction with many aspects of their lives. A low Sense of Coherence and high pain catastrophizing are associated with a worse outcome. Biopsychosocial aspects should be addressed in clinical practice.
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Affiliation(s)
- Ellen Lyckegård Finn
- Department of Translational Medicine—Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Astrid Parinder
- Department of Translational Medicine—Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
| | - Lars. B. Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Vervullens S, Meert L, Meeus M, Heusdens CHW, Verdonk P, Foubert A, Abatih E, Durnez L, Verbrugghe J, Smeets RJEM. Application of the IASP Grading System to Identify Underlying Pain Mechanisms in Patients With Knee Osteoarthritis: A Prospective Cohort Study. Clin J Pain 2024; 40:563-577. [PMID: 39016267 PMCID: PMC11389887 DOI: 10.1097/ajp.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES This study aimed to apply the International Association for the Study of Pain (IASP) grading system for identifying nociplastic pain in knee osteoarthritis (KOA) awaiting total knee arthroplasty (TKA) and propose criteria to fine-tune decision-making. In addition, the study aimed to characterize a "probable" versus "no or possible" nociplastic pain mechanism using biopsychosocial variables and compare both groups in their 1-year post-TKA response. METHODS A secondary analysis of baseline data of a longitudinal prospective study involving 197 patients with KOA awaiting total TKA in Belgium and the Netherlands was performed. Two approaches, one considering 4 and the other 3 pain locations (step 2 of the grading system), were presented. Linear mixed model analyses were performed to compare the probable and no or possible nociplastic pain mechanism groups for several preoperative biopsychosocial-related variables and 1-year postoperative pain. Also, a sensitivity analysis, comparing 3 pain mechanism groups, was performed. RESULTS Thirty (15.22%-approach 4 pain locations) and 46 (23.35%-approach 3 pain locations) participants were categorized under probable nociplastic pain. Irrespective of the pain location approach or sensitivity analysis, the probable nociplastic pain group included more woman, was younger, exhibited worse results on various preoperative pain-related and psychological variables, and had more pain 1-year post-TKA compared with the other group. DISCUSSION This study proposed additional criteria to fine-tune the grading system for nociplastic pain (except for discrete/regional/multifocal/widespread pain) and characterized a subgroup of patients with KOA with probable nociplastic pain. Future research is warranted for further validation.
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Affiliation(s)
- Sophie Vervullens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - Christiaan H W Heusdens
- Department of Orthopedics and Traumatology, University Hospital of Antwerp, Antwerp
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk
| | - Peter Verdonk
- ORTHOCA, Antwerp, Belgium
- ASTARC Department, Antwerp University, Antwerp
| | - Anthe Foubert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-La-Neuve
| | - Emmanuel Abatih
- DASS (Center for Data Analysis and Statistical Science), Ghent University, Krijgslaan, Gent
| | - Lies Durnez
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Jonas Verbrugghe
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Jirachaipitak S, Euasobhon P, Cenpakdee S, Wangnamthip S, Rushatamukayanunt P. Intravenous Lidocaine Response as a Predictor for Oral Oxcarbazepine Efficacy in Neuropathic Pain Syndrome: A Prospective Cohort Study. Med Sci Monit 2024; 30:e945612. [PMID: 39295120 PMCID: PMC11421305 DOI: 10.12659/msm.945612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Providing pain relief for patients with neuropathic pain syndrome (NPS) is difficult, as sodium-channel blockers pose serious adverse events (AEs). Intravenous (i.v.) lidocaine infusion responses may identify patients likely to benefit from oral sodium channel blockers. We evaluated i.v. lidocaine responses to predict oral oxcarbazepine (OXC) efficacy in patients with NPS. MATERIAL AND METHODS This prospective cohort study administered one-time 3 mg/kg i.v. lidocaine infusion to patients with NPS. Numeric rating scale (NRS) pain scores and AEs were observed. Next, OXC 150 mg was prescribed; dosages were increased by 150 mg every 3 days until ≥50% pain reduction or the maximum tolerable dose or 1800 mg/day was reached. NRS, rescue drug requirements, and AEs were evaluated by phone at 1, 3, and 5 weeks and clinic visits at 2, 4, and 6 weeks. Depression, Anxiety & Stress Scales 21 (DASS-21), and EuroQol-Five Dimensions-Five Levels (EQ-5D-5L) questionnaires were assessed at baseline and in week 6. RESULTS Of 46 patients, 14 discontinued due to intolerable AEs, and 32 were in the final analysis. Average post-intervention NRS significantly decreased from 6.8±1.7 (baseline) to 3.8±2.0 (lidocaine) and 4.1±2.3 (OXC); P<0.001. Negative and positive predictive values for OXC efficacy were 76.2% (95% CI: 61.6-86.5%) and 54.5% (95% CI: 32-75.4%), respectively. Six weeks after OXC treatment, 20 and 11 patients achieved ≥30% pain reduction and ≥50% pain relief, respectively. EQ-5D-5L (P=0.018) and DASS-21 stress dimension (P<0.001) significantly improved. CONCLUSIONS Negative responses to i.v. lidocaine predicted a lack of oral OXC response. AEs of OXC may have obscured an analgesic effect.
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Affiliation(s)
- Sukunya Jirachaipitak
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pramote Euasobhon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suthanee Cenpakdee
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suratsawadee Wangnamthip
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pranee Rushatamukayanunt
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Chen R, Hu J, Zhang Y, Liu Y, Cao L, He F, Wang Q, Chen Y, Zhang S, Tang S, Min B. Sodium aescinate alleviates neuropathic pain through suppressing OGT-mediated O-GlcNAc modification of TLR3 to inactivate MAPK signaling pathway. Brain Res Bull 2024; 217:111077. [PMID: 39265741 DOI: 10.1016/j.brainresbull.2024.111077] [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: 07/01/2024] [Revised: 09/08/2024] [Accepted: 09/10/2024] [Indexed: 09/14/2024]
Abstract
Neuropathic pain results from damage to nerves or the brain, and is characterized by symptoms such as allodynia, spontaneous pain, and hyperalgesia. The causes of this type of pain are intricate, which can make it difficult to treat. Sodium aescinate (SA), a natural extract from horse chestnut tree seeds, has been shown to act as a neuroprotector by inhibiting microglia activation. This study aims to explore the therapeutic potential of SA for neuropathic pain and the molecular mechanisms regulated by SA treatment. Through in vivo animal models and experiments, we found that SA treatment significantly reduced mechanical allodynia and heat hyperalgesia in neuropathic pain models. Additionally, SA inhibited O-GlcNAc-transferase (OGT)-induced O-GlcNAcylation (O-GlcNAc) modification in neuropathic pain mice. OGT overexpression could impede the therapeutic effects of SA on neuropathic pain. Further investigation revealed that Toll-like receptor 3 (TLR3), stabilized by OGT-induced O-GlcNAc modification, could activate the Mitogen activated protein kinase (MAPK) signaling pathway. Further in vivo experiments demonstrated that TLR3-mediated p38 mitogen-activated protein kinase (p38MAPK) activation is involved in SA-mediated relief of neuropathic pain. In conclusion, this study uncovers a novel molecular pathway deactivated by SA treatment in neuropathic pain.
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Affiliation(s)
- Rong Chen
- Department of Pain, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, China
| | - Jiantao Hu
- Department of Respiratory Medicine, Bijie City Qixingguan District People's Hospital, Bijie, Guizhou 551700, China
| | - Yang Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, China
| | - Yang Liu
- Department of Orthopedics, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, China
| | - Liujian Cao
- Department of Anorectal Surgery, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, China
| | - Fan He
- Department of Oncology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, China
| | - Qin Wang
- Department of Rheumatology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, China
| | - Ying Chen
- Department of Anesthesiology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, China
| | - Shengwei Zhang
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, China.
| | - Songjiang Tang
- Department of Anesthesiology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, China
| | - Baojun Min
- Department of Anesthesiology, Qianxi People's Hospital, Bijie, Guizhou 551500, China.
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Zhou JZ, Deng J, Luo DX, Mai JW, Wu JY, Duan YJ, Dong B, Xin WJ, Xu T, Wei JY. Sex differences in functional and structural alterations of hippocampus region in chronic pain: a DTI and resting-state fMRI study. Front Neurosci 2024; 18:1428666. [PMID: 39308951 PMCID: PMC11412943 DOI: 10.3389/fnins.2024.1428666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/15/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction It is well known that there are significant differences in the prevalence of chronic pain between males and females. Human and animal imaging studies have shown that chronic pain profoundly alters the structure and function of brain regions. However, there is limited research on the sex-specific mechanisms underlying the brain plasticity and adaptive changes associated with chronic pain. In this article, we conducted a multimodal study to evaluate how nerve injury-induced chronic pain affects the brain. Methods Male and female Sprague-Dawley (SD) rats with spared nerve injury (SNI) model underwent resting-state functional magnetic resonance imaging (rs-fMRI) (male sham group: n = 18; male SNI group: n = 18; female sham group: n = 20; female SNI group: n = 18) and magnetic resonance diffusion tensor imaging (DTI) (male sham group: n = 23; male SNI group: n = 21; female sham group: n = 20; female SNI group: n = 21) scanning. ICA method, Fractional amplitude of low-frequency fluctuations (fALFF), immunofluorescence staining, and graph theory analysis was utilized to extract the rs-fMRI changes of brain regions of each group. Results Using SNI model, which promotes long-lasting mechanical allodynia, we found that neuropathic pain deeply modified the intrinsic organization of the brain functional network in male and female rats (main effect of operation: F = 298.449, P < 0.001). 64 independent components (ICs) in the brain were divided and assigned to 16 systems. In male rats, we observed significant alterations in the microstructure of the hippocampal cornu ammonis 1 and cornu ammonis 2 (CA1/CA2) region, as indicated by increased mean diffusivity (MD) (CA1_L: P = 0.02; CA1_R: P = 0.031; CA2_L: P = 0.035; CA2_R: P = 0.015) and radial diffusivity (RD) (CA1_L: P = 0.028; CA1_R: P = 0.033; CA2_L: P = 0.037; CA2_R: P = 0.038) values, along with enhanced activating transcription factor 3 (ATF3) expression. Conversely, in female rats, we found significant increases in the fractional amplitude of low frequency fluctuations (fALFF) value within the hippocampal dentate gyrus (DG) (F = 5.419, P = 0.023), accompanied by elevated c-Fos signal (F = 6.269, P = 0.031). Furthermore, graph theory analysis revealed notable differences in the small-world network of the hippocampal system in female rats, characterized by reduced small-world attributes and increased inter-nodal transmission efficiency. Discussion Our study indicates sex differences in structural and functional alterations in the hippocampal system in rats under chronic pain conditions. The results suggest that the hippocampus system plays an important role in the different mechanisms of chronic pain in different sexes. These findings provide reliable insights to explore the complex mechanisms underlying sex differences in chronic pain.
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Affiliation(s)
- Jun-Zhi Zhou
- Center for Infection and Immunity and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
- Neuroscience Program, Zhongshan School of Medicine, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-sen University, Guangzhou, China
| | - Jie Deng
- Center for Infection and Immunity and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
- Neuroscience Program, Zhongshan School of Medicine, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-sen University, Guangzhou, China
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - De-Xing Luo
- Department of Anesthesiology, Huizhou Central People’s Hospital, Huizhou, China
| | - Jing-Wen Mai
- Department of Anesthesiology, Huizhou Central People’s Hospital, Huizhou, China
| | - Jia-Yan Wu
- Neuroscience Program, Zhongshan School of Medicine, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-sen University, Guangzhou, China
| | - Yu-Juan Duan
- Neuroscience Program, Zhongshan School of Medicine, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-sen University, Guangzhou, China
| | - Bo Dong
- Neuroscience Program, Zhongshan School of Medicine, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-sen University, Guangzhou, China
| | - Wen-Jun Xin
- Center for Infection and Immunity and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
- Neuroscience Program, Zhongshan School of Medicine, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-sen University, Guangzhou, China
- Guangdong-Hong Kong-Macao University Joint Laboratory of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Ting Xu
- Center for Infection and Immunity and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
- Neuroscience Program, Zhongshan School of Medicine, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-sen University, Guangzhou, China
- Guangdong-Hong Kong-Macao University Joint Laboratory of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Jia-You Wei
- Center for Infection and Immunity and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Zhuhai, China
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Koechlin H, Locher C, Barke A, Korwisi B. Retrospective identification of the diagnosis of chronic primary musculoskeletal pain: a pragmatic suggestion by The Pain Net. Pain 2024:00006396-990000000-00690. [PMID: 39172815 DOI: 10.1097/j.pain.0000000000003380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/07/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Helen Koechlin
- Department of Psychosomatics and Psychiatry, University Children's Hospital, University of Zurich, Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonia Barke
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University Duisburg-Essen, Essen, Germany
| | - Beatrice Korwisi
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University Duisburg-Essen, Essen, Germany
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Lemos MD, Barbosa LM, Andrade DCD, Lucato LT. Contributions of neuroimaging in central poststroke pain: a review. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-11. [PMID: 39216489 DOI: 10.1055/s-0044-1789225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Central neuropathic poststroke pain (CNPSP) affects up to 12% of patients with stroke in general and up to 18% of patients with sensory deficits. This pain syndrome is often incapacitating and refractory to treatment. Brain computed tomography and magnetic resonance imaging (MRI) are widely used methods in the evaluation of CNPSP. OBJECTIVE The present study aims to review the role of neuroimaging methods in CNPSP. METHODS We performed a literature review of the main clinical aspects of CNPSP and the contribution of neuroimaging methods to study its pathophysiology, commonly damaged brain sites, and possible differential diagnoses. Lastly, we briefly mention how neuroimaging can contribute to the non-pharmacological CNPSP treatment. Additionally, we used a series of MRI from our institution to illustrate this review. RESULTS Imaging has been used to explain CNPSP pathogenesis based on spinothalamic pathway damage and connectome dysfunction. Imaging locations associated with CNPSP include the brainstem (mainly the dorsolateral medulla), thalamus (especially the ventral posterolateral/ventral posteromedial nuclei), cortical areas such as the posterior insula and the parietal operculum, and, more recently, the thalamocortical white matter in the posterior limb of the internal capsule. Imaging also brings the prospect of helping search for new targets for non-pharmacological treatments for CNPSP. Other neuropathic pain causes identified by imaging include syringomyelia, multiple sclerosis, and herniated intervertebral disc. CONCLUSION Imaging is a valuable tool in the complimentary evaluation of CNPSP patients in clinical and research scenarios.
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Affiliation(s)
- Marcelo Delboni Lemos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia, São Paulo SP, Brazil
| | - Luciana Mendonça Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Daniel Ciampi de Andrade
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Leandro Tavares Lucato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia, São Paulo SP, Brazil
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Braffett BH, El ghormli L, Albers JW, Feldman EL, Herman WH, Gubitosi-Klug RA, Martin CL, Orchard TJ, White NH, Lachin JM, Perkins BA, Pop-Busui R. Neuropathic Pain With and Without Diabetic Peripheral Neuropathy in Type 1 Diabetes. Diabetes Care 2024; 47:1559-1567. [PMID: 38300889 PMCID: PMC11362121 DOI: 10.2337/dc23-1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/08/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Diabetic peripheral neuropathy (DPN) is common; however, the features and burden of neuropathic pain (NP) in type 1 diabetes (T1D) are poorly understood. We evaluated the incidence of first occurrence, annual prevalence, remission, and risk factors for NP during long-term follow-up of participants with T1D. RESEARCH DESIGN AND METHODS The Michigan Neuropathy Screening Instrument (MNSI) was administered annually (1994-2020) for 1,324 participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. NP with clinical signs of DPN (NP DPN+) was defined according to self-reported NP plus an examination score >2, while NP without clinical signs of DPN (NP DPN-) was defined according to self-reported NP and an examination score ≤2. RESULTS At EDIC year 1, median age for participants was 36 years (interquartile range 30, 41), diabetes duration 13 years (10, 18), and HbA1c 7.9% (7.2, 8.9). At year 26 (median diabetes duration 39 years), cumulative incidence of NP was 57%, regardless of concomitant clinical signs of DPN (36% NP DPN+ vs. 46% NP DPN-). NP prevalence was 20% at 26 years (11% NP DPN+ and 9% NP DPN-), suggesting frequent remission. Annualized remission rates were similar regardless of pain medication use. In addition to HbA1c, female sex was associated with NP DPN-. CONCLUSIONS NP incidence in T1D was high and frequently occurred in the absence of clinical signs of neuropathy, as assessed with the MNSI. Pain remission was not explained by pain medication use. Effective clinical strategies for identification and management are needed.
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Affiliation(s)
| | - Laure El ghormli
- Biostatistics Center, The George Washington University, Rockville, MD
| | | | | | | | - Rose A. Gubitosi-Klug
- Case Western Reserve University, Rainbow Babies and Children’s Hospital, Cleveland, OH
| | | | | | - Neil H. White
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - John M. Lachin
- Biostatistics Center, The George Washington University, Rockville, MD
| | - Bruce A. Perkins
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Brezic N, Gligorevic S, Candido KD, Knezevic NN. Assessing suicide risk in chronic pain management: a narrative review across drug classes. Expert Opin Drug Saf 2024; 23:1135-1155. [PMID: 39126380 DOI: 10.1080/14740338.2024.2391999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/28/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Chronic pain presents a multifaceted challenge in clinical practice, necessitating a nuanced understanding of pharmacological interventions to optimize treatment outcomes. This review provides an outline of various pharmacological agents commonly used in chronic pain management and highlights their safety considerations, particularly regarding suicide risk. AREAS COVERED This review discusses the role of antidepressants, anticonvulsants, GABA receptor agonists, NMDA receptor antagonists, corticosteroids, cannabis and cannabinoids, bisphosphonates, calcitonin, and alpha-2 adrenergic receptor agonists in chronic pain management. It assesses their therapeutic benefits, potential for misuse, and psychiatric adverse effects, including the risk of suicide. Each pharmacological class is evaluated in terms of its efficacy, safety profile, and considerations for clinical practice. We searched peer-reviewed English literature on the topic using the MEDLINE database without time restrictions. EXPERT OPINION While pharmacological interventions offer promise in alleviating chronic pain, healthcare providers must carefully weigh their benefits against potential risks, including the risk of exacerbating psychiatric symptoms and increasing suicide risk. Individualized treatment approaches, close monitoring, and multidisciplinary collaboration are essential for optimizing pain management strategies while mitigating adverse effects. Ongoing research efforts are crucial for advancing our understanding of these pharmacological interventions and refining pain management practices.
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Affiliation(s)
- Nebojsa Brezic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
| | - Strahinja Gligorevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
| | - Kenneth D Candido
- Department of Anesthesiology, University of Illinois, Chicago, IL, USA
- Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Nebojsa Nick Knezevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
- Department of Anesthesiology, University of Illinois, Chicago, IL, USA
- Department of Surgery, University of Illinois, Chicago, IL, USA
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Mills EP, Bosma RL, Rogachov A, Cheng JC, Osborne NR, Kim JA, Besik A, Bhatia A, Davis KD. Pretreatment Brain White Matter Integrity Associated With Neuropathic Pain Relief and Changes in Temporal Summation of Pain Following Ketamine. THE JOURNAL OF PAIN 2024; 25:104536. [PMID: 38615801 DOI: 10.1016/j.jpain.2024.104536] [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: 11/17/2023] [Revised: 03/07/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
Neuropathic pain (NP) is a prevalent condition often associated with heightened pain responsiveness suggestive of central sensitization. Neuroimaging biomarkers of treatment outcomes may help develop personalized treatment strategies, but white matter (WM) properties have been underexplored for this purpose. Here we assessed whether WM pathways of the default mode network (DMN: medial prefrontal cortex [mPFC], posterior cingulate cortex, and precuneus) and descending pain modulation system (periaqueductal gray [PAG]) are associated with ketamine analgesia and attenuated temporal summation of pain (TSP, reflecting central sensitization) in NP. We used a fixel-based analysis of diffusion-weighted imaging data to evaluate WM microstructure (fiber density [FD]) and macrostructure (fiber bundle cross-section) within the DMN and mPFC-PAG pathways in 70 individuals who underwent magnetic resonance imaging and TSP testing; 35 with NP who underwent ketamine treatment and 35 age- and sex-matched pain-free individuals. Individuals with NP were assessed before and 1 month after treatment; those with ≥30% pain relief were considered responders (n = 18), or otherwise as nonresponders (n = 17). We found that WM structure within the DMN and mPFC-PAG pathways did not differentiate responders from nonresponders. However, pretreatment FD in the anterior limb of the internal capsule correlated with pain relief (r=.48). Moreover, pretreatment FD in the DMN (left mPFC-precuneus/posterior cingulate cortex; r=.52) and mPFC-PAG (r=.42) negatively correlated with changes in TSP. This suggests that WM microstructure in the DMN and mPFC-PAG pathway is associated with the degree to which ketamine reduces central sensitization. Thus, fixel metrics of WM structure may hold promise to predict ketamine NP treatment outcomes. PERSPECTIVE: We used advanced fixel-based analyses of MRI diffusion-weighted imaging data to identify pretreatment WM microstructure associated with ketamine outcomes, including analgesia and markers of attenuated central sensitization. Exploring associations between brain structure and treatment outcomes could contribute to a personalized approach to treatment for individuals with NP.
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Affiliation(s)
- Emily P Mills
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Rachael L Bosma
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Anton Rogachov
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Joshua C Cheng
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Natalie R Osborne
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Junseok A Kim
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ariana Besik
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Anuj Bhatia
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Karen D Davis
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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11
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Hernando-Garijo I, Medrano-de-la-Fuente R, Mingo-Gómez MT, Lahuerta Martín S, Ceballos-Laita L, Jiménez-Del-Barrio S. Effects of exercise therapy on diabetic neuropathy: A systematic review and meta-analysis. Physiother Theory Pract 2024; 40:2116-2129. [PMID: 37341684 DOI: 10.1080/09593985.2023.2227975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE To evaluate the effects of exercise therapy on neuropathic symptoms, signs, psychosocial aspects, and physical function in people with diabetic neuropathy (DN). METHODS A search in PubMed, Web of Science, Physiotherapy Evidence (PEDro), and Cochrane databases was performed from inception to Invalid Date NaN, . Randomized clinical trials (RCTs) were selected in patients with DN comparing exercise therapy with a control group. The studies' methodological quality was assessed with the PEDro scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the overall quality. RESULTS Eleven RCTs (n = 517 participants) were included. Nine studies showed high methodological quality. Mean (MD) and standardized mean differences (SMD) were observed in favor of exercise therapy for symptoms (MD = -1.05; confidence interval 95% = -1.90 to -0.20), signs (SMD = -0.66; confidence interval 95%= -1 to -0.32), and physical function (SMD = -0.45; confidence interval 95% = -0.66 to -0.24). No changes were found in psychosocial aspects (SMD = -0.37; confidence interval 95% = -0.92 to 0.18). The overall quality of evidence was very low. CONCLUSION The quality of evidence suggesting that exercise therapy provides short-term benefits in neuropathic symptoms, signs, and physical function in patients with DN is very low. Furthermore, there were no effects found on psychosocial aspects.
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Affiliation(s)
- Ignacio Hernando-Garijo
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
| | - Ricardo Medrano-de-la-Fuente
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
| | - María Teresa Mingo-Gómez
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
| | | | - Luis Ceballos-Laita
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
| | - Sandra Jiménez-Del-Barrio
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
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12
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Galosi E, Pirone C, Ceccarelli F, Esposito N, Falco P, Leopizzi M, Di Maio V, Tramontana L, De Stefano G, Di Pietro G, Di Stefano G, Garufi C, Leone C, Natalucci F, Orefice V, Alessandri C, Spinelli FR, Truini A, Conti F. Clinical, histologic, and immunologic signatures of Small Fiber Neuropathy in Systemic Lupus Erythematosus. J Peripher Nerv Syst 2024; 29:315-328. [PMID: 38981675 DOI: 10.1111/jns.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND AND OBJECTIVES Systemic Lupus Erythematosus (SLE) often causes damage to small nerve fibers, leading to distressing painful and autonomic symptoms. Despite this, Small Fiber Neuropathy (SFN) remains an underrecognized complication for SLE patients. In this cross-sectional study, we aimed to assess SFN in patients with SLE and to explore its correlations with immunologic disease features and clinical manifestations. METHODS We recruited 50 SLE patients (1 male to 12.5 females, aged 20-80 years) reporting painful disturbances. We conducted a comprehensive clinical and neurophysiological evaluation, using Nerve Conduction Studies and Quantitative Sensory Testing. Additionally, we carried out an extensive laboratory assessment of disease-related serological parameters. We also performed a thorough skin biopsy analysis, investigating somatic and autonomic innervation while detecting complement and inflammatory cell infiltrates within the skin. RESULTS Out of 50 patients, 19 were diagnosed with SFN, primarily characterized by a non-length-dependent distribution; 7 had a mixed neuropathy, with both large and small fiber involvement. Patients with SFN were younger than patients with a mixed neuropathy (p = .0143); furthermore, they were more likely to have a history of hypocomplementemia (p = .0058) and to be treated with cyclosporine A (p = .0053) compared to patients without neuropathy. However, there were no significant differences in painful and autonomic symptoms between patients with and without SFN. DISCUSSION This study highlights the relevant frequency of SFN with a non-length-dependent distribution among SLE patients experiencing painful symptoms. Indeed, SFN emerges as an early manifestation of SLE-related neuropathy and is closely associated with hypocomplementemia, suggesting a potential pathogenic role of the complement system. Moreover, SFN may be influenced by disease-modifying therapies. However, the precise role of SFN in shaping painful and autonomic symptoms in patients with SLE remains to be fully elucidated.
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Affiliation(s)
- Eleonora Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Carmelo Pirone
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Fulvia Ceccarelli
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Nicoletta Esposito
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Pietro Falco
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Martina Leopizzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Valeria Di Maio
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Lorenzo Tramontana
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Giuseppe Di Pietro
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giulia Di Stefano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Cristina Garufi
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Caterina Leone
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Francesco Natalucci
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Valeria Orefice
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Cristiano Alessandri
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Francesca Romana Spinelli
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Lupus Clinic, Rheumatology, Sapienza Università di Roma, Rome, Italy
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13
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Schmidt H, Drusko A, Renz MP, Schlömp L, Tost H, Schuh-Hofer S, Tesarz J, Meyer-Lindenberg A, Treede RD. Application of the grading system for "nociplastic pain" in chronic primary and chronic secondary pain conditions: a field study. Pain 2024:00006396-990000000-00695. [PMID: 39190340 DOI: 10.1097/j.pain.0000000000003355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 06/15/2024] [Indexed: 08/28/2024]
Abstract
ABSTRACT The concept "nociplastic pain" has been developed for patients with features of nociceptive system sensitization that are not explained as nociceptive or neuropathic. Here, we tested how well the recently published grading system differentiates between chronic primary and secondary pain conditions. We recruited patients with fibromyalgia (FMS, n = 41), complex regional pain syndrome (CRPS, n = 11), osteoarthritis (OA, n = 21), or peripheral nerve injury (PNI, n = 8). We used clinical history, pain drawings, quantitative sensory testing (QST), and questionnaires to classify their pains as possibly or probably "nociplastic." All patients with chronic primary pain exhibited widespread/regional pain not explainable by either nociceptive or neuropathic mechanisms. Widespread pain occurred in 12 patients with OA but was identified as nociceptive in 11 of 12. Regional pain occurred in 4 patients with PNI but was identified as neuropathic in 3 of 4. At this step, the grading system had 100% sensitivity and 93% specificity. Clinical evidence for pain hypersensitivity by QST, and history of hypersensitivity and mental comorbidities did not differentiate between chronic primary pain (QST: 36/52 = 69%, history: 43/52 = 83%) and secondary pain conditions (QST: 20/29 = 69%, history: 24/29 83%). Based on these data, specificity remained excellent (93%), but sensitivity dropped substantially (60%) due to lacking evidence for pain hypersensitivity in many patients with FMS. This low sensitivity suggests that the published grading system is not suitable for screening purposes. We suggest structural and content modifications to improve sensitivity, including placement of patient history before clinical examination and addition of a high tender point count as evidence for widespread pain hypersensitivity.
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Affiliation(s)
- Hannah Schmidt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Neurophysiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Armin Drusko
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Malika Pia Renz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lea Schlömp
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sigrid Schuh-Hofer
- Department of Neurophysiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Neurology, University Medical Center Tübingen, Tübingen, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rolf-Detlef Treede
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Neurophysiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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14
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Ninneman JV, Roberge GA, Stegner AJ, Cook DB. Exercise Training for Chronic Pain: Available Evidence, Current Recommendations, and Potential Mechanisms. Curr Top Behav Neurosci 2024. [PMID: 39120812 DOI: 10.1007/7854_2024_504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Chronic pain conditions pose a significant global burden of disability, with epidemiological data indicating a rising incidence. Exercise training is commonly recommended as a standalone or complementary approach for managing various chronic pain conditions like low back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia syndrome, and neuropathic pain. Regardless of the specific condition or underlying cause (e.g., autoimmune disease, chronic inflammation), exercise training consistently leads to moderate to large reductions in pain. Moreover, exercise yields numerous benefits beyond pain alleviation, including small-to-moderate improvements in disability, quality of life, and physical function. Despite its efficacy, there is a lack of comprehensive research delineating the optimal intensity, duration, and type of exercise for maximal benefits; however, evidence suggests that sustained engagement in regular exercise or physical activity is necessary to achieve and maintain reductions in both clinical pain intensity ratings and the level that pain interferes with activities of daily living. Additionally, the precise mechanisms through which exercise mitigates pain remain poorly understood and likely vary based on the pathophysiological mechanisms underlying each condition.
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Affiliation(s)
- Jacob V Ninneman
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gunnar A Roberge
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron J Stegner
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Dane B Cook
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
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15
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Sallomy C, Awolade P, Rahnasto-Rilla M, Hämäläinen M, Nousiainen LP, Johansson NG, Hiltunen S, Turhanen P, Moilanen E, Lahtela-Kakkonen M, Timonen JM. TRPA1 Inhibition Effects by 3-Phenylcoumarin Derivatives. ACS Med Chem Lett 2024; 15:1221-1226. [PMID: 39140042 PMCID: PMC11318103 DOI: 10.1021/acsmedchemlett.4c00072] [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: 02/08/2024] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 08/15/2024] Open
Abstract
Transient receptor potential ankyrin 1 (TRPA1) protein plays an important role in the inflammatory response, and it has been associated with different pain conditions and pain-related diseases, making TRPA1 a valid target for painkillers. In this study, we identified potential TRPA1 inhibitors and located their binding sites utilizing computer-aided drug design (CADD) techniques. The designed 3-phenylcoumarin-based TRPA1 inhibitors were successfully synthesized using a microwave assisted synthetic strategy. 3-(3-Bromophenyl)-7-acetoxycoumarin (5), 7-hydroxy-3-(3-hydroxyphenyl)coumarin (12) and 3-(3-hydroxyphenyl)coumarin (23) all showed inhibitory activity toward TRPA1 in vitro. Compound 5 also decreased the size and formation of breast cancer cells. Hence, targeting TRPA1 may represent a promising alternative for the treatment of pain and inflammation.
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Affiliation(s)
- Carita Sallomy
- School
of Pharmacy, University of Eastern Finland, Kuopio 70211, Finland
| | - Paul Awolade
- School
of Chemistry and Physics, University of
KwaZulu-Natal, P/Bag X54001, Westville, Durban 4041, South Africa
| | | | - Mari Hämäläinen
- Faculty
of Medicine and Health Technology, Tampere
University and Tampere University Hospital, Tampere 33520, Finland
| | - Liisa P. Nousiainen
- Institute
of Biomedicine, Faculty of Health Sciences,
University of Eastern Finland, Kuopio 70211, Finland
| | - Niklas G. Johansson
- Drug
Research Program, Division of Pharmaceutical Chemistry and Technology,
Faculty of Pharmacy, University of Helsinki, Helsinki 00014, Finland
| | - Sanna Hiltunen
- School
of Pharmacy, University of Eastern Finland, Kuopio 70211, Finland
| | - Petri Turhanen
- School
of Pharmacy, University of Eastern Finland, Kuopio 70211, Finland
| | - Eeva Moilanen
- Faculty
of Medicine and Health Technology, Tampere
University and Tampere University Hospital, Tampere 33520, Finland
| | | | - Juri M. Timonen
- School
of Pharmacy, University of Eastern Finland, Kuopio 70211, Finland
- Drug
Research Program, Division of Pharmaceutical Chemistry and Technology,
Faculty of Pharmacy, University of Helsinki, Helsinki 00014, Finland
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16
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Bäckryd E, Ghafouri N, Gerdle B, Dragioti E. Rehabilitation interventions for neuropathic pain: a systematic review and meta-analysis of randomized controlled trials. J Rehabil Med 2024; 56:jrm40188. [PMID: 39101676 PMCID: PMC11318642 DOI: 10.2340/jrm.v56.40188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVE Rehabilitation interventions for chronic pain typically include education, cognitive behavioural therapy, and exercise therapy, or a combination of these. A systematic review and meta-analysis of rehabilitation interventions for neuropathic pain was conducted. DESIGN Randomized controlled trials were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and PsycINFO databases from inception up to 3 March 2022. SUBJECTS/PATIENTS Adults with chronic (> 3 months) neuropathic pain. METHODS Primary outcomes were pain intensity, pain-related disability, and work participation. Secondary outcomes were quality of life, emotional strain, insomnia, and adverse outcomes, according to VAPAIN guidelines. Analyses were made post-intervention, which was defined as the assessment point immediately following the intervention or at the first-time measurement conducted after the intervention period. RESULTS In total, 15 studies (total population, n = 764) were incorporated. Most common interventions were cognitive behavioural programmes including acceptance and commitment therapy (n = 4), mindfulness-based interventions (n = 5), and yoga (n = 2). Psychological interventions reduced both pain intensity (SMD -0.49, 95% CI -0.88 to -0.10) and pain-related disability (SMD -0.51, 95% CI -0.98 to -0.03), whereas other interventions had an effect on pain intensity but not on pain-related disability. CONCLUSION Rehabilitation interventions, and psychological interventions in particular, seem to be of value for patients with chronic neuropathic pain.
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Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Nazdar Ghafouri
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Tesfaye S, Saravanan P, Ehler E, Zinek K, Palka-Kisielowska I, Nastaj M, Serusclat P, Lipone P, Vergallo A, Quarchioni E, Calisti F, Comandini A, Cattaneo A. Efficacy and Safety of Trazodone and Gabapentin Fixed-Dose Combination in Patients Affected by Painful Diabetic Neuropathy: Randomized, Controlled, Dose-Finding Study. Pain Ther 2024; 13:987-1006. [PMID: 38914876 PMCID: PMC11255147 DOI: 10.1007/s40122-024-00624-3] [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: 05/01/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Up to 50% of diabetic patients with neuropathy suffer from chronic pain, namely painful diabetic neuropathy (PDN), an unmet medical need with significant impact on quality of life. Gabapentin is widely used for PDN, albeit with frequent dose-limiting effects. Trazodone, an antidepressant with multi-modal action, has shown promising results when given at low doses as an add-on to gabapentin. Upon previous clinical trials and experimental evidence, a fixed-dose combination (FDC) of both compounds, at low doses, was developed for neuropathic pain. METHODS This was a phase II, randomized, double-blind, placebo and reference controlled, dose-finding, multicenter, international, prospective study. Male and female diabetic patients aged 18-75 years and affected by PDN were eligible for enrolment. Patients were randomized (1:1:1:1:2 ratio) to trazodone and gabapentin (Trazo/Gaba) 2.5/25 mg t.i.d. for 8 weeks, Trazo/Gaba 5/50 mg t.i.d. for 8 weeks, Trazo/Gaba 10/100 mg t.i.d. for 8 weeks, gabapentin (Gaba), or placebo (PLB). The aim of the study was to collect preliminary information on the effect of the 3 different FDCs of Trazo/Gaba on pain intensity based on the 11-point numeric rating score (NRS) after 8 weeks of treatment. The secondary objectives were the evaluation of the percentage of responders, neuropathic pain symptoms, anxiety, sleep, quality of life, safety, and tolerability. The primary efficacy endpoint was evaluated with last observation carried out forward (LOCF), using an analysis of covariance (ANCOVA), including treatment and centers as factors and baseline as covariate and applying linear contrast test, excluding the active treatment. Only if the linear contrast test was significant (p < 0.05), the step-down Dunnett test would be used to determine the minimum effective dose significantly different from PLB. If linearity was not verified, an adjusted ANCOVA model and comparisons with Dunnett test were performed. Before the application of the ANCOVA model, the non-significance of interaction treatment per baseline was verified. RESULTS A total of 240 patients were included in the modified intention-to-treat (m-ITT) population: 39 in Trazo/Gaba 2.5/25 mg, 38 in Trazo/Gaba 5/50 mg, 37 in Trazo/Gaba 10/100 mg, 83 in PLB, and 43 in Gaba. After 8 weeks of treatment, changes of the average daily pain score based on the 11-point NRS from baseline were - 2.52 ± 2.31 in Trazo/Gaba 2.5/25 mg group, - 2.24 ± 1.96 in Trazo/Gaba 5/50 mg group, - 2.46 ± 2.12 in Trazo/Gaba 10/100 mg group, - 1.92 ± 2.21 in Gaba group, and - 2.02 ± 1.95 in the PLB group. The linear contrast test did not result in significant differences (p > 0.05) among treatment groups. Consequently, the minimum effective dose against PLB was not determined. The multiple comparison with Dunnett adjustment did not show any statistically significant differences vs. PLB after 8 weeks of treatment: Trazo/Gaba 2.5/25 mg (95% confidence interval (CI) - 1.2739, 0.2026; p = 0.1539); Trazo/Gaba 5/50 mg (95% CI - 0.9401, 0.5390; p = 0.5931); Trazo/Gaba 10/100 mg (95% CI - 1.0342, 0.4582; p = 0.4471). However, patients receiving the lowest dose of Trazo/Gaba 2.5/25 mg showed a statistically significant difference to PLB after 6 weeks of treatment (95% CI - 1.6648, - 0.2126; p = 0.0116). Positive results were also found for responder patients, other items related to the pain, anxiety, depression, sleep, and quality of life, consistently in favor to the lowest Trazo/Gaba FDC. Two serious adverse events (SAEs) occurred but were judged unrelated to the study treatment. Treatment-emergent adverse events (TEAEs) were mainly mild-to-moderate in intensity and involved primarily nervous system, gastrointestinal disorders, and investigations. CONCLUSIONS The primary end point of the study was the change from baseline of the average daily pain score based on the 11-point NRS after 8 weeks of treatment. While the primary endpoint was not reached, patients treated with Trazo/Gaba 2.5/25 mg t.i.d. showed statistically significant improvement of pain and other scores after 6 weeks and reported consistent better results in comparison to PLB on primary and secondary endpoints for the overall study duration. According to these results, the lowest dose of Trazo/Gaba FDC may be the best candidate for further clinical development to confirm the potential benefits of the FDC drug for this condition. CLINICAL TRIAL REGISTRATION NCT03749642.
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Affiliation(s)
- Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ponnusamy Saravanan
- Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital NHS Trust, Nuneaton, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Edvard Ehler
- Department of Neurology, Regional Hospital Pardubice, Pardubice, Czech Republic
| | - Karel Zinek
- Neurosanatio s.r.o., Litomyšl, Czech Republic
| | | | | | - Pierre Serusclat
- Departement d'Endocrinologie, Centre de Recherche Clinique, G.H.M les Portes du Sud, Venissieux, France
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Adam F, Chatellier G, Alfonsi P. Assessment of the concordance between DN4 scores performed by the patient (self-assessment) or by the physician (hetero-assessment) to detect subacute neuropathic postoperative pain. Eur J Pain 2024; 28:1095-1100. [PMID: 38243671 DOI: 10.1002/ejp.2241] [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: 06/20/2023] [Revised: 12/26/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Centres dedicated to chronic postsurgical pain (CPSP) have been developed, but delays for accessing to it are generally long. Teleconsultation might be a means to facilitate access to care by allowing an initial triage. CPSPs are neuropathic pain in around half of the cases and their diagnosis is mainly based on the score obtained from validated questionnaires. Among them, those requiring a neurological examination (i.e. the Douleur Neuropathique en 4 questions [DN4]) have a better sensitivity and specificity, and should be preferred. However, effectiveness of a remote neurological examination remains to be established. The aim of this observational study is to check during a face-to-face consultation if, after a short training, a naïve patient is capable to self-assess the clinical signs of neuropathic sensations. METHODS Thirty patients with suspected neuropathic pain were seen in a face-to-face postoperative pain consultation. Before examination, the patient was instructed to fill the DN4 questionnaire, including the neurological examination. Once explanations were given and checked, the patient was left and completed it alone. Then, the pain physician performed the DN4 questionnaire. Inter-rater reliability between patient and pain physician was assessed for each item and for DN4 score with the Kappa coefficient. RESULTS For each item of the DN4 questionnaire, Kappa coefficients were between 0.74 and 1, and could be considered as excellent. For DN4 ≥ 4, the Kappa coefficient was 0.86. CONCLUSIONS Our results suggest that after a short training, a naïve patient is capable of recognizing and diagnosing symptoms of neuropathic pain. SIGNIFICANCE Our results suggest that self-assessment, carried out after brief training and using a simple tool, provides results comparable to those obtained by a specialist physician to diagnose symptoms of neuropathic pain. If the results of the current study are confirmed on a larger scale, self-assessment will help improve access to specialized chronic pain care by better orienting patients and opening up access to teleconsultations.
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Affiliation(s)
- Frédéric Adam
- Department of Anesthesiology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Gilles Chatellier
- Clinical Research Unit, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Pascal Alfonsi
- Department of Anesthesiology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Canlı K, Van Oijen J, Van Oosterwijck J, Meeus M, Van Oosterwijck S, De Meulemeester K. Influence of sensory retraining on cortical reorganization in peripheral neuropathy: A systematic review. PM R 2024; 16:888-907. [PMID: 38155585 DOI: 10.1002/pmrj.13126] [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: 07/27/2023] [Revised: 11/19/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE This study systematically reviewed the literature about sensory retraining effect in comparison to other rehabilitative techniques on cortical reorganization in patients with peripheral neuropathic pain. TYPE: Systematic review. LITERATURE SURVEY After an electronic search of PubMed, Web of Science, and Embase, risk of bias was assessed using the revised Cochrane risk of bias tool for randomized controlled trials and the ROBINS-1 (Risk of bias in non-randomized studies-of interventions) for non-randomized studies of intervention. METHODOLOGY The strength of conclusion was determined using the evidence-based guideline development approach. SYNTHESIS Limited evidence indicates a higher increase in cortical inhibition and a higher reduction in cortical activation during a motor task of the affected hemisphere after graded motor imagery compared to wait-list. Higher reductions in map volume (total excitability of the cortical representation) of the affected hemisphere after peripheral electrical stimulation (PES) were observed when compared to transcranial direct current stimulation (tDCS) or to sham treatment with limited evidence. No other differences in cortical excitability and representation of the affected and non-affected hemisphere were observed when comparing mirror therapy with sham therapy or tDCS, PES with sham therapy or tDCS, and graded motor imagery with wait-list. CONCLUSIONS Graded motor imagery and PES result in higher cortical excitability reductions of the affected hemisphere compared to wait-list, tDCS and sham treatment, respectively.
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Affiliation(s)
- Kübra Canlı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Joris Van Oijen
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
| | - Jessica Van Oosterwijck
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerpen, Belgium
| | - Sophie Van Oosterwijck
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Kayleigh De Meulemeester
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
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20
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Pinilla-Fernández I, Ríos-León M, Deelchand DK, Garrido L, Torres-Llacsa M, García-García F, Vidorreta M, Ip IB, Bridge H, Taylor J, Barriga-Martín A. Chronic neuropathic pain components in whiplash-associated disorders correlate with metabolite concentrations in the anterior cingulate and dorsolateral prefrontal cortex: a consensus-driven MRS re-examination. Front Med (Lausanne) 2024; 11:1404939. [PMID: 39156690 PMCID: PMC11328873 DOI: 10.3389/fmed.2024.1404939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/12/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Whiplash injury (WHI) is characterised by a forced neck flexion/extension, which frequently occurs after motor vehicle collisions. Previous studies characterising differences in brain metabolite concentrations and correlations with neuropathic pain (NP) components with chronic whiplash-associated disorders (WAD) have been demonstrated in affective pain-processing areas such as the anterior cingulate cortex (ACC). However, the detection of a difference in metabolite concentrations within these cortical areas with chronic WAD pain has been elusive. In this study, single-voxel magnetic resonance spectroscopy (MRS), following the latest MRSinMRS consensus group guidelines, was performed in the anterior cingulate cortex (ACC), left dorsolateral prefrontal cortex (DLPFC), and occipital cortex (OCC) to quantify differences in metabolite concentrations in individuals with chronic WAD with or without neuropathic pain (NP) components. Materials and methods Healthy individuals (n = 29) and participants with chronic WAD (n = 29) were screened with the Douleur Neuropathique 4 Questionnaire (DN4) and divided into groups without (WAD-noNP, n = 15) or with NP components (WAD-NP, n = 14). Metabolites were quantified with LCModel following a single session in a 3 T MRI scanner within the ACC, DLPFC, and OCC. Results Participants with WAD-NP presented moderate pain intensity and interference compared with the WAD-noNP group. Single-voxel MRS analysis demonstrated a higher glutamate concentration in the ACC and lower total choline (tCho) in the DLPFC in the WAD-NP versus WAD-noNP group, with no intergroup metabolite difference detected in the OCC. Best fit and stepwise multiple regression revealed that the normalised ACC glutamate/total creatine (tCr) (p = 0.01), DLPFC n-acetyl-aspartate (NAA)/tCr (p = 0.001), and DLPFC tCho/tCr levels (p = 0.02) predicted NP components in the WAD-NP group (ACC r 2 = 0.26, α = 0.81; DLPFC r 2 = 0.62, α = 0.98). The normalised Glu/tCr concentration was higher in the healthy than the WAD-noNP group within the ACC (p < 0.05), but not in the DLPFC or OCC. Neither sex nor age affected key normalised metabolite concentrations related to WAD-NP components when compared to the WAD-noNP group. Discussion This study demonstrates that elevated glutamate concentrations within the ACC are related to chronic WAD-NP components, while higher NAA and lower tCho metabolite levels suggest a role for increased neuronal-glial signalling and cell membrane dysfunction in individuals with chronic WAD-NP components.
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Affiliation(s)
- Irene Pinilla-Fernández
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Grupo de Sistemas Complejos, Universidad Politécnica de Madrid, Madrid, Spain
| | - Marta Ríos-León
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
| | - Dinesh Kumar Deelchand
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Leoncio Garrido
- Departamento de Química-Física, Instituto de Ciencia y Tecnología de Polímeros (ICTP-CSIC), CSIC, Madrid, Spain
| | - Mabel Torres-Llacsa
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Servicio de Radiodiagnóstico, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Fernando García-García
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Servicio de Radiodiagnóstico, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | - I. Betina Ip
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Holly Bridge
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Harris Manchester College, University of Oxford, Oxford, United Kingdom
| | - Andrés Barriga-Martín
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Research Group in Spine Pathology, Orthopedic Surgery and Traumatology Unit, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Faculty of Medicine, University of Castilla La Mancha, Toledo, Spain
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Bäckryd E, Themistocleous A, Larsson A, Gordh T, Rice ASC, Tesfaye S, Bennett DL, Gerdle B. Eleven neurology-related proteins measured in serum are positively correlated to the severity of diabetic neuropathy. Sci Rep 2024; 14:17068. [PMID: 39048581 PMCID: PMC11269577 DOI: 10.1038/s41598-024-66471-6] [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: 11/07/2023] [Accepted: 07/01/2024] [Indexed: 07/27/2024] Open
Abstract
About 20% of patients with diabetes suffer from chronic pain with neuropathic characteristics. We investigated the multivariate associations between 92 neurology-related proteins measured in serum from 190 patients with painful and painless diabetic neuropathy. Participants were recruited from the Pain in Neuropathy Study, an observational cross-sectional multicentre study in which participants underwent deep phenotyping. In the exploration cohort, two groups were defined by hierarchical cluster analyses of protein data. The proportion of painless vs painful neuropathy did not differ between the two groups, but one group had a significantly higher grade of neuropathy as measured by the Toronto Clinical Scoring System (TCSS). This finding was replicated in the replication cohort. Analyzing both groups together, we found that a group of 11 inter-correlated proteins (TNFRSF12A, SCARB2, N2DL-2, SKR3, EFNA4, LAYN, CLM-1, CD38, UNC5C, GFR-alpha-1, and JAM-B) were positively associated with TCSS values. Notably, EFNA4 and UNC5C are known to be part of axon guidance pathways. To conclude, although cluster analysis of 92 neurology-related proteins did not distinguish painful from painless diabetic neuropathy, we identified 11 proteins which positively correlated to neuropathy severity and warrant further investigation as potential biomarkers.
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Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | | | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David L Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Björn Gerdle
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Antolak SJ. The pudendal syndrome: A photo essay of nerve compression damage visualized at neurolysis in patients with chronic neuropathic pelvic pain. Neurourol Urodyn 2024. [PMID: 39032061 DOI: 10.1002/nau.25555] [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: 02/07/2024] [Revised: 06/07/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024]
Abstract
AIMS (1) To use intraoperative photographs to visualize and explain pudendal nerve compressions and anatomical variations of compression sites in patients with chronic pelvic pain. (2) To emphasize the diagnostic importance of sensory examination with a safety pin at the six pudendal nerve branches in all patients with chronic pelvic pain; the dorsal nerves (penis or clitoris; the perineal nerves; and the inferior rectal nerves). METHODS Between 2003 and 2014, "definite" pudendal neuropathy was diagnosed by examination and with two neurophysiologic tests. Neurolysis, via a transgluteal approach, was recommended only after 14 weeks of conservative care failed to adequately improve symptoms and validated symptom scores. Photographs of surgical findings were culled for their educational impact. An illustration of each photo clarifies the surgical anatomy. RESULTS The transgluteal incision permits access to pudendal anatomy and compression sites from the subpiriformis area through the interligamentary space and the pudendal canal (Alcock canal). Compressions were acquired or congenital and severity varied significantly. Pinprick sensory testing diagnoses pudendal neuropathy in 92% of both genders. Mid-nerve compression occurred commonly between the sacrotuberous and sacrospinous ligaments less frequently in the Alcock canal, but also at aberrant pathways, for example, between layers of the sacrotuberous ligament; a separate inferior rectal nerve passing through the sacrospinous ligament; at an anomalous lateral pathway posterior to the ischial spine. The results of international surgeons are discussed. CONCLUSIONS Decompression surgery was recommended in approximately 35% of patients in this practice, when pudendal neuropathy (pudendal syndrome), did not respond to two conservative levels of treatment: (1) nerve protection and medications and, (2) a series of three pudendal nerve perineural injections given at 4-week intervals. Significant nerve compression is consistently observed. Pathophysiology includes axonopathy from ischemia and demyelination. Neuropathy is readily diagnosed using a pinprick sensory examination of six pudendal nerve branches. Monitoring with the National Institutes of Health Chronic Prostatitis Symptom Index records cures >13 years.
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23
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Farnes N, Jacobsen HB, Stubhaug A, Vambheim SM. H-coil repetitive transcranial magnetic stimulation does not improve executive function in patients with chronic peripheral neuropathic pain: a randomized sham-controlled crossover study. Front Psychiatry 2024; 15:1401008. [PMID: 39086728 PMCID: PMC11288963 DOI: 10.3389/fpsyt.2024.1401008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Deep rTMS is an increasingly popular noninvasive brain stimulation technique which has shown promise for treating cognitive impairments. However, few studies have investigated the cognitive effects it could exert in patients with chronic peripheral neuropathic pain. Therefore, we aimed to assess the effects of deep rTMS on executive functioning in patients with peripheral neuropathic pain, in a randomized, double-blind crossover trial. Methods In total, 17 patients were randomly assigned to receive both active and sham deep H-coil rTMS targeting the primary motor cortex. Each treatment period consisted of five daily rTMS sessions. Selected tests of executive functioning from the CANTAB test battery (paired associates learning, stop signal task, spatial working memory and multitasking test) were performed at baseline, and at 1 week and 3 weeks follow-ups. Results We did not find any significant interactions between time and treatment for the measures of executive functioning for the patient group, or for patients with reduced cognition compared to normative means. Conclusion High-frequency deep H-coil rTMS targeting the hand area of the primary motor cortex and delivered over 5 consecutive days did not improve executive functioning in patients with chronic peripheral neuropathic pain. Clinical trial registration https://clinicaltrials.gov/, identifier NCT05488808.
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Affiliation(s)
- Nadine Farnes
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Henrik B. Jacobsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Mind Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sara M. Vambheim
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care Oslo University Hospital, Oslo, Norway
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24
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Shraim MA, Massé-Alarie H, Farrell MJ, Cavaleri R, Loggia ML, Hodges PW. Neuroinflammatory activation in sensory and motor regions of the cortex is related to sensorimotor function in individuals with low back pain maintained by nociplastic mechanisms: A preliminary proof-of-concept study. Eur J Pain 2024. [PMID: 39007713 DOI: 10.1002/ejp.2313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Chronic pain involves communication between neural and immune systems. Recent data suggest localization of glial (brain immune cells) activation to the sensorimotor regions of the brain cortex (S1/M1) in chronic low back pain (LBP). As glia perform diverse functions that impact neural function, activation might contribute to sensorimotor changes, particularly in LBP maintained by increased nervous system sensitivity (i.e., nociplastic pain). This preliminary proof-of-concept study aimed to: (i) compare evidence of neuroinflammatory activation in S1/M1 between individuals with and without LBP (and between nociceptive and nociplastic LBP phenotypes), and (ii) evaluate relationships between neuroinflammatory activation and sensorimotor function. METHODS Simultaneous PET-fMRI measured neuroinflammatory activation in functionally defined S1/M1 in pain-free individuals (n = 8) and individuals with chronic LBP (n = 9; nociceptive: n = 4, nociplastic: n = 5). Regions of S1/M1 related to the back were identified using fMRI during motor tasks and thermal stimuli. Sensorimotor measures included single and paired-pulse transcranial magnetic stimulation (TMS) and quantitative sensory testing (QST). Sleep, depression, disability and pain questionnaires were administered. RESULTS Neuroinflammatory activation was greater in the lower back cortical representation of S1/M1 of the nociplastic LBP group than both nociceptive LBP and pain-free groups. Neuroinflammatory activation in S1/M1 was positively correlated with sensitivity to hot (r = 0.52) and cold (r = 0.55) pain stimuli, poor sleep, depression, disability and BMI, and negatively correlated with intracortical facilitation (r = -0.41). CONCLUSION This preliminary proof-of-concept study suggests that neuroinflammation in back regions of S1/M1 in individuals with nociplastic LBP could plausibly explain some characteristic features of this LBP phenotype. SIGNIFICANCE STATEMENT Neuroinflammatory activation localized to sensorimotor areas of the brain in individuals with nociplastic pain might contribute to changes in sensory and motor function and aspects of central sensitization. If cause-effect relationships are established in longitudinal studies, this may direct development of therapies that target neuroinflammatory activation.
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Affiliation(s)
- Muath A Shraim
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Hugo Massé-Alarie
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
- Centre Interdisciplinaire de Recherche en réadaptation et Integration Sociale (CIRRIS), Université Laval, Québec City, Québec, Canada
| | - Michael J Farrell
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Rocco Cavaleri
- Brain Stimulation and Rehabilitation Lab, Western Sydney University, School of Health Sciences, Sydney, New South Wales, Australia
| | - Marco L Loggia
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul W Hodges
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
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Gierthmühlen J, Attal N, Baskozos G, Bennedsgaard K, Bennett DL, Bouhassira D, Crombez G, Finnerup NB, Granovsky Y, Jensen TS, John J, Kennes LN, Laycock H, Pascal MMV, Rice ASC, Shafran-Topaz L, Themistocleous AC, Yarnitsky D, Baron R. What is associated with painful polyneuropathy? A cross-sectional analysis of symptoms and signs in patients with painful and painless polyneuropathy. Pain 2024:00006396-990000000-00643. [PMID: 38968400 DOI: 10.1097/j.pain.0000000000003310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/16/2024] [Indexed: 07/07/2024]
Abstract
ABSTRACT It is still unclear how and why some patients develop painful and others painless polyneuropathy. The aim of this study was to identify multiple factors associated with painful polyneuropathies (NeuP). A total of 1181 patients of the multicenter DOLORISK database with painful (probable or definite NeuP) or painless (unlikely NeuP) probable or confirmed neuropathy were investigated clinically, with questionnaires and quantitative sensory testing. Multivariate logistic regression including all variables (demographics, medical history, psychological symptoms, personality items, pain-related worrying, life-style factors, as well as results from clinical examination and quantitative sensory testing) and machine learning was used for the identification of predictors and final risk prediction of painful neuropathy. Multivariate logistic regression demonstrated that severity and idiopathic etiology of neuropathy, presence of chronic pain in family, Patient-Reported Outcomes Measurement Information System Fatigue and Depression T-Score, as well as Pain Catastrophizing Scale total score are the most important features associated with the presence of pain in neuropathy. Machine learning (random forest) identified the same variables. Multivariate logistic regression archived an accuracy above 78%, random forest of 76%; thus, almost 4 out of 5 subjects can be classified correctly. This multicenter analysis shows that pain-related worrying, emotional well-being, and clinical phenotype are factors associated with painful (vs painless) neuropathy. Results may help in the future to identify patients at risk of developing painful neuropathy and identify consequences of pain in longitudinal studies.
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Affiliation(s)
- Janne Gierthmühlen
- Interdisciplinary Pain Unit, Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Nadine Attal
- Inserm U987, APHP, CHU Ambroise Pare, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Georgios Baskozos
- The Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Kristine Bennedsgaard
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Denmark
| | - David L Bennett
- The Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Didier Bouhassira
- Inserm U987, APHP, CHU Ambroise Pare, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Nanna B Finnerup
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Yelena Granovsky
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | | | - Jishi John
- The Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Lieven Nils Kennes
- Department of Economics and Business Administration, University of Applied Sciences Stralsund, Stralsund, Germany
| | - Helen Laycock
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Mathilde M V Pascal
- The Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Leah Shafran-Topaz
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | | | - David Yarnitsky
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
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Chapman KB, Amireh A, van Helmond N, Yousef TA. Evaluation of Washout Periods After Dorsal Root Ganglion Stimulation Trial. Neuromodulation 2024; 27:881-886. [PMID: 38551547 DOI: 10.1016/j.neurom.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Dorsal root ganglion stimulation (DRG-S) is a novel therapy to treat chronic pain. It has shown efficacy when delivered intermittently, suggesting a delayed washout effect exists. To measure the washout period, and to determine whether there are differences in washout times among different types of treated pain, we measured the time for pain to return at the end of the patients' one-week DRG stimulation trials. MATERIALS AND METHODS Patients who completed a successful DRG-S trial were included. The times until 25% (t25) and 90% (t90) of baseline pain level returned were recorded. The patients were divided into neuropathic, nociceptive, and mixed pain groups for subgroup comparison. t25 and t90 were plotted in the entire cohort and subgroups using reverse Kaplan-Meier plots (failure curves) and compared using a log-rank test. RESULTS In total, 29 consecutive patients were included. Median t25 and t90 times were 7.1 and 19.5 hours, respectively. Median (interquartile range) times were longest for the nociceptive pain group (n = 17) and shortest for the neuropathic pain group (n = 6), with the mixed-pain group (n = 6) in between (t25: 7.1 [1.7-19.4], 3.40 [1.4-8.4], and 5.7 [0.8-17.6]; t90, 22.0 [10.7-71.0], 7.6 [3.6-19.8], and 20.9 [14.2-31.2], respectively). t90 times differed significantly by pain type (p = 0.040). CONCLUSIONS This study showed a prolonged washout period after cessation of DRG-S therapy. Washout times vary according to pain type. The observed effects are possibly due to long-term depression of pain signaling and could allow the implementation of alternative stimulation strategies with DRG-S. Further investigations evaluating DRG-S washout times are warranted.
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Affiliation(s)
- Kenneth B Chapman
- The Spine & Pain Institute of New York, New York City, NY, USA; Department of Anesthesiology, New York University Langone Medical Center, New York City, NY, USA; The Zucker School of Medicine at Hofstra/Northwell, New York City, NY, USA; Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Ahmad Amireh
- The Spine & Pain Institute of New York, New York City, NY, USA
| | - Noud van Helmond
- The Spine & Pain Institute of New York, New York City, NY, USA; Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Tariq A Yousef
- The Spine & Pain Institute of New York, New York City, NY, USA
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Mesaroli G, Davidge KM, Davis AM, Perruccio AV, Choy S, Walker SM, Stinson JN. Age and Sex Differences in Pediatric Neuropathic Pain and Complex Regional Pain Syndrome: A Scoping Review. Clin J Pain 2024; 40:428-439. [PMID: 38616343 DOI: 10.1097/ajp.0000000000001217] [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: 07/26/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Age and sex differences may exist in the frequency (incidence, prevalence) or symptoms of neuropathic pain (NP) and complex regional pain syndrome (CRPS) due to biopsychosocial factors (eg, neurodevelopment, physiological and hormonal changes, psychosocial differences) that evolve through childhood and adolescence. Age and sex differences may have implications for evaluating screening and diagnostic tools and treatment interventions. OBJECTIVE To map the existing literature on pediatric NP and CRPS with respect to age and sex distributions, and age and sex differences in symptomology and frequency. METHODS A scoping literature review was conducted. Databases were searched from inception to January 2023. Data were collected on study design, setting, demographics, and age and sex differences in frequency and symptoms. RESULTS Eighty-seven studies were included. Distribution of participants with CRPS (n=37 studies) was predominantly early adolescence (10 to 14 y) and female sex, while NP (n=42 studies) was most commonly reported throughout adolescence (10 to 19 y) in both sexes. Forty-one studies examined age and sex differences in frequency; 6 studies reported higher frequency in adolescence. Very few studies (n=11) examined differences in symptomology. DISCUSSION Large epidemiological studies are required to further understand age and sex differences in frequency of pediatric NP and CRPS. Age and sex differences must be considered when evaluating screening and diagnostic tools and treatment interventions to ensure relevance and validity to both sexes and across ages. Validated tools will improve understanding of age-dependent and sex-dependent differences in symptoms, pathophysiology, and psychosocial impact of pediatric NP and CRPS.
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Affiliation(s)
- Giulia Mesaroli
- Department of Physical Therapy, University of Toronto
- Department of Rehabilitation, The Hospital for Sick Children and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
| | - Kristen M Davidge
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children and Department of Surgery, University of Toronto
| | - Aileen M Davis
- Department of Physical Therapy, University of Toronto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto
| | - Samantha Choy
- Department of Physical Therapy, University of Toronto
| | - Suellen M Walker
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Jennifer N Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
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Shi YQ, Sun ZH, Wang ZZ, Su CY, Zhang W, Yu LY, Xu Y, Gao YL, Wang HB, Tian JW, Li CM. A novel role for microtubule affinity-regulating kinases in neuropathic pain. Br J Pharmacol 2024; 181:2012-2032. [PMID: 38112022 DOI: 10.1111/bph.16303] [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: 08/03/2023] [Revised: 09/15/2023] [Accepted: 10/03/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Neuropathic pain affects millions of patients, but there are currently few viable therapeutic options available. Microtubule affinity-regulating kinases (MARKs) regulate the dynamics of microtubules and participate in synaptic remodelling. It is unclear whether these changes are involved in the central sensitization of neuropathic pain. This study examined the role of MARK1 or MARK2 in regulating neurosynaptic plasticity induced by neuropathic pain. EXPERIMENTAL APPROACH A rat spinal nerve ligation (SNL) model was established to induce neuropathic pain. The role of MARKs in nociceptive regulation was assessed by genetically knocking down MARK1 or MARK2 in amygdala and systemic administration of PCC0105003, a novel small molecule MARK inhibitor. Cognitive function, anxiety-like behaviours and motor coordination capability were also examined in SNL rats. Synaptic remodelling-associated signalling changes were detected with electrophysiological recording, Golgi-Cox staining, western blotting and qRT-PCR. KEY RESULTS MARK1 and MARK2 expression levels in amygdala and spinal dorsal horn were elevated in SNL rats. MARK1 or MARK2 knockdown in amygdala and PCC0105003 treatment partially attenuated pain-like behaviours along with improving cognitive deficit, anxiogenic-like behaviours and motor coordination in SNL rats. Inhibition of MARKs signalling reversed synaptic plasticity at the functional and structural levels by suppressing NR2B/GluR1 and EB3/Drebrin signalling pathways both in amygdala and spinal dorsal horn. CONCLUSION AND IMPLICATIONS These results suggest that MARKs-mediated synaptic remodelling plays a key role in the pathogenesis of neuropathic pain and that pharmacological inhibitors of MARKs such as PCC0105003 could represent a novel therapeutic strategy for the management of neuropathic pain.
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Affiliation(s)
- Yao-Qin Shi
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
| | - Zhi-Hong Sun
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
| | - Zhe-Zhe Wang
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
| | - Chun-Yu Su
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
| | - Wei Zhang
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
| | - Lin-Yao Yu
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
| | - Yang Xu
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
| | - Yong-Lin Gao
- College of Life Sciences, Yantai University, Yantai, China
| | - Hong-Bo Wang
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
| | - Jing-Wei Tian
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
| | - Chun-Mei Li
- From the school of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong Province, China
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Ferraro MC, McAuley JH. Clinimetrics: Douleur Neuropathique en 4 Questions (DN4). J Physiother 2024; 70:238-239. [PMID: 38531755 DOI: 10.1016/j.jphys.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/14/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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30
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He WC, Hou SL, Wang KB, Xu N, Li K, Xiong T, Luo J. Treadmill running on neuropathic pain: via modulation of neuroinflammation. Front Mol Neurosci 2024; 17:1345864. [PMID: 38989156 PMCID: PMC11233809 DOI: 10.3389/fnmol.2024.1345864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/24/2024] [Indexed: 07/12/2024] Open
Abstract
Neuropathic pain is a type of chronic pain caused by an injury or somatosensory nervous system disease. Drugs and exercise could effectively relieve neuropathic pain, but no treatment can completely stop neuropathic pain. The integration of exercise into neuropathic pain management has attracted considerable interest in recent years, and treadmill training is the most used among exercise therapies. Neuropathic pain can be effectively treated if its mechanism is clarified. In recent years, the association between neuroinflammation and neuropathic pain has been explored. Neuroinflammation can trigger proinflammatory cytokines, activate microglia, inhibit descending pain modulatory systems, and promote the overexpression of brain-derived neurotrophic factor, which lead to the generation of neuropathic pain and hypersensitivity. Treadmill exercise can alleviate neuropathic pain mainly by regulating neuroinflammation, including inhibiting the activity of pro-inflammatory factors and over activation of microglia in the dorsal horn, regulating the expression of mu opioid receptor expression in the rostral ventromedial medulla and levels of γ-aminobutyric acid to activate the descending pain modulatory system and the overexpression of brain-derived neurotrophic factor. This article reviews and summarizes research on the effect of treadmill exercise on neuropathic pain and its role in the regulation of neuroinflammation to explore its benefits for neuropathic pain treatment.
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Affiliation(s)
- Wei-Chun He
- Department of Rehabilitation Medicine, General Hospital of NingXia Medical University, Yinchuan, China
| | - Shuang-Long Hou
- Department of Sport Rehabilitation, Xi’an Physical Education University, Xi’an, China
| | - Kai-Bin Wang
- Department of Rehabilitation Medicine, General Hospital of NingXia Medical University, Yinchuan, China
| | - Ning Xu
- Department of Rehabilitation Medicine, General Hospital of NingXia Medical University, Yinchuan, China
| | - Ke Li
- Department of Rehabilitation Medicine, General Hospital of NingXia Medical University, Yinchuan, China
| | - Ting Xiong
- Department of Rehabilitation Medicine, General Hospital of NingXia Medical University, Yinchuan, China
| | - Jing Luo
- Department of Rehabilitation Medicine, General Hospital of NingXia Medical University, Yinchuan, China
- Department of Sport Rehabilitation, Xi’an Physical Education University, Xi’an, China
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31
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Salis F, Sardo S, Finco G, Gessa GL, Franconi F, Agabio R. Sex-Gender Differences Are Completely Neglected in Treatments for Neuropathic Pain. Pharmaceuticals (Basel) 2024; 17:838. [PMID: 39065689 PMCID: PMC11280170 DOI: 10.3390/ph17070838] [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: 06/02/2024] [Revised: 06/18/2024] [Accepted: 06/22/2024] [Indexed: 07/28/2024] Open
Abstract
As sex-gender differences have been described in the responses of patients to certain medications, we hypothesized that the responses to medications recommended for neuropathic pain may differ between men and women. We conducted a literature review to identify articles reporting potential sex-gender differences in the efficacy and safety of these medications. Only a limited number of studies investigated potential sex-gender differences. Our results show that women seem to achieve higher blood concentrations than men during treatment with amitriptyline, nortriptyline, duloxetine, venlafaxine, and pregabalin. Compared to men, higher rates of women develop side effects during treatment with gabapentin, lidocaine, and tramadol. Globally, the sex-gender differences would suggest initially administering smaller doses of these medications to women with neuropathic pain compared to those administered to men. However, most of these differences have been revealed by studies focused on the treatment of other diseases (e.g., depression). Studies focused on neuropathic pain have overlooked potential sex-gender differences in patient responses to medications. Despite the fact that up to 60% of patients with neuropathic pain fail to achieve an adequate response to medications, the potential role of sex-gender differences in the efficacy and safety of pharmacotherapy has not adequately been investigated. Targeted studies should be implemented to facilitate personalized treatments for neuropathic pain.
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Affiliation(s)
- Francesco Salis
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, CA, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA, Italy; (S.S.); (G.F.)
| | - Salvatore Sardo
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA, Italy; (S.S.); (G.F.)
| | - Gabriele Finco
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA, Italy; (S.S.); (G.F.)
| | - Gian Luigi Gessa
- Neuroscience Institute, Section of Cagliari, National Research Council, 09042 Monserrato, CA, Italy;
| | - Flavia Franconi
- Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, SAR, Italy;
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, CA, Italy
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Pușcașu C, Negreș S, Zbârcea CE, Ungurianu A, Ștefănescu E, Blebea NM, Chiriță C. Evaluating the Antihyperalgesic Potential of Sildenafil-Metformin Combination and Its Impact on Biochemical Markers in Alloxan-Induced Diabetic Neuropathy in Rats. Pharmaceuticals (Basel) 2024; 17:783. [PMID: 38931450 PMCID: PMC11206800 DOI: 10.3390/ph17060783] [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: 05/10/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: Globally, about 600 million people are afflicted with diabetes, and one of its most prevalent complications is neuropathy, a debilitating condition. At the present time, the exploration of novel therapies for alleviating diabetic-neuropathy-associated pain is genuinely captivating, considering that current therapeutic options are characterized by poor efficacy and significant risk of side effects. In the current research, we evaluated the antihyperalgesic effect the sildenafil (phosphodiesterase-5 inhibitor)-metformin (antihyperglycemic agent) combination and its impact on biochemical markers in alloxan-induced diabetic neuropathy in rats. (2) Methods: This study involved a cohort of 70 diabetic rats and 10 non-diabetic rats. Diabetic neuropathy was induced by a single dose of 130 mg/kg alloxan. The rats were submitted to thermal stimulus test using a hot-cold plate and to tactile stimulus test using von Frey filaments. Moreover, at the end of the experiment, the animals were sacrificed and their brains and livers were collected to investigate the impact of this combination on TNF-α, IL-6, nitrites and thiols levels. (3) Results: The results demonstrated that all sildenafil-metformin combinations decreased the pain sensitivity in the von Frey test, hot plate test and cold plate test. Furthermore, alterations in nitrites and thiols concentrations and pro-inflammatory cytokines (specifically TNF-α and IL-6) were noted following a 15-day regimen of various sildenafil-metformin combinations. (4) Conclusions: The combination of sildenafil and metformin has a synergistic effect on alleviating pain in alloxan-induced diabetic neuropathy rats. Additionally, the combination effectively decreased inflammation, inhibited the rise in NOS activity, and provided protection against glutathione depletion.
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Affiliation(s)
- Ciprian Pușcașu
- Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Traian Vuia 6, 020956 Bucharest, Romania; (C.P.); (S.N.); (A.U.); (E.Ș.); (C.C.)
| | - Simona Negreș
- Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Traian Vuia 6, 020956 Bucharest, Romania; (C.P.); (S.N.); (A.U.); (E.Ș.); (C.C.)
| | - Cristina Elena Zbârcea
- Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Traian Vuia 6, 020956 Bucharest, Romania; (C.P.); (S.N.); (A.U.); (E.Ș.); (C.C.)
| | - Anca Ungurianu
- Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Traian Vuia 6, 020956 Bucharest, Romania; (C.P.); (S.N.); (A.U.); (E.Ș.); (C.C.)
| | - Emil Ștefănescu
- Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Traian Vuia 6, 020956 Bucharest, Romania; (C.P.); (S.N.); (A.U.); (E.Ș.); (C.C.)
| | - Nicoleta Mirela Blebea
- Faculty of Pharmacy, “Ovidius” University of Constanța, Căpitan Aviator Al. Şerbănescu 6, 900470 Constanța, Romania;
| | - Cornel Chiriță
- Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Traian Vuia 6, 020956 Bucharest, Romania; (C.P.); (S.N.); (A.U.); (E.Ș.); (C.C.)
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Kern KU, Quandel T, Theis S, Schubert T. Characteristics and outcomes of peripheral neuropathic pain patients with repeated applications of high-concentration capsaicin cutaneous patch: Results of a retrospective chart review in Germany. Pain Pract 2024; 24:700-708. [PMID: 38321913 DOI: 10.1111/papr.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate patient characteristics, concomitant analgesic medication, and pain intensity in a real-world setting in Germany, focusing on the repeated application of high-concentration capsaicin patch (HCCP) for neuropathic pain. DESIGN Data were collected from electronic medical records of patients who received at least two HCCP treatments between January 2011 and July 2022. Subgroup analyses were performed based on the number of HCCP treatments, age groups, and specific neuropathic pain conditions. SETTING The study was conducted at an outpatient pain center in Wiesbaden, Germany. SUBJECTS The study included 97 patients, primarily diagnosed with neuropathic back pain, postoperative or post-traumatic neuropathic pain, and postherpetic neuralgia. METHODS The daily dose of concomitant medications (eg, opioids and anticonvulsants) at the start of capsaicin therapy was compared with the average within 2 years of capsaicin therapy. The last observation carried forward method was used if HCCP treatment was discontinued before the end of the 2-year period. RESULTS The majority of patients received concomitant medications, with opioids, anticonvulsants, and antidepressants being the most common. The average daily morphine equivalent dose decreased significantly during HCCP treatment. Pain intensity at baseline was generally high, but substantial improvements were observed in patients who received at least three HCCP applications. CONCLUSIONS This study provides evidence for the effectiveness of HCCP treatment in reducing pain intensity and concomitant opioid use in patients with neuropathic pain. Further research is needed to explore the long-term outcomes and optimal treatment regimens for different patient populations.
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Affiliation(s)
- Kai-Uwe Kern
- Institute of Pain Medicine/Pain Practice, Wiesbaden, Germany
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34
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De Stefano G, Truini A. An overview of diagnosis and assessment methods for neuropathic pain. Presse Med 2024; 53:104234. [PMID: 38636786 DOI: 10.1016/j.lpm.2024.104234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
Neuropathic pain, defined as pain arising as a consequence of a lesion or disease affecting the somatosensory nervous system, requires precise diagnostic assessment. Different diagnostic tools have been devised for the diagnosis of neuropathic pain. This review offers insights into the diagnostic accuracy of screening questionnaires and different tests that investigate the somatosensory nervous system, in patients with suspected neuropathic pain. Thus, it illustrates how these tools can aid clinicians in accurately diagnosing neuropathic pain.
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Affiliation(s)
| | - Andrea Truini
- Sapienza University, Department of Human Neuroscience, Rome, Italy.
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Miclescu A, Rönngren C, Bengtsson M, Gordh T, Hedin A. Increased risk of persistent neuropathic pain after traumatic nerve injury and surgery for carriers of a human leukocyte antigen haplotype. Pain 2024; 165:1404-1412. [PMID: 38147413 PMCID: PMC11090029 DOI: 10.1097/j.pain.0000000000003143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 12/28/2023]
Abstract
ABSTRACT It is not known why some patients develop persistent pain after nerve trauma while others do not. Among multiple risk factors for the development of persistent posttrauma and postsurgical pain, a neuropathic mechanism due to iatrogenic nerve lesion has been proposed as the major cause of these conditions. Because there is some evidence that the human leukocyte antigen (HLA) system plays a role in persistent postsurgical pain, this study aimed to identify the genetic risk factors, specifically among HLA loci, associated with chronic neuropathic pain after traumatic nerve injuries and surgery in the upper extremities. Blood samples were taken to investigate the contribution of HLA alleles (ie, HLA-A, HLA-B, HLA-DRB1, HLA-DQB1, and HLA-DPB1) in a group of patients with persistent neuropathic pain (n = 70) and a group of patients with neuropathy without pain (n = 61). All subjects had intraoperatively verified nerve damage in the upper extremity. They underwent bedside clinical neurological examination to identify the neuropathic pain component according to the present grading system of neuropathic pain. Statistical analyses on the allele and haplotype were conducted using the BIGDAWG package. We found that the HLA haplotype A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02 was associated with an increased risk of developing persistent neuropathic pain in the upper extremity (OR = 9.31 [95% CI 1.28-406.45], P < 0.05). No significant associations were found on an allele level when correcting for multiple testing. Further studies are needed to investigate whether this association is on a haplotypic level or if certain alleles may be causing the association.
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Affiliation(s)
| | | | - Mats Bengtsson
- Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Anders Hedin
- Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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McBenedict B, Goh KS, Yau RCC, Elamin S, Yusuf WH, Verly G, Thomas A, Alphonse B, Ouabicha K, Valentim G, Hauwanga WN, Lima Pessôa B. Neuropathic Pain Secondary to Multiple Sclerosis: A Narrative Review. Cureus 2024; 16:e61587. [PMID: 38962595 PMCID: PMC11221503 DOI: 10.7759/cureus.61587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system (CNS). Neuropathic pain in MS is a debilitating symptom that significantly impairs the quality of life for a substantial proportion of MS patients. Neuropathic pain in MS stems primarily from demyelination, axonal loss, CNS inflammation, and direct damage to the myelin sheath, leading to pain manifestations such as ongoing extremity pain, Lhermitte's phenomenon, and trigeminal neuralgia (TN). The pathophysiological mechanisms behind MS-related neuropathic pain are explored in this review, highlighting central sensitization, neural dysfunction, spinal thalamic tract dysfunction, and inflammatory processes that exacerbate neuronal damage. Neuropathic pain in MS necessitates comprehensive assessment tools and neurophysiological tests to differentiate neuropathic pain from other MS symptoms accurately. Treatment strategies for MS-related neuropathic pain encompass pharmacological interventions, including anticonvulsants and antidepressants, and emerging therapies targeting specific inflammatory processes. The review advocates for a holistic approach to management, incorporating innovative treatments and multidisciplinary strategies to address both the physical symptoms and psychosocial aspects of this disorder. This comprehensive overview underscores the importance of ongoing research into targeted therapies to improve patient outcomes and enhance the quality of life for those affected by MS.
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Affiliation(s)
| | - Kang Suen Goh
- Internal Medicine, Monash University Malaysia, Johor Bahru, MYS
| | | | - Sara Elamin
- Medicine, University of Medical Sciences and Technology, Khartoum, SDN
| | | | - Gabriel Verly
- Neurology, Federal University of Rio de Janeiro, Rio de Janeiro, BRA
| | - Anusha Thomas
- Neurology, Christian Medical College & Hospital, Ludhiana, IND
| | - Berley Alphonse
- Internal Medicine, University Notre Dame of Haiti, Port-au-Prince, HTI
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Ma LW, Liu YF, Zhang H, Huang CJ, Li A, Qu XZ, Lin JP, Yang Y, Yao YX. Electroacupuncture attenuates neuropathic pain via suppressing BIP-IRE-1α-mediated endoplasmic reticulum stress in the anterior cingulate cortex. Biol Res 2024; 57:34. [PMID: 38812057 PMCID: PMC11134655 DOI: 10.1186/s40659-024-00511-3] [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: 11/14/2022] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
Studies have suggested that endoplasmic reticulum stress (ERS) is involved in neurological dysfunction and that electroacupuncture (EA) attenuates neuropathic pain (NP) via undefined pathways. However, the role of ERS in the anterior cingulate cortex (ACC) in NP and the effect of EA on ERS in the ACC have not yet been investigated. In this study, an NP model was established by chronic constriction injury (CCI) of the left sciatic nerve in rats, and mechanical and cold tests were used to evaluate behavioral hyperalgesia. The protein expression and distribution were evaluated using western blotting and immunofluorescence. The results showed that glucose-regulated protein 78 (BIP) and inositol-requiring enzyme 1α (IRE-1α) were co-localized in neurons in the ACC. After CCI, BIP, IRE-1α, and phosphorylation of IRE-1α were upregulated in the ACC. Intra-ACC administration of 4-PBA and Kira-6 attenuated pain hypersensitivity and downregulated phosphorylation of IRE-1α, while intraperitoneal injection of 4-PBA attenuated hyperalgesia and inhibited the activation of P38 and JNK in ACC. In contrast, ERS activation by intraperitoneal injection of tunicamycin induced behavioral hyperalgesia in naive rats. Furthermore, EA attenuated pain hypersensitivity and inhibited the CCI-induced overexpression of BIP and pIRE-1α. Taken together, these results demonstrate that EA attenuates NP by suppressing BIP- and IRE-1α-mediated ERS in the ACC. Our study presents novel evidence that ERS in the ACC is implicated in the development of NP and provides insights into the molecular mechanisms involved in the analgesic effect of EA.
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Affiliation(s)
- Lin-Wei Ma
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Department of Anesthesia, First People's Hospital of Linping District of Hangzhou City, 369 Yingbin Road, Hangzhou, 311100, China
| | - Yu-Fan Liu
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Hui Zhang
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Chang-Jun Huang
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Department of Anesthesia, First People's Hospital of Linping District of Hangzhou City, 369 Yingbin Road, Hangzhou, 311100, China
| | - Ang Li
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Xin-Zhe Qu
- Department of Orthopedics, Graduated School, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, China
| | - Jia-Piao Lin
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Yan Yang
- Department of Neurobiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310020, China.
- School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, 310058, China.
| | - Yong-Xing Yao
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
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Mori N, Hosomi K, Nishi A, Miyake A, Yamada T, Matsugi A, Jono Y, Lim C, Khoo HM, Tani N, Oshino S, Saitoh Y, Kishima H. Repetitive transcranial magnetic stimulation focusing on patients with neuropathic pain in the upper limb: a randomized sham-controlled parallel trial. Sci Rep 2024; 14:11811. [PMID: 38782994 PMCID: PMC11116497 DOI: 10.1038/s41598-024-62018-x] [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: 01/06/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
This study aimed to evaluate the efficacy and safety of navigation-guided repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex in patients with neuropathic pain in the upper limb. This randomized, blinded, sham-controlled, parallel trial included a rTMS protocol (10-Hz, 2000 pulses/session) consisting of five daily sessions, followed by one session per week for the next seven weeks. Pain intensity, as well as pain-related disability, quality of life, and psychological status, were assessed. For the primary outcome, pain intensity was measured daily using a numerical rating scale as a pain diary. Thirty patients were randomly assigned to the active rTMS or sham-stimulation groups. In the primary outcome, the decrease (least square [LS] mean ± standard error) in the weekly average of a pain diary at week 9 compared to the baseline was 0.84 ± 0.31 in the active rTMS group and 0.58 ± 0.29 in the sham group (LS mean difference, 0.26; 95% confidence interval, - 0.60 to 1.13). There was no significant effect on the interaction between the treatment group and time point. Pain-related disability score improved, but other assessments showed no differences. No serious adverse events were observed. This study did not show significant pain relief; however, active rTMS tended to provide better results than sham. rTMS has the potential to improve pain-related disability in addition to pain relief.Clinical Trial Registration number: jRCTs052190110 (20/02/2020).
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Affiliation(s)
- Nobuhiko Mori
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Koichi Hosomi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Neurosurgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
| | - Asaya Nishi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Akimitsu Miyake
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
- Department of AI and Innovative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University, Daitou, Japan
| | - Yasutomo Jono
- Faculty of Health Sciences, Naragakuen University, Nara, Japan
| | - Chanseok Lim
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Suita, Japan
| | - Hui Ming Khoo
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naoki Tani
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Youichi Saitoh
- Department of Mechanical Science and Bioengineering, Osaka University Graduate School of Engineering Science, Toyonaka, Japan
- Tokuyukai Rehabilitation Clinic, Toyonaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Isoardo G, Adenzato M, Ciullo S, Fontana E, Stura I, Migliaretti G, Titolo P, Matteoni E, Calvo A, Laino F, Palumbo F, Ardito RB. Emotion Processing in Peripheral Neuropathic Pain: An Observational Study. Med Sci (Basel) 2024; 12:27. [PMID: 38804383 PMCID: PMC11130802 DOI: 10.3390/medsci12020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND In clinical practice, the implementation of tailored treatment is crucial for assessing the patient's emotional processing profile. Here, we investigate all three levels of analysis characterizing emotion processing, i.e., recognition, representation, and regulation, in patients with peripheral neuropathic pain (PNP). METHODS Sixty-two patients and forty-eight healthy controls underwent quantitative sensory testing, i.e., psychophysical tests to assess somatosensory functions such as perception of cold (CDT), heat-induced pain (HPT), and vibration (VDT), as well as three standardized tasks to assess emotional processing: (1) the Ekman 60-Faces Test (EK-60F) to assess recognition of basic facial emotions, (2) the Reading the Mind in the Eyes Test (RME) to assess the ability to represent the feelings of another person by observing their eyes, and (3) the 20-item Toronto Alexithymia Scale (TAS-20) to assess emotional dysregulation, i.e., alexithymia. RESULTS General Linear Model analysis revealed a significant relationship between left index finger VDT z-scores in PNP patients with alexithymia. The RME correlated with VDT z-scores of the left little finger and overall score for the EK-60F. CONCLUSIONS In patients with PNP, emotion processing is impaired, which emphasizes the importance of assessing these abilities appropriately in these patients. In this way, clinicians can tailor treatment to the needs of individual patients.
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Affiliation(s)
- Gianluca Isoardo
- Department of Neurosciences & Mental Health, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy;
| | - Mauro Adenzato
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.A.); (S.C.); (E.F.)
| | - Stefano Ciullo
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.A.); (S.C.); (E.F.)
| | - Elena Fontana
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.A.); (S.C.); (E.F.)
| | - Ilaria Stura
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (I.S.); (E.M.); (A.C.); (F.P.)
| | - Giuseppe Migliaretti
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Torino, Italy;
| | - Paolo Titolo
- UOD Reconstructive Microsurgery, Department of Orthopedics & Traumatology, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy;
| | - Enrico Matteoni
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (I.S.); (E.M.); (A.C.); (F.P.)
| | - Andrea Calvo
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (I.S.); (E.M.); (A.C.); (F.P.)
- 1st Neurology Unit, Department of Neurosciences & Mental Health, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy
| | - Federica Laino
- Unit of Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy;
| | - Francesca Palumbo
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (I.S.); (E.M.); (A.C.); (F.P.)
| | - Rita B. Ardito
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.A.); (S.C.); (E.F.)
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Kersebaum D, Sendel M, Lassen J, Fabig SC, Forstenpointner J, Reimer M, Canaan-Kühl S, Gaedeke J, Rehm S, Gierthmühlen J, Baron R, Hüllemann P. Cold-evoked potentials in Fabry disease and polyneuropathy. FRONTIERS IN PAIN RESEARCH 2024; 5:1352711. [PMID: 38812855 PMCID: PMC11133603 DOI: 10.3389/fpain.2024.1352711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/02/2024] [Indexed: 05/31/2024] Open
Abstract
Background Fabry disease (FD) causes cold-evoked pain and impaired cold perception through small fiber damage, which also occurs in polyneuropathies (PNP) of other origins. The integrity of thinly myelinated fibers and the spinothalamic tract is assessable by cold-evoked potentials (CEPs). In this study, we aimed to assess the clinical value of CEP by investigating its associations with pain, autonomic measures, sensory loss, and neuropathic signs. Methods CEPs were examined at the hand and foot dorsum of patients with FD (n = 16) and PNP (n = 21) and healthy controls (n = 23). Sensory phenotyping was performed using quantitative sensory testing (QST). The painDETECT questionnaire (PDQ), FabryScan, and measures for the autonomic nervous system were applied. Group comparisons and correlation analyses were performed. Results CEPs of 87.5% of the FD and 85.7% of the PNP patients were eligible for statistical analysis. In all patients combined, CEP data correlated significantly with cold detection loss, PDQ items, pain, and autonomic measures. Abnormal CEP latency in FD patients was associated with an abnormal heart frequency variability item (r = -0.684; adjusted p = 0.04). In PNP patients, CEP latency correlated significantly with PDQ items, and CEP amplitude correlated with autonomic measures (r = 0.688, adjusted p = 0.008; r = 0.619, adjusted p = 0.024). Furthermore, mechanical pain thresholds differed significantly between FD (gain range) and PNP patients (loss range) (p = 0.01). Conclusions Abnormal CEPs were associated with current pain, neuropathic signs and symptoms, and an abnormal function of the autonomic nervous system. The latter has not been mirrored by QST parameters. Therefore, CEPs appear to deliver a wider spectrum of information on the sensory nervous system than QST alone.
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Affiliation(s)
- Dilara Kersebaum
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
- Schön Clinic Rendsburg, Department of Psychiatry, Psychotherapy and Psychosomatics, Rendsburg, Germany
| | - Manon Sendel
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Josephine Lassen
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sophie-Charlotte Fabig
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Maren Reimer
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sima Canaan-Kühl
- Division of Nephrology, Department of Medicine, Charité, Berlin, Germany
| | - Jens Gaedeke
- Division of Nephrology, Department of Medicine, Charité, Berlin, Germany
| | - Stefanie Rehm
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Janne Gierthmühlen
- Interdisciplinary Pain and Palliative Care Division, Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Philipp Hüllemann
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Hong SW, Piao L, Cho EH, Seo EH, Kim SH. The Effect of Pregabalin on Microglia Differentiation in Rat with Neuropathic pain: A Preliminary Study. Int J Med Sci 2024; 21:1265-1273. [PMID: 38818478 PMCID: PMC11134577 DOI: 10.7150/ijms.96236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
This study investigated the effects of pregabalin on microglial differentiation in rats with neuropathic pain (NP) induced by sciatic nerve ligation and transection. After confirming NP, the rats were randomly allocated to either a pregabalin or control group. The pregabalin group received intraperitoneal injections of 10 mg/kg pregabalin, while the control group received an equivalent volume of normal saline following surgery. On postoperative day 28, neuronal damage, microglial activity, and microglial differentiation were assessed. The pregabalin group exhibited significantly less neuronal damage compared to the control group, along with a significant decrease in activated microglial expression in both the brain and spinal cord. Pregabalin treatment also significantly altered the microglial phenotype expression, with a decrease in the M1 phenotype percentage and an increase in the M2 phenotype percentage in both the brain (M1 phenotype: 43.52 ± 12.16% and 18.00 ± 8.57% in the control and pregabalin groups, respectively; difference: 27.26 [15.18-42.10], p = 0.002; M2 phenotype: 16.88 ± 6.47% and 39.63 ± 5.82% in the control and pregabalin groups, respectively; difference 22.04 [17.17-32.70], p < 0.001) and the spinal cord ipsilateral to nerve injury (M1 phenotype: 44.35 ± 12.12% and 13.78 ± 5.39% in the control and pregabalin groups, respectively; difference 30.46 [21.73-44.45], p < 0.001; M2 phenotype: 7.64 ± 3.91% and 33.66 ± 7.95% in the control and pregabalin groups, respectively; difference 27.41 [21.21-36.30], p < 0.001). Overall, pregabalin treatment significantly decreased the microglial M1 phenotype while increasing the microglial M2 phenotype in NP rats.
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Affiliation(s)
- Seung-Wan Hong
- Department of Anesthesiology and Pain medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Liyun Piao
- Department of Infection and Immunology, Konkuk University School of Medicine, Seoul, Korea
| | - Eun-Hwa Cho
- Department of Infection and Immunology, Konkuk University School of Medicine, Seoul, Korea
| | - Eun-Hye Seo
- Korea mRNA vaccine initiative, Gachon University, Incheon, Korea
| | - Seong-Hyop Kim
- Department of Anesthesiology and Pain medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Infection and Immunology, Konkuk University School of Medicine, Seoul, Korea
- Department of Medicine, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, Korea
- Department of Medical Education, Konkuk University School of Medicine, Seoul, Korea
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Oguchi M, Nicholas MK, Asghari A, Sanders D, Wrigley PJ. Psychologically based interventions for adults with chronic neuropathic pain: a scoping review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:400-414. [PMID: 38310361 PMCID: PMC11145456 DOI: 10.1093/pm/pnae006] [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: 07/15/2023] [Revised: 12/10/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE As psychologically based interventions have been shown to have clinical utility for adults with chronic pain generally, a similar benefit might be expected in the management of chronic neuropathic pain (NeuP). However, to date, this has not been established, with existing systematic reviews on this topic being hampered by the scarcity of randomized controlled trials (RCTs). This review aimed to identify the type of psychologically based interventions studied for adults with chronic NeuP. It also aimed to assess whether there are enough RCTs to justify undertaking an updated systematic review. METHODS Seven databases and 2 clinical trial registries were searched for NeuP and psychologically based interventions from database inception to December 2021, and the search was updated in February 2023. The search was broadened by reviewing the reference list of included studies and contacting field experts. Predetermined study characteristics were extracted. RESULTS Of 4682 records screened, 33 articles (less than 1%) met the eligibility criteria. Four broad intervention approaches were observed, including cognitive-behavioral approaches (n = 16), mindfulness/meditation (n = 10), trauma-focused therapy (n = 4), and hypnosis (n = 3). Thirteen RCTs were identified, and of these, 9 retained 20 participants in each arm after treatment. CONCLUSIONS Cognitive-behavioral therapy was the most common therapeutic approach identified, whereas mindfulness/meditation was the most frequently used technique. Almost half to two-thirds of the studies reported significant improvements in pain, disability, or distress, which suggests that psychologically based interventions are potentially beneficial for adults with chronic NeuP. An updated systematic review seems warranted. STUDY REGISTRATION Open Science Framework (https://osf.io) (December 6, 2021; DOI: 10.17605/OSF.IO/WNSTM).
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Affiliation(s)
- Mayumi Oguchi
- Sydney Medical School—Northern, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and the Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
- Pain Management and Research Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Michael K Nicholas
- Sydney Medical School—Northern, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and the Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
- Pain Management and Research Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Ali Asghari
- Sydney Medical School—Northern, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and the Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
- Pain Management and Research Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Duncan Sanders
- Sydney Medical School—Northern, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and the Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
| | - Paul J Wrigley
- Sydney Medical School—Northern, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and the Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
- Pain Management and Research Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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Ríos-León M, Taylor J, Segura-Fragoso A, Barriga-Martín A. Usefulness of the DN4, S-LANSS, and painDETECT screening questionnaires to detect the neuropathic pain components in people with acute whiplash-associated disorders: a cross-sectional study. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:344-351. [PMID: 38150190 PMCID: PMC11063748 DOI: 10.1093/pm/pnad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Although the presence of neuropathic pain (NP) components has been reported in whiplash-associated disorders (WAD), no studies have analyzed the usefulness of NP screening questionnaires to detect NP components in WAD. This study aimed to assess the usefulness of 3 NP screening tools (Douleur Neuropathique 4 [DN4], self-administered Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS], and painDETECT questionnaire [PDQ]) to detect the presence of NP components in acute WAD. DESIGN A cross-sectional study. SETTING Hospital. SUBJECTS Of 188 eligible individuals, 50 people (68% women, mean age = 40.3 ± 12.5 years) with acute WAD (52% Grade III) were included. METHODS Specialized physicians initially screened participants for the presence of NP components according to clinical practice and international recommendations. After physician assessment, blinded investigators used NP screening questionnaires (DN4, S-LANSS, and PDQ) to assess participants within 2 weeks of their accident. The diagnostic accuracy of these tools was analyzed and compared with the reference standard (physicians' assessments). RESULTS The 3 screening questionnaires showed excellent discriminant validity (area under the curve: ≥0.8), especially S-LANSS (area under the curve: 0.9; P < .001). DN4 demonstrated the highest sensitivity (87%), followed by S-LANSS (75%), while S-LANSS and PDQ showed the highest specificity (85% and 82%, respectively). These tools demonstrated a strong correlation with the reference standard (S-LANSS: rho = 0.7; PDQ: rho = 0.62; DN4: rho = 0.7; all, P < .001). CONCLUSIONS The DN4, S-LANSS, and PDQ show excellent discriminant validity to detect the presence of NP components in acute WAD, especially S-LANSS. Initial screening with these tools might improve management of WAD.
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Affiliation(s)
- Marta Ríos-León
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos (SESCAM), Toledo 45071, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo 45071, Spain
| | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos (SESCAM), Toledo 45071, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo 45071, Spain
- Harris Manchester College, University of Oxford, Oxford OX1 3TD, United Kingdom
| | - Antonio Segura-Fragoso
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos (SESCAM), Toledo 45071, Spain
| | - Andrés Barriga-Martín
- Department of Orthopaedic Surgery, Hospital Nacional de Parapléjicos (SESCAM), Toledo 45071, Spain
- School of Medicine, University of Castilla-La Mancha, Toledo 45071, Spain
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Khan MA, Koh RGL, Rashidiani S, Liu T, Tucci V, Kumbhare D, Doyle TE. Cracking the Chronic Pain code: A scoping review of Artificial Intelligence in Chronic Pain research. Artif Intell Med 2024; 151:102849. [PMID: 38574636 DOI: 10.1016/j.artmed.2024.102849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The aim of this review is to identify gaps and provide a direction for future research in the utilization of Artificial Intelligence (AI) in chronic pain (CP) management. METHODS A comprehensive literature search was conducted using various databases, including Ovid MEDLINE, Web of Science Core Collection, IEEE Xplore, and ACM Digital Library. The search was limited to studies on AI in CP research, focusing on diagnosis, prognosis, clinical decision support, self-management, and rehabilitation. The studies were evaluated based on predefined inclusion criteria, including the reporting quality of AI algorithms used. RESULTS After the screening process, 60 studies were reviewed, highlighting AI's effectiveness in diagnosing and classifying CP while revealing gaps in the attention given to treatment and rehabilitation. It was found that the most commonly used algorithms in CP research were support vector machines, logistic regression and random forest classifiers. The review also pointed out that attention to CP mechanisms is negligible despite being the most effective way to treat CP. CONCLUSION The review concludes that to achieve more effective outcomes in CP management, future research should prioritize identifying CP mechanisms, CP management, and rehabilitation while leveraging a wider range of algorithms and architectures. SIGNIFICANCE This review highlights the potential of AI in improving the management of CP, which is a significant personal and economic burden affecting more than 30% of the world's population. The identified gaps and future research directions provide valuable insights to researchers and practitioners in the field, with the potential to improve healthcare utilization.
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Affiliation(s)
- Md Asif Khan
- Department of Electrical and Computer Engineering at McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Ryan G L Koh
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON M5G 2A2, Canada
| | - Sajjad Rashidiani
- Department of Electrical and Computer Engineering at McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Theodore Liu
- Department of Electrical and Computer Engineering at McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Victoria Tucci
- Faculty of Health Sciences at McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Dinesh Kumbhare
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON M5G 2A2, Canada
| | - Thomas E Doyle
- Department of Electrical and Computer Engineering at McMaster University, Hamilton, ON L8S 4K1, Canada.
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Ferraro MC, O'Connell NE, Sommer C, Goebel A, Bultitude JH, Cashin AG, Moseley GL, McAuley JH. Complex regional pain syndrome: advances in epidemiology, pathophysiology, diagnosis, and treatment. Lancet Neurol 2024; 23:522-533. [PMID: 38631768 DOI: 10.1016/s1474-4422(24)00076-0] [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: 09/09/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 04/19/2024]
Abstract
Complex regional pain syndrome (CRPS) is a rare pain disorder that usually occurs in a limb after trauma. The features of this disorder include severe pain and sensory, autonomic, motor, and trophic abnormalities. Research from the past decade has offered new insights into CRPS epidemiology, pathophysiology, diagnosis, and treatment. Early identification of individuals at high risk of CRPS is improving, with several risk factors established and some others identified in prospective studies during the past 5 years. Better understanding of the pathophysiological mechanisms of CRPS has led to its classification as a chronic primary pain disorder, and subtypes of CRPS have been updated. Procedures for diagnosis have also been clarified. Although effective treatment of CRPS remains a challenge, evidence-based integrated management approaches provide new opportunities to improve patient care. Further advances in diagnosis and treatment of CRPS will require coordinated, international multicentre initiatives.
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Affiliation(s)
- Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Claudia Sommer
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany
| | - Andreas Goebel
- Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Janet H Bultitude
- Centre for Pain Research, Department of Psychology, University of Bath, Bath, UK
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - G Lorimer Moseley
- IMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
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Mulè S, Rosso G, Botta M, Brovero A, Ferrari S, Galla R, Molinari C, Uberti F. Design of Mixed Medicinal Plants, Rich in Polyphenols, Vitamins B, and Palmitoylethanolamide-Based Supplement to Help Reduce Nerve Pain: A Preclinical Study. Int J Mol Sci 2024; 25:4790. [PMID: 38732008 PMCID: PMC11083932 DOI: 10.3390/ijms25094790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Neuropathy affects 7-10% of the general population and is caused by a lesion or disease of the somatosensory system. The limitations of current therapies highlight the necessity of a new innovative approach to treating neuropathic pain (NP) based on the close correlation between oxidative stress, inflammatory process, and antioxidant action. The advantageous outcomes of a novel combination composed of Hop extract, Propolis, Ginkgo Biloba, Vitamin B, and palmitoylethanolamide (PEA) used as a treatment was evaluated in this study. To assess the absorption and biodistribution of the combination, its bioavailability was first examined in a 3D intestinal barrier model that replicated intestinal absorption. Further, a 3D nerve tissue model was developed to study the biological impacts of the combination during the essential pathways involved in NP. Our findings show that the combination could cross the intestinal barrier and reach the peripheral nervous system, where it modulates the oxidative stress, inflammation levels, and myelination mechanism (increased NRG, MPZ, ERB, and p75 levels) under Schwann cells damaging. This study proves the effectiveness of Ginkgo Biloba, Propolis, Hop extract, Vitamin B, and PEA in avoiding nerve damage and suggests a potential alternative nutraceutical treatment for NP and neuropathies.
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Affiliation(s)
- Simone Mulè
- Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale (UPO), 13100 Vercelli, Italy; (S.M.); (G.R.); (M.B.); (S.F.); (R.G.); (C.M.)
| | - Giorgia Rosso
- Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale (UPO), 13100 Vercelli, Italy; (S.M.); (G.R.); (M.B.); (S.F.); (R.G.); (C.M.)
| | - Mattia Botta
- Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale (UPO), 13100 Vercelli, Italy; (S.M.); (G.R.); (M.B.); (S.F.); (R.G.); (C.M.)
| | - Arianna Brovero
- Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy;
| | - Sara Ferrari
- Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale (UPO), 13100 Vercelli, Italy; (S.M.); (G.R.); (M.B.); (S.F.); (R.G.); (C.M.)
| | - Rebecca Galla
- Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale (UPO), 13100 Vercelli, Italy; (S.M.); (G.R.); (M.B.); (S.F.); (R.G.); (C.M.)
- Noivita Srls, Spin Off, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Claudio Molinari
- Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale (UPO), 13100 Vercelli, Italy; (S.M.); (G.R.); (M.B.); (S.F.); (R.G.); (C.M.)
| | - Francesca Uberti
- Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale (UPO), 13100 Vercelli, Italy; (S.M.); (G.R.); (M.B.); (S.F.); (R.G.); (C.M.)
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Sommer C, Baron R, Sachau J, Papagianni A, Özgül ÖS, Enax-Krumova E. [The EAN-NeuPSIG guideline on the diagnosis of neuropathic pain-a summary]. Schmerz 2024:10.1007/s00482-024-00806-0. [PMID: 38602515 DOI: 10.1007/s00482-024-00806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/12/2024]
Abstract
In this joint guideline of the scientific societies and working groups mentioned in the title, evidence-based recommendations for the use of screening questionnaires and diagnostic tests in patients with neuropathic pain were developed. The systematic literature search and meta-analysis yielded the following results: Of the screening questionnaires, Douleur Neuropathique en 4 Questions (DN4), I‑DN4 (self-administered DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) received a strong recommendation, while S‑LANSS (self-administered LANSS) and PainDETECT received weak recommendations for their use in the diagnostic workup of patients with possible neuropathic pain. There was a strong recommendation for the use of skin biopsy and a weak recommendation for quantitative sensory testing and nociceptive evoked potentials. The role of confocal corneal microscopy is still unclear. Functional imaging and peripheral nerve blocks are helpful in elucidating the pathophysiology, but current literature does not support their use in diagnosing neuropathic pain. In selected cases, genetic testing in specialized centers may be considered.
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Affiliation(s)
- Claudia Sommer
- Neurologische Klinik, Universitätsklinikum Würzburg, 97080, Würzburg, Deutschland.
| | - Ralf Baron
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Juliane Sachau
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | | | - Özüm S Özgül
- Neurologische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Elena Enax-Krumova
- Neurologische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bochum, Deutschland
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48
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Xia W, Ou M, Chen Y, Chen F, Yan M, Xiao Z, Xu X. Experiences of patients with advanced cancer coping with chronic pain: a qualitative analysis. BMC Palliat Care 2024; 23:94. [PMID: 38600476 PMCID: PMC11005139 DOI: 10.1186/s12904-024-01418-2] [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: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To gain insight into the perceptions, and beliefs of patients with advanced cancer coping with chronic pain and to identify their attitudes and demands on pain management. METHODS From July to September 2022, 17 patients with advanced cancer living with chronic pain were recruited from a tertiary cancer hospital in Hunan Province, China. Qualitative and semi-structured interviews were conducted individually, with 30-45 minutes for each. The Colaizzi 7-step analysis method in phenomenological research was used for data analysis. RESULTS The experience of pain acceptance by advanced cancer patients with chronic pain was summarized into four themes: pain catastrophizing (unable to ignore the pain, try various methods to relieve the pain, exaggerating pain perception, and lack of knowledge about proper pain management), rumination (compulsive rumination and worrying rumination), avoidance coping (situational avoidance and repressive avoidance) and constructive action (setting clear value goal and taking reciprocal action). CONCLUSION Most patients with advanced cancer had low pain acceptance and negative attitudes. Feeling helpless in the face of pain and suffering alone were their norm. Long-term negative emotions could lead to gradual depression and loss of hope for treatment, resulting in pain catastrophizing and persistent rumination. Nevertheless, a few patients accepted pain with positive attitudes. Medical professionals should pay more attention to the psychological status of advanced cancer patients with chronic pain, and employ alternative therapies, for example, cognitive behavioral therapy. More efforts are needed to reduce patients' pain catastrophizing, and promote their pain acceptance by a better understanding of pain through health education.
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Affiliation(s)
- Wanting Xia
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Meijun Ou
- Head & Neck Plastic Surgery, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yongyi Chen
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Furong Chen
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Mengyao Yan
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Zhirui Xiao
- Department of Nursing, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xianghua Xu
- Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
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Subedi A, Tiwari A, Etemad AF, Huang Y, Chatterjee B, McLeod SL, Lu Y, Gonzalez D, Ghosh K, Singh SK, Ruiz Echartea ME, Grimm SL, Coarfa C, Pan HL, Majumder S. Nerve injury inhibits Oprd1 and Cnr1 transcription through REST in primary sensory neurons. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.17.579842. [PMID: 38585789 PMCID: PMC10996832 DOI: 10.1101/2024.02.17.579842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The transcription repressor REST in the dorsal root ganglion (DRG) is upregulated by peripheral nerve injury and promotes the development of chronic pain. However, the genes targeted by REST in neuropathic pain development remain unclear. The expression levels of 4 opioid receptor (Oprm1, Oprd1, Oprl1, Oprk1) and the cannabinoid CB1 receptor (Cnr1) genes in the DRG regulate nociception. In this study, we determined the role of REST in the control of their expression in the DRG induced by spared nerve injury (SNI) in both male and female mice. Transcriptomic analyses of male mouse DRGs followed by quantitative reverse transcription polymerase chain reaction analyses of both male and female mouse DRGs showed that SNI upregulated expression of Rest and downregulated mRNA levels of all 4 opioid receptor and Cnr1 genes, but Oprm1 was upregulated in female mice. Analysis of publicly available bioinformatic data suggested that REST binds to the promoter regions of Oprm1 and Cnr1. Chromatin immunoprecipitation analyses indicated differing levels of REST at these promoters in male and female mice. Full-length Rest conditional knockout in primary sensory neurons reduced SNI-induced pain hypersensitivity and rescued the SNI-induced reduction in the expression of Oprd1 and Cnr1 in the DRG in both male and female mice. Our results suggest that nerve injury represses the transcription of Oprd1 and Cnr1 via REST in primary sensory neurons and that REST is a potential therapeutic target for neuropathic pain.
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Kumar A, Soliman N, Gan Z, Cullinan P, Vollert J, Rice AS, Kemp H. A systematic review of the prevalence of postamputation and chronic neuropathic pain associated with combat injury in military personnel. Pain 2024; 165:727-740. [PMID: 38112578 PMCID: PMC10949216 DOI: 10.1097/j.pain.0000000000003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Combat trauma can lead to widespread tissue damage and limb loss. This may result in chronic neuropathic and post amputation pain, including phantom limb pain (PLP) and residual limb pain (RLP). The military population is distinct with respect to demographic, injury, and social characteristics compared with other amputation and trauma cohorts. We undertook a systematic review of studies of military personnel, with a history of combat injury, that reported a prevalence of any type of postamputation pain or chronic neuropathic pain, identified from Embase and MEDLINE databases.Using the inverse variance method with a random-effects model, we undertook a meta-analysis to determine an overall prevalence and performed exploratory analyses to identify the effect of the type of pain, conflict, and time since injury on prevalence. Pain definitions and types of pain measurement tools used in studies were recorded. Thirty-one studies (14,738 participants) were included. The pooled prevalence of PLP, RLP, and chronic neuropathic pain were 57% (95% CI: 46-68), 61% (95% CI: 50-71), and 26% (95% CI: 10-54), respectively. Between-study heterogeneity was high (I 2 : 94%-98%). Characterisation of duration, frequency, and impact of pain was limited. Factors reported by included studies as being associated with PLP included the presence of RLP and psychological comorbidity. The prevalence of postamputation pain and chronic neuropathic pain after combat trauma is high. We highlight inconsistency of case definitions and terminology for pain and the need for consensus in future research of traumatic injury.
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Affiliation(s)
- Alexander Kumar
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
- Academic Department of Military Anaesthesia, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Nadia Soliman
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Zoe Gan
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Paul Cullinan
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jan Vollert
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Andrew S.C. Rice
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Harriet Kemp
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
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