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Chiamulera C, Benvegnù G, Piva A, Paolone G. Ecocebo: How the interaction between environment and drug effects may improve pharmacotherapy outcomes. Neurosci Biobehav Rev 2024; 161:105648. [PMID: 38565340 DOI: 10.1016/j.neubiorev.2024.105648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024]
Abstract
This narrative review describes the research on the effects of the association between environmental context and medications, suggesting the benefit of specific design interventions in adjunction to pharmacotherapy. The literature on Evidence-Based Design (EBD) studies and Neuro-Architecture show how contact with light, nature, and specific physical features of urban and interior architecture may enhance the effects of analgesic, anxiolytics, and antidepressant drugs. This interaction mirrors those already known between psychedelics, drugs of abuse, and setting. Considering that the physical feature of space is a component of the complex placebo configuration, the aim is to highlight those elements of built or natural space that may help to improve drug response in terms of efficacy, tolerability, safety, and compliance. Ecocebo, the integration of design approaches such as EBD and Neuro-Architecture may thus contribute to a more efficient, cost-sensitive, and sustainable pharmacotherapy.
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Affiliation(s)
- Cristiano Chiamulera
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Giulia Benvegnù
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessandro Piva
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giovanna Paolone
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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2
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Rubal-Otero L, Gil-Ugidos A, Villar AJG, Carrillo-de-la-Peña MT. Temporal summation of second pain is affected by cognitive load. J Neurosci Res 2024; 102:e25363. [PMID: 38895850 DOI: 10.1002/jnr.25363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
This work attempted to clarify the interaction of cognition and pain sensitization during a paradigm of Temporal Summation of Second Pain (TSSP). We analyzed pain ratings and electroencephalographic (EEG) activity obtained from 21 healthy participants during the presentation of four experimental conditions that differed in the manipulation of attention to painful stimuli or working memory load (Attention to hand & TSSP; 0-back & TSSP (low cognitive load); 2-back & TSSP (high cognitive load); 2-back (without pain)). We found that the TSSP was reduced when the attention was diverted and the cognitive load increased, and this reduction was accompanied by higher midfrontal theta activity and lower posterior alpha and central beta activity. Although it is well established that TSSP is a phenomenon that occurs at the spinal level, here we show that it is also affected by supraspinal attentional mechanisms. Delivery of painful repeated stimuli did not affect the performance of the 2-back task but was associated with smaller amplitudes of attentional event-related potentials (ERPs) after standard stimuli (not the target). The study of brain activity during TSSP allowed to clarify the role of top-down attentional modulation in pain sensitization processes. Results contribute to a better understanding of cognitive dysfunction in pain conditions and reinforce the use of therapeutic strategies based on distracting attention away from pain.
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Affiliation(s)
- Lara Rubal-Otero
- Brain and Pain (BaP) Lab, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Antonio Gil-Ugidos
- Brain and Pain (BaP) Lab, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Alberto Jacobo González Villar
- Psychological Neuroscience Lab, Centro de Investigação em Psicologia, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - María Teresa Carrillo-de-la-Peña
- Brain and Pain (BaP) Lab, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
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3
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Robinson CL, D'Souza RS, Yazdi C, Diejomaoh EM, Schatman ME, Emerick T, Orhurhu V. Reviewing the Potential Role of Artificial Intelligence in Delivering Personalized and Interactive Pain Medicine Education for Chronic Pain Patients. J Pain Res 2024; 17:923-929. [PMID: 38464902 PMCID: PMC10924768 DOI: 10.2147/jpr.s439452] [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: 09/18/2023] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
The integration of artificial intelligence (AI) in patient pain medicine education has the potential to revolutionize pain management. By harnessing the power of AI, patient education becomes more personalized, interactive, and supportive, empowering patients to understand their pain, make informed decisions, and actively participate in their pain management journey. AI tailors the educational content to individual patients' needs, providing personalized recommendations. It introduces interactive elements through chatbots and virtual assistants, enhancing engagement and motivation. AI-powered platforms improve accessibility by providing easy access to educational resources and adapting content to diverse patient populations. Future AI applications in pain management include explaining pain mechanisms, treatment options, predicting outcomes based on individualized patient-specific factors, and supporting monitoring and adherence. Though the literature on AI in pain medicine and its applications are scarce yet growing, we propose avenues where AI may be applied and review the potential applications of AI in pain management education. Additionally, we address ethical considerations, patient empowerment, and accessibility barriers.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Efemena M Diejomaoh
- Department of Psychiatry & Behavioral Science, Meharry Medical College, Nashville, TN, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
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4
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Fougère M, Greco-Vuilloud J, Arnous C, Abel F, Lowe C, Elie V, Marchand S. Sensory stimulations potentializing digital therapeutics pain control. FRONTIERS IN PAIN RESEARCH 2023; 4:1168377. [PMID: 37745799 PMCID: PMC10511651 DOI: 10.3389/fpain.2023.1168377] [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: 02/17/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
For the past two decades, using Digital Therapeutics (DTx) to counter painful symptoms has emerged as a novel pain relief strategy. Several studies report that DTx significantly diminish pain while compensating for the limitations of pharmacological analgesics (e.g., addiction, side effects). Virtual reality (VR) is a major component of the most effective DTx for pain reduction. Notably, various stimuli (e.g., auditory, visual) appear to be frequently associated with VR in DTx. This review aims to compare the hypoalgesic power of specific stimuli with or without a VR environment. First, this review will briefly describe VR technology and known elements related to its hypoalgesic effect. Second, it will non-exhaustively list various stimuli known to have a hypoalgesic effect on pain independent of the immersive environment. Finally, this review will focus on studies that investigate a possible potentialized effect on pain reduction of these stimuli in a VR environment.
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Affiliation(s)
| | | | | | | | | | | | - Serge Marchand
- Lucine, Bordeaux, France
- Faculté de Médecine et des Sciences de la Santé, Centre de Recherche Clinique du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
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5
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Rao AK, Chandra S, Dutt V. Learning from feedback: Evaluation of dynamic decision-making in virtual reality under various repetitive training frameworks. Front Psychol 2022; 13:872061. [DOI: 10.3389/fpsyg.2022.872061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Dynamic decision-making involves a series of interconnected interdependent confluence of decisions to be made. Experiential training is preferred over traditional methods to train individuals in dynamic decision-making. Imparting experiential training in physical settings can be very expensive and unreliable. In virtual reality (VR), synthetic environments play a significant role in providing flexible and cost-effective training environments to enhance dynamic decision-making. However, it is still unclear how VR can be used to impart dynamic decision-making training to increase cognitive performance in complex situations. Besides, different repetitive training methods like desirable difficulty framework and heterogeneity of practice have been evaluated on generic cognitive and motor tasks. However, an evaluation of how these repetitive training methods facilitate dynamic decision-making in an individual in a virtual complex environment setting is lacking in the literature. The objective of this study is to evaluate the effect of different repetitive training methods in immersive VR on dynamic decision-making in a complex search-and-shoot environment. In a lab-based experiment, 66 healthy subjects are divided equally and randomly into three between-subject training conditions: heterogenous, difficult, and sham. On Day 1, all the participants, regardless of the condition, executed an environment of a baseline difficulty level. From Days 2 to 7, the participants alternatively executed the novice difficulty and expert difficulty versions of the environment in the heterogenous condition. In difficult conditions, the participants executed the expert difficulty version of the environment from Days 2 to 7. In the sham condition, the participants executed an unrelated VR environment from Days 2 to 7. On Day 8, the participants executed the baseline difficulty version of the environment again in all the conditions. Various performance and workload-based measures were acquired. Results revealed that the participants in the heterogenous and difficult conditions performed significantly better on Day 8 compared with Day 1. The results inferred that a combination of immersive VR environment with repetitive heterogenous training maximized performance and decreased cognitive workload at transfer. We expect to use these conclusions to create effective training environments in VR for imparting training to military personnel in dynamic decision-making scenarios.
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Scott H, Griffin C, Coggins W, Elberson B, Abdeldayem M, Virmani T, Larson-Prior LJ, Petersen E. Virtual Reality in the Neurosciences: Current Practice and Future Directions. Front Surg 2022; 8:807195. [PMID: 35252318 PMCID: PMC8894248 DOI: 10.3389/fsurg.2021.807195] [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: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
Virtual reality has made numerous advancements in recent years and is used with increasing frequency for education, diversion, and distraction. Beginning several years ago as a device that produced an image with only a few pixels, virtual reality is now able to generate detailed, three-dimensional, and interactive images. Furthermore, these images can be used to provide quantitative data when acting as a simulator or a rehabilitation device. In this article, we aim to draw attention to these areas, as well as highlight the current settings in which virtual reality (VR) is being actively studied and implemented within the field of neurosurgery and the neurosciences. Additionally, we discuss the current limitations of the applications of virtual reality within various settings. This article includes areas in which virtual reality has been used in applications both inside and outside of the operating room, such as pain control, patient education and counseling, and rehabilitation. Virtual reality's utility in neurosurgery and the neurosciences is widely growing, and its use is quickly becoming an integral part of patient care, surgical training, operative planning, navigation, and rehabilitation.
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Affiliation(s)
- Hayden Scott
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- *Correspondence: Hayden Scott
| | - Connor Griffin
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - William Coggins
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Brooke Elberson
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mohamed Abdeldayem
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Linda J. Larson-Prior
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Erika Petersen
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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7
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Recent Applications of Virtual Reality for the Management of Pain in Burn and Pediatric Patients. Curr Pain Headache Rep 2021; 25:4. [PMID: 33443603 DOI: 10.1007/s11916-020-00917-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Virtual reality, via integration of immersive visual and auditory modalities, offers an innovative approach to pain management. The purpose of this review is to investigate the clinical application of virutal reality as an adjunct analgesic to standard of care, particularly in pediatric and burn patients. RECENT FINDINGS Although relatively new, virtual reality has been successfully implemented in a wide range of clinical scenarios for educational, diagnostic, and therapeutic purposes. Most recent literature supports the use of this adjunct analgesic in reducing pain intensity for pediatric and burn patients undergoing acute, painful procedures. This summative review demonstrates the efficacy of virtual reality in altering pain perception by decreasing pain and increasing functionality among pediatric and burn patients. However, large, multi-center randomized controlled trials are still warranted to generalize these findings to more diverse patient demographics and medical scenarios.
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Won AS, Pandita S, Kruzan KP. Social Interaction and Pain Threshold in Virtual Reality. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2020; 23:829-845. [PMID: 33179974 PMCID: PMC7757604 DOI: 10.1089/cyber.2020.0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This experiment examined the effects of social presence and perceived location of a virtual environment on participants' pain thresholds in a preregistered, within-subjects experiment. First, we examined the effects of social interaction versus being alone in a virtual environment. Second, we compared a virtual environment representing a remote location to a replication of the laboratory environment. Social interaction predicted increased pain tolerance, but there was no effect of the "location" of the virtual environment. To our knowledge, this research project is the first to use real-time social interaction in virtual reality as a distractor for experimental thermal pain, and the first to examine the potential interaction between social interaction and transportation to different virtual locations. While this task is not directly analogous to the experience of pain in a medical setting, this preliminary study indicates future avenues for patient treatment. Clinical Trial Registration number: 1701006910.
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Affiliation(s)
| | - Swati Pandita
- Department of Communication, Cornell University, Ithaca, New York, USA
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Lier EJ, Oosterman JM, Assmann R, de Vries M, van Goor H. The effect of Virtual Reality on evoked potentials following painful electrical stimuli and subjective pain. Sci Rep 2020; 10:9067. [PMID: 32494060 PMCID: PMC7270181 DOI: 10.1038/s41598-020-66035-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/13/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Virtual reality (VR) has been shown to reduce pain, however outcome parameters of previous studies have primarily been of a subjective nature and susceptible to bias. This study investigated the effect of VR on cortical processing of evoked potentials (EPs) and subjectively reported pain. Additionally, we explored whether subjects' demographic and personal characteristics modulated the effect of VR analgesia. METHODS Three VR conditions were compared in a randomized cross-over study of 30 healthy volunteers: Passive VR (i.e. no interaction possible with the virtual world), active VR (interactive virtual environment) and no VR (black screen). Subjects received noxious electrical stimuli at random intervals during all conditions. EPs, recorded at Cz, were extracted time locked to stimuli. Pain scores were reported after each condition. RESULTS Active VR significantly decreased pain scores and amplitudes of N1 and P3. Passive VR had no analgesic effect. Age was significantly correlated to pain scores, with older subjects demonstrating larger effects of VR. Gender, game experience, and susceptibility for immersion, did not influence VR analgesia. CONCLUSION Active VR decreases pre-perceptual and perceptual brain activity following painful electrical stimuli, corresponding with reduced pain experience. VR has potential to serve as a non-pharmacologic treatment for pain, particularly in elderly patients.
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Affiliation(s)
- E J Lier
- Department of Surgery, Radboud university medical center Nijmegen, Nijmegen, The Netherlands.
| | - J M Oosterman
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - R Assmann
- Department of Surgery, Radboud university medical center Nijmegen, Nijmegen, The Netherlands
| | - M de Vries
- Department of Surgery, Radboud university medical center Nijmegen, Nijmegen, The Netherlands
| | - H van Goor
- Department of Surgery, Radboud university medical center Nijmegen, Nijmegen, The Netherlands
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10
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A Simple Pattern of Movement is not Able to Inhibit Experimental Pain in FM Patients and Controls: an sLORETA Study. Brain Sci 2020; 10:brainsci10030190. [PMID: 32214053 PMCID: PMC7139913 DOI: 10.3390/brainsci10030190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022] Open
Abstract
Motor cortex activation seems to induce an analgesic effect on pain that would be different between patients with fibromyalgia (FM) and control subjects. This study was conducted to analyze the changes of the laser-evoked potentials (LEPs) induced during a finger tapping task in the FM patients and the controls employing a multi-dipolar analysis according to Standardized low resolution brain electromagnetic tomography (sLORETA) method. The LEPs from 38 FM patients and 21 controls were analyzed. The LEPs were recorded while subjects performed a slow and a fast finger tapping task. We confirmed that the difference between N1, N2 and P2 wave amplitudes between conditions and groups was not significant. In control subjects, the fast finger tapping task induced a modification of cortical source activation in the main areas processing laser stimulation from the moving hand independently from the movement speed. In summary, a simple and repetitive movement is not able to induce consistent inhibition of experimental pain evoked by the moving and the not moving hand in each group. It could interfere with LEP sources within the limbic area at least in control subjects, without inhibit cortical responses or explain the different pattern of motor and pain interaction in FM patients.
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Wu T, Fan J, Chen Y, Xiang J, Zhu D, Zhang J, Shi J, Jiang T. Interictal Abnormalities of Neuromagnetic Gamma Oscillations in Migraine Following Negative Emotional Stimulation. Front Behav Neurosci 2018; 12:169. [PMID: 30174594 PMCID: PMC6108251 DOI: 10.3389/fnbeh.2018.00169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 07/16/2018] [Indexed: 01/03/2023] Open
Abstract
Here, we aimed to investigate brain activity in migraineurs in response to emotional stimulation. Magnetoencephalography (MEG) was used to examine 20 patients with episodic migraine (EM group), 15 patients with chronic migraine (CM group), and 35 healthy participants (control group). Neuromagnetic brain activity was elicited by emotional stimulation using photographs of facial expressions. We analyzed the latency and amplitude of M100 and M170 components and used Morlet wavelet and beamformers to analyze the spectral and spatial signatures of MEG signals in gamma band (30–100 Hz). We found that the timing and frequency of MEG activity differed across the three groups in response negative emotional stimuli. First, peak M170 amplitude was significantly lower in the CM group than in the control group. Second, compared with the control group, the average spectral power was significantly lower in the EM group and CM group at M100 and M170. Third, the average spectral powers of the M100 and M170 in the CM group were negatively correlated with either HAM-D scores or migraine attack frequency. No significant differences across groups was found for positive or neutral emotional stimuli. Furthermore, after negative emotional stimuli, the MEG source analysis demonstrated that the CM group showed a significantly higher percentage of amygdala activation than the control group for M100 and M170. Thus, during headache free phases, migraineurs have abnormal brain activity in the gamma band in response to negative emotional stimuli. Trial Registration:ChiCTR-RNC-17012599. Registered 7 September, 2017.
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Affiliation(s)
- Ting Wu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Fan
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yueqiu Chen
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Xiang
- Department of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Donglin Zhu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Junpeng Zhang
- Department of Medical Information and Engineering, School of Electrical Engineering and Information, Sichuan University, Chengdu, China
| | - Jingping Shi
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, School of Medicine, Nanjing University, Nanjing, China
- *Correspondence: Jingping Shi,
| | - Tianzi Jiang
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China
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12
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Russo A, Coppola G, Pierelli F, Parisi V, Silvestro M, Tessitore A, Tedeschi G. Pain Perception and Migraine. Front Neurol 2018; 9:576. [PMID: 30116215 PMCID: PMC6082953 DOI: 10.3389/fneur.2018.00576] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/26/2018] [Indexed: 12/20/2022] Open
Abstract
Background: It is well-known that both inter- and intra-individual differences exist in the perception of pain; this is especially true in migraine, an elusive pain disorder of the head. Although electrophysiology and neuroimaging techniques have greatly contributed to a better understanding of the mechanisms involved in migraine during recent decades, the exact characteristics of pain threshold and pain intensity perception remain to be determined, and continue to be a matter of debate. Objective: The aim of this review is to provide a comprehensive overview of clinical, electrophysiological, and functional neuroimaging studies investigating changes during various phases of the so-called “migraine cycle” and in different migraine phenotypes, using pain threshold and pain intensity perception assessments. Methods: A systematic search for qualitative studies was conducted using search terms “migraine,” “pain,” “headache,” “temporal summation,” “quantitative sensory testing,” and “threshold,” alone and in combination (subject headings and keywords). The literature search was updated using the additional keywords “pain intensity,” and “neuroimaging” to identify full-text papers written in English and published in peer-reviewed journals, using PubMed and Google Scholar databases. In addition, we manually searched the reference lists of all research articles and review articles. Conclusion: Consistent data indicate that pain threshold is lower during the ictal phase than during the interictal phase of migraine or healthy controls in response to pressure, cold and heat stimuli. There is evidence for preictal sub-allodynia, whereas interictal results are conflicting due to either reduced or no observed difference in pain threshold. On the other hand, despite methodological limitations, converging observations support the concept that migraine attacks may be characterized by an increased pain intensity perception, which normalizes between episodes. Nevertheless, future studies are required to longitudinally evaluate a large group of patients before and after pharmacological and non-pharmacological interventions to investigate phases of the migraine cycle, clinical parameters of disease severity and chronic medication usage.
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Affiliation(s)
- Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli, ", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli,", Naples, Italy
| | - Gianluca Coppola
- Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, G. B. Bietti Foundation-IRCCS, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Vincenzo Parisi
- Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, G. B. Bietti Foundation-IRCCS, Rome, Italy
| | - Marcello Silvestro
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli, ", Naples, Italy
| | - Alessandro Tessitore
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli, ", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli,", Naples, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli, ", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli,", Naples, Italy.,Institute for Diagnosis and Care "Hermitage Capodimonte," Naples, Italy
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13
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Coppola G, Petolicchio B, Di Renzo A, Tinelli E, Di Lorenzo C, Parisi V, Serrao M, Calistri V, Tardioli S, Cartocci G, Ambrosini A, Caramia F, Di Piero V, Pierelli F. Cerebral gray matter volume in patients with chronic migraine: correlations with clinical features. J Headache Pain 2017; 18:115. [PMID: 29322264 PMCID: PMC5762618 DOI: 10.1186/s10194-017-0825-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 12/23/2022] Open
Abstract
Background To date, few MRI studies have been performed in patients affected by chronic migraine (CM), especially in those without medication overuse. Here, we performed magnetic resonance imaging (MRI) voxel-based morphometry (VBM) analyses to investigate the gray matter (GM) volume of the whole brain in patients affected by CM. Our aim was to investigate whether fluctuations in the GM volumes were related to the clinical features of CM. Methods Twenty untreated patients with CM without a past medical history of medication overuse underwent 3-Tesla MRI scans and were compared to a group of 20 healthy controls (HCs). We used SPM12 and the CAT12 toolbox to process the MRI data and to perform VBM analyses of the structural T1-weighted MRI scans. The GM volume of patients was compared to that of HCs with various corrected and uncorrected thresholds. To check for possible correlations, patients’ clinical features and GM maps were regressed. Results Initially, we did not find significant differences in the GM volume between patients with CM and HCs (p < 0.05 corrected for multiple comparisons). However, using more-liberal uncorrected statistical thresholds, we noted that compared to HCs, patients with CM exhibited clusters of regions with lower GM volumes including the cerebellum, left middle temporal gyrus, left temporal pole/amygdala/hippocampus/pallidum/orbitofrontal cortex, and left occipital areas (Brodmann areas 17/18). The GM volume of the cerebellar hemispheres was negatively correlated with the disease duration and positively correlated with the number of tablets taken per month. Conclusion No gross morphometric changes were observed in patients with CM when compared with HCs. However, using more-liberal uncorrected statistical thresholds, we observed that CM is associated with subtle GM volume changes in several brain areas known to be involved in nociception/antinociception, multisensory integration, and analgesic dependence. We speculate that these slight morphometric impairments could lead, at least in a subgroup of patients, to the development and continuation of maladaptive acute medication usage. Electronic supplementary material The online version of this article (10.1186/s10194-017-0825-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gianluca Coppola
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy.
| | - Barbara Petolicchio
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Antonio Di Renzo
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy
| | - Emanuele Tinelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Vincenzo Parisi
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Valentina Calistri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Stefano Tardioli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Gaia Cartocci
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Francesca Caramia
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,IRCCS-Neuromed, Pozzilli, IS, Italy
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14
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Devlin AS, Andrade CC. Quality of the Hospital Experience: Impact of the Physical Environment. HANDBOOK OF ENVIRONMENTAL PSYCHOLOGY AND QUALITY OF LIFE RESEARCH 2017. [DOI: 10.1007/978-3-319-31416-7_23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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15
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Arroll B, Alrutz S, Moyes S. An exploration of the basis for patient complaints about the oldness of magazines in practice waiting rooms: cohort study. BMJ 2014; 349:g7262. [PMID: 25500116 PMCID: PMC4263958 DOI: 10.1136/bmj.g7262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms. DESIGN Cohort study. SETTING Waiting room of a general practice in Auckland, New Zealand. PARTICIPANTS 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women's Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was defined as having five or more photographs of celebrities on the front cover and most gossipy as having up to 10 such images. INTERVENTIONS The magazines were marked with a unique number on the back cover, placed in three piles in the waiting room, and monitored twice weekly. MAIN OUTCOME MEASURES Disappearance of magazines less than 2 months old versus magazines 3-12 months old, the overall rate of loss of magazines, and the rate of loss of gossipy versus non-gossipy magazines. RESULTS 47 of the 82 magazines with a visible date on the front cover were aged less than 2 months. 28 of these 47 (60%) magazines and 10 of the 35 (29%) older magazines disappeared (P=0.002). After 31 days, 41 of the 87 (47%, 95% confidence interval 37% to 58%) magazines had disappeared. None of the 19 non-gossipy magazines (the Economist and Time magazine) had disappeared compared with 26 of the 27 (96%) gossipy magazines (P<0.001). All 15 of the most gossipy magazines and none of the non-gossipy magazines [corrected] had disappeared by 31 days. The study was terminated at this point. CONCLUSIONS General practice waiting rooms contain mainly old magazines. This phenomenon relates to the disappearance of the magazines rather than to the supply of old ones. Gossipy magazines were more likely to disappear than non-gossipy ones. On the grounds of cost we advise practices to supply old copies of non-gossipy magazines. A waiting room science curriculum is urgently needed.
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Affiliation(s)
- Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Stowe Alrutz
- Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Simon Moyes
- Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand
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Wiederhold BK, Gao K, Sulea C, Wiederhold MD. Virtual reality as a distraction technique in chronic pain patients. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2014; 17:346-52. [PMID: 24892196 PMCID: PMC4043365 DOI: 10.1089/cyber.2014.0207] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We explored the use of virtual reality distraction techniques for use as adjunctive therapy to treat chronic pain. Virtual environments were specifically created to provide pleasant and engaging experiences where patients navigated on their own through rich and varied simulated worlds. Real-time physiological monitoring was used as a guide to determine the effectiveness and sustainability of this intervention. Human factors studies showed that virtual navigation is a safe and effective method for use with chronic pain patients. Chronic pain patients demonstrated significant relief in subjective ratings of pain that corresponded to objective measurements in peripheral, noninvasive physiological measures.
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Affiliation(s)
| | - Kenneth Gao
- Virtual Reality Medical Center, San Diego, California
| | - Camelia Sulea
- Virtual Reality Medical Institute, Brussels, Belgium
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