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Biao D, Umoh K, Qiguang C, Xiaole W, Ting F, Yuqian Y, Jinchao Z, Fushui L. The Role of Mindfulness Therapy in the Treatment of Chronic Pain. Curr Pain Headache Rep 2024:10.1007/s11916-024-01284-w. [PMID: 38951466 DOI: 10.1007/s11916-024-01284-w] [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] [Accepted: 06/12/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE OF REVIEW Mindfulness therapy is a widely used treatment for many diseases and has been shown to improve pain-related functions. There is growing support for the use of psychotherapy in the treatment of chronic pain. While studies have shown a positive effect of mindfulness therapy, it is important to consider psychosocial factors as there are still a small number of studies that question its effectiveness. RECENT FINDINGS Based on current studies, mindfulness therapy involves cognitive factors related to chronic pain, both in terms of cognitive production and its impact on cognitive control. Psychological and neurobasic studies were reviewed to provide a deeper understanding of these components, which include thought inhibition, attention deficit, pain catastrophizing, and self-efficacy. Mindfulness therapy has the potential to normalize psychology and nerves, and increase internal and external connectivity to work networks related to stress perception, cognition, and emotion. However, further research is needed to fully understand its effects. By exploring the relationship between mindfulness therapy and chronic pain. This review provides a new avenue for future research in psychotherapy for patients with chronic pain.
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Affiliation(s)
- Deng Biao
- School of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - KuyikAbasi Umoh
- School of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Cao Qiguang
- Apartment of Acupotomy and Chiropractic, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Wang Xiaole
- Apartment of Acupotomy and Chiropractic, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
| | - Fang Ting
- Apartment of Acupotomy and Chiropractic, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yang Yuqian
- School of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Zhu Jinchao
- School of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Liu Fushui
- Apartment of Acupotomy and Chiropractic, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
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Luebke L, Lopes CG, Myka Y, Lumma A, Adamczyk WM, Carvalho GF, Scholten-Peeters GGM, Luedtke K, Szikszay TM. Assessing the Influence of Nonischemic A-Fiber Conduction Blockade on Offset Analgesia: An Experimental Study. THE JOURNAL OF PAIN 2024:104611. [PMID: 38908497 DOI: 10.1016/j.jpain.2024.104611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/31/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
Offset analgesia (OA) is believed to reflect the efficiency of the endogenous pain modulatory system. However, the underlying mechanisms are still being debated. Previous research suggested both, central and peripheral mechanisms, with the latter involving the influence of specific A-delta-fibers. Therefore, this study aimed to investigate the influence of a nonischemic A-fiber conduction blockade on the OA response in healthy participants. A total of 52 participants were recruited for an A-fiber conduction blockade via compression of the superficial radial nerve. To monitor fiber-specific peripheral nerve conduction capacity, quantitative sensory testing was performed continuously. Before, during, and after the A-fiber block, an individualized OA paradigm was applied to the dorsum of both hands (blocked and control sides were randomized). The pain intensity of each heat stimulus was evaluated by an electronic visual analog scale. A successful A-fiber conduction blockade was achieved in thirty participants. OA has been verified within time (before, during, and after blockade) and condition (blocked and control side) (P < .01, d > .5). Repeated measurements analysis of variance showed no significant interaction effects between OA within condition and time (P = .24, η²p = .05). Hence, no significant effect of A-fiber blockade was detected on OA during noxious heat stimulation. The results suggest that peripheral A-fiber afferents may play a minor role in OA compared with alternative central mechanisms or other fibers. However, further studies are needed to substantiate a central rather than peripheral influence on OA. PERSPECTIVE: This article presents the observation of OA before, during, and after a successful A-fiber conduction blockade in healthy volunteers. A better understanding of the mechanisms of OA and endogenous pain modulation, in general, may help to explain the underlying aspects of pain disorders.
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Affiliation(s)
- Luisa Luebke
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany.
| | - Clara Gieseke Lopes
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Amsterdam, The Netherlands
| | - Yasmin Myka
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany
| | - Annika Lumma
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany
| | - Wacław M Adamczyk
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany; Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Gabriela F Carvalho
- Department of Physiotherapy, Faculty of Health, Safety and Society, Furtwangen University, Furtwangen, Germany
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Amsterdam, The Netherlands
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany
| | - Tibor M Szikszay
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany
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Ito A, Yang S, Shinto E, Shinto A, Toyofuku A, Kurata J. Interhemispheric and Corticothalamic White-Matter Dysfunction Underlies Affective Morbidity and Impaired Pain Modulation in Chronic Pain. Anesth Analg 2024:00000539-990000000-00827. [PMID: 38837907 DOI: 10.1213/ane.0000000000006992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Although patients with chronic pain show behavioral signs of impaired endogenous pain modulation, responsible cerebral networks have yet to be anatomically delineated. We used diffusion tensor imaging (DTI) to examine the white-matter alterations in patients with chronic pain compared with healthy subjects. We further measured thermal pain modulatory responses using the offset analgesia (OA) paradigm. We tested whether the white-matter indices be associated with psychophysical parameters reflecting morbidity and modulatory responses of pain in patients, and whether they could serve as diagnostic biomarkers of chronic pain. METHODS Twenty-six patients with chronic pain and 18 age- and gender-matched healthy controls were enrolled. After completing psychophysical questionnaires, they underwent OA measurement and whole-brain DTI in a 3 Tesla magnetic resonance imaging scanner. Fractional anisotropy (FA) and radial diffusivity (RD) of the white-matter were computed and compared between the groups with tract-based spatial statistics using the FMRIB Software Library (FSL) software. Correlations were sought among white-matter indices, thermal pain responses, and psychophysical parameters. The white-matter indices and OA-related parameters were tested whether they distinguish patients from controls by receiver operating characteristic analysis. RESULTS During OA, patients showed a shorter latency to the maximum (maximum visual analog scale [VAS] latency, 16.0 ± 3.7 vs 18.9 ± 3.1 second [mean ± standard deviation, SD]; P = .032) but a longer latency to the minimum pain (OA latency, 15.6 ± 3.5 vs 11.1 ± 4.2 seconds; P = .004) than controls. They showed a smaller mean FA (0.44 ± 0.12 vs 0.45 ± 0.11; P = .012) and a larger mean RD of the global white-matter (0.00057 ± 0.00002 vs 0.00056 ± 0.00002; P = .038) than controls, at specific areas including the corpus callosum, anterior thalamic radiation, and forceps major. FA of the splenium of the corpus callosum was associated with maximum VAS latency (r = 0.493) and OA latency (r = -0.552). The Pain Catastrophizing Scale scores showed strong negative correlations with FA across those specific areas (r = -0.405). Those latencies during OA and white-matter metrics distinguished patients from controls (P < .05). CONCLUSIONS Patients with chronic pain showed dysfunction of the white matter concerned with interhemispheric communication of sensorimotor information as well as descending corticothalamic modulation of pain in association with affective morbidity and altered temporal dynamics of pain perception. We suggest that an impaired interhemispheric modulation of pain, through the corpus callosum, might be a novel cerebral mechanism in chronification of pain.
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Affiliation(s)
- Atsushi Ito
- From the Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Sushuang Yang
- Department of Anesthesiology, Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Eri Shinto
- Department of Anesthesiology, Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Shinto
- Department of Anesthesiology, Keio University Graduate School of Medicine, Tokyo, Japan
| | - Akira Toyofuku
- From the Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Jiro Kurata
- From the Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
- Department of Anesthesiology, Jikei University Graduate School of Medicine, Tokyo, Japan
- Department of Anesthesiology, Keio University Graduate School of Medicine, Tokyo, Japan
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Verbakel I, Bou Kheir G, de Rijk M, Dhondt K, Bliwise D, Pauwaert K, Monaghan T, Hervé F, Vogelaers D, Mariman A, Everaert K. Is the insomnia phenotype the common denominator in LUTS during transition periods? An expert NOPIA research group review. Neurourol Urodyn 2024; 43:1134-1146. [PMID: 38289321 DOI: 10.1002/nau.25372] [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: 09/29/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
AIMS As people age, sleep stages and characteristics transition over time, but sleep deficits can profoundly impact health and cognitive functioning. Chronic sleep deprivation is linked to impaired attention and productivity, weakened immunity, increased risk of cardiovascular disease, obesity, and mental health disorders. Insomnia, obstructive sleep apnea syndrome, hormonal changes, nocturia, neurological disorders, and life events interfere with sleep patterns and some are linked to lower urinary tract symptoms (LUTS). This NOPIA symposium on Lifelong LUTS aimed to analyze the literature on associations between sleep and LUTS, generate ideas for future research, and explore whether there is support for the concept of lifelong LUTS in relation to changes in sleep throughout the lifespan. METHODS An international panel of experts took part in an online meeting addressing the role of lifelong LUTS in relationship to sleep and the brain organized by the NOPIA research group. The manuscript summarizes existing literature, hypotheses, future research ideas, and clinical recommendations. RESULTS Insomnia, sleep fragmentation, hyperarousal, and sensory processing disorders emerged as potential factors in the relationship between sleep and LUTS. Insomnia is often a persistent factor and may have been the initial symptom; however, it is often unrecognized and/or unaddressed in healthcare settings. By recognizing insomnia as a primary driver of various health issues, including nocturia, transitional care aims to address root causes and underlying problems earlier to initiate appropriate treatment. CONCLUSIONS A multidisciplinary approach with collaboration between healthcare professionals from various disciplines, such as urology, sleep medicine, gynecology, pediatrics, and geriatrics, is needed and should include validated measurements such as the insomnia severity index and sleep and voiding diaries. Ensuring ongoing follow-up and monitoring through transitional care is crucial for individuals with persistent sleep problems and LUTS, allowing issues that arise or fluctuate over the lifespan to be addressed.
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Affiliation(s)
- Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Karlien Dhondt
- Department of Child and Adolescent Psychiatry, Pediatric Sleep Center, Ghent University Hospital, Ghent, Belgium
| | - Don Bliwise
- Sleep Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kim Pauwaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Thomas Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - François Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Dirk Vogelaers
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
- Department of General Internal Medicine, AZ Delta, Roeselare, Belgium
| | - An Mariman
- Center for Integrative Medicine, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
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Slaven EJ, Alarcio N, Fields C, Hayes M, Weiss E, Eckert NR. An investigation of neurological and/or biomechanical factors underpinning the effect of a thrust manipulation on chronic ankle symptoms: an observational study. J Man Manip Ther 2024; 32:198-205. [PMID: 37694967 PMCID: PMC10956908 DOI: 10.1080/10669817.2023.2251864] [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: 01/23/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Ankle sprains are a commonly occurring musculoskeletal injury potentially resulting in persistent pain and/or altered motion. Thrust manipulation may serve as an interventional strategy but limited evidence exists on the mechanism(s) by which a change to symptoms might occur. OBJECTIVE The study sought to quantify the immediate effect of a thrust manipulation to the ankle to determine a mechanism by which change to symptoms occurred. METHODS Eleven participants (6 m/5f, 26.09 ± 4.25 yrs) with a history of ankle sprain that occurred greater than three months ago with recurring pain and/or altered motion were recruited. Participants underwent neurophysiological testing to assess any pain alterations and instrumented gait analysis (IGA) for biomechanical assessment pre-post thrust manipulation to the ankle. RESULTS There were no significant differences in ankle dorsiflexion (DF) (p = 0.62), plantarflexion (PF) (p = 0.23), ground reaction force (GRF), or velocity (p = 0.63) following thrust manipulation compared to baseline; however, pre- and post-data did show differences in pain pressure threshold (p = 0.046). There were no significant differences in dynamic pain measurements. CONCLUSIONS Ankle sprains that result in persistent pain and/or altered motion can be impacted by a thrust manipulation which appears to act through neurophysiological mechanisms.
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Affiliation(s)
- Emily J. Slaven
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
| | - Nick Alarcio
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
| | - Chandler Fields
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
| | - Mallory Hayes
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
| | - Emily Weiss
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
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Luebke L, von Selle J, Adamczyk WM, Knorr MJ, Carvalho GF, Gouverneur P, Luedtke K, Szikszay TM. Differential Effects of Thermal Stimuli in Eliciting Temporal Contrast Enhancement: A Psychophysical Study. THE JOURNAL OF PAIN 2024; 25:228-237. [PMID: 37591481 DOI: 10.1016/j.jpain.2023.08.005] [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: 05/02/2023] [Revised: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
Offset analgesia (OA) is observed when pain relief is disproportional to the reduction of noxious input and is based on temporal contrast enhancement (TCE). This phenomenon is believed to reflect the function of the inhibitory pain modulatory system. However, the mechanisms contributing to this phenomenon remain poorly understood, with previous research focusing primarily on painful stimuli and not generalizing to nonpainful stimuli. Therefore, the aim of this study was to investigate whether TCE can be induced by noxious as well as innocuous heat and cold stimuli. Asymptomatic subjects (n = 50) were recruited to participate in 2 consecutive experiments. In the first pilot study (n = 17), the parameters of noxious and innocuous heat and cold stimuli were investigated in order to implement them in the main study. In the second (main) experiment, subjects (n = 33) participated in TCE paradigms consisting of 4 different modalities, including noxious heat (NH), innocuous heat (IH), noxious cold (NC), and innocuous cold (IC). The intensity of the sensations of each thermal modality was assessed using an electronic visual analog scale. TCE was confirmed for NH (P < .001), NC (P = .034), and IC (P = .002). Conversely, TCE could not be shown for IH (P = 1.00). No significant correlation between TCE modalities was found (r < .3, P > .05). The results suggest that TCE can be induced by both painful and nonpainful thermal stimulation but not by innocuous warm temperature. The exact underlying mechanisms need to be clarified. However, among other potential mechanisms, this may be explained by a thermo-specific activation of C-fiber afferents by IH and of A-fiber afferents by IC, suggesting the involvement of A-fibers rather than C-fibers in TCE. More research is needed to confirm a peripheral influence. PERSPECTIVE: This psychophysical study presents the observation of temporal contrast enhancement during NH, NC, and innocuous cold stimuli but not during stimulation with innocuous warm temperatures in healthy volunteers. A better understanding of endogenous pain modulation mechanisms might be helpful in explaining the underlying aspects of pain disorders.
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Affiliation(s)
- Luisa Luebke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Schleswig-Holstein, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Schleswig-Holstein, Germany
| | - Janne von Selle
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Schleswig-Holstein, Germany
| | - Wacław M Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Schlesien, Poland; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Moritz J Knorr
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Schleswig-Holstein, Germany
| | - Gabriela F Carvalho
- Department of Physiotherapy, Faculty of Health, Safety and Society, Furtwangen University, Furtwangen, Germany
| | - Philip Gouverneur
- Institute of Medical Informatics, University of Luebeck, Lübeck, Schleswig-Holstein, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Schleswig-Holstein, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Schleswig-Holstein, Germany
| | - Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Lübeck, Schleswig-Holstein, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Schleswig-Holstein, Germany
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Higa S, Oba M, Saito S, Itoh K. Effect of Catastrophic Thinking on the Analgesic Effect of Electroacupuncture. Med Acupunct 2023; 35:311-318. [PMID: 38162552 PMCID: PMC10753907 DOI: 10.1089/acu.2023.0010] [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: 01/03/2024] Open
Abstract
Introduction Patients with chronic pain and high-level catastrophic thoughts often do not respond to acupuncture. This may be related to hypofunctioning of the dorsolateral prefrontal cortex and the descending pain inhibitory system. Therefore, we examined the relationship between the level of catastrophic thinking and the analgesic effect of electroacupuncture using the pain catastrophizing scale (PCS). We also evaluated the descending pain inhibitory system using conditioned pain modulation (CPM) and offset analgesia (OA). The relationship between catastrophic thinking and the descending pain inhibitory system was also examined. Materials and Methods After testing the hospital anxiety and depression scale and the PCS in 14 healthy adults, the current pain threshold (CPT), CPM, and OA were measured, in order, before the intervention. Thereafter, electroacupuncture was applied to 3 limbs (the dominant hand and both lower extremities) at 4 Hz, and to the scalp at 100 Hz, for 30 minutes, and the CPT was measured again immediately after the intervention. The difference in the CPT before and after the intervention was taken as the analgesic effect. Results The participants were divided into 2 groups, the H-PCS group (≥16 points) and the L-PCS group (≤15 points), according to the PCS score, and the analgesic effects of electroacupuncture were significantly different (P = 0.04). However, no relationship was found between the PCS score and the CPM (r = -0.02, P = 0.94) and OA effects (r = -0.19, P = 0.49). Conclusion It was suggested that people with high-level catastrophic thinking may find it difficult to obtain the analgesic effects of electroacupuncture.
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Affiliation(s)
- Shohei Higa
- Graduate School, Meiji University of Integrative Medicine, Nantan, Japan
| | - Miho Oba
- Graduate School, Meiji University of Integrative Medicine, Nantan, Japan
| | - Shingo Saito
- Department of Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Nantan, Japan
| | - Kazunori Itoh
- Department of Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Nantan, Japan
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Cosentino G, Antoniazzi E, Cavigioli C, Tang V, Tammam G, Zaffina C, Tassorelli C, Todisco M. Repetitive Transcranial Magnetic Stimulation of the Human Motor Cortex Modulates Processing of Heat Pain Sensation as Assessed by the Offset Analgesia Paradigm. J Clin Med 2023; 12:7066. [PMID: 38002678 PMCID: PMC10672427 DOI: 10.3390/jcm12227066] [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: 09/13/2023] [Revised: 10/26/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Offset analgesia (OA), which is defined as a disproportionately large reduction in pain perception following a small decrease in a heat stimulus, quantifies temporal aspects of endogenous pain modulation. In this study on healthy subjects, we aimed to (i) determine the Heat Pain Threshold (HPT) and the response to constant and dynamic heat stimuli assessing sensitization, adaptation and OA phenomena at the thenar eminence; (ii) evaluate the effects of high-frequency repetitive Transcranial Magnetic Stimulation (rTMS) of the primary motor cortex (M1) on these measures. Twenty-four healthy subjects underwent quantitative sensory testing before and after active or sham 10 Hz rTMS (1200 stimuli) of the left M1, during separate sessions. We did not observe any rTMS-related changes in the HPT or visual analogue scale (VAS) values recorded during the constant trial. Of note, at baseline, we did not find OA at the thenar eminence. Only after active rTMS did we detect significantly reduced VAS values during dynamic heat stimuli, indicating a delayed and attenuated OA phenomenon. rTMS of the left M1 may activate remote brain areas that belong to the descending pain modulatory and reward systems involved in the OA phenomenon. Our findings provide insights into the mechanisms by which rTMS of M1 could exert its analgesic effects.
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Affiliation(s)
- Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Elisa Antoniazzi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Camilla Cavigioli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Vanessa Tang
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Giulia Tammam
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Chiara Zaffina
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
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Kono R, Oono Y, Takagi S, Uth XJ, Petersen KK, Arendt-Nielsen L, Kohase H. Preoperatively assessed offset analgesia predicts acute postoperative pain following orthognathic surgery. Scand J Pain 2023; 23:720-728. [PMID: 37392129 DOI: 10.1515/sjpain-2023-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/02/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES High intensity and longer duration of acute postoperative pain are generally associated with a higher risk of developing chronic postoperative pain. Therefore, it is important to identify the preoperative predictors for acute postoperative pain. Preoperative evaluation of offset analgesia (OA) and the Pain Catastrophising Scale (PCS) may be potential predictors for acute postoperative pain. This study aimed to investigate the relationship between preoperative OA, PCS, and acute postoperative pain following orthognathic surgery. METHODS Thirty patients (19 females) scheduled to undergo orthognathic surgery were included in this study. OA and PCS were evaluated preoperatively, and the patients reported their postoperative pain intensity using the visual analogue scale [0-100 mm] until it reached zero (number of days with pain). OA was induced on the dominant forearm via three consecutive painful heat pulses delivered for 5 s (T1=46 °C), 5 s (T2=47 °C), and 20 s (T3=46 °C). Subsequently, the associations between OA, PCS, and the number of days with pain were analysed. RESULTS The median duration of postoperative pain was 10.3 days. Multiple linear regression analysis showed a significant (p=0.0019) predictive value of OA (p=0.008) for the number of days with pain. The PCS-magnification component was positively correlated with the number of days with pain (R=0.369, p=0.045), with no predictive values of PCS-total and PCS-subscale scores observed. CONCLUSIONS Preoperative evaluation of OA may be a new individualised, predictive tool for the number of days with acute postoperative pain following orthognathic surgery; hence, a possible biomarker for the patient's vulnerability to developing chronic postoperative pain. ETHICAL COMMITTEE NUMBER The study was approved by the Ethics Committee of Meikai University (A1624, A2113). TRIAL REGISTRY NUMBER This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) Clinical Trial (Unique ID: UMIN000026719, UMIN000046957).
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Affiliation(s)
- Ryoko Kono
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Yuka Oono
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Saori Takagi
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Xenia Jørgensen Uth
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær Petersen
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Hikaru Kohase
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Sakado, Japan
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10
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Szikszay TM, Adamczyk WM, Panskus J, Heimes L, David C, Gouverneur P, Luedtke K. Psychological mechanisms of offset analgesia: The effect of expectancy manipulation. PLoS One 2023; 18:e0280579. [PMID: 36649306 PMCID: PMC9844857 DOI: 10.1371/journal.pone.0280579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
A frequently used paradigm to quantify endogenous pain modulation is offset analgesia, which is defined as a disproportionate large reduction in pain following a small decrease in a heat stimulus. The aim of this study was to determine whether suggestion influences the magnitude of offset analgesia in healthy participants. A total of 97 participants were randomized into three groups (hypoalgesic group, hyperalgesic group, control group). All participants received four heat stimuli (two constant trials and two offset trials) to the ventral, non-dominant forearm while they were asked to rate their perceived pain using a computerized visual analogue scale. In addition, electrodermal activity was measured during each heat stimulus. Participants in both intervention groups were given a visual and verbal suggestion about the expected pain response in an hypoalgesic and hyperalgesic manner. The control group received no suggestion. In all groups, significant offset analgesia was provoked, indicated by reduced pain ratings (p < 0.001) and enhanced electrodermal activity level (p < 0.01). A significant group difference in the magnitude of offset analgesia was found between the three groups (F[2,94] = 4.81, p < 0.05). Participants in the hyperalgesic group perceived significantly more pain than the hypoalgesic group (p = 0.031) and the control group (p < 0.05). However, the electrodermal activity data did not replicate this trend (p > 0.05). The results of this study indicate that suggestion can be effective to reduce but not increase endogenous pain modulation quantified by offset analgesia in healthy participants.
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Affiliation(s)
- Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
| | - Waclaw M Adamczyk
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany.,Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Janina Panskus
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
| | - Lotte Heimes
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
| | - Carolin David
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
| | - Philip Gouverneur
- Institute of Medical Informatics, University of Luebeck, Luebeck, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
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11
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Oono Y, Kono R, Kiyohara Y, Takagi S, Ide Y, Nagasaka H, Kohase H. Photobiomodulation enhanced endogenous pain modulation in healthy volunteers. Lasers Med Sci 2022; 38:16. [PMID: 36562828 PMCID: PMC9789003 DOI: 10.1007/s10103-022-03686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/12/2022] [Indexed: 12/24/2022]
Abstract
To examine the effects of photobiomodulation (PBM) in healthy volunteers using photonic stimulation of acupuncture points on conditioned pain modulation (CPM), temporal summation of pain (TSP), and offset analgesia (OA), which reflect some aspects of endogenous pain modulation. We included 15 men and 15 women (age, 31.5 [27.3-37.0], body mass index, 25.7 [24.4-27.1], Fitzpatrick skin typing, II: 20, III: 8, IV: 2). CPM, TSP, and OA were evaluated after a sham procedure (control session) and after acupuncture point stimulation (LI4 and LI10 on the non-dominant forearm) using linear polarized near-infrared light irradiation (LPNILI; wavelengths peaked at approximately 1000 nm, output: 1.4 W/cm2, spot diameter: 10 mm, spot size: 1.02 cm2, maximum temperature: 40.5 °C, pulse width: 1 s, frequency: 0.2 Hz) (PBM session). Differences in CPM, TSP, and OA between the two sessions were evaluated by the paired t-test and Fisher's exact test (statistical significance: p < 0.05). Values indicate median [interquartile range]. LPNILI significantly increased CPM in all participants (control session: 12.1 [-4.5-37.4], PBM session: 23.9 [8.3-44.8], p < 0.05) and women (control session: 16.7 [-3.4-36.6], PBM session: 38.7 [24.6-52.1], p < 0.05). The CPM effect increment was significantly higher in women than in men (p = 0.0253). LPNILI decreased TSP in participants with higher TSP ratios (p = 0.0219) and increased OA in participants with lower OA scores (p = 0.0021). LPNILI enhanced endogenous pain modulation in healthy volunteers, particularly in women, as evaluated using CPM. CPM, TSP, and OA evaluations are potentially useful for discriminating PBM responders from non-responders.
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Affiliation(s)
- Yuka Oono
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan.
| | - Ryoko Kono
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan
| | - Yuki Kiyohara
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan
| | - Saori Takagi
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan
| | - Yasuo Ide
- Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan
| | - Hikaru Kohase
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan
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12
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Adamczyk WM, Szikszay TM, Nahman-Averbuch H, Skalski J, Nastaj J, Gouverneur P, Luedtke K. To Calibrate or not to Calibrate? A Methodological Dilemma in Experimental Pain Research. THE JOURNAL OF PAIN 2022; 23:1823-1832. [PMID: 35918020 DOI: 10.1016/j.jpain.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/24/2022] [Accepted: 07/20/2022] [Indexed: 05/23/2023]
Abstract
To calibrate or not to calibrate? This question is raised by almost everyone designing an experimental pain study with supra-threshold stimulation. The dilemma is whether to individualize stimulus intensity to the pain threshold / supra-threshold pain level of each participant or whether to provide the noxious stimulus at a fixed intensity so that everyone receives the identical input. Each approach has unique pros and cons which need to be considered to i) accurately design an experiment, ii) enhance statistical inference in the given data and, iii) reduce bias and the influence of confounding factors in the individual study e.g., body composition, differences in energy absorption and previous experience. Individualization requires calibration, a procedure already irritating the nociceptive system but allowing to match the pain level across individuals. It leads to a higher variability of the stimulus intensity, thereby influencing the encoding of "noxiousness" by the central nervous system. Results might be less influenced by statistical phenomena such as ceiling/floor effects and the approach does not seem to rise ethical concerns. On the other hand, applying a fixed (standardized) intensity reduces the problem of intensity encoding leading to a large between-subjects variability in pain responses. Fixed stimulation intensities do not require pre-exposure. It can be proposed that one method is not preferable over another, however the choice depends on the study aim and the desired level of external validity. This paper discusses considerations for choosing the optimal approach for experimental pain studies and provides recommendations for different study designs. PERSPECTIVE: To calibrate pain or not? This dilemma is related to almost every experimental pain research. The decision is a trade-off between statistical power and greater control of stimulus encoding. The article decomposes both approaches and presents the pros and cons of either approach supported by data and simulation experiment.
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Affiliation(s)
- Waclaw M Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Institute of Health Sciences, Department of Physiotherapy, Pain & Exercise Research Luebeck (P.E.R.L.), University of Lübeck, Lübeck, Germany.
| | - Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain & Exercise Research Luebeck (P.E.R.L.), University of Lübeck, Lübeck, Germany
| | - Hadas Nahman-Averbuch
- Washington University Pain Center, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jacek Skalski
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Jakub Nastaj
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Philip Gouverneur
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain & Exercise Research Luebeck (P.E.R.L.), University of Lübeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
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13
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Effects of stimulation area and temperature rates on offset analgesia. Pain Rep 2022; 7:e1043. [PMID: 36284798 PMCID: PMC9584187 DOI: 10.1097/pr9.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Offset analgesia describes the effect of a slightly reduced nociceptive stimulus, resulting in a disproportionate large reduction in the pain perception. This effect may be associated with descending pain inhibition, but parameters influencing this phenomenon are poorly understood. OBJECTIVES In this study, 2 separate experiments were conducted to investigate both, the spatial aspects of offset analgesia and the influence of different rates of temperature rise. METHODS In both experiments, 29 healthy participants received individualized and heat-based offset analgesia paradigms applied to the forearm, with continuous assessment of pain intensity. In experiment 1, offset analgesia paradigms with 3 different rates of temperature rise were applied, whereas in experiment 2, offset analgesia paradigms with 2 different heat application areas were used. RESULTS The results of experiment 1 showed that different temperature rates had no effect on the offset analgesia response (P > 0.05). Experiment 2, however, showed the influence of the size of a stimulated area on offset analgesia (P = 0.009), which can be explained mainly by the influence of spatial summation of pain and habituation processes. CONCLUSIONS The study showed a lack of influence of different temperature rates on offset analgesia; however, spatial aspects of offset analgesia could be identified. These are most likely based on spatial summation of pain and altered adaptation to pain.
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14
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Li T, Zhang S, Ikeda E, Kobinata H. Functional connectivity modulations during offset analgesia in chronic pain patients: an fMRI study. Brain Imaging Behav 2022; 16:1794-1802. [PMID: 35314949 DOI: 10.1007/s11682-022-00652-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/02/2022]
Abstract
Patients with neuropathic pain and fibromyalgia showed reduced or absent offset analgesia (OA) response and attenuated cerebral activity in descending pain modulatory and reward systems in patients. However, neural network modifications of OA in chronic pain have not been determined. We enrolled 23 patients with various chronic pain and 17 age- and gender- matched healthy controls. All participants were given OA-related noxious thermal stimuli, including 3 repeats of offset analgesia paradigm at 46-47-46 °C and constant paradigm at 46 °C on the left volar forearm under whole-brain functional magnitude resonance imaging (fMRI). We evaluated magnitude of OA, examined OA modulated functional connectivity using psychophysiological interaction analysis and resting-state functional connectivity analysis and explored their behavioral correlations in patients compared with controls.Compared to controls, chronic pain patients showed smaller magnitude of OA (P = 0.047). OA modulated connectivity decreased between posterior cingulate cortex (PCC) and right medial prefrontal cortex (MPFC) in proportion to current chronic pain (P = 0.018); decreased between right pallidum and right thalamus, and increased between right caudate nucleus and left primary somatosensory cortex (P FDR < 0.05).The impaired PCC-MPFC connectivity might play an important role in dysfunction of OA and contribute to pain chronification.
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Affiliation(s)
- Tianjiao Li
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Shuo Zhang
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eri Ikeda
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Kobinata
- Department of Anesthesiology, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
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15
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Alter BJ, Santosa H, Nguyen QH, Huppert TJ, Wasan AD. Offset analgesia is associated with opposing modulation of medial versus dorsolateral prefrontal cortex activations: A functional near-infrared spectroscopy study. Mol Pain 2022; 18:17448069221074991. [PMID: 35083928 PMCID: PMC9047820 DOI: 10.1177/17448069221074991] [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] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 12/02/2022] Open
Abstract
Offset analgesia is defined by a dramatic drop in perceived pain intensity with a relatively small decrease in noxious input. Although functional magnetic resonance imaging studies implicate subcortical descending inhibitory circuits during offset analgesia, the role of cortical areas remains unclear. The current study identifies cortical correlates of offset analgesia using functional near infrared spectroscopy (fNIRS). Twenty-four healthy volunteers underwent fNIRS scanning during offset (OS) and control (Con) heat stimuli applied to the forearm. After controlling for non-neural hemodynamic responses in superficial tissues, widespread increases in cortical oxygenated hemoglobin concentration were observed, reflecting cortical activation during heat pain. OS-Con contrasts revealed deactivations in bilateral medial prefrontal cortex (mPFC) and bilateral somatosensory cortex (SSC) associated with offset analgesia. Right dorsolateral prefrontal cortex (dlPFC) showed activation only during OS. These data demonstrate opposing cortical activation patterns during offset analgesia and support a model in which right dlPFC underlies ongoing evaluation of pain intensity change. With predictions of decreasing pain intensity, right dlPFC activation likely inhibits ascending noxious input via subcortical pathways resulting in SSC and mPFC deactivation. This study identifies cortical circuitry underlying offset analgesia and introduces the use of fNIRS to study pain modulation in an outpatient clinical environment.
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Affiliation(s)
- Benedict J. Alter
- Department of Anesthesiology and
Perioperative Medicine, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Hendrik Santosa
- Department of Radiology, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Quynh H. Nguyen
- Department of Anesthesiology and
Perioperative Medicine, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Theodore J. Huppert
- Department of Electrical and
Computer Engineering, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Ajay D. Wasan
- Department of Anesthesiology and
Perioperative Medicine, University of
Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of
Pittsburgh, Pittsburgh, PA, USA
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16
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Szikszay TM, Adamczyk WM, Hoegner A, Woermann N, Luedtke K. The effect of acute-experimental pain models on offset analgesia. Eur J Pain 2021; 25:1150-1161. [PMID: 33533139 DOI: 10.1002/ejp.1740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Offset analgesia (OA) is characterized by a disproportionately large decrease in pain perception after a slight decrease in noxious stimulation. In patients with ongoing pain, this response is reduced. The effect is pronounced in painful body areas. The influence of acute pain has not been sufficiently investigated. The aim of this study was to investigate the influence of two experimental acute pain models, measured within the area of acute pain and on the non-affected opposite side, thereby considering the possible somatotopic nature of OA. METHODS Healthy, pain-free volunteers (n = 75) were randomly assigned to one of three groups (cold water, exercise and control group). The 'cold water group' immersed one hand into cold water for 3 min (Cold Pressor Task), while the 'exercise group' performed an isometric grip exercise for 3 min. There was no manipulation in the control group. Each experimental pain stimulus was performed at both (dominant, non-dominant) forearms. The individualized OA paradigm consisted of offset and constant temperature trials. Offset analgesia was measured immediately before, during and after the experimental pain stimuli. RESULTS A significant difference in OA was shown during experimental pain when compared to the control condition (exercise vs. control: p < 0.001, cold vs. control: p = 0.001), with no difference between the experimental conditions (p > 0.05). Immediately following the pain stimulation, results were marginally non-significant (p = 0.05). CONCLUSIONS Experimental painful stimulation reduced OA. This result should be interpreted with caution due to potential influences of conditioned pain modulation or exercise-induced hypoalgesia as well as possible floor effects. SIGNIFICANCE Temporal contrast of pain perception is inhibited in acute pain states. This study showed that reduced offset analgesia is observed when pain is experimentally induced using noxious cold and exercise stimuli.
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Affiliation(s)
- Tibor M Szikszay
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany.,Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Waclaw M Adamczyk
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany.,Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Alexandra Hoegner
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - Nele Woermann
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany.,Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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17
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Tapentadol treatment results in long-term pain relief in patients with chronic low back pain and associates with reduced segmental sensitization. Pain Rep 2020; 5:e877. [PMID: 33364540 PMCID: PMC7752667 DOI: 10.1097/pr9.0000000000000877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 11/26/2022] Open
Abstract
The endogenous pain system may be used as a biomarker in the pharmacological treatment of patients with CLBP, enabling an individualized, mechanism-based treatment approach. Introduction: Chronic low back pain (CLBP) is one of the most common chronic pain conditions in pain practice. Objectives: In the current study, we describe phenotypes of patients with CLBP based on the status of their endogenous pain modulatory system. Methods: Conditioned pain modulation (a measure of central pain inhibition), temporal summation (TS, a measure of pain facilitation), and offset analgesia (a measure of temporal filtering of nociception) were evaluated in 53 patients with CLBP at painful and nonpainful sites. Next, in a double-blind, randomized, placebo-controlled trial, 40 patients with defective conditioned pain modulation responses received treatment with tapentadol prolonged-release or placebo for 3 months. Results: The majority of patients (87%) demonstrated loss of central pain inhibition combined with segmentally increased TS and reduced offset analgesia at the lower back region. During treatment, tapentadol reduced pain intensity more than placebo (tapentadol −19.5 ± 2.1 mm versus placebo −7.1 ± 1.8 mm, P = 0.025). Furthermore, tapentadol significantly decreased pain facilitation by reduction of TS responses at the lower back (tapentadol −0.94 ± 1.9 versus placebo 0.01 ± 1.5, P = 0.020), which correlated with pain reduction (P < 0.001). Conclusion: Patients with CLBP demonstrated different phenotypes of endogenous pain modulation. In patients with reduced conditioned pain modulation, tapentadol produced long-term pain relief that coincided with reduction of signs of pain facilitation. These data indicate that the endogenous pain system may be used as a biomarker in the pharmacological treatment of CLBP, enabling an individualized, mechanism-based treatment approach.
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18
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Alter BJ, Aung MS, Strigo IA, Fields HL. Onset hyperalgesia and offset analgesia: Transient increases or decreases of noxious thermal stimulus intensity robustly modulate subsequent perceived pain intensity. PLoS One 2020; 15:e0231124. [PMID: 33290407 PMCID: PMC7723268 DOI: 10.1371/journal.pone.0231124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022] Open
Abstract
Reported pain intensity depends not only on stimulus intensity but also on previously experienced pain. A painfully hot temperature applied to the skin evokes a lower subjective pain intensity if immediately preceded by a higher temperature, a phenomenon called offset analgesia. Previous work indicated that prior pain experience can also increase subsequent perceived pain intensity. Therefore, we examined whether a given noxious stimulus is experienced as more intense when it is preceded by an increase from a lower temperature. Using healthy volunteer subjects, we observed a disproportionate increase in pain intensity at a given stimulus intensity when this intensity is preceded by a rise from a lower intensity. This disproportionate increase is similar in magnitude to that of offset analgesia. We call this effect onset hyperalgesia. Control stimuli, in which a noxious temperature is held constant, demonstrate that onset hyperalgesia is distinct from receptor or central sensitization. The absolute magnitudes of offset analgesia and onset hyperalgesia correlate with each other but not with the noxious stimulus temperature. Finally, the magnitude of both offset analgesia and onset hyperalgesia depends on preceding temperature changes. Overall, this study demonstrates that the perceptual effect of a noxious thermal stimulus is influenced in a bidirectional manner depending upon both the intensity and direction of change of the immediately preceding thermal stimulus.
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Affiliation(s)
- Benedict J. Alter
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Mya Sandi Aung
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America
| | - Irina A. Strigo
- San Francisco VA Health Care System & Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
| | - Howard L. Fields
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
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19
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Lunde CE, Szabo E, Holmes SA, Borsook D, Sieberg CB. Commentary: Novel Use of Offset Analgesia to Assess Adolescents and Adults with Treatment Resistant Endometriosis-Associated Pain. J Pain Res 2020; 13:2775-2782. [PMID: 33204144 PMCID: PMC7660453 DOI: 10.2147/jpr.s276135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022] Open
Abstract
Background and Objective Endometriosis, affecting approximately 176 million adults and adolescents worldwide, is a debilitating condition in which uterine tissue grows outside the uterus. The condition costs the US economy approximately $78 billion annually in pain-related disability. By understanding the neural underpinnings of endometriosis-associated pain (EAP) and risk factors for chronification, translational research methods could lessen diagnostic delays and maximize successful pain remediation. This can be accomplished by the novel use of a known method, offset analgesia (OA), to better elucidate the neural mechanisms that may contribute to and maintain EAP. This commentary will provide justification and rationale for the use of OA in the study of EAP. Conclusion Utilizing an OA paradigm in patients with endometriosis, especially adolescents, may (1) provide insight into neural mechanisms contributing to pain maintenance, which could capture those at-risk for the transition to chronic pelvic pain, (2) provide a metric for the development of future centrally mediated treatment options for this population, and (3) elucidate the brain changes that result in resistance to treatment and pain chronification.
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Affiliation(s)
- Claire E Lunde
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA.,Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
| | - Edina Szabo
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Scott A Holmes
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Christine B Sieberg
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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20
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Sitsen E, van Velzen M, de Rover M, Dahan A, Niesters M. Hyperalgesia and Reduced Offset Analgesia During Spinal Anesthesia. J Pain Res 2020; 13:2143-2149. [PMID: 33061546 PMCID: PMC7519835 DOI: 10.2147/jpr.s258533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/11/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction Spinal anesthesia induces short-term deafferentation and causes connectivity changes in brain areas involved in endogenous pain modulation. We determined whether spinal anesthesia alters pain sensitivity and offset analgesia. Offset analgesia is a manifestation of endogenous pain modulation and characterized by profound analgesia upon a small decrease in noxious stimulation. Methods In this randomized controlled crossover trial, static thermal pain responses and offset analgesia were obtained in 22 healthy male volunteers during spinal anesthesia and control conditions (absence of spinal anesthesia). Pain responses and offset analgesia were measured on a remote skin area above the upper level of anesthesia (C8/Th1). Results Following spinal injection of the local anesthetic, the average maximum anesthesia level was Th6. Static pain scores at C8/Th1 were higher during spinal anesthesia compared to control: 59.1 ± 15.0 mm (spinal anesthesia) versus 51.7 ± 19.7 mm (control; p = 0.03). Offset analgesia responses were decreased during spinal analgesia: pain score decrease 79 ± 27% (spinal anesthesia) versus 90 ± 17% (control; p = 0.016). Discussion We confirmed that spinal anesthesia-induced deafferentation causes hyperalgesic responses to noxious thermal stimulation and reduced offset analgesia at dermatomes remote and above the level of deafferentation. While these data suggest that the reduction of offset analgesia has a central origin, related to alterations in brain areas involved in inhibitory pain control, we cannot exclude alternative (peripheral) mechanisms. Trial Registration Dutch Cochrane Center under identifier (www.trialregister.nl) NL3874.
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Affiliation(s)
- Elske Sitsen
- Department of Anesthesiology, Leiden University Medical Center, Leiden, RC 2300, the Netherlands
| | - Monique van Velzen
- Department of Anesthesiology, Leiden University Medical Center, Leiden, RC 2300, the Netherlands
| | - Mischa de Rover
- Department of Anesthesiology, Leiden University Medical Center, Leiden, RC 2300, the Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, RC 2300, the Netherlands
| | - Marieke Niesters
- Department of Anesthesiology, Leiden University Medical Center, Leiden, RC 2300, the Netherlands
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Qian Y, Wang Z, Zhou S, Zhao W, Yin C, Cao J, Wang Z, Li Y. MKP1 in the medial prefrontal cortex modulates chronic neuropathic pain via regulation of p38 and JNK1/2. Int J Neurosci 2020; 130:643-652. [PMID: 31518515 DOI: 10.1080/00207454.2019.1667785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Aim: The medial prefrontal context (mPFC) plays pivotal roles in initiation, development, and maintenance of chronic pain, whereas the underlying molecular mechanisms remain elusive, which invited investigation of potential involvement of MKP1 in mPFC in mice in neuropathic pain, and its cellular and molecular mechanisms.Materials and methods: Neuropathic pain model was established in adult male Kunming mice via chronic constrictive injury (CCI) of the sciatic nerve. Paw withdrawal latency (PWL) was measured at the plantar area by radiant heat test. Stereotaxic microinjection was applied in mice as per the atlas of Mouse Brain in Stereotaxic Coordinates. mRNA levels of MKP1 in mPFC in CCI mice were assessed by RT-PCR; protein expressions of MKP1, p-p38, p-JNK and p-ERK in mPFC in CCI mice were analyzed by Western blotting, and expressions of the c-Fos in mPFC in CCI mice evaluated by immunohistochemistry. Moreover, Lenti-MKP1 particles or BCI treatment was employed to inhibit MKP1 in mPFC contralateral to the injury.Results: MKP1 was activated and persistently upregulated in mPFC neurons in CCI mice. Inhibition of MKP1 in the mPFC contralateral to the injury could reverse CCI-induced pain behavior and neuronal activity either via employment of Lenti-MKP1 particles or BCI treatment. MKP1 in the mPFC modulated neuropathic pain via dephosphorization of p38 and JNK1/2.Conclusion: The findings demonstrated that MKP1 in mPFC could play a paramount role in the modulation of neuropathic pain, which might be associated to the increased neuronal excitability in the mPFC and downregulated p-p38 and p-JNK expression.
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Affiliation(s)
- Yiling Qian
- Department of Anesthesiology, Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Zhiyong Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Siqi Zhou
- Department of Gastroenterology, The Drum Tower Clinical College of Nanjing Medical University, Nanjing, China
| | - Weinan Zhao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Cui Yin
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Junli Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhiping Wang
- Department of Anesthesiology, Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yanqiang Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
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22
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23
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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24
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Neuroimaging of pain in animal models: a review of recent literature. Pain Rep 2019; 4:e732. [PMID: 31579844 PMCID: PMC6728006 DOI: 10.1097/pr9.0000000000000732] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 01/19/2023] Open
Abstract
Neuroimaging of pain in animals allows us to better understand mechanisms of pain processing and modulation. In this review, we discuss recently published brain imaging studies in rats, mice, and monkeys, including functional magnetic resonance imaging (MRI), manganese-enhanced MRI, positron emission tomography, and electroencephalography. We provide an overview of innovations and limitations in neuroimaging techniques, as well as results of functional brain imaging studies of pain from January 1, 2016, to October 10, 2018. We then discuss how future investigations can address some bias and gaps in the field. Despite the limitations of neuroimaging techniques, the 28 studies reinforced that transition from acute to chronic pain entails considerable changes in brain function. Brain activations in acute pain were in areas more related to the sensory aspect of noxious stimulation, including primary somatosensory cortex, insula, cingulate cortex, thalamus, retrosplenial cortex, and periaqueductal gray. Pharmacological and nonpharmacological treatments modulated these brain regions in several pain models. On the other hand, in chronic pain models, brain activity was observed in regions commonly associated with emotion and motivation, including prefrontal cortex, anterior cingulate cortex, hippocampus, amygdala, basal ganglia, and nucleus accumbens. Neuroimaging of pain in animals holds great promise for advancing our knowledge of brain function and allowing us to expand human subject research. Additional research is needed to address effects of anesthesia, analysis approaches, sex bias and omission, and potential effects of development and aging.
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25
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Derbyshire SWG, Long VJE, Asplund CL. Stepwise increasing sequential offsets cannot be used to deliver high thermal intensities with little or no perception of pain. J Neurophysiol 2019; 122:729-736. [PMID: 31242398 DOI: 10.1152/jn.00007.2019] [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: 11/22/2022] Open
Abstract
Offset analgesia (OA) is the disproportionate decrease in pain experience following a slight decrease in noxious heat stimulus intensity. We tested whether sequential offsets would allow noxious temperatures to be reached with little or no perception of pain. Forty-eight participants continuously rated their pain experience during trials containing trains of heat stimuli delivered by Peltier thermode. Stimuli were adjusted through either stepwise sequential increases of 2°C and decreases of 1°C or direct step increases of 1°C up to a maximum of 46°C. Step durations (1, 2, 3, or 6 s) varied by trial. Pain ratings generally followed presented temperature, regardless of step condition or duration. For 6-s steps, OA was observed after each decrease, but the overall pain trajectory was unchanged. We found no evidence that sequential offsets could allow for little pain perception during noxious temperature presentation.NEW & NOTEWORTHY Offset analgesia is the disproportionate decrease in pain experience following a slight decrease in noxious heat stimulus intensity. We tested whether sequential offsets would allow noxious temperatures to be reached with little or no perception of pain. We found little evidence of such overall analgesia. In contrast, we observed analgesic effects after each offset with long-duration stimuli, even with relatively low-temperature noxious stimuli.
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Affiliation(s)
- Stuart W G Derbyshire
- Department of Psychology, National University of Singapore, Singapore.,Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Victoria Jane En Long
- Division of Social Sciences, Yale-NUS College, National University of Singapore, Singapore
| | - Christopher L Asplund
- Department of Psychology, National University of Singapore, Singapore.,Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Social Sciences, Yale-NUS College, National University of Singapore, Singapore.,N.1 Institute for Health, National University of Singapore, Singapore
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26
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Moana‐Filho EJ, Herrero Babiloni A, Nisley A. Endogenous pain modulation assessed with offset analgesia is not impaired in chronic temporomandibular disorder pain patients. J Oral Rehabil 2019; 46:1009-1022. [DOI: 10.1111/joor.12832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/29/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Estephan Jose Moana‐Filho
- Division of TMD and Orofacial Pain, School of Dentistry University of Minnesota Minneapolis Minnesota USA
| | - Alberto Herrero Babiloni
- Division of TMD and Orofacial Pain, School of Dentistry University of Minnesota Minneapolis Minnesota USA
| | - Aaron Nisley
- Division of TMD and Orofacial Pain, School of Dentistry University of Minnesota Minneapolis Minnesota USA
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27
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The Magnitude of Offset Analgesia as a Measure of Endogenous Pain Modulation in Healthy Participants and Patients With Chronic Pain. Clin J Pain 2019; 35:189-204. [DOI: 10.1097/ajp.0000000000000657] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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28
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Han X, Liu X, Li L, Xie B, Fan B, Qiu Y, Liu T, Li L. Neural Activation During Tonic Pain and Interaction Between Pain and Emotion in Bipolar Disorder: An fMRI Study. Front Psychiatry 2018; 9:555. [PMID: 30459652 PMCID: PMC6232121 DOI: 10.3389/fpsyt.2018.00555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Objective: Pain and affective disorders have clear clinical relevance; however, very few studies have investigated the association between pain and bipolar disorder. This study investigated the brain activity of patients with bipolar disorder (BPs) undergoing tonic pain and assessed the interaction between pain and emotion. Methods: Ten BPs and ten healthy controls (HCs) were exposed to emotional pictures (positive, neutral, or negative), tonic pain only (pain session), and emotional pictures along with tonic pain (combined session). A moderate tonic pain was induced by the infusion of hypertonic saline (5% NaCl) into the right masseter muscle with a computer-controlled system. Whole-brain blood oxygenation level dependent (BOLD) signals were acquired using 3T functional resonance imaging (fMRI). Results: Ten BPs and ten healthy participants were included in the final analysis. During the pain session, BPs accepted more saline, but showed lower pain rating scores than HCs. When experiencing pain, BPs showed a significant decrease in the BOLD signal in the bilateral insula, left inferior frontal gyrus (IFG), and left cerebellum as compared with HCs. In the combined session, the activated regions for positive mood (pain with positive mood > baseline) in BPs were the left cerebellum, right temporal gyrus, and left occipital gyrus; the activated regions for negative mood (pain with negative mood > baseline) were the right occipital gyrus, left insula, left IFG, and bilateral precentral gyrus. Conclusions: This study presents the preliminary finding of the interaction between pain and emotion in BPs. BPs exhibited lower sensitivity to pain, and the activation of insula and IFG may reflect the interaction between emotion and pain stimulus.
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Affiliation(s)
- Xue Han
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xiaowu Liu
- Neuroengineering Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Linling Li
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Bo Xie
- Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Beifang Fan
- Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yunhai Qiu
- Research Center for Intelligent Biosensing, Research Institute of Tsinghua University in Shenzhen, Shenzhen, China
| | - Tiebang Liu
- Shenzhen Key Lab for Psychological Healthcare, Shenzhen Mental Health Centre, Shenzhen, China
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China.,Shenzhen Key Lab for Psychological Healthcare, Shenzhen Mental Health Centre, Shenzhen, China.,Clinical Psychiatry Center, National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
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Abstract
One feels a disproportionately large decrease of pain sensation on a slight decrease of thermal pain stimulus. Such phenomenon is termed offset analgesia and considered mediated by endogenous analgesic mechanisms. Offset analgesia was found attenuated in patients with neuropathic pain. We further found that such attenuation occurred in a more heterogeneous population of patients with chronic pain. By functional magnetic resonance imaging, we also found negative blood oxygenation level-dependent signals at those areas concerned with descending pain modulatory and reward systems during offset analgesia in the same cohort of patients. We propose that dysfunction of those systems, as revealed by attenuation of offset analgesia, might well be part of neural mechanisms of pain chronification.
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Affiliation(s)
- Jiro Kurata
- Department of Anesthesiology and Pain Clinic, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo City, Tokyo, Japan.
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