1
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Ständer S, Schmelz M. Skin Innervation. J Invest Dermatol 2024; 144:1716-1723. [PMID: 38402477 DOI: 10.1016/j.jid.2023.10.047] [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: 08/21/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 02/26/2024]
Abstract
All layers and appendages of the skin are densely innervated by afferent and efferent neurons providing sensory information and controlling skin perfusion and sweating. In mice, neuronal functions have been comprehensively linked to unique single-cell expression patterns and to characteristic arborization of nerve endings in skin and dorsal horn, whereas for humans, specific molecular markers for functional classes of afferent neurons are still lacking. Moreover, bidirectional communication between sensory neurons and local skin cells has become of particular interest, resulting in a broader physiological understanding of sensory function but also of trophic functions and immunomodulation in disease states.
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Affiliation(s)
- Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital, Münster, Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, Mannheim Center for Translational Neuroscience (MCTN), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
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2
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Huisman D, Mansfield M, Cummins TM, Moss-Morris R, McMahon SB, Bannister K. Gastrointestinal pain: A systematic review of temporal summation of pain paradigms and outcomes. Eur J Pain 2024. [PMID: 38817207 DOI: 10.1002/ejp.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/31/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Since targeted treatment for gastrointestinal pain is elusive, identifying the mechanistic underpinning of this pain type is important. Facilitation of spinal neuronal responses underpins certain pain types, and the psychophysical temporal summation of pain (TSP) paradigm provides a proxy measure of spinal facilitatory processes. Our aim was to systematically review whether facilitated TSP is a feature of gastrointestinal pain in patients with, or pain-free people experiencing experimentally induced, gastrointestinal pain. DATABASES AND DATA TREATMENT EMBASE, MEDLINE, PsychInfo, CINAHL, and Web of Science were systematically searched, from inception to July 2023, for human studies reporting TSP paradigm outcomes in the context of gastrointestinal pain. The Appraisal tool for Cross-Sectional studies was used for quality assessment and applied independently by two researchers. RESULTS Fifteen papers consisting of cross-sectional (n = 6), case-control (n = 8), and retrospective cohort (n = 1) studies, were included. Thirteen studies investigated TSP in people with gastrointestinal pain with (n = 5) or without (n = 8) defined pathology. Two studies evoked TSP by repetitive gut stimulation in people undergoing abdominal medical procedures. Preliminary evidence showed that facilitated TSP correlated with the presence of functional gastrointestinal pain in women, and those with a history of trauma. No effect was observed in people with inflammatory bowel disease, although it was often unclear if they experienced pain. CONCLUSIONS It is not possible to conclude whether facilitated TSP is a feature of gastrointestinal pain. We recommend that subgroup findings are corroborated and that TSP paradigms are standardized in order that direct comparisons between studies may be made. SIGNIFICANCE STATEMENT Evidence indicated that pain facilitatory processes, as evidenced by a facilitated TSP outcome, contribute to functional gastrointestinal pain in women and those with a history of trauma. However, heterogeneity of study populations and paradigms precluded statistical synthesis and findings would need be corroborated. Studies exploring facilitatory processes in people with inflammatory bowel diseases did not report significant results, but pain is not a given in these conditions and, conversely, may be driven by peripheral inflammation during active disease. This should be taken in consideration in future explorations. REGISTRATION REVIEW PROSPERO CRD42022341845.
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Affiliation(s)
- Danielle Huisman
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Mansfield
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Tatum M Cummins
- Neurorestoration Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen B McMahon
- Neurorestoration Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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3
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Cohen SP, Caterina MJ, Yang SY, Socolovsky M, Sommer C. Pain in the Context of Sensory Deafferentation. Anesthesiology 2024; 140:824-848. [PMID: 38470115 DOI: 10.1097/aln.0000000000004881] [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: 03/13/2024]
Abstract
Pain that accompanies deafferentation is one of the most mysterious and misunderstood medical conditions. Prevalence rates for the assorted conditions vary considerably but the most reliable estimates are greater than 50% for strokes involving the somatosensory system, brachial plexus avulsions, spinal cord injury, and limb amputation, with controversy surrounding the mechanistic contributions of deafferentation to ensuing neuropathic pain syndromes. Deafferentation pain has also been described for loss of other body parts (e.g., eyes and breasts) and may contribute to between 10% and upwards of 30% of neuropathic symptoms in peripheral neuropathies. There is no pathognomonic test or sign to identify deafferentation pain, and part of the controversy surrounding it stems from the prodigious challenges in differentiating cause and effect. For example, it is unknown whether cortical reorganization causes pain or is a byproduct of pathoanatomical changes accompanying injury, including pain. Similarly, ascertaining whether deafferentation contributes to neuropathic pain, or whether concomitant injury to nerve fibers transmitting pain and touch sensation leads to a deafferentation-like phenotype can be clinically difficult, although a detailed neurologic examination, functional imaging, and psychophysical tests may provide clues. Due in part to the concurrent morbidities, the physical, psychologic, and by extension socioeconomic costs of disorders associated with deafferentation are higher than for other chronic pain conditions. Treatment is symptom-based, with evidence supporting first-line antineuropathic medications such as gabapentinoids and antidepressants. Studies examining noninvasive neuromodulation and virtual reality have yielded mixed results.
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Affiliation(s)
- Steven P Cohen
- Departments of Anesthesiology, Neurology, Physical Medicine and Rehabilitation, Psychiatry and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Michael J Caterina
- Neurosurgery Pain Research Institute and Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Su-Yin Yang
- Psychology Service, Woodlands Health, and Adjunct Faculty, Lee Kong Chian School of Medicine, Singapore
| | - Mariano Socolovsky
- Department of Neurosurgery, University of Buenos Aires, Buenos Aires, Argentina
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4
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Cazzaniga S, Real G, Finazzi S, Lorini LF, Forget P, Bugada D. How to Modulate Peripheral and Central Nervous System to Treat Acute Postoperative Pain and Prevent Pain Persistence. Curr Neuropharmacol 2024; 22:23-37. [PMID: 37563811 DOI: 10.2174/1570159x21666230810103508] [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: 10/31/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 08/12/2023] Open
Abstract
Chronic postoperative pain (CPSP) is a major issue after surgery, which may impact on patient's quality of life. Traditionally, CPSP is believed to rely on maladaptive hyperalgesia and risk factors have been identified that predispose to CPSP, including acute postoperative pain. Despite new models of prediction are emerging, acute pain is still a modifiable factor that can be challenged with perioperative analgesic strategies. In this review we present the issue of CPSP, focusing on molecular mechanism underlying the development of acute and chronic hyperalgesia. Also, we focus on how perioperative strategies can impact directly or indirectly (by reducing postoperative pain intensity) on the development of CPSP.
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Affiliation(s)
- Sara Cazzaniga
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Giovanni Real
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Simone Finazzi
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Luca F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Patrice Forget
- School of Medicine, Medical Sciences and Nutrition, Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom
- Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, Scotland, United Kingdom
| | - Dario Bugada
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
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Vollert J, Fardo F, Attal N, Baron R, Bouhassira D, Enax-Krumova EK, Freynhagen R, Hansson P, Jensen TS, Kersebaum D, Maier C, Pogatzki-Zahn E, Rice AS, Sachau J, Schaldemose EL, Segerdahl M, Sendel M, Tölle TR, Finnerup NB, Treede RD. Paradoxical heat sensation as a manifestation of thermal hypesthesia: a study of 1090 patients with lesions of the somatosensory system. Pain 2024; 165:216-224. [PMID: 37578447 PMCID: PMC10723641 DOI: 10.1097/j.pain.0000000000003014] [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: 05/23/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023]
Abstract
ABSTRACT Paradoxical heat sensation (PHS) is the perception of warmth when the skin is cooled. Paradoxical heat sensation rarely occurs in healthy individuals but more frequently in patients suffering from lesions or disease of the peripheral or central nervous system. To further understand mechanisms and epidemiology of PHS, we evaluated the occurrence of PHS in relation to disease aetiology, pain levels, quantitative sensory testing parameters, and Neuropathic Pain Symptom Inventory (NPSI) items in patients with nervous system lesions. Data of 1090 patients, including NPSI scores from 404 patients, were included in the analysis. We tested 11 quantitative sensory testing parameters for thermal and mechanical detection and pain thresholds, and 10 NPSI items in a multivariate generalised linear model with PHS, aetiology, and pain (yes or no) as fixed effects. In total, 30% of the neuropathic patients reported PHS in contrast to 2% of healthy individuals. The frequency of PHS was not linked to the presence or intensity of pain. Paradoxical heat sensation was more frequent in patients living with polyneuropathy compared with central or unilateral peripheral nerve lesions. Patients who reported PHS demonstrated significantly lower sensitivity to thermal perception, with lower sensitivity to normally painful heat and cold stimuli. Neuropathic Pain Symptom Inventory scores were lower for burning and electric shock-like pain quality for patients with PHS. Our findings suggest that PHS is associated with loss of small thermosensory fibre function normally involved in cold and warm perception. Clinically, presence of PHS could help screening for loss of small fibre function as it is straightforward to measure or self-reported by patients.
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Affiliation(s)
- Jan Vollert
- Pain Research, MSk Lab, Department of Surgery and Cancer, Imperial College, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
| | - Francesca Fardo
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nadine Attal
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France, Université Versailles-Saint-Quentin, Versailles, France
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Didier Bouhassira
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France, Université Versailles-Saint-Quentin, Versailles, France
| | - Elena K. Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bochum, Germany
| | - Rainer Freynhagen
- Department of Anaesthesiology, Critical Care Medicine, Pain Therapy and Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital, Tutzing, Germany
- Department of Anaesthesiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Per Hansson
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Troels S. Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Dilara Kersebaum
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Christoph Maier
- University Hospital of Pediatrics and Adolescent Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
| | - Andrew S.C. Rice
- Pain Research, MSk Lab, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ellen L. Schaldemose
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Märta Segerdahl
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- MS Medical Consulting, Stockholm, Sweden
| | - Manon Sendel
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Thomas R. Tölle
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Nanna B. Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
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6
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Tsilingiris D, Schimpfle L, von Rauchhaupt E, Sulaj A, Seebauer L, Herzig S, Szendroedi J, Kopf S, Κender Ζ. Sensory Phenotypes Provide Insight Into the Natural Course of Diabetic Polyneuropathy. Diabetes 2024; 73:135-146. [PMID: 37862374 DOI: 10.2337/db23-0271] [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: 04/07/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
We aimed to investigate the characteristics and longitudinal course of sensory phenotypes identified through quantitative sensory testing (QST) in the frame of diabetic sensorimotor polyneuropathy (DSPN). A total of 316 individuals with diabetes were examined (type 2 diabetes 78.8%), 250 of whom were undergoing follow-up visits at 1, 2, and/or 4 (2.88 ± 1.27) years. Allocation into four sensory phenotypes (healthy, thermal hyperalgesia [TH], mechanical hyperalgesia [MH], and sensory loss [SL]) at every time point was based on QST profiles of the right foot. Cross-sectional analysis demonstrated a gradual worsening of clinical and electrophysiological sensory findings and increased DSPN prevalence across the groups, culminating in SL. Motor nerve impairment was observed solely in the SL group. Longitudinal analysis revealed a distinct pattern in the developmental course of the phenotype (from healthy to TH, MH, and finally SL). Those with baseline MH exhibited the highest risk of transition to SL. Reversion to healthy status was uncommon and mostly observed in the TH group. Among those without DSPN initially, presence or future occurrence of SL was associated with a three- to fivefold higher likelihood of DSPN development. Our comprehensive longitudinal study of phenotyped patients with diabetes elucidates the natural course of DSPN. QST-based sensory examination together with other tools for phenotyping may be useful in determining the natural course of diabetic neuropathy to identify patients at high risk of DSPN and guide preventive and therapeutic interventions. ARTICLE HIGHLIGHTS The course of diabetic sensorimotor polyneuropathy (DSPN) development, from healthy status to overt DSPN, is poorly understood. We studied the characteristics and longitudinal appearance of lower-extremity sensory phenotypes (healthy, thermal hyperalgesia [TH], mechanical hyperalgesia [MH], and sensory loss [SL]) identified through quantitative sensory testing in individuals with diabetes. There was an increasing severity and patterned order of longitudinal appearance across healthy, TH, MH, and SL phenotypes. SL was most strongly associated with formal DSPN. Our findings provide insight into the natural history of DSPN. Sensory phenotyping can be implemented to identify high-risk individuals and those most likely to benefit from therapeutic interventions.
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Affiliation(s)
- Dimitrios Tsilingiris
- Department for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
| | - Lukas Schimpfle
- Department for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Ekaterina von Rauchhaupt
- Department for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
| | - Alba Sulaj
- Department for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
| | - Lukas Seebauer
- Department for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Herzig
- German Center for Diabetes Research, Munich-Neuherberg, Germany
- Joint Heidelberg-Institute for Diabetes and Cancer Translational Diabetes Program, Helmholtz Center Munich, Neuherberg, Germany
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Munich-Neuherberg, Germany
| | - Julia Szendroedi
- Department for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
- Joint Heidelberg-Institute for Diabetes and Cancer Translational Diabetes Program, Helmholtz Center Munich, Neuherberg, Germany
| | - Stefan Kopf
- Department for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
| | - Ζoltan Κender
- Department for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
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7
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Fetell M, Sendel M, Li T, Marinelli L, Vollert J, Ruggerio E, Houk G, Dockum M, Albrecht PJ, Rice FL, Baron R. Cutaneous nerve fiber and peripheral Nav1.7 assessment in a large cohort of patients with postherpetic neuralgia. Pain 2023; 164:2435-2446. [PMID: 37366590 PMCID: PMC10578423 DOI: 10.1097/j.pain.0000000000002950] [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: 11/03/2022] [Revised: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 06/28/2023]
Abstract
ABSTRACT The mechanisms of pain in postherpetic neuralgia (PHN) are still unclear, with some studies showing loss of cutaneous sensory nerve fibers that seemed to correlate with pain level. We report results of skin biopsies and correlations with baseline pain scores, mechanical hyperalgesia, and the Neuropathic Pain Symptom Inventory (NPSI) in 294 patients who participated in a clinical trial of TV-45070, a topical semiselective sodium 1.7 channel (Nav1.7) blocker. Intraepidermal nerve fibers and subepidermal Nav1.7 immunolabeled fibers were quantified in skin punch biopsies from the area of maximal PHN pain, as well as from the contralateral, homologous (mirror image) region. Across the entire study population, a 20% reduction in nerve fibers on the PHN-affected side compared with that in the contralateral side was noted; however, the reduction was much higher in older individuals, approaching 40% in those aged 70 years or older. There was a decrease in contralateral fiber counts as well, also noted in prior biopsy studies, the mechanism of which is not fully clear. Nav1.7-positive immunolabeling was present in approximately one-third of subepidermal nerve fibers and did not differ on the PHN-affected vs contralateral sides. Using cluster analysis, 2 groups could be identified, with the first cluster showing higher baseline pain, higher NPSI scores for squeezing and cold-induced pain, higher nerve fiber density, and higher Nav1.7 expression. While Nav1.7 varies from patient to patient, it does not seem to be a key pathophysiological driver of PHN pain. Individual differences in Nav1.7 expression, however, may determine the intensity and sensory aspects of pain.
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Affiliation(s)
| | - Manon Sendel
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Thomas Li
- Teva Pharmaceuticals, West Chester, PA, United States
| | | | - Jan Vollert
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
- Pain Research, MSk Lab, Department of Surgery and Cancer, Imperial College, London, United Kingdom
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | | | - George Houk
- Integrated Tissue Dynamics LLC, Rensselaer, NY, United States
| | - Marilyn Dockum
- Integrated Tissue Dynamics LLC, Rensselaer, NY, United States
| | | | - Frank L. Rice
- Integrated Tissue Dynamics LLC, Rensselaer, NY, United States
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
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Akdeniz S, Pece AH, Kusderci HS, Dogru S, Tulgar S, Suren M, Okan I. Is Pain Perception Communicated through Mothers? Maternal Pain Catastrophizing Scores Are Associated with Children's Postoperative Circumcision Pain. J Clin Med 2023; 12:6187. [PMID: 37834831 PMCID: PMC10573225 DOI: 10.3390/jcm12196187] [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: 08/19/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
The aim of this study was to evaluate the relation of maternal pain catastrophizing score with children who underwent circumcision postoperative pain. This prospective cohort study was performed between March 2022 and March 2023 at Samsun University, Turkey. Demographic characteristics of mothers and children, mothers' education level, presence of chronic pain, and Beck Depression Inventory scores were recorded preoperatively. Pain catastrophizing was assessed by applying the pain catastrophizing scale (PCS) to the mothers of children who experienced postoperative circumcision pain. The mothers were divided into low-pain catastrophizing (Group 1) and high-pain catastrophizing (Group 2) group. A total of 197 mothers and sons participated in the study, with 86 (43.6%) in Group 1 and 111 (56.4%) in Group 2. Significant differences were found between the two groups in terms of the mothers' PCS scores (p < 0.001), education levels (p = 0.004), chronic pain scores (p = 0.022), and Beck Depression Inventory scores (p < 0.001). Our findings showed that children with high pain catastrophizing mothers experience greater postoperative pain than those with low pain catastrophizing mothers. This may be attributable to a mother's specific cognitive style for coping with pain, which is associated with the child's responses to painful experiences.
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Affiliation(s)
- Sevda Akdeniz
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University, 55090 Samsun, Turkey; (A.H.P.); (H.S.K.); (S.T.); (M.S.)
| | - Ahmet Haydar Pece
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University, 55090 Samsun, Turkey; (A.H.P.); (H.S.K.); (S.T.); (M.S.)
| | - Hatice Selcuk Kusderci
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University, 55090 Samsun, Turkey; (A.H.P.); (H.S.K.); (S.T.); (M.S.)
| | - Serkan Dogru
- Department of Anesthesiology and Reanimation, Mersin City Hospital, 33240 Mersin, Turkey;
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University, 55090 Samsun, Turkey; (A.H.P.); (H.S.K.); (S.T.); (M.S.)
| | - Mustafa Suren
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University, 55090 Samsun, Turkey; (A.H.P.); (H.S.K.); (S.T.); (M.S.)
| | - Ismail Okan
- Department of General Surgery, Faculty of Medicine, Istanbul Medeniyet University, 34720 Istanbul, Turkey;
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Pacifico P, Coy-Dibley JS, Miller RJ, Menichella DM. Peripheral mechanisms of peripheral neuropathic pain. Front Mol Neurosci 2023; 16:1252442. [PMID: 37781093 PMCID: PMC10537945 DOI: 10.3389/fnmol.2023.1252442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
Peripheral neuropathic pain (PNP), neuropathic pain that arises from a damage or disease affecting the peripheral nervous system, is associated with an extremely large disease burden, and there is an increasing and urgent need for new therapies for treating this disorder. In this review we have highlighted therapeutic targets that may be translated into disease modifying therapies for PNP associated with peripheral neuropathy. We have also discussed how genetic studies and novel technologies, such as optogenetics, chemogenetics and single-cell RNA-sequencing, have been increasingly successful in revealing novel mechanisms underlying PNP. Additionally, consideration of the role of non-neuronal cells and communication between the skin and sensory afferents is presented to highlight the potential use of drug treatment that could be applied topically, bypassing drug side effects. We conclude by discussing the current difficulties to the development of effective new therapies and, most importantly, how we might improve the translation of targets for peripheral neuropathic pain identified from studies in animal models to the clinic.
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Affiliation(s)
- Paola Pacifico
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James S. Coy-Dibley
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Richard J. Miller
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniela M. Menichella
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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10
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Kmiecik MJ, Tu FF, Clauw DJ, Hellman KM. Multimodal hypersensitivity derived from quantitative sensory testing predicts pelvic pain outcome: an observational cohort study. Pain 2023; 164:2070-2083. [PMID: 37226937 PMCID: PMC10440257 DOI: 10.1097/j.pain.0000000000002909] [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: 08/01/2022] [Accepted: 02/09/2023] [Indexed: 05/26/2023]
Abstract
ABSTRACT Multimodal hypersensitivity (MMH)-greater sensitivity across multiple sensory modalities (eg, light, sound, temperature, pressure)-is associated with the development of chronic pain. However, previous MMH studies are restricted given their reliance on self-reported questionnaires, narrow use of multimodal sensory testing, or limited follow-up. We conducted multimodal sensory testing on an observational cohort of 200 reproductive-aged women, including those at elevated risk for chronic pelvic pain conditions and pain-free controls. Multimodal sensory testing included visual, auditory, and bodily pressure, pelvic pressure, thermal, and bladder pain testing. Self-reported pelvic pain was examined over 4 years. A principal component analysis of sensory testing measures resulted in 3 orthogonal factors that explained 43% of the variance: MMH, pressure pain stimulus response, and bladder hypersensitivity. The MMH and bladder hypersensitivity factors correlated with baseline self-reported menstrual pain, genitourinary symptoms, depression, anxiety, and health. Over time, MMH increasingly predicted pelvic pain and was the only component to predict outcome 4 years later, even when adjusted for baseline pelvic pain. Multimodal hypersensitivity was a better predictor of pelvic pain outcome than a questionnaire-based assessment of generalized sensory sensitivity. These results suggest that MMHs overarching neural mechanisms convey more substantial long-term risk for pelvic pain than variation in individual sensory modalities. Further research on the modifiability of MMH could inform future treatment developments in chronic pain.
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Affiliation(s)
- Matthew J. Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F. Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Daniel J. Clauw
- Departments of Anesthesiology, Medicine, and Psychiatry, Chronic Pain and Fatigue Research Center, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kevin M. Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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11
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Rutter-Locher Z, Arumalla N, Norton S, Taams LS, Kirkham BW, Bannister K. A systematic review and meta-analysis of questionnaires to screen for pain sensitisation and neuropathic like pain in inflammatory arthritis. Semin Arthritis Rheum 2023; 61:152207. [PMID: 37163841 DOI: 10.1016/j.semarthrit.2023.152207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Targeted pain relief is a major unmet medical need for patients with inflammatory arthritis (IA), where approximately 40% of patients experience persistent pain. Self-reported questionnaires which report on pain sensitivity and neuropathic like pain may provide an insight into certain pain types to guide targeted treatment. OBJECTIVE In this systematic review and meta-analysis we evaluated self-reported pain sensitivity and neuropathic like pain in subjects with IA, as defined by questionnaires. METHODS MEDLINE, Embase, Web of Science, PsycINFO and google scholar were searched for publications and conference abstracts, reporting on pain sensitivity and neuropathic pain using painDETECT, DN4, LANSS, CSI, PSQ and McGill pain questionnaire in adult patients with IA. Risk of bias was assessed using National Institute of Health Quality Assessment Tool. Meta-analysis according to individual questionnaire criteria, was undertaken. RESULTS 63 studies (38 full text and 25 conference abstracts) were included in the review, reporting on a total of 13,035 patients. On meta-analysis, prevalence of pain sensitivity/neuropathic like pain in IA was 36% (95% CI 31-41%) according to painDETECT, 31% (95% CI 26-37%) according to the DN4, 40% (95% CI 32-49%) according to the LANSS and 42% (95% CI 34-51%) according to the CSI. On meta-regression, prevalence of pain sensitivity/neuropathic pain in RA was significantly lower than SpA (p = 0.01) and PsA (p = 0.002) using the painDETECT questionnaire. Across all questionnaires, pain sensitivity and neuropathic like pain were significantly associated with worse pain severity, disease activity, disability, quality of life and anxiety and depression measures. Studies reporting on whether neuropathic like pain is a predictor of treatment outcome were inconsistent. CONCLUSION Pain sensitivity and neuropathic like pain contribute to pain perception in up to 42% of patients with IA. Despite substantial heterogeneity between studies on meta-analysis, this review highlights the large proportion of patients with IA who may experience pain due to underlying mechanisms other than, or in addition to, synovial inflammation.
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Affiliation(s)
- Zoe Rutter-Locher
- Rheumatology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Nikita Arumalla
- Rheumatology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sam Norton
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Leonie S Taams
- Centre for Inflammation Biology and Cancer Immunology (CIBCI), Department of Inflammation Biology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Bruce W Kirkham
- Rheumatology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, Wolfson CARD, Guy's Campus, King's College London, London SE1 1UL, UK
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12
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Adams GR, Gandhi W, Harrison R, van Reekum CM, Wood-Anderson D, Gilron I, Salomons TV. Do "central sensitization" questionnaires reflect measures of nociceptive sensitization or psychological constructs? A systematic review and meta-analyses. Pain 2023; 164:1222-1239. [PMID: 36729810 DOI: 10.1097/j.pain.0000000000002830] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/21/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT Central sensitization (CS) is defined as an increased nociceptive responsiveness due to sensitization of neurons in the central nervous system, usually the result of prolonged nociceptive input or a disease state associated with noxious inputs (eg, polyarthritis). The concept of CS has recently been adopted in clinical assessments of chronic pain, but its diagnosis in humans may now include a wide range of hypervigilant responses. The purpose of this review is to ascertain whether self-report questionnaires linked with CS are associated with enhanced nociceptive responses or whether they measure sensitivity in a broader sense (ie, emotional responses). According to our published, PROSPERO-registered review protocol (CRD42021208731), a predefined search of studies that involve the Central Sensitization Inventory (CSI) or Pain Sensitivity Questionnaire (PSQ), correlated with either nociceptive sensory tests or emotional hypervigilance was conducted on MEDLINE, PsycINFO, and Web of Science. Correlations between the CSI or PSQ with our primary outcomes were extracted and meta-analysed. A review of 66 studies totalling 13,284 participants found that the CSI (but not the PSQ) strongly correlated with psychological constructs: depression, anxiety, stress, pain catastrophising, sleep, and kinesiophobia. The CSI and PSQ showed weak or no correlations with experimental measures of nociceptive sensitivity: pain thresholds, temporal summation, or conditioned pain modulation. The PSQ did, however, correlate strongly with phasic heat and tonic cold pain tests. The studies reviewed did not provide sufficient evidence that self-report measures reflect a canonical understanding of CS. The CSI more closely reflects psychological hypervigilance than increased responsiveness of nociceptive neurons.
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Affiliation(s)
- Greig R Adams
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Wiebke Gandhi
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Richard Harrison
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Carien M van Reekum
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | | | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Tim V Salomons
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
- Department of Psychology, Queen's University, Kingston, ON, Canada
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13
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van Veenendaal N, Foss NB, Miserez M, Pawlak M, Zwaans WAR, Aasvang EK. A narrative review on the non-surgical treatment of chronic postoperative inguinal pain: a challenge for both surgeon and anaesthesiologist. Hernia 2023; 27:5-14. [PMID: 36315351 PMCID: PMC9931782 DOI: 10.1007/s10029-022-02693-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic pain is one of the most frequent clinical problems after inguinal hernia surgery. Despite more than two decades of research and numerous publications, no evidence exists to allow for chronic postoperative inguinal pain (CPIP) specific treatment algorithms. METHODS This narrative review presents the current knowledge of the non-surgical management of CPIP and makes suggestions for daily practice. RESULTS There is a paucity for high-level evidence of non-surgical options for CPIP. Different treatment options and algorithms have been published for chronic pain patients in the last decades. DISCUSSION AND CONCLUSION It is suggested that non-surgical treatment is introduced in the management of all CPIP patients. The overall approach to interventions should be pragmatic, tiered and multi-interventional, starting with least invasive and only moving to more invasive procedures upon lack of effect. Evaluation should be multidisciplinary and should take place in specialized centres. We strongly suggest to follow general guidelines for treatment of persistent pain and to build a database allowing for establishing CPIP specific evidence for optimal analgesic treatments.
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Affiliation(s)
- N van Veenendaal
- Department of Anesthesiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - N B Foss
- Department of Anaesthesia and Intensive Care, Hvidovre University Hospital, Copenhagen, Denmark
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Pawlak
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - W A R Zwaans
- Department of General Surgery, Máxima Medical Center, Veldhoven, Eindhoven, The Netherlands.,SolviMáx Center of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E K Aasvang
- Department of Anesthesiology, Center for Cancer and Organ Diseases, Rigshopitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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14
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Reinhold AK, Kindl GK, Dietz C, Scheu N, Mehling K, Brack A, Birklein F, Rittner HL. Molecular and clinical markers of pain relief in complex regional pain syndrome: An observational study. Eur J Pain 2023; 27:278-288. [PMID: 36440973 DOI: 10.1002/ejp.2058] [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: 09/19/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is marked by disproportionate pain after trauma. Whilst the long-term outcome is crucial to patients, predictors or biomarkers of the course of pain or CRPS symptoms are still lacking. In particular, microRNAs, such as miR-223, decreased in CRPS, have been described only in cross-sectional studies. METHODS In this study, we characterised CRPS patients over a course of 2.5 years of standard treatment. The patient underwent clinical examination including pain measurement, symptom questionnaires, quantitative sensory testing (QST) and blood sampling. Exosomal microRNA levels were measured via qPCR. After follow-up, patients were stratified into 'pain relief' (mean pain reduced by ≥2 numeric rating scale) or 'persistence' (mean pain unchanged or worsened). The primary outcome was miR-223 and miR-939 expression, secondary outcomes were differences in clinical parameters between groups and time points. RESULTS Thirty-nine patients were included, 33 of whom qualified for stratification. Overall, patients reported lower pain and improved clinical characteristics after 2.5 years, but no significant changes in QST or miR-223 and miR-939 expression levels. 16 patients met the criteria for pain relief. This was associated with stable exosomal miR-223 expression, whilst levels further decreased in pain persistence. Clinically, pain relief was marked by shorter disease duration and correlated positively with high initial pain. CONCLUSION We identified progressively reduced miR-223 as a putative biomarker of chronic CRPS pain. Clinically, this study underlines the importance of early diagnosis and treatment showing that high initial pain does not predict an unfavourable outcome. Finally, pain relief and recovery of sensory disturbances seem independent processes.
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Affiliation(s)
- Ann Kristin Reinhold
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Gudrun-Karin Kindl
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Christopher Dietz
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Nathalie Scheu
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Katharina Mehling
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Brack
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Frank Birklein
- Department of Neurology, Mainz University Hospitals, Mainz, Germany
| | - Heike L Rittner
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Center for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany
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15
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Edwards RR, Schreiber KL, Dworkin RH, Turk DC, Baron R, Freeman R, Jensen TS, Latremoliere A, Markman JD, Rice ASC, Rowbotham M, Staud R, Tate S, Woolf CJ, Andrews NA, Carr DB, Colloca L, Cosma-Roman D, Cowan P, Diatchenko L, Farrar J, Gewandter JS, Gilron I, Kerns RD, Marchand S, Niebler G, Patel KV, Simon LS, Tockarshewsky T, Vanhove GF, Vardeh D, Walco GA, Wasan AD, Wesselmann U. Optimizing and Accelerating the Development of Precision Pain Treatments for Chronic Pain: IMMPACT Review and Recommendations. THE JOURNAL OF PAIN 2023; 24:204-225. [PMID: 36198371 PMCID: PMC10868532 DOI: 10.1016/j.jpain.2022.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/01/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
Large variability in the individual response to even the most-efficacious pain treatments is observed clinically, which has led to calls for a more personalized, tailored approach to treating patients with pain (ie, "precision pain medicine"). Precision pain medicine, currently an aspirational goal, would consist of empirically based algorithms that determine the optimal treatments, or treatment combinations, for specific patients (ie, targeting the right treatment, in the right dose, to the right patient, at the right time). Answering this question of "what works for whom" will certainly improve the clinical care of patients with pain. It may also support the success of novel drug development in pain, making it easier to identify novel treatments that work for certain patients and more accurately identify the magnitude of the treatment effect for those subgroups. Significant preliminary work has been done in this area, and analgesic trials are beginning to utilize precision pain medicine approaches such as stratified allocation on the basis of prespecified patient phenotypes using assessment methodologies such as quantitative sensory testing. Current major challenges within the field include: 1) identifying optimal measurement approaches to assessing patient characteristics that are most robustly and consistently predictive of inter-patient variation in specific analgesic treatment outcomes, 2) designing clinical trials that can identify treatment-by-phenotype interactions, and 3) selecting the most promising therapeutics to be tested in this way. This review surveys the current state of precision pain medicine, with a focus on drug treatments (which have been most-studied in a precision pain medicine context). It further presents a set of evidence-based recommendations for accelerating the application of precision pain methods in chronic pain research. PERSPECTIVE: Given the considerable variability in treatment outcomes for chronic pain, progress in precision pain treatment is critical for the field. An array of phenotypes and mechanisms contribute to chronic pain; this review summarizes current knowledge regarding which treatments are most effective for patients with specific biopsychosocial characteristics.
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Affiliation(s)
| | | | | | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, House D, 24105 Kiel, Germany
| | - Roy Freeman
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | - Nick A Andrews
- Salk Institute for Biological Studies, San Diego, California
| | | | | | | | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
| | - Luda Diatchenko
- Department of Anesthesia and Faculty of Dentistry, McGill University, Montreal, California
| | - John Farrar
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Robert D Kerns
- Yale University, Departments of Psychiatry, Neurology, and Psychology, New Haven, Connecticut
| | | | | | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | | | | | | | | | - Gary A Walco
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Ajay D Wasan
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ursula Wesselmann
- Department of Anesthesiology/Division of Pain Medicine, Neurology and Psychology, The University of Alabama at Birmingham, Birmingham, Alabama
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16
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Reply to Hoegh et al. Pain 2023; 164:e116. [PMID: 36638308 DOI: 10.1097/j.pain.0000000000002823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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17
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Miclescu AA, Granlund P, Butler S, Gordh T. Association between systemic inflammation and experimental pain sensitivity in subjects with pain and painless neuropathy after traumatic nerve injuries. Scand J Pain 2023; 23:184-199. [PMID: 35531763 DOI: 10.1515/sjpain-2021-0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/05/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Peripheral neuropathies that occur secondary to nerve injuries may be painful or painless, and including a low-grade inflammation and pro-inflammatory cytokines associated with both regeneration and damage of peripheral nerve cells and fibers. Currently, there are no validated methods that can distinguished between neuropathic pain and painless neuropathy. The aim of this study was to search for proinflammatory and anti-inflammatory proteins associated with pain and experimental pain sensitivity in subjects with surgeon-verified nerve injuries in the upper extremities. METHODS One hundred and thirty-one subjects [69 with neuropathic pain, NP; 62 with painless neuropathy, nP] underwent a conditioned pain modulation (CPM) test that included a cold pressor task (CPT) conducted with the non-injured hand submerged in cold water (4 °C) until pain was intolerable. CPM was assessed by pain ratings to pressure stimuli before and after applying the CPT. Efficient CPM effect was defined as the ability of the individual's CS to inhibit at least 29% of pain (eCPM). The subjects were assigned to one of two subgroups: pain sensitive (PS) and pain tolerant (PT) after the time they could tolerate their hand in cold water (PS<40 s and PT=60 s) . Plasma samples were analyzed for 92 proteins incorporated in the inflammation panel using multiplex Protein Extension Array Technology (PEA). Differentially expressed proteins were investigated using both univariate and multivariate analysis (principal component analysis-PCA and orthogonal partial least-squares discriminant analysis-OPLS-DA). RESULTS Significant differences in all protein levels were found between PS and PT subgroups (CV-ANOVA p<0.001), but not between NP and nP groups (p=0.09) or between inefficient CPM (iCPM) and eCPM (p=0.53) subgroups. Several top proteins associated with NP could be detected using multivariate regression analysis such as stromelysin 2 (MMPs), interleukin-2 receptor subunit beta (IL2RB), chemokine (C-X-C motif) ligand 3 (CXCL3), fibroblast growth factor 5 (FGF5), chemokine (C-C motif) ligand 28 (CCL28), CCL25, CCL11, hepatocyte growth factor (HGF), interleukin 4 (IL4), IL13. After adjusting for multiple testing, none of these proteins correlated significantly with pain. Higher levels of CCL20 (p=0.049) and CUB domain-containing protein (CDCP-1; p=0.047) were found to correlate significantly with cold pain sensitivity. CDCP-1 was highly associated with both PS and iCPM (p=0.042). CONCLUSIONS No significant alterations in systemic proteins were found comparing subjects with neuropathic pain and painless neuropathy. An expression of predominant proinflammatory proteins was associated with experimental cold pain sensitivity in both subjects with pain and painless neuropathy. One these proteins, CDC-1 acted as "molecular fingerprint" overlapping both CPM and CPT. This observation might have implications for the study of pain in general and should be addressed in more detail in future experiments.
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Affiliation(s)
| | - Pontus Granlund
- Department Surgical Science, Uppsala University, Uppsala, Sweden
| | - Stephen Butler
- Department Surgical Science, Uppsala University, Uppsala, Sweden
| | - Torsten Gordh
- Department Surgical Science, Uppsala University, Uppsala, Sweden
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18
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Kemp HI, Vollert J, Davies NWS, Moyle GJ, Rice ASC. A Comparison of Self-reported Pain Measures Between Sensory Phenotypes in HIV-associated Sensory Neuropathy. THE JOURNAL OF PAIN 2023; 24:112-127. [PMID: 36116766 DOI: 10.1016/j.jpain.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 07/30/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023]
Abstract
Painful HIV-associated neuropathy (HIV-SN) is a prevalent co-morbidity of HIV infection. Sensory phenotyping, using quantitative sensory testing (QST) could allow for improved stratification to guide personalized treatment. However, previous methods of QST interpretation have demonstrated limited association with self-reported pain measures. This study sought to identify differences in self-reported pain measures between composite QST-derived sensory phenotypes, and to examine any differences in participants reporting multi-site, multi-etiology chronic pain. In this cross-sectional observational study of participants with HIV (n = 133), individuals were allocated to neuropathy and neuropathic pain groups through clinical assessment and nerve conduction testing. They completed symptom-based questionnaires and underwent standardized QST. Participants were assigned, by pre-determined algorithm, to a QST-derived sensory phenotype. Symptoms were compared between sensory phenotypes. Symptom characteristics and Neuropathic Pain Symptom Inventory scores differed between QST-derived sensory phenotypes: 'sensory loss' was associated with more paroxysmal and paraesthetic symptoms compared to 'thermal hyperalgesia' and 'healthy' phenotypes (P = .023-0.001). Those with painful HIV-SN and additional chronic pain diagnoses were more frequently allocated to the 'mechanical hyperalgesia' phenotype compared to those with painful HIV-SN alone (P = .006). This study describes heterogeneous sensory phenotypes in people living with HIV. Differences in self-reported pain outcomes between sensory phenotypes has the potential to guide future stratified trials and eventually more targeted therapy. PERSPECTIVE: This article presents quantitative sensory testing derived phenotypes, thought to reflect differing pathophysiological pain mechanisms and relates them to self-reported pain measures in people with HIV infection. This could help clinicians stratify patients to individualize analgesic interventions more effectively.
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Affiliation(s)
- Harriet I Kemp
- Pain Research Group, Imperial College London, London, UK.
| | - Jan Vollert
- Pain Research Group, Imperial College London, London, UK; Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany; Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Germany
| | - Nicholas W S Davies
- Department of Neurology, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Graeme J Moyle
- Department of HIV Medicine, Chelsea & Westminster NHS Foundation Trust, London, UK
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19
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Burand Jr. AJ, Waltz TB, Manis AD, Hodges MR, Stucky CL. HomeCageScan analysis reveals ongoing pain in Fabry rats. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 13:100113. [PMID: 36660199 PMCID: PMC9843259 DOI: 10.1016/j.ynpai.2022.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
HomeCageScan (HCS) is an automated behavioral scoring system that can be used to classify and quantify rodent behaviors in the home cage. Although HCS has been used for a number of inducible models of severe pain, little has been done to test this system in clinically relevant genetic disease models associated with chronic pain such as Fabry disease. Rats with Fabry disease exhibit mechanical hypersensitivity, however, it is unclear if these rodents also exhibit ongoing non-evoked pain. Therefore, we analyzed HCS data from male and female rats with Fabry disease. Using hierarchical clustering and principal component analysis, we found both sex and genotype differences in several home cage behaviors. Additionally, we used hierarchical clustering to derive behavioral clusters in an unbiased manner. Analysis of these behavioral clusters showed that primarily female Fabry animals moved less, spent less time caring for themselves (e.g., less time spent grooming and drinking), explored less, and slept more; changes that are similar to lifestyle changes observed in patients with long lasting chronic pain. We also show that sniffing, one of the exploratory behaviors that is depressed in Fabry animals, can be partly restored with the analgesic gabapentin, suggesting that depressed sniffing may reflect ongoing pain. Therefore, this approach to HCS data analysis can be used to assess drug efficacy in Fabry disease and potentially other genetic and inducible rodent models associated with persistent pain.
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Affiliation(s)
- Anthony J. Burand Jr.
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, United States
| | - Tyler B. Waltz
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, United States
| | - Anna D. Manis
- Department of Physiology, Medical College of Wisconsin, Milwaukee, United States
| | - Matthew R. Hodges
- Department of Physiology, Medical College of Wisconsin, Milwaukee, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, United States
| | - Cheryl L. Stucky
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, United States
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20
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Raputova J, Rajdova A, Vollert J, Srotova I, Rebhorn C, Üçeyler N, Birklein F, Sommer C, Vlckova E, Bednarik J. Continuum of sensory profiles in diabetes mellitus patients with and without neuropathy and pain. Eur J Pain 2022; 26:2198-2212. [PMID: 36069121 PMCID: PMC9825847 DOI: 10.1002/ejp.2034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Quantitative sensory testing (QST) assesses the functional integrity of small and large nerve fibre afferents and central somatosensory pathways; QST was assumed to provide insight into the mechanisms of neuropathy. We analysed QST profiles and phenotypes in patients with diabetes mellitus to study whether these could differentiate patients with and without pain and neuropathy. METHODS A standardized QST protocol was performed and 'loss and gain of function' abnormalities were analysed in four groups of subjects: diabetic patients with painful (pDSPN; n = 220) and non-painful distal symmetric polyneuropathy (nDSPN; n = 219), diabetic patients without neuropathy (DM; n = 23) and healthy non-diabetic subjects (n = 37). Based on the QST findings, diabetic subjects were further stratified into four predefined prototypic phenotypes: sensory loss (SL), thermal hyperalgesia (TH), mechanical hyperalgesia (MH) and healthy individuals. RESULTS Patients in the pDSPN group showed the greatest hyposensitivity ('loss of function'), and DM patients showed the lowest, with statistically significant increases in thermal, thermal pain, mechanical and mechanical pain sensory thresholds. Accordingly, the frequency of the SL phenotype was significantly higher in the pDSPN subgroup (41.8%), than expected (p < 0.0042). The proportion of 'gain of function' abnormalities was low in both pDSPN and nDSPN patients without significant differences. CONCLUSIONS There is a continuum in the sensory profiles of diabetic patients, with a more pronounced sensory loss in pDSPN group probably reflecting somatosensory nerve fibre degeneration. An analysis of 'gain of function' abnormalities (allodynia, hyperalgesia) did not offer a key to understanding the pathophysiology of spontaneous diabetic peripheral neuropathic pain. SIGNIFICANCE This article, using quantitative sensory testing profiles in large cohorts of diabetic patients with and without polyneuropathy and pain, presents a continuum in the sensory profiles of diabetic patients, with more pronounced 'loss of function' abnormalities in painful polyneuropathy patients. Painful diabetic polyneuropathy probably represents a 'more progressed' type of neuropathy with more pronounced somatosensory nerve fibre degeneration. The proportion of 'gain of function' sensory abnormalities was low, and these offer limited understanding of pathophysiological mechanisms of spontaneous neuropathic pain.
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Affiliation(s)
- Jana Raputova
- Department of Neurology, Centre for Neuromuscular Diseases (Associated National Centre in the European Reference Network ERN EURO‐NMD)University Hospital BrnoBrnoCzech Republic,Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Aneta Rajdova
- Department of Neurology, Centre for Neuromuscular Diseases (Associated National Centre in the European Reference Network ERN EURO‐NMD)University Hospital BrnoBrnoCzech Republic,Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Jan Vollert
- Pain Research, Faculty of Medicine, Department of Surgery & Cancer, Chelsea and Westminster CampusImperial College LondonLondonUK,Medical Faculty Mannheim, Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim (CBTM)Ruprecht‐Karls‐UniversityHeidelbergGermany
| | - Iva Srotova
- Department of Neurology, Centre for Neuromuscular Diseases (Associated National Centre in the European Reference Network ERN EURO‐NMD)University Hospital BrnoBrnoCzech Republic,Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Cora Rebhorn
- Department of NeurologyUniversity Medical CentreMainzGermany
| | | | - Frank Birklein
- Department of NeurologyUniversity Medical CentreMainzGermany
| | | | - Eva Vlckova
- Department of Neurology, Centre for Neuromuscular Diseases (Associated National Centre in the European Reference Network ERN EURO‐NMD)University Hospital BrnoBrnoCzech Republic,Faculty of MedicineMasaryk UniversityBrnoCzech Republic,Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
| | - Josef Bednarik
- Department of Neurology, Centre for Neuromuscular Diseases (Associated National Centre in the European Reference Network ERN EURO‐NMD)University Hospital BrnoBrnoCzech Republic,Faculty of MedicineMasaryk UniversityBrnoCzech Republic,Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
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21
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Vollert J. Sensory testing might not be perfect - but it is the best biomarker for pain phenotypes we have right now. Scand J Pain 2022; 22:673-675. [PMID: 36129126 DOI: 10.1515/sjpain-2022-0092] [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: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
Abstract
Currently available treatments for neuropathic pain fail in roughly half of the patients - and it is impossible to predict which treatments will help patients. Stratification of neuropathic pain patients is needed, and sensory profiling has so far been the most promising approach: it has been shown to be responsive to treatment, linked to potential mechanisms, and, most importantly, predictive of treatment success. Despite a number of limitations, it is the currently most promising stratification tool and should be refined rather than disregarded.
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Affiliation(s)
- Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
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22
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Schmelz M. Lessons learned - Moving on from QST sensory profiles. Scand J Pain 2022; 22:670-672. [PMID: 36130022 DOI: 10.1515/sjpain-2022-0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
Abstract
Quantitative sensory testing (QST) has been optimized to diagnose in particular small fiber neuropathy and has been successfully used for decades. "Sensory phenotypes" have been derived from the QST data in an attempt to stratify patients with chronic pain and to gain mechanistic insights. However, studies consistently show that there is no difference in sensory phenotypes between neuropathy patients with and without pain and no successful stratification has been shown using the current version of "sensory phenotypes". Thus, after falsification of the initial hypothesis it is time to focus on more promising approaches.
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Affiliation(s)
- Martin Schmelz
- Department of Experimental Pain Research, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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23
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Wold A, Rådman L, Norman K, Olausson H, Thordstein M. Clinical Evaluation of Nerve Function in Electrical Accident Survivors with Persisting Neurosensory Symptoms. Brain Sci 2022; 12:brainsci12101301. [PMID: 36291235 PMCID: PMC9599311 DOI: 10.3390/brainsci12101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Work related electrical accidents are prevalent and can cause persisting symptoms. We used clinical neurophysiological techniques to assess neurosensory function following electrical accidents and correlated test results with the patients’ symptoms. Methods: We studied 24 patients who reported persisting neurosensory symptoms following a workplace electrical accident. We assessed nerve function using quantitative sensory testing (QST), thermal roller testing, laser evoked potential (LEP), and electroneurography. The patients’ results were compared with previously established normative data. Results: Altogether, 67% of the patients showed at least one neurosensory impairment with a large heterogeneity in test results across patients. At a group level, we observed significant deviations in in QST, LEP, and sensory and motor neurography. Overall, we found a weak correlation between test results and self-reported symptoms. Conclusions: In a majority of patients with neurosensory symptoms after a workplace electrical accident, neurosensory testing confirmed the existence of an underlying impairment of the nervous system.
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Affiliation(s)
- Andrew Wold
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Correspondence:
| | - Lisa Rådman
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
| | - Kerstin Norman
- National Unit for Health and Safety, Swedish Police Authority, 10226 Stockholm, Sweden
| | - Håkan Olausson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Neuro, Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
| | - Magnus Thordstein
- Neuro, Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Department of Clinical Neurophysiology, Region Östergötland University Hospital, 58185 Linköping, Sweden
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24
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Mogil JS. The history of pain measurement in humans and animals. FRONTIERS IN PAIN RESEARCH 2022; 3:1031058. [PMID: 36185770 PMCID: PMC9522466 DOI: 10.3389/fpain.2022.1031058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
Pain needs to be measured in order to be studied and managed. Pain measurement strategies in both humans and non-human animals have varied widely over the years and continue to evolve. This review describes the historical development of human and animal algesiometry.
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25
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Lunden LK, Kleggetveit IP, Schmelz M, Jorum E. Cold allodynia is correlated to paroxysmal and evoked mechanical pain in complex regional pain syndrome (CRPS). Scand J Pain 2022; 22:533-542. [PMID: 35429156 DOI: 10.1515/sjpain-2021-0208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/09/2022] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Mechanisms of complex regional pain syndrome (CRPS) are still debated. Identifying subgroups of patients have been attempted in the hope of linking clinical findings to possible mechanisms. The aim of the present study was to investigate whether subgroups of CRPS (based on quantitative sensory testing (QST)-results) differed with respect to different characteristics of pain like spontaneous ongoing or paroxysmal pain and mechanical dynamic allodynia. METHODS 61 CRPS-patients (type 1 and 2) were examined clinically and with QST, in affected and contralateral extremity, with assessment of thresholds for warmth, cold and heat-and cold pain. RESULTS 43 patients (20 men, 23 men) were diagnosed with CRPS 1 (70.5%) and 18 patients (8 women and 10 men) with CRPS 2 (29.5%). Three subgroups were defined based on thermal thresholds; A (thermal allodynia 22.9%), B (thermal hyposensitivity 37.3%), C (thermal allodynia and hyposensitivity 39.3%). Paroxysmal pain was more prevalent in patients with thermal allodynia (merging group A + C, 25/38-65.8%) compared to patients without thermal allodynia (group B, 5/23-21.7%) (p-value=0.00085). CONCLUSIONS We suggest that cold allodynia is based on hyper-excitability of very superficial skin nociceptors. The correlation between paroxysmal pain, allodynia to light touch and cold allodynia suggests that activity in those peripheral nociceptors can drive both, paroxysmal pain and spinal sensitization leading to stroke evoked allodynia. Mechanistically, the physical cold stimulus can unmask disease-related hyperexcitability by closure of temperature-sensitive potassium channels or induction of resurgent currents. Small fiber degeneration alone may not be the crucial mechanism in CRPS, nor explain pain.
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Affiliation(s)
- Lars Kristian Lunden
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inge Petter Kleggetveit
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Schmelz
- Department of Experimental Pain Research, MCTN, University of Heidelberg, Mannheim, Germany
| | - Ellen Jorum
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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26
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Central sensitization: clinical utility of a physiological concept for the International Statistical Classification of Diseases and Related Health Problems and for nociplastic pain. Pain 2022; 163:S99-S107. [PMID: 36099342 DOI: 10.1097/j.pain.0000000000002740] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/14/2022] [Indexed: 01/14/2023]
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27
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Landmann G, Stockinger L, Gerber B, Benrath J, Schmelz M, Rukwied R. Local hyperexcitability of C-nociceptors may predict responsiveness to topical lidocaine in neuropathic pain. PLoS One 2022; 17:e0271327. [PMID: 35834539 PMCID: PMC9282664 DOI: 10.1371/journal.pone.0271327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/28/2022] [Indexed: 12/03/2022] Open
Abstract
We explored whether increased C-nociceptor excitability predicts analgesic effects of topical lidocaine in 33 patients with mono- (n = 15) or poly-neuropathy (n = 18). Excitability of C-nociceptors was tested by transcutaneous electrical sinusoidal (4 Hz) and half sine wave (single 500 ms pulse) stimulation delivered to affected and non-affected sites. Analgesic effects of 24 hrs topical lidocaine were recorded. About 50% of patients reported increased pain from symptomatic skin upon continuous 4 Hz sinusoidal and about 25% upon 500 ms half sine wave stimulation. Electrically-evoked half sine wave pain correlated to their clinical pain level (r = 0.37, p < 0.05). Lidocaine-patches reduced spontaneous pain by >1-point NRS in 8 of 28 patients (p < 0.0001, ANOVA). Patients with increased pain to 2.5 sec sinusoidal stimulation at 0.2 and 0.4 mA intensity had significantly stronger analgesic effects of lidocaine and in reverse, patients with a pain reduction of >1 NRS had significantly higher pain ratings to continuous 1 min supra-threshold sinusoidal stimulation. In the assessed control skin areas of the patients, enhanced pain upon 1 min 4 Hz stimulation correlated to increased depression scores (HADS). Electrically assessed C-nociceptor excitability identified by slowly depolarizing electrical stimuli might reflect the source of neuropathic pain in some patients and can be useful for patient stratification to predict potential success of topical analgesics. Central neuronal circuitry assessment reflected by increased pain in control skin associated with higher HADS scores suggest central sensitization phenomena in a sub-population of neuropathic pain patients.
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Affiliation(s)
- Gunther Landmann
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Lenka Stockinger
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Benjamin Gerber
- Department of Anesthesiology and Intensive Care, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Justus Benrath
- Department of Anesthesiology and Intensive Care, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Roman Rukwied
- Department of Experimental Pain Research, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
- * E-mail:
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28
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da Cunha PHM, Dongyang L, Fernandes AM, Thibes RB, Sato J, Tanaka H, Dale C, Lapa JDDS, de Morais ADS, Soares FHC, da Silva VA, Graven-Nielsen T, Teixeira MJ, de Andrade DC. Non-invasive insular stimulation for peripheral neuropathic pain: Influence of target or symptom? Neurophysiol Clin 2022; 52:109-116. [DOI: 10.1016/j.neucli.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022] Open
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29
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Innovations and advances in modelling and measuring pain in animals. Nat Rev Neurosci 2022; 23:70-85. [PMID: 34837072 PMCID: PMC9098196 DOI: 10.1038/s41583-021-00536-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/12/2022]
Abstract
Best practices in preclinical algesiometry (pain behaviour testing) have shifted over the past decade as a result of technological advancements, the continued dearth of translational progress and the emphasis that funding institutions and journals have placed on rigour and reproducibility. Here we describe the changing trends in research methods by analysing the methods reported in preclinical pain publications from the past 40 years, with a focus on the last 5 years. We also discuss how the status quo may be hampering translational success. This discussion is centred on four fundamental decisions that apply to every pain behaviour experiment: choice of subject (model organism), choice of assay (pain-inducing injury), laboratory environment and choice of outcome measures. Finally, we discuss how human tissues, which are increasingly accessible, can be used to validate the translatability of targets and mechanisms identified in animal pain models.
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30
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Mapping chemotherapy-induced peripheral neuropathy phenotype and health-related quality of life in patients with cancer through exploratory analysis of multimodal assessment data. Support Care Cancer 2022; 30:4007-4017. [DOI: 10.1007/s00520-022-06821-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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31
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Jonas R, Schmelz M. Sensitization of supra-threshold pain responses-Translational aspects and mechanisms. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 2:1078890. [PMID: 36926107 PMCID: PMC10013001 DOI: 10.3389/fnetp.2022.1078890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
A substantial translational gap in pain research has been reflected by a mismatch of relevant primary pain assessment endpoints in preclinical vs. clinical trials. Since activity-dependent mechanisms may be neglected during reflexive tests, this may add as a confounding factor during preclinical pain assessment. In this perspective, we consider the evidence for a need for supra-threshold pain assessment in the pain research literature. In addition to that, we focus on previous results that may demonstrate an example mechanism, where the detection of neuron-glial interactions on pain seems to be substantially depending on the assessment of pain intensity beyond threshold levels.
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Affiliation(s)
- Robin Jonas
- Department of Translational Pharmacology, Medical School EWL, Bielefeld University, Bielefeld, Germany.,UMCG Pain Center, Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Martin Schmelz
- Department of Experimental Pain Research, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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32
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Kennedy DL, Vollert J, Ridout D, Alexander CM, Rice ASC. Responsiveness of quantitative sensory testing-derived sensory phenotype to disease-modifying intervention in patients with entrapment neuropathy: a longitudinal study. Pain 2021; 162:2881-2893. [PMID: 33769367 DOI: 10.1097/j.pain.0000000000002277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT The German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) method for sensory phenotyping is used to stratify patients by mechanism-associated sensory phenotype, theorised to be predictive of intervention efficacy. We hypothesised that change in pain and sensory dysfunction would relate to change in sensory phenotype. We investigated the responsiveness of sensory phenotype to surgery in patients with an entrapment neuropathy. With ethical approval and consent, this observational study recruited patients with neurophysiologically confirmed carpal tunnel syndrome. Symptom and pain severity parameters and DFNS QST were evaluated before and after carpal tunnel surgery. Surgical outcome was evaluated by patient-rated change. Symptom severity score of the Boston Carpal Tunnel Questionnaire and associated pain and paraesthesia subgroups were comparators for clinically relevant change. Quantitative sensory testing results (n = 76) were compared with healthy controls (n = 54). At 6 months postsurgery, 92% participants reported a good surgical outcome and large decrease in pain and symptom severity (P < 0.001). Change in QST parameters occurred for thermal detection, thermal pain, and mechanical detection thresholds with a moderate to large effect size. Change in mechanical pain measures was not statistically significant. Change occurred in sensory phenotype postsurgery (P < 0.001); sensory phenotype was associated with symptom subgroup (P = 0.03) and patient-rated surgical outcome (P = 0.02). Quantitative sensory testing-derived sensory phenotype is sensitive to clinically important change. In an entrapment neuropathy model, sensory phenotype was associated with patient-reported symptoms and demonstrated statistically significant, clinically relevant change after disease-modifying intervention. Sensory phenotype was independent of disease severity and may reflect underlying neuropathophysiology.
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Affiliation(s)
- Donna L Kennedy
- Pain Research Group, Imperial College London, London, United Kingdom
| | - Jan Vollert
- Pain Research Group, Imperial College London, London, United Kingdom
- MSK Labs, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Germany
| | - Deborah Ridout
- Population, Policy and Practice Programme, University College London Great Ormond St Institute of Child Health, London, United Kingdom
| | - Caroline M Alexander
- Therapies Department, Imperial College Healthcare NHS Trust, London, United Kingdom
- MSK Labs, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Andrew S C Rice
- Pain Research Group, Imperial College London, London, United Kingdom
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33
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Johnson S, Marshall A, Hughes D, Holmes E, Henrich F, Nurmikko T, Sharma M, Frank B, Bassett P, Marshall A, Magerl W, Goebel A. Mechanistically informed non-invasive peripheral nerve stimulation for peripheral neuropathic pain: a randomised double-blind sham-controlled trial. J Transl Med 2021; 19:458. [PMID: 34742297 PMCID: PMC8572078 DOI: 10.1186/s12967-021-03128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Induction of long-term synaptic depression (LTD) is proposed as a treatment mechanism for chronic pain but remains untested in clinical populations. Two interlinked studies; (1) A patient-assessor blinded, randomised, sham-controlled clinical trial and (2) an open-label mechanistic study, sought to examine therapeutic LTD for persons with chronic peripheral nerve injury pain. METHODS (1) Patients were randomised using a concealed, computer-generated schedule to either active or sham non-invasive low-frequency nerve stimulation (LFS), for 3 months (minimum 10 min/day). The primary outcome was average pain intensity (0-10 Likert scale) recorded over 1 week, at 3 months, compared between study groups. (2) On trial completion, consenting subjects entered a mechanistic study assessing somatosensory changes in response to LFS. RESULTS (1) 76 patients were randomised (38 per group), with 65 (31 active, 34 sham) included in the intention to treat analysis. The primary outcome was not significant, pain scores were 0.3 units lower in active group (95% CI - 1.0, 0.3; p = 0.30) giving an effect size of 0.19 (Cohen's D). Two non-device related serious adverse events were reported. (2) In the mechanistic study (n = 19) primary outcomes of mechanical pain sensitivity (p = 0.006) and dynamic mechanical allodynia (p = 0.043) significantly improved indicating reduced mechanical hyperalgesia. CONCLUSIONS Results from the RCT failed to reach significance. Results from the mechanistic study provide new evidence for effective induction of LTD in a clinical population. Taken together results add to mechanistic understanding of LTD and help inform future study design and approaches to treatment. Trial registration ISRCTN53432663.
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Affiliation(s)
- Selina Johnson
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK. .,Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | - Anne Marshall
- Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation (CHEME) Department, Bangor University, Bangor, Wales, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation (CHEME) Department, Bangor University, Bangor, Wales, UK
| | - Florian Henrich
- Department of Neurophysiology, Mannheim Centre for Translational Neurosciences, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Heidelberg, Germany
| | - Turo Nurmikko
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
| | - Manohar Sharma
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK
| | - Bernhard Frank
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK.,Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Andrew Marshall
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK.,Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Walter Magerl
- Department of Neurophysiology, Mannheim Centre for Translational Neurosciences, Medical Faculty Mannheim, Ruprecht Karls-University Heidelberg, Heidelberg, Germany
| | - Andreas Goebel
- The Pain Management Programme, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, UK.,Pain Research Institute, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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34
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Realigning the role of quantitative sensory testing in sensory profiling of patients with and without neuropathic pain. Pain 2021; 162:2780. [PMID: 34652323 DOI: 10.1097/j.pain.0000000000002378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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36
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Bordeleau M, Léonard G, Gauthier L, Ferland CE, Backonja M, Vollert J, Marchand S, Jackson P, Cantin L, Prud’Homme M. Classification of Qualitative Fieldnotes Collected During Quantitative Sensory Testing: A Step Towards the Development of a New Mixed Methods Approach in Pain Research. J Pain Res 2021; 14:2501-2511. [PMID: 34434059 PMCID: PMC8380625 DOI: 10.2147/jpr.s301655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Quantitative sensory testing (QST) is a standardized method to assess somatosensory function. The collection of qualitative information, during the QST procedure, could be an interesting way to facilitate the characterization of altered sensory perception and the identification of different pain phenotypes. The aims of this study were 1) to classify qualitative fieldnotes of sensory abnormalities collected during an independent QST study, and 2) to generate a qualitative interview guide that could be included in the traditional QST procedure as a step towards the implementation of a mixed methods approach. PATIENTS AND METHODS QST data were collected from 48 chronic neuropathic pain patients treated with spinal cord stimulation (SCS). Three body areas, with or without SCS, were tested: the painful limb targeted by SCS, the contralateral area, and the ipsilateral upper limb. After each trial of each QST modality, patients were encouraged to report any sensory abnormalities they could identify with a pain quality scale or using their own words. RESULTS Qualitative self-reported sensory abnormalities were dichotomized into two groups: altered sensory intensities and altered sensory perceptions. Altered sensory intensities were classified as sensory loss or sensory gain subgroups. Altered sensory perceptions were classified as paresthesia and dysesthesia subgroups Overall, 630 qualitative fieldnotes of altered sensations were collected: 385 on the painful limb, 173 at the contralateral area, and 72 at the ipsilateral upper limb. Based on these qualitative data, we propose a standardized method to collect qualitative data involving 9 open- and close-ended questions and 21 codes. CONCLUSION Our findings have highlighted the value of qualitative sensory evaluation during QST and constitute an important milestone in the development of a mixed methods protocol in phenotyping research.
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Affiliation(s)
- Martine Bordeleau
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
| | - Guillaume Léonard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
| | - Lynn Gauthier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, Quebec City, QC, Canada
- Oncology Division, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Université Laval Cancer Research Center, Quebec City, QC, Canada
| | - Catherine Estelle Ferland
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada
| | - Miroslav Backonja
- Department of Neurology, University of Wisconsin, Madison, WI, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Jan Vollert
- Pain Research, MSK lab, Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Serge Marchand
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
- Sherbrooke University Hospital Research Center (CRCHUS), Sherbrooke, QC, Canada
| | - Philip Jackson
- CIRRIS, Quebec City, QC, Canada
- CERVO Brain Research Center, Quebec City, QC, Canada
- School of Psychology, Laval University, Quebec City, QC, Canada
| | - Léo Cantin
- Centre de recherche du CHU de Québec – Université Laval, Axe neurosciences, Quebec City, QC, Canada
- Department of Surgery, Division of neurosurgery, CHU de Québec – Université Laval, Quebec City, QC, Canada
| | - Michel Prud’Homme
- Centre de recherche du CHU de Québec – Université Laval, Axe neurosciences, Quebec City, QC, Canada
- Department of Surgery, Division of neurosurgery, CHU de Québec – Université Laval, Quebec City, QC, Canada
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Gemignani F, Bellanova MF, Saccani E, Pavesi G. Non-length-dependent small fiber neuropathy: Not a matter of stockings and gloves. Muscle Nerve 2021; 65:10-28. [PMID: 34374103 DOI: 10.1002/mus.27379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/11/2021] [Accepted: 07/18/2021] [Indexed: 12/17/2022]
Abstract
The clinical spectrum of small fiber neuropathy (SFN) encompasses manifestations related to the involvement of thinly myelinated A-delta and unmyelinated C fibers, including not only the classical distal phenotype, but also a non-length-dependent (NLD) presentation that can be patchy, asymmetrical, upper limb-predominant, or diffuse. This narrative review is focused on NLD-SFN. The diagnosis of NLD-SFN can be problematic, due to its varied and often atypical presentation, and diagnostic criteria developed for distal SFN are not suitable for NLD-SFN. The topographic pattern of NLD-SFN is likely related to ganglionopathy restricted to the small neurons of dorsal root ganglia. It is often associated with systemic diseases, but about half the time is idiopathic. In comparison with distal SFN, immune-mediated diseases are more common than dysmetabolic conditions. Treatment is usually based on the management of neuropathic pain. Disease-modifying therapy, including immunotherapy, may be effective in patients with identified causes. Future research on NLD-SFN is expected to further clarify the interconnected aspects of phenotypic characterization, diagnostic criteria, and pathophysiology.
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Affiliation(s)
- Franco Gemignani
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria F Bellanova
- Laboratory of Neuromuscular Histopathology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Saccani
- Neurology Unit, Department of Specialized Medicine, University Hospital of Parma, Parma, Italy
| | - Giovanni Pavesi
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Enax-Krumova E, Attal N, Bouhassira D, Freynhagen R, Gierthmühlen J, Hansson P, Kuehler BM, Maier C, Sachau J, Segerdahl M, Tölle T, Treede RD, Ventzel L, Baron R, Vollert J. Contralateral Sensory and Pain Perception Changes in Patients With Unilateral Neuropathy. Neurology 2021; 97:e389-e402. [PMID: 34011572 DOI: 10.1212/wnl.0000000000012229] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/19/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To test whether contralateral sensory abnormalities in the clinically unaffected area of patients with unilateral neuropathic pain are due to the neuropathy or pain mechanisms. METHODS We analyzed the contralateral clinically unaffected side of patients with unilateral painful or painless neuropathy (peripheral nerve injury [PNI], postherpetic neuropathy [PHN], radiculopathy) by standardized quantitative sensory testing following a validated protocol. Primary outcome was the independent contribution of the following variables on the contralateral sensory function using generalized linear regression models: pain intensity, disease duration, etiology, body area, and sensory patterns in the most painful area. RESULTS Among 424 patients (PNI n = 256, PHN n = 78, radiculopathy n = 90), contralateral sensory abnormalities were frequent in both painful (n = 383) and painless (n = 41) unilateral neuropathy, demonstrating sensory loss for thermal and mechanical nonpainful stimuli and both sensory loss and gain for painful test stimuli. Analysis by etiology revealed contralateral pinprick hyperalgesia in PHN and PNI. Analysis by ipsilateral sensory phenotype demonstrated mirror-image pinprick hyperalgesia in both mechanical and thermal hyperalgesia phenotypes. Pain intensity, etiology, and affected body region predicted changes in only single contralateral somatosensory parameters. Disease duration had no impact on the contralateral sensory function. CONCLUSION Mechanisms of sensory loss seem to spread to the contralateral side in both painful and painless neuropathies. Contralateral spread of pinprick hyperalgesia was restricted to the 2 ipsilateral phenotypes that suggest sensitization; this suggest a contribution of descending net facilitation from supraspinal areas, which was reported in rodent models of neuropathic pain but not yet in human patients.
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Affiliation(s)
- Elena Enax-Krumova
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark.
| | - Nadine Attal
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Didier Bouhassira
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Rainer Freynhagen
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Janne Gierthmühlen
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Per Hansson
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Bianca M Kuehler
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Christoph Maier
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Juliane Sachau
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Märta Segerdahl
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Thomas Tölle
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Rolf-Detlef Treede
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Lise Ventzel
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Ralf Baron
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Jan Vollert
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
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Vollert J, Forstenpointner J, Enax-Krumova EK, Gierthmühlen J, Tölle T, Treede RD, Baron R. The need for previous knowledge does not render quantitative sensory testing a "failure" but part of a larger picture of the relationship between nociception and pain. Pain 2021; 162:1273-1274. [PMID: 33730009 DOI: 10.1097/j.pain.0000000000002138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jan Vollert
- Pain Research,Department of Surgery and Cancer,Imperial College,London, United Kingdom
- Neurophysiology,Mannheim Center for Translational Neuroscience MCTN,Medical Faculty Mannheim,Ruprecht Karls University,Heidelberg, Germany
| | - Julia Forstenpointner
- Division of Neurological Pain Research and Therapy,Department of Neurology,Universitätsklinikum Schleswig-HolsteinCampus Kiel, Germany
| | - Elena K Enax-Krumova
- Department of Neurology,BG University Hospital Bergmannsheil GmbH,Ruhr-University Bochum, Germany
| | - Janne Gierthmühlen
- Division of Neurological Pain Research and Therapy,Department of Neurology,Universitätsklinikum Schleswig-HolsteinCampus Kiel, Germany
| | - Thomas Tölle
- Department of Neurology,Klinikum rechts der Isar,Technische Universität München,Munich, Germany
| | - Rolf-Detlef Treede
- Neurophysiology,Mannheim Center for Translational Neuroscience MCTN,Medical Faculty Mannheim,Ruprecht Karls University,Heidelberg, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy,Department of Neurology,Universitätsklinikum Schleswig-HolsteinCampus Kiel, Germany
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