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Yokota H, Edama M, Kawanabe Y, Hirabayashi R, Sekikne C, Akuzawa H, Ishigaki T, Otsuru N, Saito K, Kojima S, Miyaguchi S, Onishi H. Effects of transcutaneous auricular vagus nerve stimulation at left cymba concha on experimental pain as assessed with the nociceptive withdrawal reflex, and correlation with parasympathetic activity. Eur J Neurosci 2024; 59:2826-2835. [PMID: 38469939 DOI: 10.1111/ejn.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 02/02/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
The aim of this study was to clarify the effects of transcutaneous auricular vagus nerve stimulation (taVNS) to the left cymba concha on the pain perception using nociceptive withdrawal reflex (NWR), which is known to be associated with chronic pain, and to investigate whether there is a relationship between taVNS-induced suppression of the NWR and parasympathetic activation. We applied either 3.0 mA, 100 Hz taVNS for 120 s on the left cymba concha (taVNS condition) or the left earlobe (Sham condition) for 20 healthy adults. NWR threshold was measured before (Baseline), immediately after (Post 0), 10 min (Post 10) and 30 min after (Post 30) stimulation. The NWR threshold was obtained from biceps femoris muscle by applying electrical stimulation to the sural nerve. During taVNS, electrocardiogram was recorded, and changes in autonomic nervous activity measured by heart rate variability (HRV) were analyzed. We found that the NWR thresholds at Post 10 and Post 30 increased compared with baseline in the taVNS group (10 min after: p = .008, 30 min after: p = .008). In addition, increased parasympathetic activity by taVNS correlated with a greater increase in NWR threshold at Post 10 and Post 30 (Post 10: p = .003; Post 30: p = .001). The present results of this single-blinded study demonstrate the pain-suppressing effect of taVNS on NWR threshold and suggest that the degree of parasympathetic activation during taVNS may predict the pain-suppressing effect of taVNS after its application.
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Affiliation(s)
- Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Yurika Kawanabe
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Chie Sekikne
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Hiroshi Akuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomonobu Ishigaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Kei Saito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Sho Kojima
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Shota Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
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Trübenbacher L, Lindenberg N, Graf BM, Backmund M, Unglaub W, Lassen CL. Nociceptive Flexion Reflex Threshold is No Suitable Marker for Diagnosing Opioid-Induced Hyperalgesia. J Pain Res 2024; 17:1067-1076. [PMID: 38505502 PMCID: PMC10948325 DOI: 10.2147/jpr.s421841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/30/2024] [Indexed: 03/21/2024] Open
Abstract
Background Opioid induced hyperalgesia (OIH) describes a state of altered pain sensation due to opioid exposure. It often occurs among persons with opioid use disorder receiving substitution therapy. Methods The purpose of this study was to find out, whether OIH diagnosis could be facilitated by an objective pain indicating marker: the Nociceptive Flexion Reflex (NFR). Forty persons with opioid use disorder, 20 of them maintained on methadone and 20 treated with buprenorphine, as well as a control group of 20 opioid-free subjects, were examined. It was aimed to find out whether and in which way these opioid agonists alter reflex threshold (NFR-T). A cold-pressor test was performed to investigate the prevalence of OIH. Furthermore, electrical stimulation and electromyography analyzation were used for NFR-T measurement. Subjective pain ratings were evaluated with a numeric rating scale. Results Significantly increased sensitivity to cold pressor pain was found in both maintenance groups when compared to their opioid-free counterparts (p < 0.001). Neither methadone nor buprenorphine showed any effect on NFR-T. This might be explained by the reflex approaching at the wrong location in the central nervous system. Consequently, NFR-T is not a suitable marker for diagnosing OIH. Conclusion Although methadone and buprenorphine have been proven to cause OIH, no effect on NFR-T was observed. A statistically significant effect could have been observed with a larger number of participants. Further research, with special focus on patients' adjuvant medication, should be conducted in the future, to facilitate diagnosis of OIH and provide appropriate pain management for maintenance patients.
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Affiliation(s)
- Luisa Trübenbacher
- Centre for Interdisciplinary Pain Medicine, Department of Anaesthesiology, University Hospital of Regensburg, Regensburg, 93053, Germany
| | - Nicole Lindenberg
- Centre for Interdisciplinary Pain Medicine, Department of Anaesthesiology, University Hospital of Regensburg, Regensburg, 93053, Germany
| | - Bernhard M Graf
- Centre for Interdisciplinary Pain Medicine, Department of Anaesthesiology, University Hospital of Regensburg, Regensburg, 93053, Germany
| | - Markus Backmund
- “Praxiszentrum im Tal”, Tal 9, 80331, Ludwig-Maximilians-University, Munich, Germany
| | - Wilhelm Unglaub
- “medbo” District Hospital, Universitätsstraße 84, 93053, University of Regensburg, Regensburg, Germany
| | - Christoph L Lassen
- Centre for Interdisciplinary Pain Medicine, Department of Anaesthesiology, University Hospital of Regensburg, Regensburg, 93053, Germany
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Peterson J, Chesbro G, Bemben MG, Larson RD, Pereira HM, Black CD. Delayed-Onset Muscle Soreness Alters Mechanical Sensitivity, but Not Thermal Sensitivity or Pain Modulatory Function. J Pain Res 2024; 17:571-581. [PMID: 38347855 PMCID: PMC10860815 DOI: 10.2147/jpr.s449787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Many clinical musculoskeletal pain conditions are characterized by chronic inflammation that sensitizes nociceptors. An unresolved issue is whether inflammation affects all nociceptors in a similar manner. Exercise-induced muscle damage (EIMD) has been proposed as a model for simulating clinical inflammatory pain in healthy samples. We sought to test the effect of EIMD on various painful stimuli (pressure and thermal), central pain processing (via the nociceptive flexion reflex) and endogenous pain modulation via conditioned pain modulation and exercise-induced hypoalgesia. Methods Eighteen participants (9F, age: 24.6 ± 3.3) were recruited for repeated measures testing and each completed pain sensitivity testing prior to and 48 hours after an eccentric exercise protocol. The participants performed a minimum of 6 rounds of 10 eccentric knee extension exercises to induce muscle damage and localized inflammation in the right quadriceps. Force decrements, knee range-of-motion, and delayed onset muscle soreness (DOMS) were used to quantify EIMD. Results There was a significant main effect of time for pressure pain (%diff; -58.9 ± 23.1; p = 0.02, ηp2 = 0.28) but no significant main effect was observed for limb (%diff; -15.5 ± 23.9; p = 0.53, ηp2 = 0.02). In contrast, there was a significant interaction between time and limb (p < 0.001, ηp2 = 0.47) whereby participants had lower pressure pain sensitivity in the right leg only after the damage protocol (%diff; -105.9 ± 29.2; p = 0.002). Discussion Individuals with chronic inflammatory pain usually have an increased sensitivity to pressure, thermal, and electrical stimuli, however, our sample, following muscle damage to induce acute inflammation only had sensitivity to mechanical pain. Exercise induced inflammation may reflect a peripheral sensitivity localized to the damaged muscle rather than a global sensitivity like those with chronic pain display.
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Affiliation(s)
- Jessica Peterson
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
- Department of Kinesiology, New Mexico State University, Las Cruces, NM, USA
- North Florida Foundation of Research and Education, Malcom Randall Veterans Medical Center, Gainesville, FL, USA
| | - Grant Chesbro
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Michael G Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Rebecca D Larson
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Hugo M Pereira
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Christopher D Black
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
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Jurth C, Lichtner G, Bienert T, von Dincklage F. The variability in nociceptive flexion reflex threshold measurement is mostly caused by probabilistic effects of the estimation algorithms: a simulation study. Int J Neurosci 2024:1-10. [PMID: 38315138 DOI: 10.1080/00207454.2024.2312991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES The nociceptive flexion reflex (NFR) and its threshold are frequently used to investigate spinal nociception in humans. Since this threshold (NFRT) is a probabilistic measure, specific algorithms are used for NFRT estimation based on the stochastic occurrence of reflexes at different stimulus intensities. We used a validated simulation model of the NFR to investigate the amount of NFRT measurement variability induced by different estimation algorithms in a steady setting of reduced external influences. METHODS We simulated the behavior of different estimation algorithms in subjects with an artificially steady baseline NFRT variability (standard deviation: 0 mA) or low baseline NFRT variability (standard deviation: 0.156 mA), equaling a quiet experimental setting. The obtained data were analyzed for NFRT measurement variability caused by the algorithms compared to the baseline variability reflecting other physiological influences. RESULTS The standard deviation of the NFRT estimated by the different algorithms ranged between 0.381 and 3.464 mA with 96.8% to 99.6% of the measurement variability attributed to the algorithm used. Out of the investigated algorithms the dynamic staircase algorithm was most precise. CONCLUSION The NFRT measurement variability observed during quiet and steady experimental sessions is mostly caused by the properties of the estimation algorithms, due to the probabilistic nature of the reflex occurrence. Our results give reference for choosing the optimal estimation algorithm to improve measurement precision.
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Affiliation(s)
- Carlo Jurth
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gregor Lichtner
- Department of Anesthesia, Intensive Care, Emergency and Pain Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Thomas Bienert
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Falk von Dincklage
- Department of Anesthesia, Intensive Care, Emergency and Pain Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
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Kleinstäuber M, Schröder A, Daehler S, Pallesen KJ, Rask CU, Sanyer M, Van den Bergh O, Weinreich Petersen M, Rosmalen JGM. Aetiological Understanding of Fibromyalgia, Irritable Bowel Syndrome, Chronic Fatigue Syndrome and Classificatory Analogues: A Systematic Umbrella Review. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e11179. [PMID: 38356902 PMCID: PMC10863637 DOI: 10.32872/cpe.11179] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/27/2023] [Indexed: 02/16/2024] Open
Abstract
Background This umbrella review systematically assesses the variety and relative dominance of current aetiological views within the scientific literature for the three most investigated symptom-defined functional somatic syndromes (FSS) and their classificatory analogues within psychiatry and psychology. Method An umbrella review of narrative and systematic reviews with and without meta-analyses based on a search of electronic databases (PubMed, Web of Science, Embase, PsychINFO) was conducted. Eligible reviews were published in English, focused on research of any kind of aetiological factors in adults diagnosed with fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and somatic symptom disorder (SSD)/somatoform disorder (SFD). Results We included 452 reviews (132 systematic reviews including meta-analyses, 133 systematic reviews, 197 narrative reviews), of which 132 (29%) focused on two or more of the investigated health conditions simultaneously. Across diagnoses, biological factors were addressed in 90% (k = 405), psychological in 33% (k = 150), social in 12% (k = 54), and healthcare factors in 5% (k = 23) of the reviews. The methodological quality of the included systematic reviews (k = 255) was low (low/critically low: 41% [k = 104]; moderate: 49% [k = 126]; high quality: 10% [k = 25]). The high-quality systematic reviews suggest that deficient conditioned pain modulation, genetic factors, changes in the immune, endocrinological, gastrointestinal, cardiovascular, and nervous system, and psychosocial factors such as sexual abuse and pain catastrophizing increase the risk for FSS. Conclusion Only very few systematic reviews have used comprehensive, biopsychosocial disease models to guide the selection of aetiological factors in FSS research. Future research should strive for higher scientific standards and broaden its perspective on these health conditions.
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Affiliation(s)
- Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sarah Daehler
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | | | - Charlotte U. Rask
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Sanyer
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | | | - Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Judith G. M. Rosmalen
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Dhondt E, Van Oosterwijck S, Van Branteghem T, Rhudy JL, Danneels L, Van Oosterwijck J. Modulation of the nociceptive flexion reflex by conservative therapy in patients and healthy people: a systematic review and meta-analysis. Pain 2022; 163:1446-1463. [PMID: 34813517 DOI: 10.1097/j.pain.0000000000002499] [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: 05/27/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT The nociceptive flexion reflex (NFR) is a spinally mediated withdrawal response and is used as an electrophysiological marker of descending modulation of spinal nociception. Chemical and pharmacological modulation of nociceptive neurotransmission at the spinal level has been evidenced by direct effects of neurotransmitters and pharmacological agents on the NFR. Largely unexplored are, however, the effects of nonpharmacological noninvasive conservative interventions on the NFR. Therefore, a systematic review and meta-analysis was performed and reported following the PRISMA guidelines to determine whether and to what extent spinal nociception measured through the assessment of the NFR is modulated by conservative therapy in patients and healthy individuals. Five electronic databases were searched to identify relevant articles. Retrieved articles were screened on eligibility using the predefined inclusion criteria. Risk of bias was investigated according to Version 2 of the Cochrane risk-of-bias assessment tool for randomized trials. The evidence synthesis for this review was conducted in accordance with the Grading of Recommendations Assessment, Development and Evaluation. Thirty-six articles were included. Meta-analyses provided low-quality evidence showing that conservative therapy decreases NFR area and NFR magnitude and moderate-quality evidence for increases in NFR latency. This suggests that conservative interventions can exert immediate central effects by activating descending inhibitory pathways to reduce spinal nociception. Such interventions may help prevent and treat chronic pain characterized by enhanced spinal nociception. Furthermore, given the responsiveness of the NFR to conservative interventions, the NFR assessment seems to be an appropriate tool in empirical evaluations of treatment strategies.PROSPERO registration number: CRD42020164495.
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Affiliation(s)
- Evy Dhondt
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group
| | - Sophie Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Thomas Van Branteghem
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jamie L Rhudy
- Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Lieven Danneels
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jessica Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group
- Research Foundation-Flanders (FWO), Brussels, Belgium
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