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Xu J, Zhang H, Chen D, Xu K, Li Z, Wu H, Geng X, Wei X, Wu J, Cui W, Wei S. Looking for a Beam of Light to Heal Chronic Pain. J Pain Res 2024; 17:1091-1105. [PMID: 38510563 PMCID: PMC10953534 DOI: 10.2147/jpr.s455549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
Chronic pain (CP) is a leading cause of disability and a potential factor that affects biological processes, family relationships, and self-esteem of patients. However, the need for treatment of CP is presently unmet. Current methods of pain management involve the use of drugs, but there are different degrees of concerning side effects. At present, the potential mechanisms underlying CP are not completely clear. As research progresses and novel therapeutic approaches are developed, the shortcomings of current pain treatment methods may be overcome. In this review, we discuss the retinal photoreceptors and brain regions associated with photoanalgesia, as well as the targets involved in photoanalgesia, shedding light on its potential underlying mechanisms. Our aim is to provide a foundation to understand the mechanisms underlying CP and develop light as a novel analgesic treatment has its biological regulation principle for CP. This approach may provide an opportunity to drive the field towards future translational, clinical studies and support pain drug development.
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Affiliation(s)
- Jialing Xu
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Hao Zhang
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Dan Chen
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Kaiyong Xu
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Zifa Li
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Hongyun Wu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Xiwen Geng
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Xia Wei
- NMPA Key Laboratory for Research and Evaluation of Generic Drugs, Shandong Institute for Food and Drug Control, Ji’nan, Shandong, People’s Republic of China
| | - Jibiao Wu
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Wenqiang Cui
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Sheng Wei
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
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Palfai TP, Morone NE, Kratzer MPL, Murray GE, Otis JD, Maisto SA, Rowland BHP. Mobile health intervention to address chronic pain among those who engage in hazardous drinking: A pilot study. Drug Alcohol Depend 2024; 256:111121. [PMID: 38367537 PMCID: PMC11056789 DOI: 10.1016/j.drugalcdep.2024.111121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/28/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Hazardous drinking has been associated with chronic pain in community and medical samples. The purpose of this study was to develop a novel, integrated mobile health intervention that improves pain management and reduces hazardous drinking that may be implemented in primary care settings. METHODS Forty-eight participants with moderate or greater chronic pain and hazardous drinking were recruited from primary care clinics and through social media sites. Following baseline assessment, participants were randomized to a counselor-supported smartphone app intervention (INTV) or a counselor delivered treatment-as-usual control condition (CTL). RESULTS Results supported the feasibility and acceptability of the smartphone app intervention. Participants found it easy to use, reported high levels of satisfaction, and showed high levels of engagement with the app. Between-group effect size estimates at follow-up showed small effects for the intervention on pain ratings. However, using clinically meaningful change thresholds of 30% and 50% improvement in pain scores, 38% and 25% respectively of those in the INTV condition showed reductions compared to 20% and 12.5% respectively in the CTL condition. Effect size estimates did not indicate intervention superiority on alcohol outcomes as participants in both conditions showed considerable reductions in drinking over the course of the study. CONCLUSIONS Results supported the view that a mobile health intervention delivered via smartphone with electronic coaching is a feasible and acceptable method of addressing chronic pain among those who engage in hazardous drinking. Future work should test the efficacy of this approach in a fully powered trial.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA.
| | - Natalia E Morone
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA
| | - Maya P L Kratzer
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
| | - Grace E Murray
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
| | - John D Otis
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, 801 430 Huntington Hall, Syracuse NY 13210, USA
| | - Bonnie H P Rowland
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
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Zhang Z, Pasapula M, Wang Z, Edwards K, Norrish A. The effectiveness of cupping therapy on low back pain: A systematic review and meta-analysis of randomized control trials. Complement Ther Med 2024; 80:103013. [PMID: 38184285 DOI: 10.1016/j.ctim.2024.103013] [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: 05/04/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVES This study aims to investigate the effectiveness of cupping therapy on low back pain (LBP). METHODS Medline, Embase, Scopus and WANFANG databases were searched for relevant cupping RCTs on low back pain articles up to 2023. A complementary search was manually made on 27 September for update screening. Full-text English and Chinese articles on all ethnic adults with LBP of cupping management were included in this study. Studies looking at acute low back pain only were excluded. Two independent reviewers screened and extracted data, with any disagreement resolved through consensus by a third reviewer. The methodological quality of the included studies was evaluated independently by two reviewers using an adapted tool. Change-from-baseline outcomes were treated as continuous variables and calculated according to the Cochrane Handbook. Data were extracted and pooled into the meta-analysis by Review Manager software (version 5.4, Nordic Cochrane Centre). RESULTS Eleven trials involving 921 participants were included. Five studies were assessed as being at low risk of bias, and six studies were of acceptable quality. High-quality evidence demonstrated cupping significantly improves pain at 2-8 weeks endpoint intervention (d=1.09, 95% CI: [0.35-1.83], p = 0.004). There was no continuous pain improvement observed at one month (d=0.11, 95% CI: [-1.02-1.23], p = 0.85) and 3-6 months (d=0.39, 95% CI: [-0.09-0.87], p = 0.11). Dry cupping did not improve pain (d=1.06, 95% CI: [-0.34, 2.45], p = 0.14) compared with wet cupping (d=1.5, 95% CI: [0.39-2.6], p = 0.008) at the endpoint intervention. There was no evidence indicating the association between pain reduction and different types of cupping (p = 0.2). Moderate- to low-quality evidence showed that cupping did not reduce chronic low back pain (d=0.74, 95% CI: [-0.67-2.15], p = 0.30) and non-specific chronic low back pain (d=0.27, 95% CI: [-1.69-2.24], p = 0.78) at the endpoint intervention. Cupping on acupoints showed a significant improvement in pain (d=1.29, 95% CI: [0.63-1.94], p < 0.01) compared with the lower back area (d=0.35, 95% CI: [-0.29-0.99], p = 0.29). A potential association between pain reduction and different cupping locations (p = 0.05) was found. Meta-analysis showed a significant effect on pain improvement compared to medication therapy (n = 8; d=1.8 [95% CI: 1.22 - 2.39], p < 0.001) and usual care (n = 5; d=1.07 [95% CI: 0.21- 1.93], p = 0.01). Two studies demonstrated that cupping significantly mediated sensory and emotional pain immediately, after 24 h, and 2 weeks post-intervention (d= 5.49, 95% CI [4.13-6.84], p < 0.001). Moderate evidence suggested that cupping improved disability at the 1-6 months follow-up (d=0.67, 95% CI: [0.06-1.28], p = 0.03). There was no immediate effect observed at the 2-8 weeks endpoint (d=0.40, 95% CI: [-0.51-1.30], p = 0.39). A high degree of heterogeneity was noted in the subgroup analysis (I2 >50%). CONCLUSION High- to moderate-quality evidence indicates that cupping significantly improves pain and disability. The effectiveness of cupping for LBP varies based on treatment durations, cupping types, treatment locations, and LBP classifications. Cupping demonstrated a superior and sustained effect on pain reduction compared with medication and usual care. The notable heterogeneity among studies raises concerns about the certainty of these findings. Further research should be designed with a standardized cupping manipulation that specifies treatment sessions, frequency, cupping types, and treatment locations. The actual therapeutic effects of cupping could be confirmed by using objective pain assessments. Studies with at least six- to twelve-month follow-ups are needed to investigate the long-term efficacy of cupping in managing LBP. TRIAL REGISTRATION This systematic review was initially registered on PROSPERO with registration code: CRD42021271245 on 08 September 2021.
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Affiliation(s)
- Zixin Zhang
- University of Nottingham, Nottingham NG7 2RD, United Kingdom; University of Sydney, Faculty of Medicine and Health, Institute of Musculoskeletal Health.
| | - Mahesh Pasapula
- University of Nottingham, Nottingham NG7 2RD, United Kingdom.
| | - Zelu Wang
- University of Nottingham, Nottingham NG7 2RD, United Kingdom.
| | | | - Alan Norrish
- University of Nottingham, Nottingham NG7 2RD, United Kingdom.
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Buonanno P, Iacovazzo C, Marra A, de Siena AU, Josu T, Zampi M, Sedda D, Servillo G, Vargas M. Potential Role of Focal Microvibration (Equistasi ®) in the Management of Chronic Pain: A Pilot Study. Pain Ther 2024; 13:185-198. [PMID: 38057548 PMCID: PMC10796875 DOI: 10.1007/s40122-023-00562-6] [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: 09/21/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Chronic pain is one of the leading causes of medical consultation with a dramatic psychophysical and socioeconomic impact. Focal microvibration (Equistasi®) is a revolutionary technology that converts the thermal energy of the skin into vibration. Equistasi® was shown to be effective in the treatment of gait and balance dysfunction in many pathological conditions such as Parkinson's disease and multiple sclerosis. Our aim was to explore the efficacy of focal microvibration in the management of chronic pain. METHODS We randomized 60 patients with pain of different origin into two groups: an experimental group (group E) treated with Equistasi, and a control group (group C) treated with standard pharmacological therapy. Pain, disability, and working capacity were evaluated by Brief Pain Inventory (BPI), Oswestry Disability Index (ODI), and Work Ability Index (WAI) at the baseline and after 7 (T7), 15 (T15), 30 (T30), 60 (T60), and 90 (T90) days. RESULTS According to BPI, average and worst pain in the last 24 h significantly decreased in group E at T15 and this result persisted up to T90; pain interference on general activity, mood, waling ability, normal work, relations with other people, sleep, and enjoyment of life decreased in group E with a significant improvement from T15. Lifting activity and work ability in relation to demands also significantly improved in group E. No significant changes in BPI, ODI, and WAI scores were recorded in group C during the follow-up. CONCLUSIONS Focal microvibration can be an effective tool for managing chronic pain in combination with other therapies.
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Affiliation(s)
- Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Andrea Uriel de Siena
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Tatiana Josu
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Maddalena Zampi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Davide Sedda
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
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Hasriadi, Dasuni Wasana PW, Thongphichai W, Samun Y, Sukrong S, Towiwat P. Curcuma latifolia Roscoe extract reverses inflammatory pain in mice and offers a favorable CNS safety profile. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:116877. [PMID: 37442490 DOI: 10.1016/j.jep.2023.116877] [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: 05/19/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Curcuma latifolia Roscoe, a plant in the Curcuma genus, has been used as a food additive and folk medicine in Thailand to treat pelvic pain and improve premenstrual syndrome. Although it has been used for centuries, no scientific studies have proved its potential effects on inflammatory pain and central nervous system (CNS) safety profiles. AIM OF THE STUDY This study aimed to evaluate the potential effects of the ethanolic extract of C. latifolia rhizome on inflammatory pain in mice, together with its CNS safety profiles. MATERIALS AND METHODS First, network pharmacology was employed to identify the role of bioactive constituents in C. latifolia on inflammatory pain. In addition, in vitro pharmacology was also evaluated to confirm the anti-inflammatory activity of C. latifolia extract at cellular levels in activated macrophages and microglia. Furthermore, the efficacy of the plant extract in attenuating formalin-induced pain-like behaviors in mice was evaluated. Mice were orally administered the extract (125, 250, 500 mg/kg) followed by the measurement of formalin-induced pain-like behaviors. The LABORAS automated behavioral analysis and rotarod test were used to assess potential CNS side effects of C. latifolia extract (500 mg/kg) in mice. RESULTS The results demonstrated that major bioactive constituents present in C. latifolia have the ability to regulate multiple targets, biological processes and pathways associated with inflammatory pain as assessed by network pharmacology. C. latifolia modulated peripheral and central immune cells via reducing proinflammatory mediators (NO, TNF-α, and IL-6). C. latifolia extract improved formalin-induced pain-like behaviors in a dose-dependent manner during phase II of the formalin test. The efficacy of the plant extract at doses of 250 and 500 mg/kg was comparable to that of the positive control (indomethacin 10 mg/kg). Furthermore, the highest therapeutic dose of the extract did not affect motor coordination, exploratory behaviors, general behaviors, and overall well-being of mice, indicating no development of potential CNS adverse effects after administration of the extract. CONCLUSION These findings provide novel perspectives on using C. latifolia extract for pain management, considering its therapeutic efficacy and CNS safety.
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Affiliation(s)
- Hasriadi
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, 10330, Bangkok, Thailand.
| | - Peththa Wadu Dasuni Wasana
- Pharmaceutical Sciences and Technology Program, Faculty of Pharmaceutical Sciences, Chulalongkorn University, 10330, Bangkok, Thailand; Department of Pharmacy, Faculty of Allied Health Sciences, University of Ruhuna, Galle, 80000, Sri Lanka.
| | - Wisuwat Thongphichai
- Center of Excellence in DNA Barcoding of Thai Medicinal Plants, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Yodsagon Samun
- Center of Excellence in DNA Barcoding of Thai Medicinal Plants, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Suchada Sukrong
- Center of Excellence in DNA Barcoding of Thai Medicinal Plants, Chulalongkorn University, Bangkok, 10330, Thailand; Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Pasarapa Towiwat
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, 10330, Bangkok, Thailand; Natural Products for Ageing and Chronic Diseases Research Unit, Chulalongkorn University, Bangkok, 10330, Thailand.
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Zhu C, Lan X, Wei Z, Yu J, Zhang J. Allosteric modulation of G protein-coupled receptors as a novel therapeutic strategy in neuropathic pain. Acta Pharm Sin B 2024; 14:67-86. [PMID: 38239234 PMCID: PMC10792987 DOI: 10.1016/j.apsb.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/09/2023] [Accepted: 07/12/2023] [Indexed: 01/22/2024] Open
Abstract
Neuropathic pain is a debilitating pathological condition that presents significant therapeutic challenges in clinical practice. Unfortunately, current pharmacological treatments for neuropathic pain lack clinical efficacy and often lead to harmful adverse reactions. As G protein-coupled receptors (GPCRs) are widely distributed throughout the body, including the pain transmission pathway and descending inhibition pathway, the development of novel neuropathic pain treatments based on GPCRs allosteric modulation theory is gaining momentum. Extensive research has shown that allosteric modulators targeting GPCRs on the pain pathway can effectively alleviate symptoms of neuropathic pain while reducing or eliminating adverse effects. This review aims to provide a comprehensive summary of the progress made in GPCRs allosteric modulators in the treatment of neuropathic pain, and discuss the potential benefits and adverse factors of this treatment. We will also concentrate on the development of biased agonists of GPCRs, and based on important examples of biased agonist development in recent years, we will describe universal strategies for designing structure-based biased agonists. It is foreseeable that, with the continuous improvement of GPCRs allosteric modulation and biased agonist theory, effective GPCRs allosteric drugs will eventually be available for the treatment of neuropathic pain with acceptable safety.
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Affiliation(s)
- Chunhao Zhu
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
- School of Basic Medical Science, Ningxia Medical University, Yinchuan 750004, China
| | - Xiaobing Lan
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
| | - Zhiqiang Wei
- Medicinal Chemistry and Bioinformatics Center, Ocean University of China, Qingdao 266100, China
| | - Jianqiang Yu
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
| | - Jian Zhang
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
- Medicinal Chemistry and Bioinformatics Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing 210023, China
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Kvarstein G, Kindlundh-Högberg AM, Ould Setti M, Namane R, Muzwidzwa R, Richter H, Hakkarainen KM. An observational post-authorization safety study (PASS) of naloxegol drug utilization in four European countries. Pharmacoepidemiol Drug Saf 2024; 33:e5710. [PMID: 37969030 DOI: 10.1002/pds.5710] [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: 03/24/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Naloxegol has been shown to be an efficient alternative to treat opioid-induced constipation (OIC). This study aimed at describing the characteristics of naloxegol users and assessing patterns of naloxegol use and associated factors. METHODS This drug utilization cohort study used observational registry data on patients newly prescribed naloxegol in four European countries. Patient characteristics and patterns of naloxegol use and associated factors were described. RESULTS A total of 17 254 naloxegol users were identified across the countries. Their median age was 56-71 years, and each country had a majority of women (ranging 57.5%-62.9%). Multiple comorbidities, including cancer, were common. Natural opium alkaloids and osmotically acting laxatives (excluding saline) were the most frequently used opioids and laxatives. Overall prior use of opioids ranged from 91.9% to 99.6% and overall prior use of laxatives ranged from 69.9% to 92.4%. Up to 77.7% had prior use of medications with interaction potential, and up to 44.5% used them concurrently with naloxegol. Naloxegol was discontinued by 55.1%-90.9% of users, typically during the first 30 days. Approximately 10%-30% switched to or augmented the treatment with another constipation medication or restarted naloxegol after discontinuation. Augmentation with another constipation medication was relatively common, suggesting that naloxegol was used for multifactorial constipation. CONCLUSION The present study reflects real-world clinical use of naloxegol, including in vulnerable patient groups. Some naloxegol users lacked laxative or regular opioid use within six months before index date or used naloxegol concomitantly with medications presenting an interaction potential.
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Affiliation(s)
- Gunnvald Kvarstein
- Institute for Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | - Mounir Ould Setti
- Global Database Studies, Real World Solutions, IQVIA, Espoo, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Rafik Namane
- Kyowa Kirin International plc, Galabank Business Park, Galashiels, UK
| | | | - Hartmut Richter
- Epidemiology, Real World Solutions, IQVIA, Frankfurt/Main, Germany
| | - Katja M Hakkarainen
- Global Database Studies, Real World Solutions, IQVIA, Mölndal, Sweden
- Epidemiology & Real-World Science, RWE Scientific Affairs, Parexel International, Gothenburg, Sweden
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Nielsen SS, Skou ST, Larsen AE, Polianskis R, Arendt-Nielsen L, Østergaard AS, Kjær-Staal Petersen K, Vægter HB, Søndergaard J, Christensen JR. Changes in pain, daily occupations, lifestyle, and health following an occupational therapy lifestyle intervention: a secondary analysis from a feasibility study in patients with chronic high-impact pain. Scand J Pain 2024; 24:sjpain-2023-0043. [PMID: 38037749 DOI: 10.1515/sjpain-2023-0043] [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: 03/30/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES This study explored changes in pain-related parameters, occupational function, occupational balance, lifestyle factors, and self-perceived health status in adults with chronic high-impact pain participating in an occupational therapy lifestyle intervention. METHODS This one-group longitudinal feasibility study was performed in three continuous feasibility rounds. The occupational therapists-led intervention targeted meaningful occupations, regular physical activity, and a healthy diet. The intervention contained individual and group sessions and was added to the standard multidisciplinary chronic pain treatment. Outpatients (n=40, 85 % females, 46.6 ± 10.9 years old) participated in the study between April 2019 and December 2021. The analysis includes data for 31 participants. Analysis of pre-post changes assessed after each feasibility round were performed for the outcomes: pain intensity, pain sensitivity and pain modulation (pressure pain threshold and tolerance, temporal summation of pain and conditioned pain modulation), pain self-efficacy, pain catastrophizing, motor and process skills, occupational balance, daily wake-time movement, daily walking steps, body mass index, waist circumference, blood pressure, and self-perceived health status. RESULTS Improvements in motor skills (assessment of motor and process skills score=0.20 (1.37; 1.57), 95 % CI 0.01; 0.38) and temporal summation of pain (-1.19 (2.86; -1.67), 95 % CI -2.16; -0.22), but a decrease in pain tolerance (-7.110 (54.42; 47.32), 95 % CI -13.99; -0.22) were observed. Correlation analysis suggested moderate-to-very strong statistically significant relationships in several outcomes related to pain, health, pain coping, occupational balance, occupational functioning, body anthropometrics, and pain sensitivity. CONCLUSIONS This study suggested that the lifestyle intervention would benefit motor skills while effects on other outcomes were unclear in adults with chronic pain. To confirm the findings, a randomized trial evaluating effectiveness is needed. Ethical committee number: SJ-307 Reg. Clinicaltrials.gov: NCT03903900.
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Affiliation(s)
- Svetlana Solgaard Nielsen
- Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse & Ringsted Hospitals, Slagelse, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse & Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anette Enemark Larsen
- Department of Therapy and Midwifery Studies, Faculty of Health Sciences, University College Copenhagen, Copenhagen, Denmark
| | - Romanas Polianskis
- Multidisciplinary Pain Centre, Department of Anesthesiology, Naestved Hospital, Naestved, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Skov Østergaard
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Henrik Bjarke Vægter
- Pain Research Group/Pain Centre, Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- User Perspectives, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Lançon K, Séguéla P. Dysregulated neuromodulation in the anterior cingulate cortex in chronic pain. Front Pharmacol 2023; 14:1289218. [PMID: 37954846 PMCID: PMC10634228 DOI: 10.3389/fphar.2023.1289218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Chronic pain is a significant global socioeconomic burden with limited long-term treatment options. The intractable nature of chronic pain stems from two primary factors: the multifaceted nature of pain itself and an insufficient understanding of the diverse physiological mechanisms that underlie its initiation and maintenance, in both the peripheral and central nervous systems. The development of novel non-opioidergic analgesic approaches is contingent on our ability to normalize the dysregulated nociceptive pathways involved in pathological pain processing. The anterior cingulate cortex (ACC) stands out due to its involvement in top-down modulation of pain perception, its abnormal activity in chronic pain conditions, and its contribution to cognitive functions frequently impaired in chronic pain states. Here, we review the roles of the monoamines dopamine (DA), norepinephrine (NE), serotonin (5-HT), and other neuromodulators in controlling the activity of the ACC and how chronic pain alters their signaling in ACC circuits to promote pathological hyperexcitability. Additionally, we discuss the potential of targeting these monoaminergic pathways as a therapeutic strategy for treating the cognitive and affective symptoms associated with chronic pain.
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Affiliation(s)
| | - Philippe Séguéla
- Department of Neurology and Neurosurgery, Alan Edwards Centre for Research on Pain, Montréal Neurological Institute, McGill University, Montréal, QC, Canada
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10
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Paladini A, Gharibo C, Khalbous S, Salti A, Ergönenç T, Pasqualucci A, Varrassi G. Looking Back, Moving Forward in Pain Medicine. Cureus 2023; 15:e44716. [PMID: 37809214 PMCID: PMC10552787 DOI: 10.7759/cureus.44716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Pain is an ancient medical complaint and a clinical riddle that has never been entirely solved. Looking back into history was the springboard to a look into the future of pain medicine. This article was based on a series of presentations given in a recent congress (May 2023) and represents the research, views, and opinions of the authors. Opium has been used for millennia to treat pain, but when it gained broad use in the United States in the 1980s and 1990s, it was so vastly overprescribed and mis-prescribed that it led to a public health crisis. This, in turn, led to the reaction where opioids at times were under-prescribed, leaving out many patients who may have benefited from opioids while leaving many legacy pain patients to manage withdrawal on their own and with few analgesic options. Cannabinoids (CB) were likewise widely used for various conditions, including pain, but were outlawed in the 20th century, only to be brought back as a potential analgesic agent. Interventional pain medicine is a developing discipline and has reinforced the concept of the interdisciplinary pain clinic. It plays an increasingly important part in modern medicine overall, especially with the support of ultrasound, for both diagnosis and therapy. Today, the views about pain have changed. Anyone has accepted that pain is not purely a physical phenomenon but a biopsychosocial phenomenon that occurs within a cultural context. Pain management remains a small but vitally important medical subspecialty that is critical from a functional enablement and population health perspective, which is helping to navigate new therapeutic targets, new drugs and routes of administration, greater understanding of pain psychology, and new technologies. Pain control today means early intervention, functional enablement through pain alleviation, educating patients about pain management, and minimizing the transition from acute to chronic pain.
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Affiliation(s)
- Antonella Paladini
- Life, Health, and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
| | - Christopher Gharibo
- Pain Management, New York University (NYU) Langone Health, New York City, USA
| | | | - Ammar Salti
- Anesthesia and Pain Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, ARE
| | - Tolga Ergönenç
- Anesthesia and Reanimation, Morphological Madrid Research Center, Madrid, ESP
- Anesthesia and Reanimation, Akyazi Hospital Pain and Palliative Care, Sakarya, TUR
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11
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Gharibo C, Drewes AM, Breve F, Rekatsina M, Narvaez Tamayo MA, Varrassi G, Paladini A. Iatrogenic Side Effects of Pain Therapies. Cureus 2023; 15:e44583. [PMID: 37790027 PMCID: PMC10545448 DOI: 10.7759/cureus.44583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/02/2023] [Indexed: 10/05/2023] Open
Abstract
Pain regimens, particularly for chronic cancer and noncancer pain, must balance the important analgesic benefits against potential risks. Many effective and frequently used pain control regimens are associated with iatrogenic adverse events. Interventional procedures can be associated with nerve injuries, vascular injuries, trauma to the spinal cord, and epidural abscesses. Although rare, these adverse events are potentially catastrophic. Pharmacologic remedies for pain must also consider potential side effects that can occur even at therapeutic doses of over-the-counter remedies such as paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs. Opioids are effective pain relievers but are associated with many side effects, some of which can be treatment limiting. A prevalent and distressing side effect of opioid therapy is constipation. Opioid-induced constipation is caused by binding to opioid receptors in the gastrointestinal system, making conventional laxatives ineffective. Peripherally acting mu-opioid receptor antagonists are a new drug class that offers the benefits of preserving opioid analgesia without side effects in the gastrointestinal system. An important safety concern, particularly among geriatric patients is the increasingly prevalent condition of polypharmacy. Many senior patients take five or more medications, including some that may be contraindicated in geriatric patients, duplicative of other drugs, have potential pharmacokinetic drug-drug interactions, or may not be the optimal choice for the patient's age and condition. Careful assessment of medications in the elderly, including possibly deprescribing with tapering of certain drugs, may be warranted but should be done systematically and under clinical supervision.
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Affiliation(s)
| | - Asbjørn M Drewes
- Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, DNK
| | - Frank Breve
- Pharmacy, Temple University, Philadelphia, USA
| | | | | | | | - Antonella Paladini
- Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
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12
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Burghle A, Pottegård A, Rasmussen M, Bruun B, Roost Hosbjerg J, Lundby C. Use of analgesics in Denmark: A national survey. Basic Clin Pharmacol Toxicol 2023; 132:321-327. [PMID: 36662830 DOI: 10.1111/bcpt.13837] [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: 04/05/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
People suffering from pain constitute a sizeable and heterogeneous patient group. Conventional oral analgesics are considered a cheap and safe first-line treatment. These drugs are used on both a regular and 'as needed' basis and are often obtained over-the-counter (OTC). We explored patient-reported patterns of use and adverse effects of analgesics in a community pharmacy questionnaire. Eight pharmacies invited persons aged ≥18 years requesting analgesics via prescription or OTC to complete an electronic questionnaire. A total of 2410 participants completed the questionnaire (68% female; 50% ≥ 60 years). Most participants filled a prescription for paracetamol (61%; n = 842) and non-steroidal analgesics (n = 363; 26%). Among OTC users, most obtained paracetamol (61%). Among prescription users, 73% (n = 1114) had their analgesic prescribed for daily use; however, of these only 61% (n = 630) reported using it daily, while 35% (n = 363) reported 'as needed' use. Of all prescriptions, 80% (n = 898) were labelled with the standardized indication 'against pain'. Self-reported indications showed that back pain and muscle/joint pain were the most common indications. Among non-new users of OTC analgesics (n = 841), 17% (n = 141) used their medication daily. Finally, 90% (n = 1658) of all participants reported not experiencing adverse effects. Our findings suggest a need for continuous assessment of analgesic patterns of use after treatment initiation to inform counselling in community pharmacies and elsewhere.
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Affiliation(s)
- Alaa Burghle
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense, Denmark
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
| | - Malthe Rasmussen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Belinda Bruun
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Roost Hosbjerg
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carina Lundby
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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13
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Electromyography-biofeedback for chronic low back pain: A qualitative cohort study. Complement Ther Med 2023; 73:102922. [PMID: 36716896 DOI: 10.1016/j.ctim.2023.102922] [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: 11/02/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND AIMS Surface electromyography-biofeedback (sEMG-BF) may reduce the burden of CLBP by improving physical functioning, sleep, pain catastrophizing, anxiety, and depression. This qualitative study investigated the impact of weekly EMG-BF sessions on adults with CLBP. METHODS Twenty-six individuals with CLBP participated in telephone interviews after completing an 8-week virtual sEMG-BF intervention. Trained interviewers conducted the 10-to-15-minute semi-structured interviews to understand participants' experience with the intervention. Common themes and subthemes were identified and analyzed using MAXQDA 2022 software. RESULTS Participants were predominantly middle-aged females (M = 45, range of 19 - 66) who have had exposure to utilizing conventional therapies such as physical therapy, chiropractor, and massage for the treatment of CLBP. This study focused on participants who reported their experience of the main outcome study which included perceived reductions in CLBP symptoms, including pain and stress, and positive effects on self-awareness and sleep. Three overarching themes emerged and were further divided into subthemes: participants' involvement (virtual experience, accessibility of device, and future recommendations) perceived benefits (participants gained awareness, recommendations for future treatment, met expectations, and implementation), and desire for flexibility (obstacles and COVID-19 Impact). No adverse effects were reported by any of the participants within the study. CONCLUSIONS Both physical and psychological improvements were reported by participants following an sEMG-BF intervention. Specific implementation procedures and critical barriers were identified. In particular, the ability to receive care for CLBP during the COVID-19 pandemic was important to participants.
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14
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Bonin EAC, Lejeune N, Szymkowicz E, Bonhomme V, Martial C, Gosseries O, Laureys S, Thibaut A. Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review. Front Syst Neurosci 2023; 17:1112206. [PMID: 37021037 PMCID: PMC10067681 DOI: 10.3389/fnsys.2023.1112206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.
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Affiliation(s)
- Estelle A. C. Bonin
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre Hospitalier Neurologique (CHN) William Lennox, Saint-Luc Hospital Group, Ottignies-Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Emilie Szymkowicz
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Liège University Hospital, Liège, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSS), University Laval, Québec City, QC, Canada
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- *Correspondence: Aurore Thibaut,
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15
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Lee N, Park GT, Lim JK, Choi EB, Moon HJ, Kim DK, Choi SM, Song YC, Kim TK, Kim JH. Mesenchymal stem cell spheroids alleviate neuropathic pain by modulating chronic inflammatory response genes. Front Immunol 2022; 13:940258. [PMID: 36003384 PMCID: PMC9393760 DOI: 10.3389/fimmu.2022.940258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic neuropathic pain is caused by dysfunction of the peripheral nerves associated with the somatosensory system. Mesenchymal stem cells (MSCs) have attracted attention as promising cell therapeutics for chronic pain; however, their clinical application has been hampered by the poor in vivo survival and low therapeutic efficacy of transplanted cells. Increasing evidence suggests enhanced therapeutic efficacy of spheroids formed by three-dimensional culture of MSCs. In the present study, we established a neuropathic pain murine model by inducing a chronic constriction injury through ligation of the right sciatic nerve and measured the therapeutic effects and survival efficacy of spheroids. Monolayer-cultured and spheroids were transplanted into the gastrocnemius muscle close to the damaged sciatic nerve. Transplantation of spheroids alleviated chronic pain more potently and exhibited prolonged in vivo survival compared to monolayer-cultured cells. Moreover, spheroids significantly reduced macrophage infiltration into the injured tissues. Interestingly, the expression of mouse-origin genes associated with inflammatory responses, Ccl11/Eotaxin, interleukin 1A, tumor necrosis factor B, and tumor necrosis factor, was significantly attenuated by the administration of spheroids compared to that of monolayer. These results suggest that MSC spheroids exhibit enhanced in vivo survival after cell transplantation and reduced the host inflammatory response through the regulation of main chronic inflammatory response-related genes.
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Affiliation(s)
- Nayeon Lee
- Convergence Stem Cell Research Center, Medical Research Institute, Pusan National University, Yangsan, South Korea
- Department of Physiology, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Gyu Tae Park
- Convergence Stem Cell Research Center, Medical Research Institute, Pusan National University, Yangsan, South Korea
- Department of Physiology, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Jae Kyung Lim
- Department of Physiology, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Eun Bae Choi
- Department of Physiology, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Hye Ji Moon
- Department of Physiology, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Dae Kyoung Kim
- Department of Physiology, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Seong Min Choi
- Department of Physiology, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Young Cheol Song
- Department of Physiology, School of Medicine, Pusan National University, Yangsan, South Korea
| | - Tae Kyun Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jae Ho Kim
- Convergence Stem Cell Research Center, Medical Research Institute, Pusan National University, Yangsan, South Korea
- Department of Physiology, School of Medicine, Pusan National University, Yangsan, South Korea
- *Correspondence: Jae Ho Kim,
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Hasriadi, Dasuni Wasana PW, Suwattananuruk P, Thompho S, Thitikornpong W, Vajragupta O, Rojsitthisak P, Towiwat P. Curcumin Diethyl γ-Aminobutyrate, a Prodrug of Curcumin, for Enhanced Treatment of Inflammatory Pain. ACS Pharmacol Transl Sci 2022; 5:774-790. [PMID: 36110378 PMCID: PMC9469498 DOI: 10.1021/acsptsci.2c00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 11/30/2022]
Abstract
Curcumin is a naturally occurring polyphenol compound with potential analgesic effects. It has been shown to improve pain-like behaviors in numerous models of pain. Despite its potential, curcumin exhibits poor physicochemical and pharmacokinetic properties, which hinder its oral therapeutic efficacy. Curcumin diethyl γ-aminobutyrate (CUR-2GE), a carbamate prodrug of curcumin, was designed to overcome these limitations and demonstrated greater anti-neuroinflammatory effects compared to curcumin in vitro. Thus, this study evaluated the effect of CUR-2GE and its parent compound on pain-like behaviors in carrageenan- and LPS-induced mouse models. The possible side effects of CUR-2GE were also assessed by exploring its effects on motor coordination and spontaneous locomotor activity after acute and chronic treatments. The results showed that CUR-2GE improved mechanical and thermal hyperalgesia and locomotor activity to a greater extent than curcumin in carrageenan-induced mice. These results are in line with the ability of CUR-2GE to suppress peripheral inflammation in the paw tissue of carrageenan-induced mice, indicated by a significant decrease in TNF-α and IL-6 expression levels. Similarly, in LPS-induced mice, CUR-2GE improved sickness and pain-like behaviors (exploratory behaviors and long-term locomotor activity) to a greater extent than curcumin. Furthermore, CUR-2GE significantly reduced the level of proinflammatory cytokines in both the plasma and spinal cord tissue of LPS-induced mice, exhibiting significantly higher inhibition than curcumin. Moreover, the motor coordination, and locomotive behaviors of mice were not affected by both acute and chronic administration of CUR-2GE, indicating no potential CNS side effects. Thus, CUR-2GE demonstrated enhanced therapeutic efficacy in mouse models of inflammatory pain without any possible CNS side effects, suggesting its potential to be developed as an analgesic agent against inflammatory pain.
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Affiliation(s)
- Hasriadi
- Center of Excellence in Natural Products for Ageing and Chronic Diseases, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Peththa Wadu Dasuni Wasana
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
- Pharmaceutical Sciences and Technology Program, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Piyapan Suwattananuruk
- Pharmaceutical Sciences and Technology Program, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Somphob Thompho
- Pharmaceutical Research Instrument Center, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Worathat Thitikornpong
- Center of Excellence in Natural Products for Ageing and Chronic Diseases, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Opa Vajragupta
- Center of Excellence in Natural Products for Ageing and Chronic Diseases, Chulalongkorn University, Bangkok 10330, Thailand
- Molecular Probes for Imaging Research Network Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pornchai Rojsitthisak
- Center of Excellence in Natural Products for Ageing and Chronic Diseases, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pasarapa Towiwat
- Center of Excellence in Natural Products for Ageing and Chronic Diseases, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
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Bicego A, Rousseaux F, Faymonville ME, Nyssen AS, Vanhaudenhuyse A. Neurophysiology of hypnosis in chronic pain: A review of recent literature. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2022; 64:62-80. [PMID: 34748463 DOI: 10.1080/00029157.2020.1869517] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Chronic pain is a complex phenomenon which includes biological, psychological, and socio-professional factors that undermine patients' everyday life. Currently, only few patients significantly benefit from pharmacological treatments and many have to stop them because of negative side effects. Moreover, no medication or treatment addresses all aspects of chronic pain at once (i.e., sensations, emotions, behaviors, and cognitions), positioning chronic pain as an important public health issue and thus contributing to high health-care costs. Consequently, patients and health-care providers are increasingly turning to complementary non-pharmacological techniques such as hypnosis. Clinical research has demonstrated a decrease of pain perception, pain interference, depression and anxiety, and an increase in global quality of life when patients with chronic pain have benefited from hypnosis learning. Neuroimaging studies offer a possible explanation of these results by focusing on neural processes of pain modulation in chronic pain patients' brain. Studies conducted with chronic pain patients showed a modulation of pain matrix activity during hypnosis with a specific involvement of the anterior cingulate cortex (related to emotional and cognitive processing of pain). Therefore, hypnosis seems to act upon regions underlying emotion and cognition, with an influence on pain perception and emotional regulation. In this review, we propose to carry out a review of the recent literature on hypnosis in chronic pain management. A better understanding of the beneficial effects of hypnosis on chronic pain and its neurophysiology should enable more systematic use of this technique in the management of this complex health problem.
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Affiliation(s)
- Aminata Bicego
- Sensation & Perception Research Group, GIGA Consciousness, University of Liège
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium
| | - Floriane Rousseaux
- Sensation & Perception Research Group, GIGA Consciousness, University of Liège
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium
| | - Marie-Elisabeth Faymonville
- Algology Department, University Hospital of Liège, Liège, Belgium
- Sensation & Perception Research Group, GIGA Consciousness, University of Liège
| | - Anne-Sophie Nyssen
- Sensation & Perception Research Group, GIGA Consciousness, University of Liège
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- Algology Department, University Hospital of Liège, Liège, Belgium
- Sensation & Perception Research Group, GIGA Consciousness, University of Liège
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18
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Nielsen SS, Skou ST, Larsen AE, Søndergaard J, Christensen JR. Associations of health-related quality of life with sociodemographic characteristics, health, pain, and lifestyle factors, and motivation for changing lifestyle in adults living with chronic pain: a cross-sectional exploratory study. Scand J Pain 2022; 22:142-153. [PMID: 34449176 DOI: 10.1515/sjpain-2021-0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/09/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We investigated the associations between health-related quality of life (HRQoL) and health, pain and lifestyle factors, as well as motivation for lifestyle changes, in adults living with chronic pain referred to a Danish pain centre. METHODS A total of 144 outpatients completed a questionnaire on HRQoL (EQ-5D-5L), health, pain, lifestyle factors (Body Mass Index [BMI], physical activity, smoking, alcohol, physical fitness, eating, sleep and stress) and motivation for lifestyle changes. We used multiple linear regression analyses to assess associations between HRQoL and the independent variables. RESULTS The participants (age mean 50 years, 81% females) had ≥2 body pain sites (93%), BMI≥25 (64%), sedentary lifestyle (43%) and multiple (n≥2) elevated metabolic risk factors (58%). Most considered lifestyle important for HRQoL (72%) and expressed moderate to very high motivation for changing lifestyle (92%). Poorer HRQoL in the study population was significantly associated with higher pain intensity in the most painful body site (β=-0.316, p=0.001) and very poor sleep quality (β=-0.410, p=0.024). Serious-to-extreme problems in usual activities were associated with significantly poorer health (β=-0.328, p=0.030). CONCLUSIONS Adults living with chronic pain participating in this survey had significantly lower self-evaluated HRQoL than the general population. Lower HRQoL was significantly associated with greater pain intensity and poor sleep quality. Serious-to-extreme problems in usual activities, such as work, study, housework, family and leisure, were associated with poorer self-evaluated health. We observed high frequencies of overweight, obesity, sedentary lifestyle, pain in multiple body sites and multiple lifestyle-related risk factors in the study population. Most participants felt motivated for changing lifestyle. Further interventions addressing pain alleviation, sleep quality, prevention of problems in usual activities and promotion of healthy lifestyle, e.g. physical activity and healthy eating, are needed to estimate the effect of a lifestyle-oriented approach on health and quality of life in people living with chronic pain. The results of this study will inform the research project reg. SJ-703, the Danish the Research Ethics Committee for Region Zealand, Denmark.
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Affiliation(s)
- Svetlana Solgaard Nielsen
- Research Unit of User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse & Ringsted Hospitals, Slagelse, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse & Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anette Enemark Larsen
- Department of Occupational Therapy, Institute of Therapy and Midwifery Studies, Faculty of Health Sciences, University College Copenhagen, Copenhagen, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit of User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Beating Pain with Psychedelics: Matter over Mind? Neurosci Biobehav Rev 2021; 134:104482. [PMID: 34922987 DOI: 10.1016/j.neubiorev.2021.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 02/08/2023]
Abstract
Basic pain research has shed light on key cellular and molecular mechanisms underlying nociceptive and phenomenological aspects of pain. Despite these advances, [[we still yearn for] the discovery of novel therapeutic strategies to address the unmet needs of about 70% of chronic neuropathic pain patients whose pain fails to respond to opioids as well as to other conventional analgesic agents. Importantly, a substantial body of clinical observations over the past decade cumulatively suggests that the psychedelic class of drugs may possess heuristic value for understanding and treating chronic pain conditions. The present review presents a theoretical framework for hitherto insufficiently understood neuroscience-based mechanisms of psychedelics' potential analgesic effects. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain, analgesia, inflammatory, brain connectivity, ketamine, psilocybin, functional imaging, and dendrites. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) studies employing psychedelics for alleviation of physical and emotional pain; (2) potential neuro-restorative effects of psychedelics to remediate the impaired connectivity underlying the dissociation between pain-related conscious states/cognitions and the subcortical activity/function leading to the eventual chronicity through immediate and long-term effects on dentritic plasticity; (3) anti-neuroinflammatory and pro-immunomodulatory actions of psychedelics as the may pertain to the role of these factors in the pathogenesis of neuropathic pain; (4) safety, legal, and ethical consideration inherent in psychedelics' pharmacotherapy. In addition to direct beneficial effects in terms of reduction of pain and suffering, psychedelics' inclusion in the analgesic armamentarium will contribute to deeper and more sophisticated insights not only into pain syndromes but also into frequently comorbid psychiatric condition associated with emotional pain, e.g., depressive and anxiety disorders. Further inquiry is clearly warranted into the above areas that have potential to evolve into further elucidate the mechanisms of chronic pain and affective disorders, and lead to the development of innovative, safe, and more efficacious neurobiologically-based therapeutic approaches.
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Barroso J, Branco P, Apkarian AV. Brain mechanisms of chronic pain: critical role of translational approach. Transl Res 2021; 238:76-89. [PMID: 34182187 PMCID: PMC8572168 DOI: 10.1016/j.trsl.2021.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 01/15/2023]
Abstract
Chronic pain is a leading cause of disability worldwide and its prevalence is likely to increase over the next decades. Treatment for chronic pain remains insufficient and therapeutical advances have not made comparable progress with that for many chronic disorders, thus amplifying the concern on the future burden of the disease. At the same time, and even after decades of intense research, the underlying pathophysiology of chronic pain remains minimally understood. We believe advancing our current understanding of chronic pain requires mechanistically explicit, hypothesis-driven, and clinically focused models. In this review we highlight some of the main findings over the last decades that have contributed to the present knowledge of brain mechanisms of chronic pain, and how such advances were possible due to a reverse translational research approach. We argue that this approach is essential in the chronic pain field, in order to generate new scientific hypotheses, probe physiological mechanisms, develop therapeutic strategies and translate findings back into promising human clinical trials.
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Affiliation(s)
- Joana Barroso
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Center for Chronic Pain and Drug Abuse, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Paulo Branco
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Center for Chronic Pain and Drug Abuse, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Apkar Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Center for Chronic Pain and Drug Abuse, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
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21
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Hesam-Shariati N, Chang WJ, Wewege MA, McAuley JH, Booth A, Trost Z, Lin CT, Newton-John T, Gustin SM. The analgesic effect of electroencephalographic neurofeedback for people with chronic pain: A systematic review and meta-analysis. Eur J Neurol 2021; 29:921-936. [PMID: 34813662 DOI: 10.1111/ene.15189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/02/2021] [Accepted: 11/13/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Electroencephalographic (EEG) neurofeedback has been utilized to regulate abnormal brain activity associated with chronic pain. METHODS In this systematic review, we synthesized the evidence from randomized controlled trials (RCTs) to evaluate the effect of EEG neurofeedback on chronic pain using random effects meta-analyses. Additionally, we performed a narrative review to explore the results of non-randomized studies. The quality of included studies was assessed using Cochrane risk of bias tools, and the GRADE system was used to rate the certainty of evidence. RESULTS Ten RCTs and 13 non-randomized studies were included. The primary meta-analysis on nine eligible RCTs indicated that although there is low confidence, EEG neurofeedback may have a clinically meaningful effect on pain intensity in short-term. Removing the studies with high risk of bias from the primary meta-analysis resulted in moderate confidence that there remained a clinically meaningful effect on pain intensity. We could not draw any conclusion from the findings of non-randomized studies, as they were mostly non-comparative trials or explorative case series. However, the extracted data indicated that the neurofeedback protocols in both RCTs and non-randomized studies mainly involved the conventional EEG neurofeedback approach, which targeted reinforcing either alpha or sensorimotor rhythms and suppressing theta and/or beta bands on one brain region at a time. A posthoc analysis of RCTs utilizing the conventional approach resulted in a clinically meaningful effect estimate for pain intensity. CONCLUSION Although there is promising evidence on the analgesic effect of EEG neurofeedback, further studies with larger sample sizes and higher quality of evidence are required.
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Affiliation(s)
- Negin Hesam-Shariati
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Wei-Ju Chang
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Chin-Teng Lin
- Faculty of Engineering and Information Technology, Australian Artificial Intelligence Institute, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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22
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Mari T, Henderson J, Maden M, Nevitt S, Duarte R, Fallon N. Systematic Review of the Effectiveness of Machine Learning Algorithms for Classifying Pain Intensity, Phenotype or Treatment Outcomes Using Electroencephalogram Data. THE JOURNAL OF PAIN 2021; 23:349-369. [PMID: 34425248 DOI: 10.1016/j.jpain.2021.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
Recent attempts to utilize machine learning (ML) to predict pain-related outcomes from Electroencephalogram (EEG) data demonstrate promising results. The primary aim of this review was to evaluate the effectiveness of ML algorithms for predicting pain intensity, phenotypes or treatment response from EEG. Electronic databases MEDLINE, EMBASE, Web of Science, PsycINFO and The Cochrane Library were searched. A total of 44 eligible studies were identified, with 22 presenting attempts to predict pain intensity, 15 investigating the prediction of pain phenotypes and seven assessing the prediction of treatment response. A meta-analysis was not considered appropriate for this review due to heterogenos methods and reporting. Consequently, data were narratively synthesized. The results demonstrate that the best performing model of the individual studies allows for the prediction of pain intensity, phenotypes and treatment response with accuracies ranging between 62 to 100%, 57 to 99% and 65 to 95.24%, respectively. The results suggest that ML has the potential to effectively predict pain outcomes, which may eventually be used to assist clinical care. However, inadequate reporting and potential bias reduce confidence in the results. Future research should improve reporting standards and externally validate models to decrease bias, which would increase the feasibility of clinical translation. PERSPECTIVE: This systematic review explores the state-of-the-art machine learning methods for predicting pain intensity, phenotype or treatmentresponse from EEG data. Results suggest that machine learning may demonstrate clinical utility, pending further research and development. Areas for improvement, including standardized processing, reporting and the need for better methodological assessment tools, are discussed.
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Affiliation(s)
- Tyler Mari
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | | | - Michelle Maden
- Department of Health Data Science, Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Health Data Science, Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rui Duarte
- Department of Health Data Science, Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychology, University of Liverpool, Liverpool, UK
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Mechanistic Insight into the Effects of Curcumin on Neuroinflammation-Driven Chronic Pain. Pharmaceuticals (Basel) 2021; 14:ph14080777. [PMID: 34451874 PMCID: PMC8397941 DOI: 10.3390/ph14080777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/22/2022] Open
Abstract
Chronic pain is a persistent and unremitting condition that has immense effects on patients' quality of life. Studies have shown that neuroinflammation is associated with the induction and progression of chronic pain. The activation of microglia and astrocytes is the major hallmark of spinal neuroinflammation leading to neuronal excitability in the projection neurons. Excessive activation of microglia and astrocytes is one of the major contributing factors to the exacerbation of pain. However, the current chronic pain treatments, mainly by targeting the neuronal cells, remain ineffective and unable to meet the patients' needs. Curcumin, a natural plant product found in the Curcuma genus, improves chronic pain by diminishing the release of inflammatory mediators from the spinal glia. This review details the role of curcumin in microglia and astrocytes both in vitro and in vivo and how it improves pain. We also describe the mechanism of curcumin by highlighting the major glia-mediated cascades in pain. Moreover, the role of curcumin on inflammasome and epigenetic regulation is discussed. Furthermore, we discuss the strategies used to improve the efficacy of curcumin. This review illustrates that curcumin modulating microglia and astrocytes could assure the treatment of chronic pain by suppressing spinal neuroinflammation.
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Bicego A, Monseur J, Collinet A, Donneau AF, Fontaine R, Libbrecht D, Malaise N, Nyssen AS, Raaf M, Rousseaux F, Salamun I, Staquet C, Teuwis S, Tomasella M, Faymonville ME, Vanhaudenhuyse A. Complementary treatment comparison for chronic pain management: A randomized longitudinal study. PLoS One 2021; 16:e0256001. [PMID: 34358272 PMCID: PMC8345881 DOI: 10.1371/journal.pone.0256001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background In chronic pain, it seems that the effect of cognitive-behavioral therapy (CBT) is boosted when it is combined with hypnosis. The aim of this study was to assess the efficacy of self-hypnosis combined with self-care (i.e., a type of CBT) compared to music/self-care, self-care and psychoeducation/CBT and to evaluate their long-term effects. Methods An open label randomized clinical trial enrolled patients with chronic pain and was carried out at the University Hospital of Liège (Belgium). Patients were randomized into four groups: self-hypnosis/self-care, music/self-care, self-care, psychoeducation/CBT (7 monthly sessions of 2 hours). Two follow-up sessions were delivered at 6- and 12-month. Levels of pain, fatigue intensity, anxiety, depression, insomnia severity, disability, health locus of control, mental and physical quality of life and attitudes (control, disability, harm, emotion, medical cure, medication, solicitude) towards pain were assessed before and after the treatments, and at follow-up. Results 203 patients were randomized: 52 in self-hypnosis/self-care, 59 in music/self-care, 47 in self-care, and 45 in psychoeducation/CBT. No group effect was found. A significant time effect was showed. Directly after the treatment, all groups decreased in pain attitudes and physical quality of life. Perceived control increased. At 6-month, all patients kept their levels of physical quality of life and perceived control, and showed decrease in pain intensity, harm, emotion and medical cure. At 12-month, scores that had change previously remained ameliorated, a decrease in insomnia severity and an increase in internal locus of control were observed. Conclusions The present findings are encouraging as they display long-term beneficial effects of complementary biopsychosocial-based treatments in chronic pain. It seems that patients continued to apply the learnt strategies as improvements were observed one year after the treatments had ended.
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Affiliation(s)
- Aminata Bicego
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Cognitive Ergonomy and Work Intervention Department, University of Liège, Liège, Belgium
- * E-mail: (AB); (AV)
| | - Justine Monseur
- Public Health Department, Biostatistics, University of Liège, Liège, Belgium
| | | | | | - Robert Fontaine
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Dominique Libbrecht
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Nicole Malaise
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Anne-Sophie Nyssen
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Cognitive Ergonomy and Work Intervention Department, University of Liège, Liège, Belgium
| | - Mélissa Raaf
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Floriane Rousseaux
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Cognitive Ergonomy and Work Intervention Department, University of Liège, Liège, Belgium
| | - Irène Salamun
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Cécile Staquet
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Sandrine Teuwis
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Marco Tomasella
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Marie-Elisabeth Faymonville
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
- * E-mail: (AB); (AV)
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25
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Lelic D, Olesen AE, Grønlund D, Jure FA, Drewes AM. Opioid Specific Effects on Central Processing of Sensation and Pain: A Randomized, Cross-Over, Placebo-Controlled Study. THE JOURNAL OF PAIN 2021; 22:1477-1496. [PMID: 34229074 DOI: 10.1016/j.jpain.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Moderate to severe pain is often treated with opioids, but central mechanisms underlying opioid analgesia are poorly understood. Findings thus far have been contradictory and none could infer opioid specific effects. This placebo-controlled, randomized, 2-way cross-over, double-blinded study aimed to explore opioid specific effects on central processing of external stimuli. Twenty healthy male volunteers were included and 3 sets of assessments were done at each of the 2 visits: 1) baseline, 2) during continuous morphine or placebo intravenous infusion and 3) during simultaneous morphine + naloxone or placebo infusion. Opioid antagonist naloxone was introduced in order to investigate opioid specific effects by observing which morphine effects are reversed by this intervention. Quantitative sensory testing, spinal nociceptive withdrawal reflexes (NWR), spinal electroencephalography (EEG), cortical EEG responses to external stimuli and resting EEG were measured and analyzed. Longer lasting pain (cold-pressor test - hand in 2° water for 2 minutes, tetanic electrical), deeper structure pain (bone pressure) and strong nociceptive (NWR) stimulations were the most sensitive quantitative sensory testing measures of opioid analgesia. In line with this, the principal opioid specific central changes were seen in NWRs, EEG responses to NWRs and cold-pressor EEG. The magnitude of NWRs together with amplitudes and insular source strengths of the corresponding EEG responses were attenuated. The decreases in EEG activity were correlated to subjective unpleasantness scores. Brain activity underlying slow cold-pressor EEG (1-4Hz) was decreased, whereas the brain activity underlying faster EEG (8-12Hz) was increased. These changes were strongly correlated to subjective pain relief. This study points to evidence of opioid specific effects on perception of external stimuli and the underlying central responses. The analgesic response to opioids is likely a synergy of opioids acting at both spinal and supra-spinal levels of the central nervous system. Due to the strong correlations with pain relief, the changes in EEG signals during cold-pressor test have the potential to serve as biomarkers of opioid analgesia. PERSPECTIVE: This exploratory study presents evidence of opioid specific effects on the pain system at peripheral and central levels. The findings give insights into which measures are the most sensitive for assessing opioid-specific effects.
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Affiliation(s)
- Dina Lelic
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
| | - Anne Estrup Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Debbie Grønlund
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Fabricio Ariel Jure
- Integrative Neuroscience, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Dubray C, Maincent P, Milon JY. From the pharmaceutical to the clinical: the case for effervescent paracetamol in pain management. A narrative review. Curr Med Res Opin 2021; 37:1039-1048. [PMID: 33819115 DOI: 10.1080/03007995.2021.1902297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Paracetamol has an established place in the management of mild-to-moderate pain, but has certain limitations, including varying bioavailability, and potential hepatotoxicity if taken in overdose. Effervescent formulations may help to overcome these limitations. METHODS Pubmed searches, with no limits on date or language, were conducted in February 2020. Further references were identified from the reference lists of retrieved articles, and from the authors' knowledge of the field. RESULTS Effervescent formulations contain an organic acid (usually citric acid) and carbonate or bicarbonate salts (usually sodium bicarbonate). Upon contact with water, these react to form carbon dioxide, which facilitates the disintegration of the tablet and dissolution of the active drug. Moreover, sodium bicarbonate dose-dependently increases gastric emptying, which together with rapid dissolution facilitates drug absorption. In pharmacokinetic studies, effervescent formulations result in faster absorption of paracetamol than conventional oral formulations, and this translates into a faster onset of analgesia in clinical trials. Effervescent paracetamol has a favorable safety profile, with good tolerability. Importantly, the sodium content of some preparations does not appear to increase cardiovascular risk under real world conditions. Effervescent formulations may also offer advantages in terms of ease of administration and palatability. CONCLUSIONS Effervescent formulations of paracetamol result in faster drug absorption, and hence more rapid analgesia, than oral tablets, and offer a favorable tolerability and safety profile. The use of such formulations may therefore help to promote appropriate use of paracetamol.
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Affiliation(s)
- Claude Dubray
- Centre d'Investigation Clinique Inserm CIC 1405, NeuroDol UMR 1107, Faculté de Médecine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Philippe Maincent
- Faculty of Pharmacy, Pharmaceutical Technology Department, University of Lorraine, Nancy, France
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Marchand GJ, Azadi A, Sainz K, Masoud A, Anderson S, Ruther S, Ware K, Hopewell S, Brazil G, King A, Vallejo J, Cieminski K, Galitsky A, Osipov R, Steele A, Love J. The Efficacy of Acetominophen for Total Laparoscopic Hysterectomy. JSLS 2021; 25:e2020.00104. [PMID: 34248331 PMCID: PMC8241284 DOI: 10.4293/jsls.2020.00104] [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] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Despite limited data, acetaminophen, along with other agents, is commonly included in enhanced recovery after surgery (ERAS) protocols following laparoscopic hysterectomy. We aimed to systematically review the efficacy of acetaminophen on the management of postoperative pain after laparoscopic hysterectomy. METHODS We searched PubMed, SCOPUS, Web of Science, and Cochrane Library databases for relevant clinical trials investigating the role of acetaminophen in the management of pain after laparoscopic hysterectomy. We performed the risk of bias according to Cochrane's risk of bias tool. We performed the analysis of homogeneous data under the fixed-effects model during the analysis of heterogeneous data under the random-effects model. The primary outcome was the assessment of pain score after 2, 6, 12, and 24 h. RESULTS A total of 495 patients in 13 trials were included in our meta-analysis. Acetaminophen was not superior at reducing postoperative pain scores. Further analysis at progressive temporal points revealed no further significance; effect size at after 2 h (SMD = -0.020, 95% CI (-0.216; 0.176)), 6 h (SMD = -0.115, 95% CI (-0.312; 0.083)), 12 h (SMD = -0.126, 95% CI (-0.277; 0.025)), or 24 h (SMD = 0.063, 95% CI (-0.065; 0.191)). Pooled analysis was heterogeneous (P < 0.1); therefore, we conducted a sensitivity analysis yielding homogeneous results. The drug did not reduce opioid need (MD = -0.16, 95% CI (-2.39, 2.06), P = 0.89). CONCLUSION We conclude that acetaminophen is not beneficial for reducing pain after laparoscopic hysterectomy. Other alternatives have better results. Caution should be given to the inclusion of acetaminophen in ERAS protocols designed for laparoscopic hysterectomy, especially as a single agent or to reduce opioid consumption.
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Affiliation(s)
- Greg J Marchand
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | | | - Katelyn Sainz
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Ahmed Masoud
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Sienna Anderson
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Stacy Ruther
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Kelly Ware
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Sophia Hopewell
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Giovanna Brazil
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Alexa King
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Jannelle Vallejo
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | | | - Anthony Galitsky
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Robert Osipov
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Allison Steele
- Midwestern University School of Medicine, Glendale, Arizona
| | - Jennifer Love
- Midwestern University School of Medicine, Glendale, Arizona
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Scorsone KL, Haozous EA, Hayes L, Cox KJ. Ending the Chase: Experiences of Rural Individuals with Opioid Use Disorder. Subst Use Misuse 2021; 56:1224-1231. [PMID: 33871309 DOI: 10.1080/10826084.2021.1914109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The US remains in the midst of an opioid overdose epidemic. Given that rural populations have higher rates of opioid-related morbidity and mortality, it is important to understand the factors that perpetuate opioid use and facilitate recovery in rural communities. Purpose: To explore experiences of individuals living with opioid use disorder (OUD) and to analyze these experiences within a broader sociocultural context. Methods: Using a descriptive, qualitative design, we interviewed twenty purposefully sampled participants. We used thematic content analysis to identify themes and patterns. Results: As participants became dependent, the chase for opioids was to avoid the pain of withdrawal. Waking up sick became an everyday experience, leading to a lifestyle of hustling. The pursuit of opioids resulted in physical, social, emotional, and legal consequences that fed a cycle of stigmatization. In recovery, participants learned to embrace a new way of thinking, allowing them to make new choices. The strong influence of family and community in their lives was a key factor in their resiliency and opioid use experiences. Conclusions: Individuals with OUD are impacted by intersecting social, physical, economic and policy factors that reinforce the expansion of the opioid epidemic rurally. This study provided a voice to rural individuals with opioid use disorder, a group often underrepresented in the literature, providing an understanding of their struggles and the unique sociocultural dynamics that exist in rural northern New Mexico. The complex sociocultural relationships to family and community represent important adaptive factors that could support individual healing and community transformation.
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Affiliation(s)
- Krista L Scorsone
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Rueckert-Hartman College for Health Professions, Regis University, Denver, Colorado, USA.,The College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA
| | - Emily A Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Leslie Hayes
- El Centro Family Health, Española, New Mexico, USA
| | - Kim J Cox
- The College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA
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Suso-Ribera C, Castilla D, Zaragozá I, Mesas Á, Server A, Medel J, García-Palacios A. Telemonitoring in Chronic Pain Management Using Smartphone Apps: A Randomized Controlled Trial Comparing Usual Assessment against App-Based Monitoring with and without Clinical Alarms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186568. [PMID: 32916983 PMCID: PMC7559749 DOI: 10.3390/ijerph17186568] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The usefulness of mHealth in helping to target face-to-face interventions for chronic pain more effectively remains unclear. In the present study, we aim to test whether the Pain Monitor mobile phone application (app) is well accepted by clinicians, and can help improve existent medical treatments for patients with chronic musculoskeletal pain. Regarding this last goal, we compared three treatment conditions, namely usual treatment, usual treatment with an app without alarms and usual treatment with an app with alarms. All treatments lasted one month. The three treatments were compared for all outcomes, i.e., pain severity and interference, fatigue, depressed mood, anxiety and anger. METHODS In this randomized controlled trial, the usual monitoring method (i.e., onsite; n = 44) was compared with daily ecological momentary assessment using the Pain Monitor app-both with (n = 43) and without alarms (n = 45). Alarms were sent to the clinicians in the presence of pre-established undesired clinical events and could be used to make treatment adjustments throughout the one-month study. RESULTS With the exception of anger, clinically significant changes (CSC; 30% improvement) were greater in the app + alarm condition across outcomes (e.g., 43.6% of patients experienced a CSC in depressed mood in the app + alarm condition, which occurred in less than 29% of patients in the other groups). The clinicians were willing to use the app, especially the version with alarms. CONCLUSIONS The use of apps may have some benefits in individual health care, especially when using alarms to tailor treatments.
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Affiliation(s)
- Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, 12071 Castellón, Spain;
- Correspondence: ; Tel.: +34-964-387-643
| | - Diana Castilla
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain;
- Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III) (Ciber Physiopathology Obesity and Nutrition, CB06/03 Instituto Salud Carlos III Health Institute), 28029 Madrid, Spain;
| | - Irene Zaragozá
- Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III) (Ciber Physiopathology Obesity and Nutrition, CB06/03 Instituto Salud Carlos III Health Institute), 28029 Madrid, Spain;
| | - Ángela Mesas
- Pain Clinic, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (Á.M.); (A.S.); (J.M.)
| | - Anna Server
- Pain Clinic, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (Á.M.); (A.S.); (J.M.)
| | - Javier Medel
- Pain Clinic, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (Á.M.); (A.S.); (J.M.)
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, 12071 Castellón, Spain;
- Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III) (Ciber Physiopathology Obesity and Nutrition, CB06/03 Instituto Salud Carlos III Health Institute), 28029 Madrid, Spain;
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Staats Pires A, Tan VX, Heng B, Guillemin GJ, Latini A. Kynurenine and Tetrahydrobiopterin Pathways Crosstalk in Pain Hypersensitivity. Front Neurosci 2020; 14:620. [PMID: 32694973 PMCID: PMC7338796 DOI: 10.3389/fnins.2020.00620] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
Despite the identification of molecular mechanisms associated with pain persistence, no significant therapeutic improvements have been made. Advances in the understanding of the molecular mechanisms that induce pain hypersensitivity will allow the development of novel, effective, and safe therapies for chronic pain. Various pro-inflammatory cytokines are known to be increased during chronic pain, leading to sustained inflammation in the peripheral and central nervous systems. The pro-inflammatory environment activates additional metabolic routes, including the kynurenine (KYN) and tetrahydrobiopterin (BH4) pathways, which generate bioactive soluble metabolites with the potential to modulate neuropathic and inflammatory pain sensitivity. Inflammation-induced upregulation of indoleamine 2,3-dioxygenase 1 (IDO1) and guanosine triphosphate cyclohydrolase I (GTPCH), both rate-limiting enzymes of KYN and BH4 biosynthesis, respectively, have been identified in experimental chronic pain models as well in biological samples from patients affected by chronic pain. Inflammatory inducible KYN and BH4 pathways upregulation is characterized by increase in pronociceptive compounds, such as quinolinic acid (QUIN) and BH4, in addition to inflammatory mediators such as interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α). As expected, the pharmacologic and genetic experimental manipulation of both pathways confers analgesia. Many metabolic intermediates of these two pathways such as BH4, are known to sustain pain, while others, like xanthurenic acid (XA; a KYN pathway metabolite) have been recently shown to be an inhibitor of BH4 synthesis, opening a new avenue to treat chronic pain. This review will focus on the KYN/BH4 crosstalk in chronic pain and the potential modulation of these metabolic pathways that could induce analgesia without dependence or abuse liability.
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Affiliation(s)
- Ananda Staats Pires
- Neuroinflammation Group, Department of Biomedical Sciences, Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Vanessa X. Tan
- Neuroinflammation Group, Department of Biomedical Sciences, Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Benjamin Heng
- Neuroinflammation Group, Department of Biomedical Sciences, Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gilles J. Guillemin
- Neuroinflammation Group, Department of Biomedical Sciences, Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alexandra Latini
- Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
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Rekatsina M, Paladini A, Piroli A, Zis P, Pergolizzi JV, Varrassi G. Pathophysiologic Approach to Pain Therapy for Complex Pain Entities: A Narrative Review. Pain Ther 2020; 9:7-21. [PMID: 31902121 PMCID: PMC7203327 DOI: 10.1007/s40122-019-00147-2] [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: 06/20/2019] [Indexed: 12/14/2022] Open
Abstract
Pain management is challenging for both clinicians and patients. In fact, pain patients are frequently undertreated or even completely untreated. Optimal treatment is based on targeting the underlying mechanisms of pain and tailoring the management modality for each patient using a personalized approach. This narrative review deals with pain conditions that have a complex underlying mechanism and need an individualized and frequently multifactorial approach to pain management. The research is based on previously conducted studies, and does not contain any studies with human participants or animals performed by any of the authors. This is not an exhaustive review of the current evidence. However, it provides the clinician with a perspective on pain therapy targeting the underlying pain mechanism(s). When dealing with complex pain conditions, the prudent physician benefits from having a deep knowledge of various underlying pain mechanisms in order to provide a plan for optimal pharmacological pain relief to patients.
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Affiliation(s)
- Martina Rekatsina
- Department of Anaesthesia and Pain Management, King's College Hospital, London, UK
| | | | - Alba Piroli
- Department of MESVA, University of L'Aquila, 67100, L'Aquila, Italy
| | - Panagiotis Zis
- Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Joseph V Pergolizzi
- Director of Analgesic Research Fellowship and COO, NEMA Research Inc., Naples, FL, 34108, USA
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Personality and psychiatric disorders in chronic pain male affected by erectile dysfunction: prospective and observational study. Int J Impot Res 2020; 33:339-347. [PMID: 32382105 DOI: 10.1038/s41443-020-0294-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/24/2020] [Accepted: 04/16/2020] [Indexed: 11/08/2022]
Abstract
The prevalence of personality disorders (PDs) and sexual dysfunction in chronic pain patients is higher than in general population. Our main objective was to analyse the influence of PD in patients with erectile dysfunction and chronic non-cancer pain and their response to andrological treatment. One-hundred one patients were included along 30 months. Pain intensity, quality of life, sexual life quality, anxiety and depression were analysed together with opioid dose. Erectile functioning was measured with the International Index of Erectile Function (IIEF) and PDs with Millon Clinical Multiaxial Inventory (MCMI-III). The mean age was 57 ± 12 years old, with moderate to severe pain, 70% were sexually active and presented moderate to severe ED. PDs were very frequent (31%, cut-off 85 and 84% cut-off 75 scores) mostly anxiety, compulsive, though disorder, somatoform and narcissistic. Self-defeating feature presence was significantly correlated (r = -0.4, 95% CI = -0.605 to -0.145, p = 0.002) with a more severe baseline ED and narcissistic, and a better response to andrological treatment (p = 0.010, d = 1.082). Patients with dysthymia features required significantly higher opioid doses vs. control (238 vs. 102 mg/day, respectively). These findings underline the importance of diagnosing PDs to rigorously treat patients with chronic pain and ED.
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35
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Lara CO, Burgos CF, Moraga-Cid G, Carrasco MA, Yévenes GE. Pentameric Ligand-Gated Ion Channels as Pharmacological Targets Against Chronic Pain. Front Pharmacol 2020; 11:167. [PMID: 32218730 PMCID: PMC7079299 DOI: 10.3389/fphar.2020.00167] [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: 10/18/2019] [Accepted: 02/07/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic pain is a common detrimental condition that affects around 20% of the world population. The current drugs to treat chronic pain states, especially neuropathic pain, have a limited clinical efficiency and present significant adverse effects that complicates their regular use. Recent studies have proposed new therapeutic strategies focused on the pharmacological modulation of G-protein-coupled receptors, transporters, enzymes, and ion channels expressed on the nociceptive pathways. The present work intends to summarize recent advances on the pharmacological modulation of pentameric ligand-gated ion channels, which plays a key role in pain processing. Experimental data have shown that novel allosteric modulators targeting the excitatory nicotinic acetylcholine receptor, as well as the inhibitory GABAA and glycine receptors, reverse chronic pain-related behaviors in preclinical assays. Collectively, these evidences strongly suggest the pharmacological modulation of pentameric ligand-gated ion channels is a promising strategy towards the development of novel therapeutics to treat chronic pain states in humans.
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Affiliation(s)
- César O Lara
- Department of Physiology, Faculty of Biological Sciences, University of Concepcion, Concepcion, Chile
| | - Carlos F Burgos
- Department of Physiology, Faculty of Biological Sciences, University of Concepcion, Concepcion, Chile
| | - Gustavo Moraga-Cid
- Department of Physiology, Faculty of Biological Sciences, University of Concepcion, Concepcion, Chile
| | - Mónica A Carrasco
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Gonzalo E Yévenes
- Department of Physiology, Faculty of Biological Sciences, University of Concepcion, Concepcion, Chile
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Psychological context effects of participant expectation on pain pressure thresholds as an adjunct to cervicothoracic HVLA thrust manipulation: A randomised controlled trial. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Jaén I, Suso-Ribera C, Castilla D, Zaragoza I, García-Palacios A, Gómez Palones JL. Improving chronic pain management with eHealth and mHealth: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e033586. [PMID: 31888939 PMCID: PMC6937108 DOI: 10.1136/bmjopen-2019-033586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Chronic pain has become a matter of public health concern due to its high prevalence and because public costs associated with treatment and disability increase each year. Research suggests that limitations in the traditional assessment of chronic pain patients limit the effectiveness of current medical treatments. The use of technology might serve change patient traditional monitoring into ecological momentary assessments, which might be visualised by physicians live. This study describes a randomised control trial designed to test the utility of a technology-based solution for pain telemonitoring consisting of a smartphone app for patients and a web application for physicians. The goal of this study will be to explore whether this combination of eHealth and mHealth improves the effectiveness of existing pain treatments. METHODS AND ANALYSIS Participants will be 250 patients randomly assigned to one of these two conditions: treatment-as-usual (TAU) and TAU +app+ web. All participants will receive the usual treatment for their pain. Only the TAU +app+ web group use Pain Monitor app, which generates alarms that are sent to the physicians in the face of previously established undesired events. Physicians will be able to monitor app reports using a web application, which might result in an adjustment of treatment. We anticipate that the use of Pain Monitor plus the therapist web will result in a reduction of pain intensity and side effects of the medication. Improvements on secondary outcomes, namely fatigue, mood, pain interference, rescue medication use and quality of life, are also expected. Mixed repeated-measure multivariate analyses of variances will be conducted to investigate whether there are differences between preassessment and postassessment scores as a function of the experimental condition. ETHICS AND DISSEMINATION Ethical approval from the Hospital General Universitari de Castellon was obtained. The findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03606265.
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Affiliation(s)
- Irene Jaén
- Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
| | - Carlos Suso-Ribera
- Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
| | - Diana Castilla
- Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03, Instituto de Salud Carlos III, Madrid, Spain
| | - Irene Zaragoza
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03, Instituto de Salud Carlos III, Madrid, Spain
| | - Azucena García-Palacios
- Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03, Instituto de Salud Carlos III, Madrid, Spain
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Xia YY, Xue M, Wang Y, Huang ZH, Huang C. Electroacupuncture Alleviates Spared Nerve Injury-Induced Neuropathic Pain And Modulates HMGB1/NF-κB Signaling Pathway In The Spinal Cord. J Pain Res 2019; 12:2851-2863. [PMID: 31695479 PMCID: PMC6805246 DOI: 10.2147/jpr.s220201] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/12/2019] [Indexed: 01/03/2023] Open
Abstract
Background Neuropathic pain with complications greatly affects patients worldwide. High mobility group box 1 (HMGB1) has been shown to contribute to the pathogenesis of neuropathic pain; thus, suppression of HMGB1 may provide a novel therapeutic option for neuropathic pain. Electroacupuncture (EA) has been indicated to be effective in attenuating neuropathic pain, but the underlying mechanism remains to be fully clarified. We aim to explore whether 2Hz EA stimulation regulates the spinal HMGB1/NF-κB signaling in neuropathic pain induced by spared nerve injury (SNI). Materials and methods Paw withdrawal threshold and CatWalk gait analysis were used to assess the effect of 2Hz EA on pain-related behaviors in SNI rats. Administration of 2Hz EA to SNI rats once every other day lasting for 21 days. Expression of spinal protein molecules were detected using Western blot and immunofluorescence staining. Results It was found that SNI significantly induced mechanical hypersensitivity and decrease of gait parameters, and subsequently increased the levels of HMGB1, TLR4, MyD88, and NF-κB p65 protein expression. 2Hz EA stimulation led to remarkable attenuation of mechanical hypersensitivity, upregulation of spinal HMGB1, TLR4, MyD88, and NF-κB p65 protein expressions induced by SNI, and significant improvement in gait parameters. Furthermore, immunofluorescence staining also confirmed that 2Hz EA obviously suppressed the co-expression of microglia activation marker CD11b and TLR4 or MyD88, as well as the activation of NF-κB p65 in SNI rats. Conclusion This study suggested that blockade of HMGB1/NF-κB signaling in the spinal cord may be a promising therapeutic approach for 2Hz EA management of SNI-induced neuropathic pain.
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Affiliation(s)
- Yang-Yang Xia
- Department of Physiology, Gannan Medical University, Ganzhou 341000, People's Republic of China
| | - Meng Xue
- Department of Physiology, Gannan Medical University, Ganzhou 341000, People's Republic of China
| | - Ying Wang
- Department of Physiology, Gannan Medical University, Ganzhou 341000, People's Republic of China
| | - Zhi-Hua Huang
- Department of Physiology, Gannan Medical University, Ganzhou 341000, People's Republic of China.,Pain Medicine Research Institute, Gannan Medical University, Ganzhou 341000, People's Republic of China
| | - Cheng Huang
- Department of Physiology, Gannan Medical University, Ganzhou 341000, People's Republic of China.,Pain Medicine Research Institute, Gannan Medical University, Ganzhou 341000, People's Republic of China
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Validity, Reliability, Feasibility, and Usefulness of Pain Monitor: A Multidimensional Smartphone App for Daily Monitoring of Adults With Heterogenous Chronic Pain. Clin J Pain 2019; 34:900-908. [PMID: 29659375 DOI: 10.1097/ajp.0000000000000618] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Ecological momentary assessment has been recommended in the management of chronic pain. Smartphone apps might be a useful tool for that purpose. This goal of this study was to develop and test a multidimensional smartphone app for adults with chronic pain. A multidisciplinary team developed the app content after a series of meetings, considering clinical guidelines for pain measurement. The content included pain intensity and interference, fatigue, mood, perceived health status, activity level, side effects of the medication, use of rescue medication, and pain-related sychological constructs (catastrophizing, acceptance, fear, and coping). METHODS Thirty-eight participants (21 to 59 y) used the app, called Pain Monitor, twice a day during 30 consecutive days. Patients completed a set of well-established measures at the beginning and end of the study via paper-and-pencil. Weekly phone assessments were also made for pain intensity, pain interference, fatigue, and mood. RESULTS Construct validity was revealed by moderate-to-strong correlations between app content and traditional measures. Feasibility was supported by high compliance (between 70% and 82%) and high acceptability and ease of use. Both side effects of the medication and use of rescue medication were found to be useful tools to guide treatment. DISCUSSION The new assessment protocol in the app allows for an easy and rapid multidimensional assessment of chronic pain patients.
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Varrassi G, Alon E, Bagnasco M, Lanata L, Mayoral-Rojals V, Paladini A, Pergolizzi JV, Perrot S, Scarpignato C, Tölle T. Towards an Effective and Safe Treatment of Inflammatory Pain: A Delphi-Guided Expert Consensus. Adv Ther 2019; 36:2618-2637. [PMID: 31485978 PMCID: PMC6822819 DOI: 10.1007/s12325-019-01053-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The clinical management of inflammatory pain requires an optimal balance between effective analgesia and associated safety risks. To date, mechanisms associated with inflammatory pain are not completely understood because of their complex nature and the involvement of both peripheral and central mechanisms. This Expert Consensus document is intended to update clinicians about evolving areas of clinical practice and/or available treatment options for the management of patients with inflammatory pain. METHOD An international group of experts in pain management covering the pharmacology, neurology and rheumatology fields carried out an independent qualitative systematic literature search using MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. RESULTS Existing guidelines for pain management provide recommendations that do not satisfactorily address the complex nature of pain. To achieve optimal outcomes, drug choices should be individualized to guarantee the best match between the characteristics of the patient and the properties of the medication. NSAIDs represent an important prescribing choice in the management of inflammatory pain, and the recent results on paracetamol question its appropriate use in clinical practice, raising the need for re-evaluation of the recommendations in the clinical practice guidelines. CONCLUSIONS Increasing clinicians' knowledge of the available pharmacologic options to treat different pain mechanisms offers the potential for safe, individualized treatment decisions. We hope that it will help implement the needed changes in the management of inflammatory pain by providing the best strategies and new insights to achieve the ultimate goal of managing the disease and obtaining optimal benefits for patients. FUNDING Dompé Farmaceutici SPA and Paolo Procacci Foundation.
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Affiliation(s)
- Giustino Varrassi
- Paolo Procacci Foundation, Rome, Italy.
- President of World Institute of Pain (WIP), Winston-Salem, NC, USA.
| | - Eli Alon
- University of Zurich, Zurich, Switzerland
| | - Michela Bagnasco
- Medical Affairs Department, Dompé Farmaceutici SpA, Milan, Italy
| | - Luigi Lanata
- Medical Affairs Department, Dompé Farmaceutici SpA, Milan, Italy
| | | | | | | | - Serge Perrot
- Descartes University and Cochin-Hotel Dieu Hospital, Paris, France
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Otto JC, Forstenpointner J, Sachau J, Hüllemann P, Hukauf M, Keller T, Gierthmühlen J, Baron R. A Novel Algorithm to Identify Predictors of Treatment Response: Tapentadol Monotherapy or Tapentadol/Pregabalin Combination Therapy in Chronic Low Back Pain? Front Neurol 2019; 10:979. [PMID: 31572292 PMCID: PMC6753214 DOI: 10.3389/fneur.2019.00979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/27/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose: High dose monotherapies or drug combinations are used to achieve sufficient analgesia for the treatment of severe chronic low back pain, before invasive therapy options are considered. In order to demonstrate an alternative for an empirical treatment approach, the authors' primary aim was to present an algorithm for the objective identification of treatment predictors. Additionally, the study identified baseline-characteristics in chronic low back pain patients prior to tapentadol PR treatment, as well as scrutinized those patients, either benefitting from a medium/high dose tapentadol PR monotherapy or a combination therapy (medium dose tapentadol PR + pregabalin). Patients and Methods: The statistical approach included data of a previously published randomized, double blind, phase 3b study which compared the effectiveness and safety of tapentadol PR vs. a combination of tapentadol PR and pregabalin. In total, 46 clinical parameters were included in the statistical prediction models which were applied separately either to 50 patients who already responded well during the titration period (i.e., medium dose tapentadol PR) or to 261 patients with in the comparative treatment period [i.e., monotherapy (high dose tapentadol PR) or combination therapy (medium dose tapentadol PR/pregabalin)]. Results: The first statistical model identified three co-variables (NRS-3, PDQ, SQ) with predictive effects on patients responding well (“optimal responders”) to a medium dose tapentadol PR titration. Those patients presented low baseline pain intensity scores, good sleep quality and high painDETECT scores. The second statistical model identified eight co-variables (PDQ, numbness, SF-12 MCS, SF-12 PCS, VAS, HADS-A, HADS-D, SQ) with predictive effects on patients responding to high dose tapentadol PR monotherapy vs. a combination therapy (tapentadol PR + pregabalin). The high dose tapentadol PR responders indicated high painDETECT scores, little numbness and a good mental health status. Whereas, the combination therapy (tapentadol PR + pregabalin) responders were characterized by severe sleep disturbances and little anxiety. Conclusion: The statistical analysis characterized chronic low back pain patients and identified factors contributing to a treatment response. Thus, this retrospective statistical algorithm represents an elegant method, which may contribute to future strategies toward a more individualized and improved mechanism based pain therapy.
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Affiliation(s)
- Jan C Otto
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Philipp Hüllemann
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | - Janne Gierthmühlen
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Margarit C, Roca R, Inda MDM, Muriel J, Ballester P, Moreu R, Conte AL, Nuñez A, Morales D, Peiró AM. Genetic Contribution in Low Back Pain: A Prospective Genetic Association Study. Pain Pract 2019; 19:836-847. [PMID: 31269327 DOI: 10.1111/papr.12816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/19/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Chronic pain is one of the most common reasons individuals seek medical attention. It is a major issue because of the wide interindividual variability in the analgesic response. This might be partly explained by the presence of variants in genes encoding molecules involved in pharmacodynamics and pharmacokinetics. The aim was to analyze opioid effectiveness in chronic low back pain (CLBP) relief after opioid titration, unveiling the impact of pharmacogenetics. METHODS The study included 231 opioid-naïve patients from the Spine Unit; age 63 ± 14 years, 64% female, body mass index 29 ± 6 kg/m2 , visual analog scale pain intensity score 73 ± 16 mm. Clinical data were collected at baseline, 3 months after opioid titration, and after 2 to 4 years of follow-up concerning pain (intensity and relief), quality of life, disability, comorbidities, and drug prescription (opioid dose, rotations, and adverse events). The genotype influence of OPRM1, COMT, UGT2B7, ABCB1, KCNJ6, and CYP3A5*3A in analgesic response was analyzed by reverse-transcription polymerase chain reaction genotyping. RESULTS Patients with the COMT G472A-AA genotype (rs4680) and KCNJ6 A1032G-A allele (rs2070995) CLBP responded differently to opioid titration, with higher pain intensity requiring higher dosing. Furthermore, GG- genotypes of A118G (OPRM1, rs1799971) and A854G (UGT2B7, rs776746) influenced the neuropathic component. After opioid titration, CLBP intensity, neuropathic component, low back pain disability, anxiety, and depression significantly decreased, while quality of life improved. CONCLUSION Single-nucleotide polymorphisms in genes involved in pain transmission and opioid metabolism might predispose to exaggerated sensitivity and differences in the opioid analgesic effect in patients with CLBP. We encourage clinical trials for their clinical application in chronic pain management.
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Affiliation(s)
- César Margarit
- Pain Unit, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain.,Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Reyes Roca
- Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - María-Del-Mar Inda
- Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Javier Muriel
- Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Pura Ballester
- Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Rocío Moreu
- Clinical Pharmacology Unit, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain
| | - Anna Lucia Conte
- Occupational Observatory, Miguel Hernández University of Elche, Alicante, Spain
| | - Angela Nuñez
- Operations Research Center, Miguel Hernández University of Elche, Elche, Spain
| | - Domingo Morales
- Operational Centre, Miguel Hernandez University, Elche, Spain
| | - Ana M Peiró
- Pain Unit, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain.,Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain
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Latina R, De Marinis MG, Giordano F, Osborn JF, Giannarelli D, Di Biagio E, Varrassi G, Sansoni J, Bertini L, Baglio G, D'Angelo D, Baldeschi GC, Piredda M, Carassiti M, Camilloni A, Paladini A, Casale G, Mastroianni C, Notaro P, Diamanti P, Coaccioli S, Tarsitani G, Cattaruzza MS, Arcioni R, Bisbiglia C, Bosco M, Capogrossi M, De Meo MA, D’este G, D’Orazio L, Fabroni S, Gagliardi A, Laganà S, Mattozzi I, La Placa E, Montone G, Natalini L, Orsetti R, Proietti R, Rabuffi G, Reale C, Rinaldi R, Siena G, Stefani M, Quadrino L. Epidemiology of Chronic Pain in the Latium Region, Italy: A Cross-Sectional Study on the Clinical Characteristics of Patients Attending Pain Clinics. Pain Manag Nurs 2019; 20:373-381. [PMID: 31103514 DOI: 10.1016/j.pmn.2019.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/13/2018] [Accepted: 01/24/2019] [Indexed: 11/26/2022]
Abstract
In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p = .02; and 55.2% vs. 45.9%, p < .001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Giovanni Baglio
- National Institute for Health, Migration and Poverty, Rome, Italy
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44
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Vieira C, Fragoso M, Pereira D, Medeiros R. Pain prevalence and treatment in patients with metastatic bone disease. Oncol Lett 2019; 17:3362-3370. [PMID: 30867771 PMCID: PMC6396205 DOI: 10.3892/ol.2019.10013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022] Open
Abstract
The accomplishment of successful pain treatment requires evaluation, characterization and quantification. The present study characterized pain and survival in a cohort of patients with cancer with bone metastasis who were treated with intravenous bisphosphonates. A total of 84 patients self-completed the Brief Pain Inventory (BPI) and 36-Item Short Form Survey (SF-36), between November 2010 and March 2011 with a 5-year survival follow-up as a surrogate marker of cancer burden. The median age was 62 years old (34–85), 64% of patients were female and 58% of these females had breast cancer. In the population, self-reported pain was 91.6%, with 29 patients (34.5%) reporting severe pain (score 7–10). Among these patients, only 13 (44.8%) presented a similar report to that of their clinical files and 5 were undergoing treatment with strong opioids (17.2%). A total of 45 patients (46%) had not been prescribed analgesic drugs, of these patients, 32 were treated with a weak opioid, and 13 with a strong opioid. An association was observed between pain records and the prescribed analgesic (P=0.031). BPI maximum pain and overall survival data were analyzed, and a significant association was identified between male patients presenting severe pain and decreased survival (P=0.004). Male survival was associated with severe pain, which is consistent with other data. The results revealed a skeletal-related events (SRE)-free survival (time elapsed from diagnosis of the first bone metastasis to the first SRE) of 9 months (4.39–13.73, 95% CI) with a statistically significant difference between subgroups of time since diagnosis of bone metastasis (P=0.005). The added value of the present study is the suggestion that complete and accurate pain narratives are mandatory and may contribute to the optimization of analgesia, and may help to increase survival rates. Optimal pain management for patients with cancer remains an urgent requirement.
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Affiliation(s)
- Cláudia Vieira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto 4200-072, Portugal.,Research Centre-Molecular Oncology Group-CI, Instituto Português de Oncologia do Porto Francisco Gentil, Porto 4200-072, Portugal.,Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Maria Fragoso
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto 4200-072, Portugal.,Unit of Study and Treatment of Pain, Instituto Português de Oncologia do Porto Francisco Gentil, Porto 4200-319, Portugal
| | - Deolinda Pereira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto 4200-072, Portugal
| | - Rui Medeiros
- Research Centre-Molecular Oncology Group-CI, Instituto Português de Oncologia do Porto Francisco Gentil, Porto 4200-072, Portugal.,Faculty of Medicine, University of Porto, Porto 4200-319, Portugal.,Biomedical Research Center, Faculty of Health Sciences, Fernando Pessoa University, Porto 4249-004, Portugal.,Research Department, Portuguese League Against Cancer, Porto 4200-172, Portugal
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45
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A Biopsychosocial Approach to Managing HIV-Related Pain and Associated Substance Abuse in Older Adults: a Review. AGEING INTERNATIONAL 2018. [DOI: 10.1007/s12126-018-9333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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46
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Costs and consequences of chronic pain due to musculoskeletal disorders from a health system perspective in Chile. Pain Rep 2018; 3:e656. [PMID: 30534622 PMCID: PMC6181463 DOI: 10.1097/pr9.0000000000000656] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 02/15/2018] [Accepted: 03/28/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem. Objectives: To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile. Methods: A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty. Results: The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417% of the national GDP. Lower back pain and osteoarthritis of the knee explained the larger proportion of the total cost, 31.8% and 27.1%, respectively. Depression attributed to chronic pain is another important consequence accounting for USD $94 million (Bayesian credibility interval 95% $49.1–$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs. Conclusion: Chronic pain is not only an important cause of disability but also responsible for high social and financial burden in Chile. Public health programs focused on managing chronic pain may decrease burden of disease and possibly reduce costs.
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Wastesson JW, Martikainen JE, Zoëga H, Schmidt M, Karlstad Ø, Pottegård A. Trends in Use of Paracetamol in the Nordic Countries. Basic Clin Pharmacol Toxicol 2018. [DOI: 10.1111/bcpt.13003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jonas W. Wastesson
- Aging Research Center; Karolinska Institutet & Stockholm University; Stockholm Sweden
| | | | - Helga Zoëga
- Centre of Public Health Sciences; Faculty of Medicine; University of Iceland; Reykjavík Iceland
- Medicines Policy Research Unit; Centre for Big Data Research in Health; University of New South Wales; Sydney NSW Australia
| | - Morten Schmidt
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - Øystein Karlstad
- Department of Pharmacoepidemiology; Norwegian Institute of Public Health; Oslo Norway
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
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48
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Hider-Mlynarz K, Cavalié P, Maison P. Trends in analgesic consumption in France over the last 10 years and comparison of patterns across Europe. Br J Clin Pharmacol 2018. [PMID: 29514410 DOI: 10.1111/bcp.13564] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS The aims of the present study were to describe the consumption trends of three groups of analgesics (non-opioids, and mild and strong opioids) between 2006 and 2015 in France, and compare this pattern of use with six European countries in 2015. METHODS Annual drugs sales were extracted from the French national authority's consumption database, and from the IMS Multinational Integrated Data Analysis System and national databases for European countries. RESULTS The use of mild opioids in France was found to have decreased by 53% over the past 10 years, owing to the declining use of dextropropoxyphene combinations, along with an increase in the use of non-opioids and strong opioids (from 72 to 93, and 2 to 2.8 defined daily doses/1000 inhabitants/day, respectively). Paracetamol, the most consumed analgesic, increased over this period, particularly for the adult high dose (+140%). The use of tramadol and codeine combinations also increased, by 62% and 42%, respectively. Morphine remained the most used strong opioid, although there were also large increases in the consumption of oxycodone (+613%) and fentanyl (+263% and +72% for transmucosal and transdermal forms, respectively). A comparison of the patterns of use in Europe in 2015 showed a higher consumption of mild and strong opioids in the UK. France ranked first and third place, respectively, for paracetamol and mild opioid consumption, whereas its use of strong opioids was among the lowest. CONCLUSIONS Paracetamol consumption is clearly highest in France, whereas its use of strong opioids is among the lowest in Europe, although its consumption of oxycodone has increased significantly. Further studies are required specifically to monitor these drugs.
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Affiliation(s)
- Karima Hider-Mlynarz
- French National Agency for Medicines and Health Products Safety, Surveillance Division, Saint-Denis, France
| | - Philippe Cavalié
- French National Agency for Medicines and Health Products Safety, Surveillance Division, Saint-Denis, France
| | - Patrick Maison
- French National Agency for Medicines and Health Products Safety, Surveillance Division, Saint-Denis, France
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49
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Dessouky R, Xi Y, Scott KM, Khaleel M, Gill K, Jones S, Khalifa DN, Tantawy HI, Aidaros MA, Chhabra A. Magnetic Resonance Neurography in Chronic Lumbosacral and Pelvic Pain: Diagnostic and Management Impact-Institutional Audit. World Neurosurg 2018; 114:e77-e113. [PMID: 29581014 DOI: 10.1016/j.wneu.2018.02.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE Low back and pelvic pain are among the most prevalent conditions worldwide, with major social and economic costs. The aim of this study was to evaluate the role of magnetic resonance neurography (MRN) of lumbosacral plexus in the management and outcomes of these patients with chronic pain. METHODS Consecutive patients with chronic lumbosacral and pelvic pain referred for MRN over a year were included. Preimaging and postimaging clinical diagnosis and treatment, pain levels, and location were recorded. Pain-free survival was compared between treatments using a Cox proportional hazards model. RESULTS A total of 202 patients with mean age 53.7 ± 14.8 years and a male/female ratio of 1:1.53 were included. Of these patients, 115 presented with radiculopathy (57%), 56 with pelvic pain (28%), and 31 with groin pain (15%). Mean initial pain level was 6.9 ± 1.9. Mean symptom duration was 4.21 ± 5.86 years. Of these patients, 143 (71%) had a change in management because of MRN. After MRN, reduction in pain levels was observed in 21 of 32 patients receiving conservative treatment (66%), 42 of 67 receiving injections (63%), and 27 of 33 receiving surgery (82%). Follow-ups were available in 131 patients. Median pain-free survival was 12 months. Patients treated with surgery had significantly lower pain recurrence than patients receiving other treatments in the same time frame (hazard ratio, 3.6; 95% confidence interval, 1.4-9.2; P = 0.0061). CONCLUSIONS MRN use in chronic lumbosacral and pelvic pain led to a meaningful change in diagnosis and treatment. After MRN, conservative treatment and injections provided pain relief; however, patients benefited more from surgery than from any other treatment.
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Affiliation(s)
- Riham Dessouky
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kelly M Scott
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mohammed Khaleel
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Gill
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephanie Jones
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dalia N Khalifa
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hazim I Tantawy
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Magdy A Aidaros
- Department of Neurology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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50
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Piao Y, Gwon DH, Kang DW, Hwang TW, Shin N, Kwon HH, Shin HJ, Yin Y, Kim JJ, Hong J, Kim HW, Kim Y, Kim SR, Oh SH, Kim DW. TLR4-mediated autophagic impairment contributes to neuropathic pain in chronic constriction injury mice. Mol Brain 2018; 11:11. [PMID: 29486776 PMCID: PMC5830083 DOI: 10.1186/s13041-018-0354-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 02/19/2018] [Indexed: 03/12/2023] Open
Abstract
Neuropathic pain is a complex, chronic pain state characterized by hyperalgesia, allodynia, and spontaneous pain. Accumulating evidence has indicated that the microglial Toll-like receptor 4 (TLR4) and autophagy are implicated in neurodegenerative diseases, but their relationship and role in neuropathic pain remain unclear. In this study, we examined TLR4 and its association with autophagic activity using a chronic constriction injury (CCI)-induced neuropathic pain model in wild-type (WT) and TLR4-knockout (KO) mice. The mice were assigned into four groups: WT-Contralateral (Contra), WT-Ipsilateral (Ipsi), TLR4 KO-Contra, and TLR4 KO-Ipsi. Behavioral and mechanical allodynia tests and biochemical analysis of spinal cord tissue were conducted following CCI to the sciatic nerve. Compared with the Contra group, mechanical allodynia in both the WT- and TLR4 KO-Ipsi groups was significantly increased, and a marked decrease of allodynia was observed in the TLR4 KO-Ipsi group. Although glial cells were upregulated in the WT-Ipsi group, no significant change was observed in the TLR4 KO groups. Moreover, protein expression and immunoreactive cell regulation of autophagy (Beclin 1, p62) were significantly increased in the neurons, but not microglia, of WT-Ipsi group compared with the WT-Contra group. The level of PINK1, a marker for mitophagy was increased in the neurons of WT, but not in TLR4 KO mice. Together, these results show that TLR4-mediated p62 autophagic impairment plays an important role in the occurrence and development of neuropathic pain. And what is more, microglial TLR4-mediated microglial activation might be indirectly coupled to neuronal autophage.
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Affiliation(s)
- Yibo Piao
- Department of Plastic and Reconstructive Surgery, Department of Pediatrics, Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Do Hyeong Gwon
- Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Dong-Wook Kang
- Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Tae Woong Hwang
- Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Nara Shin
- Department of Plastic and Reconstructive Surgery, Department of Pediatrics, Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea.,Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Hyeok Hee Kwon
- Department of Plastic and Reconstructive Surgery, Department of Pediatrics, Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea.,Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Hyo Jung Shin
- Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Yuhua Yin
- Department of Plastic and Reconstructive Surgery, Department of Pediatrics, Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea.,Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Jwa-Jin Kim
- Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea.,LES Corporation Inc., Gung-Dong 465-16, Yuseong-Gu, Daejeon, 305-335, Republic of Korea
| | - Jinpyo Hong
- Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Hyun-Woo Kim
- Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea
| | - Yonghyun Kim
- Department of Chemical and Biological Engineering, The University of Alabama, Tuscaloosa, AL, 35487, USA
| | - Sang Ryong Kim
- School of Life Sciences, BK21 plus KNU Creative BioResearch Group, Institute of Life Science & Biotechnology, Kyungpook National University, Daegu, 41566, South Korea
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, Department of Pediatrics, Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea. .,Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea.
| | - Dong Woon Kim
- Department of Medical Science, Department of Physiology, Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Daejeon, 35015, Republic of Korea.
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