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Wei SQ, Wei JX, Zhao S, Cao DY, Liang L. Downregulation of lysine-specific histone demethylase 1A (KDM1A/LSD1) in medial prefrontal cortex facilitates chronic stress-induced pain and emotional dysfunction in female mice. Neuropharmacology 2024; 254:109992. [PMID: 38723742 DOI: 10.1016/j.neuropharm.2024.109992] [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: 02/04/2024] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
Chronic primary pain, characterized by overlapping symptoms of chronic pain, anxiety, and depression, is strongly associated with stress and is particularly prevalent among females. Recent research has convincingly linked epigenetic modifications in the medial prefrontal cortex (mPFC) to chronic pain and chronic stress. However, our understanding of the role of histone demethylation in the mPFC in chronic stress-induced pain remains limited. In this study, we investigated the function of lysine-specific histone demethylase 1A (KDM1A/LSD1) in the context of chronic overlapping pain comorbid with anxiety and depression in female mice. We employed a chronic variable stress model to induce pain hypersensitivity in the face and hindpaws, as well as anxiety-like and depression-like behaviors, in female mice. Our findings revealed that chronic stress led to a downregulation of KDM1A mRNA and protein expression in the mPFC. Notably, overexpressing KDM1A in the mPFC alleviated the pain hypersensitivity, anxiety-like behaviors, and depression-like behaviors in female mice, without affecting basal pain responses or inducing emotional distress. Conversely, conditional knockout of KDM1A in the mPFC exacerbated pain sensitivity and emotional distress specifically in females. In summary, this study highlights the crucial role of KDM1A in the mPFC in modulating chronic stress-induced overlapping pain, anxiety, and depression in females. Our findings suggest that KDM1A may serve as a potential therapeutic target for treating chronic stress-related overlap pain and associated negative emotional disorders.
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Affiliation(s)
- Si-Qi Wei
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Testing Center of Stomatology, Xi'an Jiaotong University College of Stomatology, Xi'an, Shaanxi, 710061, PR China
| | - Jian-Xiong Wei
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China; Institute of Neuroscience, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Shijie Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Testing Center of Stomatology, Xi'an Jiaotong University College of Stomatology, Xi'an, Shaanxi, 710061, PR China
| | - Dong-Yuan Cao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Testing Center of Stomatology, Xi'an Jiaotong University College of Stomatology, Xi'an, Shaanxi, 710061, PR China.
| | - Lingli Liang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China; Institute of Neuroscience, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China.
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2
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Ruscheweyh R, Lehnen N, Henningsen P. [Migraine and psychosomatic comorbidity]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024. [PMID: 38885653 DOI: 10.1055/a-2331-0840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
As a common neurological disorder (10-15% of the population), migraine is associated with numerous comorbidities, particularly other pain syndromes, mental illnesses and functional disorders. These 'psychosomatic' comorbidities increase with migraine severity. Severely affected, comorbid patients also often have a poorer response to specific migraine therapy. Interestingly, migraine and the comorbidities mentioned have a number of common aetiological or facilitating factors, e.g. genetic factors, and show a higher incidence in women and in people with previous traumatic experiences, as well as (in the case of pain syndromes) signs of central sensitization. Another common feature is the association with current or chronic stress. We propose an extended diathesis-stress model that takes into account interrelated but individually different vulnerabilities and, depending on the stress experience, can depict both the occurrence of individual disorders (e.g. an isolated migraine) and the joint occurrence of migraine with other pain syndromes and other psychosomatic comorbidities. In summary, psychosomatic comorbidities should always be kept in mind in migraine therapy and, if necessary, treated early and multimodally.
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Affiliation(s)
- Ruth Ruscheweyh
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, München, Germany
- Klinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar der TUM, München, Germany
| | - Nadine Lehnen
- Klinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar der TUM, München, Germany
| | - Peter Henningsen
- Klinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar der TUM, München, Germany
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Pellón-Elexpuru I, Van Dijk R, Van der Valk I, Martínez-Pampliega A, Molleda A, Cormenzana S. Divorce and physical health: A three-level meta-analysis. Soc Sci Med 2024; 352:117005. [PMID: 38824838 DOI: 10.1016/j.socscimed.2024.117005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024]
Abstract
Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.
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Affiliation(s)
| | - Rianne Van Dijk
- Youth&Family Department, Utrecht University, Utrecht, the Netherlands
| | - Inge Van der Valk
- Youth&Family Department, Utrecht University, Utrecht, the Netherlands
| | | | - Asier Molleda
- Deusto FamilyPsych, Deusto University, Bilbao, Spain
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Wang Y, Kim SH, Klein ME, Chen J, Gu E, Smith S, Bortsov A, Slade GD, Zhang X, Nackley AG. A mouse model of chronic primary pain that integrates clinically relevant genetic vulnerability, stress, and minor injury. Sci Transl Med 2024; 16:eadj0395. [PMID: 38598615 DOI: 10.1126/scitranslmed.adj0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
Chronic primary pain conditions (CPPCs) affect over 100 million Americans, predominantly women. They remain ineffectively treated, in large part because of a lack of valid animal models with translational relevance. Here, we characterized a CPPC mouse model that integrated clinically relevant genetic (catechol-O-methyltransferase; COMT knockdown) and environmental (stress and injury) factors. Compared with wild-type mice, Comt+/- mice undergoing repeated swim stress and molar extraction surgery intervention exhibited pronounced multisite body pain and depressive-like behavior lasting >3 months. Comt+/- mice undergoing the intervention also exhibited enhanced activity of primary afferent nociceptors innervating hindpaw and low back sites and increased plasma concentrations of norepinephrine and pro-inflammatory cytokines interleukin-6 (IL-6) and IL-17A. The pain and depressive-like behavior were of greater magnitude and longer duration (≥12 months) in females versus males. Furthermore, increases in anxiety-like behavior and IL-6 were female-specific. The effect of COMT genotype × stress interactions on pain, IL-6, and IL-17A was validated in a cohort of 549 patients with CPPCs, demonstrating clinical relevance. Last, we assessed the predictive validity of the model for analgesic screening and found that it successfully predicted the lack of efficacy of minocycline and the CB2 agonist GW842166X, which were effective in spared nerve injury and complete Freund's adjuvant models, respectively, but failed in clinical trials. Yet, pain in the CPPC model was alleviated by the beta-3 adrenergic antagonist SR59230A. Thus, the CPPC mouse model reliably recapitulates clinically and biologically relevant features of CPPCs and may be implemented to test underlying mechanisms and find new therapeutics.
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Affiliation(s)
- Yaomin Wang
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Shin Hyung Kim
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Marguerita E Klein
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Jiegen Chen
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Elizabeth Gu
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Shad Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Andrey Bortsov
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Gary D Slade
- Center for Pain Research and Innovation, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Xin Zhang
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Andrea G Nackley
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC 27710, USA
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Boggero IA, Sangalli L, Brasch L, King CD. Social health in young women with chronic pain. Pain Rep 2024; 9:e1146. [PMID: 38505830 PMCID: PMC10950150 DOI: 10.1097/pr9.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Chronic pain may negatively affect social functioning, but no study to date has examined the specific social impact of different chronic pain conditions in young women, and whether living with multiple chronic overlapping pain conditions (COPCs) differently influences social domains. Objectives This study aimed to assess social functioning (social isolation, hostility, informational support satisfaction, social roles, emotional support, friendships, and family relationships) among young women with chronic pain compared with pain-free controls and to test whether the number of COPCs influenced the extent of social burden. Methods Participants aged 18 to 30 years with a physician-confirmed diagnoses of migraine, fibromyalgia, or temporomandibular disorder (TMD) and pain-free controls were invited to participate from across the United States. After confirming eligibility, participants completed a 1-hour REDCap online questionnaire assessing social functioning. Results One hundred four participants (mean age 24.54 ± 3.35 years) were included (n = 26 with TMD, n = 25 with fibromyalgia, n = 25 with migraine, and n = 28 controls). All 3 chronic pain groups combined reported worse functioning than controls on friendship (P = 0.038), social isolation (P = 0.002), and social roles (P < 0.001). There were no differences on social variables between the 3 chronic pain groups (all P's > 0.05). Compared with those with 3 COPCs, participants with 1 condition reported better family relationships (P = 0.024). Conclusions Experience of chronic pain-regardless of the specific pain condition-may negatively affect some areas of social functioning in young women.
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Affiliation(s)
- Ian A. Boggero
- Division of Orofacial Pain, Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, KY, USA
- Department of Psychology, College of Arts and Science, University of Kentucky, Lexington, KY, USA
- Department of Anesthesiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Linda Sangalli
- College of Dental Medicine—Illinois, Midwestern University, Downers Grove, IL, USA
| | - Lauryn Brasch
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher D. King
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Böthun A, Lövgren A, Stålnacke BM, Lampa E, Österlund C, Häggman-Henrikson B, Hellström F. Whiplash trauma did not predict jaw pain after 2 years: an explorative study. Clin Oral Investig 2024; 28:165. [PMID: 38383824 PMCID: PMC10881702 DOI: 10.1007/s00784-024-05555-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES To explore predictive factors for the development and maintenance of jaw pain over a 2-year period. METHODS One hundred nineteen cases (73 women) and 104 controls (59 women), mean age 34.9 years (SD 13.9), attended baseline and 2-year follow-up examinations. The whiplash cases visited the emergency department at Umeå University Hospital, Sweden, with neck pain within 72 h following a car accident, and baseline questionnaires were answered within a month after trauma. Controls were recruited via advertising. Inclusion criteria were age 18-70 years, living in Umeå municipality and Swedish speaking. The exclusion criterion was neck fracture for cases and a previous neck trauma for controls. Validated questionnaires recommended in the standardized Research Diagnostic Criteria for temporomandibular disorders were used. Jaw pain was assessed by two validated screening questions answered with "yes" or "no." A logistic regression analysis was used to predict the outcome variable jaw pain (yes/no) after 2 years. RESULTS Whiplash trauma did not increase the odds of development of jaw pain over a 2-year period (OR 1.97, 95% CI 0.53-7.38). However, non-specific physical symptoms (OR 8.56, 95% CI 1.08-67.67) and female gender (OR 4.89, 95% CI 1.09-22.02) did increase the odds for jaw pain after 2 years. CONCLUSION The development and maintenance of jaw pain after whiplash trauma are primarily not related to the trauma itself, but more associated with physical symptoms. CLINICAL RELEVANCE The development of jaw pain in connection with a whiplash trauma needs to be seen in a biopsychosocial perspective, and early assessment is recommended.
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Affiliation(s)
- Alicia Böthun
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Anna Lövgren
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Ewa Lampa
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Catharina Österlund
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Birgitta Häggman-Henrikson
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, 901 87, Umeå, Sweden
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Fredrik Hellström
- Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, 901 87, Umeå, Sweden
- Department of Occupational Health Science and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Zheng P, Ewing S, Tang A, Black D, Hue T, Lotz J, Peterson T, Torres-Espin A, O'Neill C. Predictors of response in PROMIS-global in a chronic low back pain specialty clinic: STarTBack and chronic overlapping pain conditions. J Back Musculoskelet Rehabil 2024:BMR230067. [PMID: 38427463 DOI: 10.3233/bmr-230067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND Tools, such as the STarTBack Screening Tool (SBT), have been developed to identify risks of progressing to chronic disability in low back pain (LBP) patients in the primary care population. However, less is known about predictors of change in function after treatment in the specialty care population. OBJECTIVE We pursued a retrospective observational cohort study involving LBP patients seen in a multidisciplinary specialty clinic to assess which features can predict change in function at follow-up. METHODS The SBT was administered at initial visit, and a variety of patient characteristics were available in the chart including the presence of chronic overlapping pain conditions (COPCs). Patient Reported Outcomes Measurement Information System-10 (PROMIS-10) global physical health (PH) and global mental health (MH) were measured at baseline and at pragmatic time points during follow-up. Linear regression was used to estimate adjusted associations between available features and changes in PROMIS scores. RESULTS 241 patients were followed for a mean of 17.0 ± 7.5 months. Mean baseline pain was 6.7 (SD 2.1), PROMIS-10 global MH score was 44.8 (SD 9.3), and PH score was 39.4 (SD 8.6). 29.7% were low-risk on the SBT, 41.8% were medium-risk, and 28.5% were high-risk. Mean change in MH and PH scores from baseline to the follow-up questionnaire were 0.86 (SD 8.11) and 2.39 (SD 7.52), respectively. Compared to low-risk patients, high-risk patients had a mean 4.35 points greater improvement in their MH score (p= 0.004) and a mean 3.54 points greater improvement in PH score (p= 0.006). Fewer COPCs also predicted greater improvement in MH and PH. CONCLUSIONS SBT and the presence of COPC, which can be assessed at initial presentation to a specialty clinic, can predict change in PROMIS following treatment. Effort is needed to identify other factors that can help predict change in function after treatment in the specialty care setting.
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Affiliation(s)
- Patricia Zheng
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Susan Ewing
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Angelina Tang
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dennis Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Trisha Hue
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jeffrey Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Thomas Peterson
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Abel Torres-Espin
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Conor O'Neill
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
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Asal MGR, Atta MHR, Abdelaliem SMF, El-Sayed AAI, El-Deeb HAAEM. Perceived stress, coping strategies, symptoms severity and function status among carpal tunnel syndrome patients: a nurse-led correlational Study. BMC Nurs 2024; 23:83. [PMID: 38303046 PMCID: PMC10832276 DOI: 10.1186/s12912-024-01761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a prevalent condition characterized by hand pain, tingling, and numbness. The severity of symptoms and functional status in CTS patients may be influenced by perceived stress and how individuals cope with it. However, scarce knowledge exists about the role of coping strategies as moderators in this relationship. Unfolding the role of perceived stress and coping strategies for CTS management will help the nurse to provide comprehensive and tailored nursing care. This will ultimately improve patient comfort, functionality, and quality of life. PURPOSES This study aimed to examine the role of coping strategies (adaptive and maladaptive) in the relationship between perceived stress and both symptoms severity and function status among those patients. METHOD We employed a multisite, correlational study design with moderation analysis. The study included 215 patients with CTS from neurosurgery outpatient clinics at three hospitals in Egypt. After obtaining their consent to participate, eligible participants completed anonymous, self-reported measures of perceived stress, the brief COPE inventory, and the Boston Carpal Tunnel Questionnaire. Demographic and biomedical data were also collected. The questionnaire took about 20 min to be completed. The data was collected over six months, starting in February 2023. RESULTS The results showed that perceived stress, adaptive coping, and maladaptive coping were significant predictors of symptoms severity and functional status. Adaptive coping moderated the relationships between perceived stress and both symptoms severity and function status, while maladaptive coping did not. The interaction between perceived stress and adaptive coping explained a moderate effect on symptoms severity and function status after controlling for the main effects and the covariates. CONCLUSION This study explored the relationship between perceived stress, coping strategies, and outcomes in patients with CTS. The results indicate that nurses play a vital role in assessing and assisting patients to adopt effective coping strategies to manage perceived stress and alleviate symptoms and functional impairment. Moreover, the findings support the need for psychological interventions that address both perceived stress and coping strategies as a way to enhance the functioning status and quality of life of patients with CTS.
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Affiliation(s)
- Maha Gamal Ramadan Asal
- Medical Surgical Nursing Department, Faculty of Nursing, Alexandria University, 9 Edmond Vermont Street - Smouha, Alexandria, Egypt.
| | - Mohamed Hussein Ramadan Atta
- Psychiatric and mental health nursing Department, Faculty of Nursing, Alexandria University, 9 Edmond Vermont Street - Smouha, Alexandria, Egypt
| | | | | | - Hoda Abdou Abd El-Monem El-Deeb
- Medical Surgical Nursing Department, Faculty of Nursing, Alexandria University, 9 Edmond Vermont Street - Smouha, Alexandria, Egypt
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Bartley EJ, Alappattu MJ, Manko K, Lewis H, Vasilopoulos T, Lamvu G. Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241248017. [PMID: 38682290 PMCID: PMC11057341 DOI: 10.1177/17455057241248017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/06/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Evidence of overlap between endometriosis and chronic pain conditions is emerging; however, little is known about how the pain experience differs based on the presence or absence of endometriosis. OBJECTIVES In a sample of women reporting chronic pelvic-abdominal pain (CPP), the aim of this study was to characterize differences in pain symptomatology between women with and without endometriosis and to examine the influence of chronic overlapping pain conditions (COPCs) on pain among these two groups. DESIGN This was a cross-sectional study, based on an online survey. METHODS Participants (aged 18+ years) completed a survey collecting pain diagnoses and symptoms assessing pelvic pain severity, pain interference, and pain impact. Independent sample t-tests, chi-square, and multiple linear regression models were employed to analyze group differences in pain symptomatology and COPCs. RESULTS Of the 525 respondents with CPP, 25% (n = 133) reported having endometriosis. Women with endometriosis were younger at the onset of pelvic pain, relative to women without endometriosis (p = 0.04). There were no differences in age, race, ethnicity, or duration of pelvic pain between women with and without endometriosis. Women with endometriosis reported higher pelvic pain severity (+0.8, 95% CI = 0.4-1.1), pain interference (+5.9, 95% CI = 2.4-9.3), and pain impact (+1.9, 95% CI = 0.8-2.9). Endometriosis was associated with a higher number of COPCs (p = 0.003), with 25% (n = 33) of women reporting ⩾3 overlapping pain conditions compared with 12% (n = 45) of those without endometriosis. Women with endometriosis had a higher frequency of fibromyalgia (p < 0.001), chronic fatigue syndrome (p < 0.001), and temporomandibular disorder (p = 0.001). The number of COPCs was associated with higher pain severity, interference, and impact, independently of endometriosis. CONCLUSION Women with endometriosis experienced higher levels of pain-related burden and COPCs compared with those without endometriosis. Pain intensity, interference, and impact increased with a higher number of pain conditions regardless of endometriosis presence.
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Affiliation(s)
- Emily J Bartley
- College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Meryl J Alappattu
- College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Kelsey Manko
- College of Medicine, University of Central Florida, Gainesville, FL, USA
| | - Hannah Lewis
- Gynecology Section, Division of Surgery, Orlando Veterans Affairs Healthcare System, Orlando, FL, USA
| | | | - Georgine Lamvu
- College of Medicine, University of Central Florida, Gainesville, FL, USA
- Gynecology Section, Division of Surgery, Orlando Veterans Affairs Healthcare System, Orlando, FL, USA
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10
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Schrepf A, Maixner W, Fillingim R, Veasley C, Ohrbach R, Smith S, Williams DA. The Chronic Overlapping Pain Condition Screener. THE JOURNAL OF PAIN 2024; 25:265-272. [PMID: 37633574 DOI: 10.1016/j.jpain.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
Ten Chronic Overlapping Pain Conditions (COPCs) are currently recognized by the National Institutes of Health Pain Consortium (eg, irritable bowel syndrome, chronic migraine headache, and chronic low back pain). These conditions affect millions of Americans; however, assessing these conditions, their co-occurrence, and their relationship to treatment has proven challenging due to time constraints and a lack of standardized measures. We present a Chronic Overlapping Pain Condition-Screener (COPC-S) that is logic-driven, efficient, and freely available in electronic format to nonprofit entities. Thirty experts were convened to identify and modify self-report criteria for each COPC as well as criteria that trigger the administration of the diagnostic criteria from a body map and a brief series of questions. Their recommendations were then programmed into the Research Electronic Data Capture platform and refined for comprehensibility and ease of use by patient focus groups. The electronic screener and physician-administered criteria were both administered to patients with known COPCs in a counter-balanced fashion to determine the level of agreement between methods. The expert panel identified screening items/body map regions and diagnostic criteria for all 10 COPCs. Patients found the content comprehensible and the platform easy to use. Cohen's Kappa statistics suggested good agreement between the electronic COPC-S and criteria administered by a physician (κ = .813). The COPC-S is an efficient tool for screening multiple COPCs and has applicability to research studies, clinical trials, and clinical practice. PERSPECTIVE: Assessing COPCs remains a challenge for researchers and clinicians. The COPC-S is an efficient and logic-driven electronic tool that allows for the rapid screening assessment of 10 COPCs. The instrument may have utility in research and clinical settings.
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Affiliation(s)
- Andrew Schrepf
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan
| | - William Maixner
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Roger Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida
| | - Christin Veasley
- Chronic Pain Research Alliance, An Initiative of The TMJ Association, Milwaukee, Wisconsin
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University of Buffalo, Buffalo, New York
| | - Shad Smith
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - David A Williams
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan
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11
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Yakkaphan P, Smith JG, Chana P, Tan HL, Ravindranath PT, Lambru G, Renton T. Temporomandibular Disorders and Fibromyalgia Prevalence: A Systematic Review and Meta-Analysis. J Oral Facial Pain Headache 2023; 37:177-193. [PMID: 37975782 PMCID: PMC10664703 DOI: 10.11607/ofph.3260] [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: 05/02/2022] [Accepted: 09/25/2022] [Indexed: 11/19/2023]
Abstract
PURPOSE To evaluate the prevalence of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) in TMD patients and the prevalence of TMDs in patients with FMS. METHOD A systematic search was performed in electronic databases. Studies published in English examining the prevalence of comorbid TMDs and CWP/FMS were included. The Newcastle-Ottawa Scale was used to assess study quality, and meta-analyses using defined diagnostic criteria were conducted to generate pooled prevalence estimates. RESULTS Nineteen studies of moderate to high quality met the selection criteria. Meta-analyses yielded a pooled prevalence rate (95% CI) for TMDs in FMS patients of 76.8% (69.5% to 83.3%). Myogenous TMDs were more prevalent in FMS patients (63.1%, 47.7% to 77.3%) than disc displacement disorders (24.2%, 19.4% to 39.5%), while a little over 40% of FMS patients had comorbid inflammatory degenerative TMDs (41.8%, 21.9% to 63.2%). Almost a third of individuals (32.7%, 4.5% to 71.0%) with TMDs had comorbid FMS, while estimates of comorbid CWP across studies ranged from 30% to 76%. CONCLUSIONS Despite variable prevalence rates among the included studies, the present review suggests that TMDs and CWP/FMS frequently coexist, especially for individuals with painful myogenous TMDs. The clinical, pathophysiologic, and therapeutic aspects of this association are important for tailoring appropriate treatment strategies.
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12
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Romero-Reyes M, Arman S, Teruel A, Kumar S, Hawkins J, Akerman S. Pharmacological Management of Orofacial Pain. Drugs 2023; 83:1269-1292. [PMID: 37632671 DOI: 10.1007/s40265-023-01927-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
Orofacial pain is a category of complex disorders, including musculoskeletal, neuropathic and neurovascular disorders, that greatly affect the quality of life of the patient. These disorders are within the fields of dentistry and medicine and management can be challenging, requiring a referral to an orofacial pain specialist, essential for adequate evaluation, diagnosis, and care. Management is specific to the diagnosis and a treatment plan is developed with diverse pharmacological and non-pharmacological modalities. The pharmacological management of orofacial pain encompasses a vast array of medication classes and approaches. This includes anti-inflammatory drugs, muscle relaxants, anticonvulsants, antidepressants, and anesthetics. In addition, as adjunct therapy, different injections can be integrated into the management plan depending on the diagnosis and needs. These include trigger point injections, temporomandibular joint (TMJ) injections, and neurotoxin injections with botulinum toxin and nerve blocks. Multidisciplinary management is key for optimal care. New and safer therapeutic targets exclusively for the management of orofacial pain disorders are needed to offer better care for this patient population.
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Affiliation(s)
- Marcela Romero-Reyes
- Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, 650 W. Baltimore St, 1st Floor, Baltimore, MD, 21201, USA.
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA.
| | - Sherwin Arman
- Orofacial Pain Program, Section of Oral Medicine, Oral Pathology and Orofacial Pain, University of California, Los Angeles, School of Dentistry, Los Angeles, CA, USA
| | | | - Satish Kumar
- Department of Periodontics, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, AZ, USA
| | - James Hawkins
- Naval Postgraduate Dental School, Naval Medical Leader and Professional Development Command, Uniformed Services University of the Health Sciences Postgraduate Dental College, Baltimore, MD, USA
| | - Simon Akerman
- Department of Pain and Neural Sciences, School of Dentistry, University of Maryland, 650 W. Baltimore St, 8th Floor, Baltimore, MD, 21201, USA
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13
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Gewandter JS, Edwards RR, Hill KP, Wasan AD, Hooker JE, Lape EC, Besharat S, Cowan P, Foll BL, Ditre JW, Freeman R. Cannabinoid Therapy: Attitudes and Experiences of People With Chronic Pain. Clin J Pain 2023; 39:249-258. [PMID: 36971412 PMCID: PMC10563515 DOI: 10.1097/ajp.0000000000001109] [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: 10/17/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Clinical trials of cannabinoids for chronic pain have mixed and often inconclusive results. In contrast, many prospective observational studies show the analgesic effects of cannabinoids. This survey study aimed to examine the experiences/attitudes of individuals with chronic pain who are currently taking, have previously taken, or never taken cannabinoids for chronic pain to inform future research. METHODS This study is based on a cross-sectional, web-based survey of individuals with self-reported chronic pain. Participants were invited to participate through an email that was distributed to the listservs of patient advocacy groups and foundations that engage individuals with chronic pain. RESULTS Of the 969 respondents, 444 (46%) respondents reported currently taking, 213 (22%) previously taken, and 312 (32%) never taken cannabinoids for pain. Participants reported using cannabinoids to treat a wide variety of chronic pain conditions. Those currently taking cannabinoids (vs previously) more frequently reported: (1) large improvements from cannabinoids in all pain types, including particularly difficult-to-treat chronic overlapping pain conditions (eg, pelvic pain), (2) improvements in comorbid symptoms (eg, sleep), and (3) lower interference from side effects. Those currently taking cannabinoids reported more frequent and satisfactory communication with clinicians regarding cannabinoid use. Those never taken cannabinoids reported a lack of suggestion/approval of a clinician (40%), illegality (25%), and lack of FDA regulation (19%) as reasons for never trying cannabinoids. CONCLUSION These findings underscore the importance of conducting high-quality clinical trials that include diverse pain populations and clinically relevant outcomes that if successful, could support FDA approval of cannabinoid products. Clinicians could then prescribe and monitor these treatments similarly to other chronic pain medications.
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Affiliation(s)
- Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Kevin P. Hill
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ajay D. Wasan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julia E. Hooker
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Emma C. Lape
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Soroush Besharat
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Bernard Le Foll
- Department of Family and Community Medicine, University of Toronto, CA
- Addictions Division, Centre for Addiction and Mental Health, Toronto, CA
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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14
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Sharma S, Slade GD, Fillingim RB, Ohrbach R. A rose by another name? Characteristics that distinguish headache secondary to temporomandibular disorder from headache that is comorbid with temporomandibular disorder. Pain 2023; 164:820-830. [PMID: 36048529 PMCID: PMC9971346 DOI: 10.1097/j.pain.0000000000002770] [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: 04/01/2022] [Accepted: 08/19/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Co-occurring pain conditions that affect overlapping body regions are complicated by the distinction between primary vs secondary pain conditions. We investigate the occurrence of headache and painful temporomandibular disorder (TMD) in a community-based, cross-sectional study of US adults in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA-II) study. A specific goal was to determine whether headache attributed to TMD is separable from primary headache. Using DC/TMD and International Classification of Headache Disorders-third edition criteria, 3 groups of individuals were created: (a) headache without TMD; (b) headache comorbid with TMD; and (c) headache attributed to TMD. Regression models compared study groups according to demographic and comorbid characteristics, and post hoc contrasts tested for differences. Descriptive statistics and Cohen d effect size were computed, by group, for each predictor variable. Differences in continuous predictors were analyzed using one-way analysis of variance. Nearly all demographic and comorbid variables distinguished the combined headache and TMD groups from the group with headache alone. Relative to the reference group with primary headache alone, markers related to headache, TMD, somatic pain processing, psychosocial, and health conditions were substantially greater in both headache comorbid with TMD and headache attributed to TMD, attesting to their qualitative similarities. However, effect sizes relative to the reference group were large for headache comorbid with TMD and larger again for headache attributed to TMD, attesting to their separability in quantitative terms. In summary, the presence of overlapping painful TMD and headache adds substantially to the biopsychosocial burden of headache and points to the importance of comprehensive assessment and differential management.
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Affiliation(s)
- Sonia Sharma
- Department of Neurosurgery, Neuro Pain Management Center, University of Rochester Medical Center, Rochester, NY, United States
- Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY, United States
| | - Gary D Slade
- Division of Pediatric and Population Health, UNC Adams School of Dentistry, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY, United States
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15
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Khan J, Singer SR, Young A, Tanaiutchawoot N, Kalladka M, Mupparapu M. Pathogenesis and Differential Diagnosis of Temporomandibular Joint Disorders. Dent Clin North Am 2023; 67:259-280. [PMID: 36965930 DOI: 10.1016/j.cden.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Temporomandibular disorders (TMDs) are an umbrella term including disorders of the temporomandibular joint and muscles of the masticatory system. They are the most common nonodontogenic cause of pain in the orofacial region. A clear understanding of various conditions, underlying mechanisms, clinical presentation, and examination skills is required to effectively diagnose and manage these patients.
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Affiliation(s)
- Junad Khan
- Orofacial Pain and TMJD, Eastman Institute for Oral Health, 625 Elmwood Avenue, Rochester, NY 14620, USA.
| | - Steven R Singer
- Department of Diagnostic Sciences Division of Oral & Maxillofacial Radiology, Rutgers School of Dental Medicine, 110 Bergen Street | PO Box 1709, Newark, NJ 07101-1709, USA
| | - Andrew Young
- Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA
| | - Naruthorn Tanaiutchawoot
- Department of Diagnostic Sciences Division of Oral & Maxillofacial Radiology, Rutgers School of Dental Medicine, 110 Bergen Street | PO Box 1709, Newark, NJ 07101-1709, USA
| | - Mythili Kalladka
- Orofacial Pain and TMJD, Eastman Institute for Oral Health, 625 Elmwood Avenue, Rochester, NY 14620, USA
| | - Mel Mupparapu
- Penn Dental Medicine, 240 S 40th Street, Philadelphia, PA 19104, USA
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16
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Hood AM, Morais CA, Fields LN, Merriwether EN, Brooks AK, Clark JF, McGill LS, Janevic MR, Letzen JE, Campbell LC. Racism exposure and trauma accumulation perpetuate pain inequities-advocating for change (RESTORATIVE): A conceptual model. AMERICAN PSYCHOLOGIST 2023; 78:143-159. [PMID: 37011166 PMCID: PMC10071409 DOI: 10.1037/amp0001042] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Experiences of racism occur across a continuum from denial of services to more subtle forms of discrimination and exact a significant toll. These multilevel systems of oppression accumulate as chronic stressors that cause psychological injury conceptualized as racism-based traumatic stress (RBTS). RBTS has overlapping symptoms with posttraumatic stress disorder (PTSD) with the added burden that threats are constantly present. Chronic pain is a public health crisis that is exacerbated by the intersection of racism and health inequities. However, the relationship between RBTS and pain has not yet been explored. To highlight how these phenomena are interlinked, we present Racism ExpoSure and Trauma AccumulatiOn PeRpetuate PAin InequiTIes-AdVocating for ChangE (RESTORATIVE); a novel conceptual model that integrates the models of racism and pain and demonstrates how the shared contribution of trauma symptoms (e.g., RBTS and PTSD) maintains and perpetuates chronic pain for racialized groups in the United States. Visualizing racism and pain as "two halves of the same coin," in which the accumulative effects of numerous events may moderate the severity of RBTS and pain, we emphasize the importance of within-group distinctiveness and intersectionality (overlapping identities). We call on psychologists to lead efforts in applying the RESTORATIVE model, acting as facilitators and advocates for the patient's lived experience with RBTS in clinical pain care teams. To assist with this goal, we offer suggestions for provider and researcher antiracism education, assessment of RBTS in pain populations, and discuss how cultural humility is a central component in implementing the RESTORATIVE model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Anna M. Hood
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health
| | - Calia A. Morais
- Department of Hematology and Oncology, The University of Alabama at Birmingham
| | | | - Ericka N. Merriwether
- Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development
- Department of Medicine, NYU Grossman School of Medicine, New York University
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest School of Medicine
| | - Jaylyn F. Clark
- Department of Anesthesiology, Wake Forest School of Medicine
| | - Lakeya S. McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Mary R. Janevic
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
| | - Janelle E. Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
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17
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Thomas S, Wang Y, Cundiff-O’Sullivan R, Massalee R, Colloca L. How negative and positive constructs and comorbid conditions contribute to disability in chronic orofacial pain. Eur J Pain 2023; 27:99-110. [PMID: 36203350 PMCID: PMC9799734 DOI: 10.1002/ejp.2042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/08/2022] [Accepted: 10/02/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Temporomandibular disorders (TMD) symptoms develop into chronic pain for some patients, but the reasons for this are unclear. Psychosocial factors and chronic overlapping pain conditions are believed to contribute to the development of pain-related disability. We examined the role of jaw function, negative and positive psychological factors and chronic overlapping pain conditions (COPCs) on pain-related disability whilst controlling for demographic variables. METHODS We collected demographics, medical and psychosocial history and the Graded Chronic Pain Scale, a measure of pain intensity and pain interference from 400 participants with chronic TMD. Structural equation modelling was used to assess a model of COPCs and the latent variables of psychological unease (pain catastrophizing, somatic symptoms and negative affect), positive valence factors (optimism and positive affect), jaw function (chewing, opening and expression limitation) and pain-related disability (pain intensity and pain interference) whilst controlling for demographic variables. RESULTS We achieved good fit of a parsimonious model (root-mean-square error of approximation = 0.063 [90% CI] [0.051-0.075]), comparative fit index = 0.942, standard root-mean-square residual = 0.067. Jaw function was the strongest latent variable predictor, followed by psychological unease and COPCs suggesting resources focused on improving joint function, psychosocial support and management of COPCs will improve pain-related disability in TMDs. CONCLUSIONS These findings not only increase the body of knowledge related to TMD clinical phenotypes but also, have a translational impact in further supporting the potential value of targeting physical therapy such as jaw exercise along with psychological interventions as multidisciplinary nonpharmacological therapeutic solutions.
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Affiliation(s)
- Sharon Thomas
- Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Yang Wang
- Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions (PBO) Center, School of Nursing, University of Maryland, Baltimore, USA
| | - Rachel Cundiff-O’Sullivan
- Placebo Beyond Opinions (PBO) Center, School of Nursing, University of Maryland, Baltimore, USA
- Program in Neuroscience, Graduate Program in Life Sciences, University of Maryland, Baltimore, MD, US
| | - Rachel Massalee
- Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions (PBO) Center, School of Nursing, University of Maryland, Baltimore, USA
| | - Luana Colloca
- Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Departments of Anaesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, USA
- Placebo Beyond Opinions (PBO) Center, School of Nursing, University of Maryland, Baltimore, USA
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18
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Posttraumatic Stress Disorder and the Role of Psychosocial Comorbidities in Chronic Orofacial Pain. Dent Clin North Am 2023; 67:141-155. [PMID: 36404075 DOI: 10.1016/j.cden.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article presents the case of a patient with persistent right-sided jaw pain with a history of multiple temporomandibular joint surgeries in the setting of persistent widespread body pain, the causes of which were fibromyalgia and osteoarthritis with multiple joint replacements, as well as psychological diagnoses of PTSD and depression. Despite extensive treatment from her orofacial pain team in combination with neurology and neurosurgery, her severe pain persisted, likely due to the consequences of untreated PTSD and depression, which led to avoidance of activities that would exacerbate her pain and thus to further disability and emotional deterioration.
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19
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Hitti M, Welte-Jzyk C, Pröbster L, Erbe C. CMD und Kieferorthopädie. INFORMATIONEN AUS ORTHODONTIE & KIEFERORTHOPÄDIE 2022. [DOI: 10.1055/a-1925-4606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
ZusammenfassungDie Craniomandibuläre Dysfunktion (CMD) ist mit einer Prävalenz
von über 30% die häufigste chronische Schmerzerkrankung
im Kiefer- Gesichtsbereich. Die Therapie erfordert einen
interdisziplinären, individuell angepassten Behandlungsansatz. Diese
Fallvorstellung soll einen Einblick über das Behandlungskonzept eines
posterior-lateralen Zwangsbisses mit Oberkiefer- Okklusionsschiene und
OK/UK Alignern (Invisalign) geben.
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Affiliation(s)
- Mirette Hitti
- Poliklinik für Kieferorthopädie der
Universitätsmedizin Mainz
| | | | | | - Christina Erbe
- Poliklinik für Kieferorthopädie der
Universitätsmedizin Mainz
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20
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Henningsen P, Hausteiner-Wiehle C, Häuser W. Migraine in the context of chronic primary pain, chronic overlapping pain disorders, and functional somatic disorders: A narrative review. Headache 2022; 62:1272-1280. [PMID: 36373821 DOI: 10.1111/head.14419] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To contextualize migraine as the most common primary headache disorder in relation to other chronic primary pain and non-pain functional somatic and mental conditions. BACKGROUND Migraine is increasingly understood as a sensory processing disorder within a broader spectrum of symptom disorders. This has implications for diagnosis and treatment. METHOD Narrative review based on a search of the literature of the last 15 years on the overlap of migraine with other symptom disorders. RESULTS Migraine as the prototypical primary headache disorder not only comprises many non-headache symptoms in itself, it also shows high comorbidity with other chronic pain and non-pain conditions (e.g., fibromyalgia syndrome, irritable bowel syndrome, functional non-epileptic seizures, depression, anxiety, and posttraumatic stress disorder). Such "symptom disorders" share several etiological factors (e.g., female preponderance, psychological vulnerability) and psychophysiological mechanisms (e.g., altered sensory processing, pain expectancy). These facts are acknowledged by several recent integrative conceptualizations such as chronic primary pain, chronic overlapping pain conditions, or functional somatic disorders. Accordingly, migraine management increasingly addresses the total symptom burden and individual contributors to symptom experience, and thus incorporates centrally acting pharmacological and non-pharmacological, that is, psychological and behavioral, treatment approaches. CONCLUSIONS Migraine and also other primary headache disorders should be seen as particular phenotypes within a broader spectrum of symptom perception and processing disorders that require integrative diagnostics and treatment. A harmonization of classifications and better interdisciplinary collaboration are desirable.
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Affiliation(s)
- Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Constanze Hausteiner-Wiehle
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany.,Department of Neurology, BG Trauma Center Murnau, Murnau, Germany
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany.,Department of Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany
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21
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Sanders AE, Weatherspoon ED, Ehrmann BM, Soma PS, Shaikh SR, Preisser JS, Ohrbach R, Fillingim RB, Slade GD. Ratio of Omega-6/Omega-3 Polyunsaturated Fatty Acids Associated With Somatic and Depressive Symptoms in People With Painful Temporomandibular Disorder and Irritable Bowel Syndrome. THE JOURNAL OF PAIN 2022; 23:1737-1748. [PMID: 35477107 PMCID: PMC9561958 DOI: 10.1016/j.jpain.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/24/2022] [Accepted: 04/07/2022] [Indexed: 04/27/2023]
Abstract
Somatic symptom disturbance is among the strongest predictors of painful temporomandibular disorder (TMD). Related psychological constructs, such as anxiety and depression, respond therapeutically to omega-3 polyunsaturated fatty acids (PUFAs) in clinical trials. This cross-sectional study investigated associations between the omega-6/omega-3 PUFA ratio and somatic symptom disturbance and depressive symptoms in a community-based sample of 501 adults and determined whether these associations differed between adults with and without TMD or irritable bowel syndrome (IBS). Liquid chromatography tandem mass spectrometry quantified PUFAs in circulating erythrocytes. Somatic symptoms and depression were quantified using Symptom Checklist-90-Revised subscales. Presence or absence of TMD and IBS, respectively, were determined by clinical examination and Rome III screening questions. The standardized beta coefficient for the omega-6/omega-3 long-chain PUFA ratio was 0.26 (95% confidence limits (CL): 0.08, 0.43) in a multivariable linear regression model in which somatic symptom disturbance was the dependent variable. When modelling depressive symptoms as the dependent variable, the standardized beta coefficient was 0.17 (95% CL:0.01, 0.34). Both associations were stronger among TMD cases and IBS cases than among non-cases. Future randomized control trials that lower the omega-6/omega-3 PUFA ratio could consider somatic or depressive symptoms as a therapeutic target for TMD or IBS pain. PERSPECTIVE: In people with TMD or IBS, a high n-6/n-3 PUFA ratio was positively associated with somatic symptom disturbance and depressive symptoms. Both measures of psychological distress were elevated in people with painful TMD and IBS. Future randomized clinical trials will determine whether lowering the n-6/n-3 ratio is therapeutic for pain.
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Affiliation(s)
- Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina.
| | - E Diane Weatherspoon
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina
| | - Brandie M Ehrmann
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina
| | - Paul S Soma
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - John S Preisser
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
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22
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Neural Basis of Etiopathogenesis and Treatment of Cervicogenic Orofacial Pain. Medicina (B Aires) 2022; 58:medicina58101324. [PMID: 36295485 PMCID: PMC9611820 DOI: 10.3390/medicina58101324] [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: 08/15/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background and Objectives: The aim of this narrative review was to analyze the neuroanatomical and neurophysiological basis of cervicogenic pain in cervico-cranial pain syndromes, focusing particularly on cervico-orofacial syndromes as a background for the proper diagnosis and non-surgical treatment. Relevant literature on the topic from past 120 years has been surveyed. (2) Material and Methods: We surveyed all original papers, reviews, or short communications published in the English, Spanish, Czech or Slovak languages from 1900 to 2020 in major journals. (3) Results: The cervicogenic headache originates from the spinal trigeminal nucleus where axons from the C1–C3 cervical spinal nerves and three branches of the trigeminal nerve converge (trigeminocervical convergence) at the interneurons that mediate cranio-cervical nociceptive interactions. The role of the temporomandibular joint in the broad clinical picture is also important. Despite abundant available experimental and clinical data, cervicogenic orofacial pain may be challenging to diagnose and treat. Crucial non-surgical therapeutic approach is the orthopedic manual therapy focused on correction of body posture, proper alignment of cervical vertebra and restoration of normal function of temporomandibular joint and occlusion. In addition, two novel concepts for the functional synthesis of cervico-cranial interactions are the tricentric concept of mouth sensorimotor control and the concept of a cervicogenic origin of bruxism. (4) Conclusions: Understanding the basis of neuroanatomical and neurophysiological neuromuscular relations enables an effective therapeutic approach based principally on orthopedic manual and dental occlusal treatment.
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Sanders AE, Weatherspoon ED, Ehrmann BM, Soma PS, Shaikh SR, Preisser JS, Ohrbach R, Fillingim RB, Slade GD. Circulating polyunsaturated fatty acids, pressure pain thresholds, and nociplastic pain conditions. Prostaglandins Leukot Essent Fatty Acids 2022; 184:102476. [PMID: 35908377 PMCID: PMC10363286 DOI: 10.1016/j.plefa.2022.102476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Polyunsaturated fatty acids (PUFAs) play a role in pain regulation. This study sought to determine whether free PUFAs found in red blood cells also play a role in nociceptive processing. We examined associations between circulating PUFAs and nociceptive thresholds to noxious mechanical stimuli. We also determined whether nociceptive thresholds were associated with nociplastic pain conditions. METHODS This cross-sectional study used stored red bloods cells and data from 605 adult participants in the OPPERA-2 study of chronic overlapping pain conditions. In OPPERA-2 adults completed quantitative sensory testing in which pressure algometry measured deep muscular tissue sensitivity at six anatomical sites. Standardized protocols classified adults for presence or absence of five nociplastic pain conditions: temporomandibular disorder, headache, low back pain, irritable bowel syndrome and fibromyalgia. Liquid chromatography tandem mass spectroscopy quantified erythrocyte PUFAs. We conducted three sets of analyses. First, a multivariable linear regression model assessed the association between n-6/n-3 PUFA ratio and the number of overlapping nociplastic pain conditions. Second, a series of 36 multivariable linear regression models assessed covariate-adjusted associations between PUFAs and nociceptive thresholds at each of six anatomical sites. Third, a series of 30 multivariable linear regression models assessed covariate-adjusted associations between nociceptive thresholds at six anatomical sites and each of five pain conditions. RESULTS In multiple linear regression, each unit increase in n-6/n-3 PUFA ratio was associated with more pain conditions (β = 0.30, 95% confidence limits: 0.07, 0.53, p = 0.012). Omega-6 linoleic acid and arachidonic acid were negatively associated with lower nociceptive thresholds at three and at five, respectively, anatomical sites. In contrast, omega-3 alpha-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid and the n-6/n-3 PUFA ratio were not associated with nociceptive thresholds at any site. Pain cases had significantly lower nociceptive thresholds than non-case controls at all anatomical sites. CONCLUSION A higher n-6/n-3 PUFA ratio was associated with more pain conditions. Omega-6 PUFAs may promote a generalized upregulation of nociceptive processing.
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Affiliation(s)
- Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America.
| | - E Diane Weatherspoon
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Brandie M Ehrmann
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Paul S Soma
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY 14260, United States of America
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL 32611, United States of America; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32611, United States of America
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
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Calandre EP, García-Leiva JM, Ordoñez-Carrasco JL. Psychosocial Variables and Healthcare Resources in Patients with Fibromyalgia, Migraine and Comorbid Fibromyalgia and Migraine: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158964. [PMID: 35897335 PMCID: PMC9331095 DOI: 10.3390/ijerph19158964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
Fibromyalgia and migraine frequently coexist. We aimed to compare the burden caused by fibromyalgia (FM), migraine (M) and comorbid fibromyalgia and migraine (FM + M) by assessing psychosocial variables and the use of healthcare resources. A survey was posted to the websites of different patients’ associations. It included sociodemographic data, the Patient Health Questionnaire-9, the Insomnia Severity Index, the EuroQOL-5D-5L and a questionnaire evaluating the use of healthcare resources during the past six months. In total, 139 FM patients, 169 M patients and 148 FM + M patients participated in the survey. Mean depression and insomnia scores were clinically relevant in every group and significantly higher in FM + M (16.3 ± 5.4 for depression, 18.5 ± 5.6 for insomnia) than in FM (14.3 ± 5.7 for depression, 16.8 ± 5.5 for insomnia) or M (11.7 ± 5.4 for depression, 13.1 ± 5.9 for depression), where p < 0.001 in both cases. Suicidal ideation was frequent in every group, but significantly more frequent in FM + M (63% vs. 45% in FM and 35% in M; p < 0.001). EQ-5D-5L (0.656 ± 0.1 in FM + M, 0.674 ± 0.1 in FM, 0.827 ± 0.1 in M, p < 0.001) and EQ-5D-5L VAS scores (38.2 ± 21.9 in FM + M, 45.6 ± 21.8 in FM, 63.5 ± 23.7 in M, p < 0.00) were lower than the reported mean population values and the lowest in FM + M. FM and FM + M used more healthcare resources than M. It is concluded that the psychosocial burden was high in the three samples. FM and FM + M had a more relevant impact on patients’ wellbeing and required more medical attention than M. The burden caused by FM + M was higher than in both individual diseases.
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Affiliation(s)
- Elena P. Calandre
- Instituto de Neurociencias “F. Oloriz”, University of Granada, 18100 Granada, Spain;
- Correspondence:
| | - Juan M. García-Leiva
- Instituto de Neurociencias “F. Oloriz”, University of Granada, 18100 Granada, Spain;
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Lövgren A, Visscher CM, Lobbezoo F, Yekkalam N, Vallin S, Wänman A, Häggman-Henrikson B. The association between myofascial orofacial pain with and without referral and widespread pain. Acta Odontol Scand 2022; 80:481-486. [PMID: 35776512 DOI: 10.1080/00016357.2022.2036363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain. MATERIALS AND METHODS Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20-69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain. RESULTS Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62-9.05 and OR 11.62 95% CI 5.18-27.88, respectively). CONCLUSION These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions.
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Affiliation(s)
- Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Negin Yekkalam
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Simon Vallin
- Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anders Wänman
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Birgitta Häggman-Henrikson
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden.,Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden
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Angst F, Lehmann S, Sandor PS, Benz T. Catastrophizing as a prognostic factor for pain and physical function in the multidisciplinary rehabilitation of fibromyalgia and low back pain. Eur J Pain 2022; 26:1569-1580. [PMID: 35634793 DOI: 10.1002/ejp.1983] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/03/2022] [Accepted: 05/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Quantitative data on longitudinal associations between catastrophizing and pain or physical function are patchy. The study aimed to quantify the prognostic value of catastrophizing for pain and function in fibromyalgia and low back pain before and after rehabilitation. METHODS The associations of state and change on the Multidimensional Pain Inventory (MPI) Pain severity scale, the Short Form 36 (SF-36) Physical functioning scale, and the Six-Minute Walking Distance (6MWD) with the Coping Strategies Questionnaire (CSQ) Catastrophizing scale were quantified by multiple regression modeling to adjust for confounders. RESULTS Sex- and age matched cohorts (n=71 each) were compared. Pain and catastrophizing were worse in fibromyalgia than in low back pain, whereas the function levels were comparable. Baseline catastrophizing predicted pain change by adjusted correlations of 0.552 (fibromyalgia) and 0.450 (low back pain), self-rated function by 0.403 and 0.308, and the 6MWD by 0.270 and -0.072. The change in catastrophizing was associated to the change in pain by 0.440 (fibromyalgia) and 0.614 (low back pain), self-rated function by 0.122 and 0.465, and the 6MWD by 0186 and 0.162. CONCLUSIONS Catastrophizing (pain-related worrying) was a potential prognostic factor, especially for pain and somewhat less for self-rated physical function but it was only weakly predictive for the walking distance in both conditions, independently of potential confounders, such as sex, age, baseline severity and others. Reduction of maladaptive coping should be integrated into the management of chronic pain.
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Affiliation(s)
- Felix Angst
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland
| | - Susanne Lehmann
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland
| | - Peter S Sandor
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland
| | - Thomas Benz
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland.,ZHAW Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland
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Hah JM, Aivaliotis VI, Hettie G, Pirrotta LX, Mackey SC, Nguyen LA. Whole Body Pain Distribution and Risk Factors for Widespread Pain Among Patients Presenting with Abdominal Pain: A Retrospective Cohort Study. Pain Ther 2022; 11:683-699. [PMID: 35467268 PMCID: PMC9098717 DOI: 10.1007/s40122-022-00382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Abdominal pain frequently co-occurs with pain in other body sites. Chronic overlapping pain conditions (COPCs) represent a group of widespread pain diagnoses. Our study characterized how patterns of somatic pain distribution are associated with COPCs and aimed to characterize predictors of widespread pain among patients with chronic abdominal pain. Methods This retrospective cohort study included adults presenting to a tertiary pain clinic, reporting abdominal pain at their initial visit, and with a follow-up visit at 12 months. Body maps divided patients into localized, intermediate, and widespread pain distribution patterns. Diagnostic and psychosocial measures were assessed across groups at the initial and follow-up visits. We analyzed the association of baseline diagnoses and demographics and time-varying changes in psychosocial measures from initial to follow-up visit with changes in pain distribution over time with alternating logistic regression (ALR). Results Among 258 patients, most were female (91.5%) and reported widespread pain (61.5%). Those with widespread pain at baseline reported elevated anger and 60.0% of patients remained in the same pain category at follow-up. Multivariable ALR demonstrated higher pain interference (AOR 1.06, 95% CI 1.02–1.10, P = 0.002), higher anxiety (AOR 1.05, 95% CI 1.01–1.09, P = 0.01), more than one COPC at initial visit (AOR 2.85, 95% CI 1.59–5.11, P = 0.0005), and initial visit widespread pain categorization (AOR 4.18, 95% CI 2.20–8.00, P < 0.0001) were associated with an increased risk of widespread pain at the follow-up visit. Conclusion Most patients with abdominal pain report additional pain locations at multiple other body sites, and non-localized pain persists 12 months after pain treatment. Screening for widespread pain and COPC at the initial visit may identify patients at higher risk for persistent or new-onset widespread pain, and interventions to reduce pain interference and anxiety may promote reversal of widespread pain.
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Affiliation(s)
- Jennifer M Hah
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Vasiliki I Aivaliotis
- Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gabrielle Hettie
- Systems Neuroscience and Pain Lab, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Luke X Pirrotta
- Systems Neuroscience and Pain Lab, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sean C Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Linda A Nguyen
- Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA
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Kleykamp BA, Ferguson MC, McNicol E, Bixho I, Arnold LM, Edwards RR, Fillingim R, Grol-Prokopczyk H, Ohrbach R, Turk DC, Dworkin RH. The prevalence of comorbid chronic pain conditions among patients with temporomandibular disorders: A systematic review. J Am Dent Assoc 2022; 153:241-250.e10. [PMID: 34952681 DOI: 10.1016/j.adaj.2021.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 08/19/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND This systematic review was designed to evaluate the presence of comorbid conditions among patients with temporomandibular disorders (TMDs). TYPES OF STUDIES REVIEWED The authors reviewed studies that reported the prevalence or incidence of chronic pain conditions or psychiatric disorders (anxiety, mood, personality disorders) among patients with any type of TMD. The authors calculated sample size-weighted prevalence estimates when data were reported in 2 or more studies for the same comorbid condition. RESULTS A total of 9 prevalence studies and no incidence studies were eligible for review; 8 of the studies examined chronic pain comorbidities. Weighted estimates showed high prevalence of pain comorbidities across studies, including current chronic back pain (66%), myofascial syndrome (50%), chronic stomach pain (50%), chronic migraine headache (40%), irritable bowel syndrome (19%), and fibromyalgia (14%). A single study examined psychiatric disorders and found that current depression was the most prevalent disorder identified (17.5%). CONCLUSIONS AND PRACTICAL IMPLICATIONS There is a high prevalence of comorbid chronic pain conditions among patients with TMDs, with more than 50% of patients reporting chronic back pain, myofascial syndrome, and chronic stomach pain. Psychiatric disorders among patients with different types of TMDs were studied less commonly in this pain population. Knowledge of the distribution of these and other comorbid disease conditions among patients with different types of TMDs can help dentists and other health care providers to identify personalized treatment strategies, including the coordination of care across medical specialties.
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de Sire A, Marotta N, Ferrillo M, Agostini F, Sconza C, Lippi L, Respizzi S, Giudice A, Invernizzi M, Ammendolia A. Oxygen-Ozone Therapy for Reducing Pro-Inflammatory Cytokines Serum Levels in Musculoskeletal and Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci 2022; 23:ijms23052528. [PMID: 35269681 PMCID: PMC8910188 DOI: 10.3390/ijms23052528] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 02/07/2023] Open
Abstract
To date, the application of oxygen-ozone (O2O3) therapy has significantly increased in the common clinical practice in several pathological conditions. However, beyond the favorable clinical effects, the biochemical effects of O2O3 are still far from being understood. This comprehensive review aimed at investigating the state of the art about the effects of O2O3 therapy on pro-inflammatory cytokines serum levels as a modulator of oxidative stress in patients with musculoskeletal and temporomandibular disorders (TMD). The efficacy of O2O3 therapy could be related to the moderate oxidative stress modulation produced by the interaction of ozone with biological components. More in detail, O2O3 therapy is widely used as an adjuvant therapeutic option in several pathological conditions characterized by chronic inflammatory processes and immune overactivation. In this context, most musculoskeletal and temporomandibular disorders (TMD) share these two pathophysiological processes. Despite the paucity of in vivo studies, this comprehensive review suggests that O2O3 therapy might reduce serum levels of interleukin 6 in patients with TMD, low back pain, knee osteoarthritis and rheumatic diseases with a concrete and measurable interaction with the inflammatory pathway. However, to date, further studies are needed to clarify the effects of this promising therapy on inflammatory mediators and their clinical implications.
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Affiliation(s)
- Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (A.A.)
- Correspondence: ; Tel.: +39-0961712819
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (A.A.)
| | - Martina Ferrillo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.F.); (A.G.)
| | - Francesco Agostini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy;
| | - Cristiano Sconza
- IRCCS Humanitas Research Center, Via Manzoni 56, 20089 Rozzano, Italy; (C.S.); (S.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Stefano Respizzi
- IRCCS Humanitas Research Center, Via Manzoni 56, 20089 Rozzano, Italy; (C.S.); (S.R.)
| | - Amerigo Giudice
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.F.); (A.G.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (A.A.)
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Sharma S, Kallen MA, Ohrbach R. Graded Chronic Pain Scale: Validation of 1-Month Reference Frame. Clin J Pain 2021; 38:119-131. [PMID: 34803153 PMCID: PMC8727576 DOI: 10.1097/ajp.0000000000001005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The 1-month Graded Chronic Pain Scale (GCPS) commonly used in clinical studies has never been validated. This study compares the GCPS 1-month with the 6 months version for reliability and validity. METHODS The Validation Project included 521 participants with at least one temporomandibular disorder for cross-sectional data and 74 participants for test-retest data. Internal reliability, stability, and construct validity were used for testing the 1-month version. Comparisons were made between the 2 versions for characteristic pain intensity (CPI), interference, and chronic pain grade (CPG). RESULTS For GCPS 1-month, internal consistency for pain intensity and interference was high (Cronbach α=0.87 and 0.94, respectively), and temporal stability was high for CPI (intraclass correlation coefficient [ICC]=0.91), interference (ICC=0.85), and CPG (weighted κ=0.88). ICC or κ between the 2 versions was 0.78 (CPI), 0.66 (interference), and 0.69 (CPG); high-impact pain, in contrast, was 0.50. Construct validity exhibited higher correlations with predictor variables for 1-month version attributes of CPI, interference, and CPG. Modified Bland-Altman plots indicated that both versions measure CPI well. DISCUSSION Overall, reliability of the 1-month GCPS is equal to or better than the 6-months version for pain intensity, disability days, pain interference, CPG, and high-impact pain. However, consistency between versions is lower for measures of disability days and interference, and for the derived measures of CPG and high-impact pain; highly skewed distributions and increasing disagreement in reported status over the time periods affect the measures of function. Therefore, we recommend that GCPS-1 month only be used to calculate pain intensity and pain interference.
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Affiliation(s)
- Sonia Sharma
- Department of Oral Diagnostic Sciences, University at Buffalo, School of Dental Medicine, Buffalo, NY
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Michael A Kallen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, School of Dental Medicine, Buffalo, NY
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Navratilova E, Fillingim RB, Porreca F. Sexual dimorphism in functional pain syndromes. Sci Transl Med 2021; 13:eabj7180. [PMID: 34757805 DOI: 10.1126/scitranslmed.abj7180] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Sexual dimorphism in functional pain suggests the need of developing sex-specific therapies.
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Affiliation(s)
- Edita Navratilova
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | | | - Frank Porreca
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA.,Mayo Clinic, Scottsdale, AZ 85259, USA
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Erdogan O, Ramsey A, Uyanik JM, Gibbs JL, Burns LE. Outcomes of referrals from endodontic to orofacial pain specialists: A retrospective cohort study. Clin Exp Dent Res 2021; 8:457-463. [PMID: 34623771 PMCID: PMC8874062 DOI: 10.1002/cre2.497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/11/2021] [Accepted: 08/25/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Diagnosis and treatment of non-odontogenic pain is challenging for endodontists. The purpose of the study was to investigate the outcomes of referrals to orofacial pain specialists made for patients with suspected non-odontogenic pain, after evaluation and/or treatment by an endodontist. MATERIALS AND METHODS A retrospective review of dental records was conducted for 60 patients referred from a postgraduate endodontic clinic to an orofacial pain clinic. Patient demographics, pain history, endodontic, and orofacial pain diagnoses were collected. Number of visits, length of treatment, and treatments prescribed were recorded. For analysis of outcomes, data pertinent to resolution/persistence of symptoms and patient compliance were analyzed. RESULTS Thirty-five patients were included in the study. The most frequent pulpal and periapical diagnoses were previously treated (62%) and symptomatic apical periodontitis (72%), respectively. The most common orofacial pain diagnosis was temporomandibular disorder. The average time spent to diagnose and treat the pain was 17 months. Pain reduction varied and was documented for 51% of patients. Indications of non-compliance with orofacial pain appointments and treatments were documented for 66% of patients. CONCLUSIONS Non-odontogenic pain diagnosis and treatment are challenging. Patients may have an increased predilection for developing persistent pain after endodontic treatment and/or have an undiagnosed, chronic orofacial pain condition as a true source of their chief complaint. It may be helpful for endodontists to set expectations of typical treatment times/plans when referring patients for evaluation and treatment of non-odontogenic pain.
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Affiliation(s)
- Ozge Erdogan
- Department of Endodontics, College of DentistryNew York UniversityNew YorkNew YorkUSA
- Division of Endodontics in Restorative Dentistry and Biomaterials SciencesHarvard School of Dental MedicineBostonMassachusettsUSA
| | - Austin Ramsey
- Department of Endodontics, College of DentistryNew York UniversityNew YorkNew YorkUSA
| | - James M. Uyanik
- Department of Oral and Maxillofacial Pathology, Radiology and MedicineCollege of Dentistry, New York UniversityNew YorkNew YorkUSA
| | - Jennifer L. Gibbs
- Division of Endodontics in Restorative Dentistry and Biomaterials SciencesHarvard School of Dental MedicineBostonMassachusettsUSA
| | - Lorel E. Burns
- Department of Endodontics, College of DentistryNew York UniversityNew YorkNew YorkUSA
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Cao DY, Hu B, Xue Y, Hanson S, Dessem D, Dorsey SG, Traub RJ. Differential Activation of Colonic Afferents and Dorsal Horn Neurons Underlie Stress-Induced and Comorbid Visceral Hypersensitivity in Female Rats. THE JOURNAL OF PAIN 2021; 22:1283-1293. [PMID: 33887444 PMCID: PMC8500917 DOI: 10.1016/j.jpain.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 12/19/2022]
Abstract
Chronic Overlapping Pain Conditions, including irritable bowel syndrome (IBS) and temporomandibular disorder (TMD), represent a group of idiopathic pain conditions that likely have peripheral and central mechanisms contributing to their pathology, but are poorly understood. These conditions are exacerbated by stress and have a female predominance. The presence of one condition predicts the presence or development of additional conditions, making this a significant pain management problem. The current study was designed to determine if the duration and magnitude of peripheral sensitization and spinal central sensitization differs between restraint stress-induced visceral hypersensitivity (SIH) and chronic comorbid pain hypersensitivity (CPH; stress during pre-existing orofacial pain). SIH in female rats, as determined by the visceromotor response, persisted at least four but resolved by seven weeks. In contrast, CPH persisted at least seven weeks. Surprisingly, colonic afferents in both SIH and CPH rats were sensitized at seven weeks. CPH rats also had referred pain through seven weeks, but locally anesthetizing the colon only attenuated the referred pain through four weeks, suggesting a transition to colonic afferent independent central sensitization. Different phenotypes of dorsal horn neurons were sensitized in the CPH rats seven weeks post stress compared to four weeks or SIH rats. The current study suggests differential processing of colonic afferent input to the lumbosacral spinal cord contributes to visceral hypersensitivity during comorbid chronic pain conditions. PERSPECTIVE: Chronic Overlapping Pain Conditions represent a unique challenge in pain management. The diverse nature of peripheral organs hinders a clear understanding of underlying mechanisms accounting for the comorbidity. This study highlights a mismatch between the condition-dependent behavior and peripheral and spinal mechanisms that contribute to visceral pain hypersensitivity.
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Affiliation(s)
- Dong-Yuan Cao
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland; Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi'an Jiaotong University College of Stomatology, Xi'an, Shaanxi, P. R. China
| | - Bo Hu
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland; Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Research Center of Stomatology, Xi'an Jiaotong University College of Stomatology, Xi'an, Shaanxi, P. R. China
| | - Yang Xue
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland; Department of Prosthodontics, Peking University School and Hospital of Stomatology, Haidian District, Beijing, P. R. China
| | - Shelby Hanson
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland
| | - Dean Dessem
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland; UM Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, Maryland
| | - Susan G Dorsey
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland; UM Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, Maryland
| | - Richard J Traub
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland; UM Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, Maryland.
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Häggman-Henrikson B, M Visscher C, Wänman A, Ljótsson B, C Peck C, Lövgren A. Even mild catastrophic thinking is related to pain intensity in individuals with painful temporomandibular disorders. J Oral Rehabil 2021; 48:1193-1200. [PMID: 34462940 DOI: 10.1111/joor.13251] [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: 12/21/2020] [Revised: 06/28/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
AIMS Temporomandibular disorders (TMD) are often associated with psychological comorbidities. One such comorbidity is pain catastrophising, that is, exaggeration of negative consequences of a painful event. The aim was to investigate catastrophising in individuals with painful TMD compared to controls and the association between catastrophising and pain intensity, number of pain sites and functional limitations. METHODS A community-based sample of 110 individuals (83 women; 20-69 yrs) with painful TMDs (myalgia/arthralgia as per Diagnostic Criteria for TMD) and 190 age- and gender-matched controls (119 women; 20-69 yrs) from the Public Dental services in Västerbotten, Sweden, participated. Associations between catastrophising and functional jaw limitations, respectively, and painful TMD were evaluated with ordinal regression adjusted for the effect of gender and age. Associations (Spearman's correlation) of the Pain catastrophising Scale (PCS) with Jaw Functional Limitation Scale (JFLS-20), pain site number (whole-body pain map), and characteristic pain intensity (CPI) and intergroup comparisons (Mann-Whitney U test) of these variables were also calculated. RESULTS Levels of catastrophising were associated with TMD pain (OR 1.6, 95%CI 1.1-2.6). Among individuals with painful TMD, catastrophising was correlated to pain intensity (r=0.458, p<0.01) and functional limitations (r=0.294-0.321, p≤0.002), but not to number of pain sites. CONCLUSION Compared to controls, community-based individuals with painful TMD demonstrated higher levels of pain catastrophising, and this catastrophising was associated with increased pain intensity and jaw dysfunction. The relatively low scores of pain catastrophising suggest that even mild catastrophic thinking is associated with pain perception and jaw function, and should be considered in patient management.
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Affiliation(s)
- Birgitta Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.,Department of Odontology/Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Anders Wänman
- Department of Odontology/Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Christopher C Peck
- The University of Sydney Westmead Initiative, The University of Sydney, Sydney, Australia
| | - Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Umeå University, Umeå, Sweden
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From One Pain to Many: The Emergence of Overlapping Pains in Children and Adolescents. Clin J Pain 2021; 37:404-412. [PMID: 33859112 DOI: 10.1097/ajp.0000000000000939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to compare children and adolescents with overlapping chronic pains (OCP) to those with single chronic pains (SCP) among youth presenting in specialized clinical settings, in an effort to identify potential risk factors for developing overlapping pains. METHODS A total of 1235 youth ages 8 to 18 seen in a tertiary care multidisciplinary pain clinic or a multidisciplinary headache clinic completed self-report measures of pain, disability, psychological functioning and clinical history and characteristics at the time of initial clinic visit. Information was captured in a chronic pain data repository and accessed for the current study. RESULTS Subsequent pain symptoms developed on average 11.9 months (SD=24.5 mo) after onset of the first pain symptom. Compared with patients with SCP, patients with OCP report more medical comorbidity, more developmental issues, and poorer current sleep and school functioning. They also scored significantly higher than patients with SCP on self-reported functional disability, pain catastrophizing, fear of pain, depression, anxiety, and psychological stress and lower quality of life (all Ps<0.001). In multivariate analysis, variables most strongly associated with presenting with OCP were age (odds ratio [OR]: 1.1, P<0.001), having a clinically significant high functional disability (OR: 1.4, P=0.3), and low quality of life (OR: 2.5, P<0.001). DISCUSSION Given their tendency toward more psychological and medical comorbidities, patients with OCP may require more intense and diverse treatment approaches. Some early life experiences may be a risk factor for development of OCP. Longitudinal studies are needed to fully evaluate the heightened risk for OCP associated with some of these factors.
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Ji C, Zhou Q, Qiu Y, Pan X, Sun X, Ding W, Mao J, Zhou Y, Luo Y. Decline of anterior cingulate functional network efficiency in first-episode, medication-naïve somatic symptom disorder and its relationship with catastrophizing. J Psychiatr Res 2021; 140:468-473. [PMID: 34147934 DOI: 10.1016/j.jpsychires.2021.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/17/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022]
Abstract
The high prevalence of somatic symptom disorder (SSD) led to cumulative burdens to the medical system. However, the pathogenesis of this disease still remains unclear. Graph theoretical analysis discovered altered network topology across various psychiatric disorders, yet alteration in the topological structure of brain functional network in SSD patients is still unexplored. Catastrophizing is a common cognitive distortion in SSD. We hypothesize that the network topological metrics of SSD should be altered, and should correlate with catastrophizing scales. 32 medication-naïve, first-episode SSD patients and 30 age, gender matched HCs were recruited. The 17-item Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA) and Cognitive Emotion Regulation Questionnaire (CERQ) were accessed. Functional MRI were scanned and brain functional networks were constructed based on 166 anatomically cerebrum regions from the automated anatomical labeling 3 (AAL3) template. Network topological metrics were calculated and compared between the two groups. Correlation between these metrics and clinical scales were also calculated. Network global efficiency of SSD was significantly lower than that of HC. Nodal global efficiency of the left subgenual anterior cingulate cortex (sgACC) of SSD was significantly lower than that of HC. FCs between the left sgACC and other 21 seed nodes were significantly declined in SSD in comparison with HC. In SSD group, HAMD total score was significantly negatively correlated with the connection between the left medial superior frontal gyrus and the left sgACC. CERQ catastrophizing score was significantly negatively correlated with nodal global efficiency of left sgACC and with the FCs between the left sgACC and other 13 seed nodes. Catastrophizing could reflect the specific sgACC-centered dysfunction of brain network global efficiency of SSD. The left sgACC may be a future treatment target of dealing with catastrophizing, which is a core cognitive distortion of SSD.
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Affiliation(s)
- Chenfeng Ji
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Qian Zhou
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Yage Qiu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Xiandi Pan
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, 165 Sanlin Road, Pudong New District, Shanghai, 200124, China
| | - Xia Sun
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Weina Ding
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Jialiang Mao
- Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China.
| | - Yanli Luo
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China.
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Barjandi G, Kosek E, Hedenberg-Magnusson B, Velly AM, Ernberg M. Comorbid Conditions in Temporomandibular Disorders Myalgia and Myofascial Pain Compared to Fibromyalgia. J Clin Med 2021; 10:3138. [PMID: 34300304 PMCID: PMC8306531 DOI: 10.3390/jcm10143138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022] Open
Abstract
The impact of comorbidities in fibromyalgia (FM) and temporomandibular disorders (TMD) have been well documented, but whether TMD sub-diagnoses myalgia (MYA) and myofascial pain with referral (MFP) differ regarding comorbidity is unclear. We aimed to elucidate this by studying the presence and associations of comorbidities in FM, MFP and MYA. An extended version of the Diagnostic Criteria for TMD axis II questionnaire was used to examine demographics, pain and comorbidities in 81 patients with FM, 80 with MYA, and 81 with MFP. Patients with MFP and FM reported a higher percentage of irritable bowel syndrome (IBS), depression, anxiety, somatic symptoms, perceived stress, and insomnia compared to MYA. Patients with FM had more IBS, depression, and somatic symptom disorder versus MFP. After adjusting for confounding variables, participants with anxiety, somatic symptoms disorder, pain catastrophizing, and perceived stress, as well as a greater number of comorbidities, were more likely to have MFP than MYA, whereas FM participants were more associated with IBS, somatic symptoms and insomnia compared to MFP. The number of comorbidities was significantly associated with widespread pain but not pain duration, body mass index or being on sick leave. In conclusion, patients with MFP were more similar to those with FM regarding comorbidity and should be differentiated from MYA in clinical settings and pain management.
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Affiliation(s)
- Golnaz Barjandi
- Scandinavian Center for Orofacial Neuroscience (SCON), Department of Dental Medicine, Karolinska Institute, SE141 04 Huddinge, Sweden; (B.H.-M.); (M.E.)
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, SE17 165 Stockholm, Sweden;
- Department of Surgical Sciences, Uppsala University, SE751 85 Uppsala, Sweden
| | - Britt Hedenberg-Magnusson
- Scandinavian Center for Orofacial Neuroscience (SCON), Department of Dental Medicine, Karolinska Institute, SE141 04 Huddinge, Sweden; (B.H.-M.); (M.E.)
- Department of Orofacial Pain and Jaw Function, Eastman Institute, SE113 24 Stockholm, Sweden
| | - Ana Miriam Velly
- Faculty of Dentistry, McGill University, Montreal, QC H3T 1E2, Canada;
- Department of Dentistry, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Malin Ernberg
- Scandinavian Center for Orofacial Neuroscience (SCON), Department of Dental Medicine, Karolinska Institute, SE141 04 Huddinge, Sweden; (B.H.-M.); (M.E.)
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Zhang L, Shi W, Lu S, Cai B, Fan S, Yang Y, Xu L. Prognostic factor analysis in patients with temporomandibular disorders after reversible treatment: study protocol for a prospective cohort study in China. BMJ Open 2021; 11:e048011. [PMID: 34215608 PMCID: PMC8256761 DOI: 10.1136/bmjopen-2020-048011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/09/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Temporomandibular disorders (TMDs) are complex multifactorial disorders. Reversible treatment has been suggested for the initial management of TMD; however, comparable therapeutic effects of different reversible intervention modalities remain controversial. Various biopsychosocial factors, which may be putative prognostic factors that influence the response to reversible treatment for TMD, have been reported to increase the risk of developing first-onset TMD. However, there is a paucity of research that aims to identify prognostic factors associated with the clinical outcomes of reversible treatment in people with TMD. The objective of this prospective cohort study is to identify prognostic factors that are associated with clinical outcomes of reversible treatment in patients with TMD and to analyse the risk factors that influence the development of chronic TMD. METHODS AND ANALYSIS We plan to recruit 834 patients with TMD who meet the inclusion criteria. Once informed consent is obtained, baseline data, including anamnestic data, physical assessments and self-report questionnaires, will be collected from participants at their first clinic visit; subsequently, they will receive 1-4 weeks of reversible treatment. The primary treatment outcome measures will be a change in the anterior maximum mouth opening, worsening of TMD pain scores assessed using a visual analogue scale (VAS) and a reduction in characteristic pain intensity. A good outcome will be defined as an anterior maximal opening ≥35 mm and at least a 30% reduction in VAS scores 3 months after baseline. The association between candidate prognostic factors and clinical outcomes of reversible TMD treatment will be analysed. ETHICS AND DISSEMINATION The protocol has been approved by the Ethics Committee of Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, based on the guidelines outlined in the Declaration of Helsinki (SH9H-2019-T316-4). The results of this study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. The authors intend to publish the results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR2000033328.
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Affiliation(s)
- Ling Zhang
- Department of Rehabilitation, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Wentao Shi
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Shenji Lu
- Department of Rehabilitation, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Bin Cai
- Department of Rehabilitation, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Shuai Fan
- Department of Rehabilitation, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Yang Yang
- Department of Rehabilitation, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Lili Xu
- Department of Rehabilitation, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
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Chronic Orofacial Pain: Models, Mechanisms, and Genetic and Related Environmental Influences. Int J Mol Sci 2021; 22:ijms22137112. [PMID: 34281164 PMCID: PMC8268972 DOI: 10.3390/ijms22137112] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic orofacial pain conditions can be particularly difficult to diagnose and treat because of their complexity and limited understanding of the mechanisms underlying their aetiology and pathogenesis. Furthermore, there is considerable variability between individuals in their susceptibility to risk factors predisposing them to the development and maintenance of chronic pain as well as in their expression of chronic pain features such as allodynia, hyperalgesia and extraterritorial sensory spread. The variability suggests that genetic as well as environmental factors may contribute to the development and maintenance of chronic orofacial pain. This article reviews these features of chronic orofacial pain, and outlines findings from studies in animal models of the behavioural characteristics and underlying mechanisms related to the development and maintenance of chronic orofacial pain and trigeminal neuropathic pain in particular. The review also considers the role of environmental and especially genetic factors in these models, focussing on findings of differences between animal strains in the features and underlying mechanisms of chronic pain. These findings are not only relevant to understanding underlying mechanisms and the variability between patients in the development, expression and maintenance of chronic orofacial pain, but also underscore the importance for considering the strain of the animal to model and explore chronic orofacial pain processes.
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Greene CS, Manfredini D. Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis. J Oral Rehabil 2021; 48:1077-1088. [PMID: 33966303 PMCID: PMC8453911 DOI: 10.1111/joor.13180] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/31/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
Background Based on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been elucidated. Methods This paper describes known vulnerability factors that make individuals susceptible to developing temporomandibular disorders (TMDs), as well as those that contribute to the perpetuation of such problems. In addition, the topic of iatrogenesis is discussed as a major contributor to the negative outcomes that can be seen in this field. Results At the patient level, anatomical, psychosocial and genetic factors may contribute to individual vulnerability. The anatomy and pathophysiology of muscles, joints, disc and nerves may all be involved in predisposing to TMD symptoms, especially when the patients have pain elsewhere in the body. Among the psychosocial factors, some features may be elucidated by the DC/TMD axis II, while others (eg illness behaviour, Munchausen syndrome, lack of acceptance of non‐mechanical approaches) require careful evaluation by trained clinicians. Genetic predisposition to first onset TMDs and to chronification of symptoms has been identified for individuals with certain psychological traits, presence of comorbid conditions and certain abnormal clinical manifestations. Regarding iatrogenesis, sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment. Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification of TMDs. The patients who present with massive occlusal and jaw repositioning changes combined with persistent severe orofacial pain are not a rarity within TMD and orofacial pain canters; these patients are the most difficult ones to manage because of this horrific combination of negative factors. Conclusions The information presented in this paper will help clinicians to understand better why some individuals develop temporomandibular disorders, why some of them will progress to becoming chronic patients, and what the appropriate responses may be.
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Affiliation(s)
- Charles S Greene
- Department of Orthodontics, University of Illinois at Chicago College of Dentistry, Chicago, IL, USA
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
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Ferrarini EG, Gonçalves ECD, Ferrareis Menegasso J, Rabelo BD, Felipetti FA, Dutra RC. Exercise Reduces Pain and Deleterious Histological Effects in Fibromyalgia-like Model. Neuroscience 2021; 465:46-59. [PMID: 33945796 DOI: 10.1016/j.neuroscience.2021.04.017] [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] [Received: 12/02/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
Fibromyalgia (FM) is characterized by chronic pain and associated comorbidities such as fatigue, anxiety, depression, and sleep disorders. There is a large amount of evidence regarding the benefits of physical exercise in controlling chronic pain. However, there is no consensus on which exercise modality is most suitable and the real benefits of this intervention to treat FM symptoms. The present study investigated the analgesic and antidepressant effects and morphophysiological responses induced by different physical exercise (aerobic and strength protocols) during the experimental model of FM. Spontaneous pain, mechanical hyperalgesia, thermal allodynia, depression-related behavior, and locomotor activity were evaluated weekly, as well as the morphological evaluation of the spinal cord and dorsal root ganglion. Aerobic and strength training protocols consistently abolished nociceptive behaviors, reducing spontaneous pain scores, cold allodynia, and frequency of response to mechanical hyperalgesia. The strength exercise modulated the depressive-like behavior. Finally, our data demonstrated that physical exercise performed for two weeks increased the number of glial cells in the dorsal root horn. However, it was not sufficient to control the other deleterious effects of the reserpine model on the spinal cord and the dorsal root. Together, these results demonstrated that different physical exercise modalities, when performed regularly in mice, proved to be effective and safe non-pharmacological alternatives for the treatment of FM. However, some gaps have yet to be studied regarding the neuroadaptive effects of physical exercise.
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Affiliation(s)
- Eduarda Gomes Ferrarini
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, 88906-072 Araranguá, Brazil; Post-Graduate Program of Neuroscience, Center of Biological Science, Campus Florianópolis, Universidade Federal de Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Elaine Cristina Dalazen Gonçalves
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, 88906-072 Araranguá, Brazil; Post-Graduate Program of Neuroscience, Center of Biological Science, Campus Florianópolis, Universidade Federal de Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Jaíne Ferrareis Menegasso
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, 88906-072 Araranguá, Brazil
| | - Bruna Daniel Rabelo
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, 88906-072 Araranguá, Brazil
| | - Francielly Andressa Felipetti
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, 88906-072 Araranguá, Brazil
| | - Rafael Cypriano Dutra
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, 88906-072 Araranguá, Brazil; Post-Graduate Program of Neuroscience, Center of Biological Science, Campus Florianópolis, Universidade Federal de Santa Catarina, 88040-900 Florianópolis, Brazil.
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Fillingim RB. In memoriam William Maixner: 1952 to 2020. Pain 2021; 162:989-992. [PMID: 37595617 DOI: 10.1097/j.pain.0000000000002200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
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