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Tana C, Cipollone F, Giamberardino MA, Martelletti P. New drugs targeting calcitonin gene-related peptide for the management of migraines. Expert Opin Emerg Drugs 2023; 28:233-240. [PMID: 37996401 DOI: 10.1080/14728214.2023.2288334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/22/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Significant advances in migraine research have contributed to the development of new drugs for the treatment of migraine. Monoclonal antibodies (mAbs) against Calcitonin Gene-Related Peptide (CGRP) or its receptor and CGRP receptor antagonists (gepants) have been associated with a good safety profile and resulted in an overall efficacy in reducing the number of monthly migraine days both in episodic and chronic forms of migraine. AREAS COVERED The results from main investigation studies (phase 2 or 3) of CGRP-targeting drugs (both anti-CGRP mAbs and gepants) are reported in this expert-opinion review. EXPERT OPINION The introduction of new drugs targeting CGRP is a significant breakthrough in the migraine field, and represents a new generation of therapeutic agents that are available to manage migraine. The evaluation of efficacy and safety in the long-term follow-up and the development of trials comparing the available drugs could improve the current knowledge. The economic sustainability of these drugs remains to be clarified, and a cost-cutting campaign should be promoted based on the high burden of migraine.
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Affiliation(s)
- Claudio Tana
- Headache Center, Geriatrics Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Science of Aging, Medical Clinic, SS. Annunziata Hospital of Chieti, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Maria Adele Giamberardino
- Headache Center, Geriatrics Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy
- Department of Medicine and Science of Aging and CAST, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Paolo Martelletti
- School of Health Sciences, Unitelma Sapienza University of Rome, Rome, Italy
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2
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Riddle DL, Dumenci L. A Latent Change Score Approach to Understanding Chronic Bodily Pain Outcomes Following Knee Arthroplasty: A Secondary Analysis of Longitudinal Data. J Bone Joint Surg Am 2023; 105:1574-1582. [PMID: 37616392 PMCID: PMC10592085 DOI: 10.2106/jbjs.23.00214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND The extent to which chronic bodily pain changes following total knee arthroplasty (TKA) is unknown. We determined the extent of chronic bodily pain changes at 1 year following TKA. METHODS Data from our randomized trial of pain coping skills, which revealed no effect of the studied interventions, were used. The presence and severity of chronic pain in 16 body regions, excluding the surgically treated knee, were determined prior to and 1 year following surgery. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale was used to quantify the extent of surgical knee pain. Latent change score (LCS) models were used to determine the extent to which true chronic bodily pain scores change after TKA. RESULTS The mean age of the sample of 367 participants was 63.4 ± 8.0 years, and 247 (67%) were female. LCS analyses showed significant 20% to 54% reductions in pain in the surgically treated lower limb (not including the surgically treated knee), pain in the non-surgically treated lower limb, and whole body pain. In bivariate LCS analyses, greater improvement in the WOMAC pain score, indicating surgical benefit of TKA, led to greater improvement in all 4 bodily pain areas beyond the surgically treated knee, even after controlling for the latent change in pain catastrophizing. CONCLUSIONS Clinically important chronic bodily pain reductions occurred following TKA and may be causally linked to the surgical procedure. Reduction in chronic bodily pain in sites other than the surgically treated knee is an additional benefit of TKA. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel L Riddle
- Departments of Physical Therapy, Orthopaedic Surgery, and Rheumatology, Virginia Commonwealth University, Richmond, Virginia
| | - Levent Dumenci
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, Pennsylvania
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3
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Hsiao FJ, Chen WT, Wu YT, Pan LLH, Wang YF, Chen SP, Lai KL, Coppola G, Wang SJ. Characteristic oscillatory brain networks for predicting patients with chronic migraine. J Headache Pain 2023; 24:139. [PMID: 37848845 PMCID: PMC10583316 DOI: 10.1186/s10194-023-01677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
To determine specific resting-state network patterns underlying alterations in chronic migraine, we employed oscillatory connectivity and machine learning techniques to distinguish patients with chronic migraine from healthy controls and patients with other pain disorders. This cross-sectional study included 350 participants (70 healthy controls, 100 patients with chronic migraine, 40 patients with chronic migraine with comorbid fibromyalgia, 35 patients with fibromyalgia, 30 patients with chronic tension-type headache, and 75 patients with episodic migraine). We collected resting-state magnetoencephalographic data for analysis. Source-based oscillatory connectivity within each network, including the pain-related network, default mode network, sensorimotor network, visual network, and insula to default mode network, was examined to determine intrinsic connectivity across a frequency range of 1-40 Hz. Features were extracted to establish and validate classification models constructed using machine learning algorithms. The findings indicated that oscillatory connectivity revealed brain network abnormalities in patients with chronic migraine compared with healthy controls, and that oscillatory connectivity exhibited distinct patterns between various pain disorders. After the incorporation of network features, the best classification model demonstrated excellent performance in distinguishing patients with chronic migraine from healthy controls, achieving high accuracy on both training and testing datasets (accuracy > 92.6% and area under the curve > 0.93). Moreover, in validation tests, classification models exhibited high accuracy in discriminating patients with chronic migraine from all other groups of patients (accuracy > 75.7% and area under the curve > 0.8). In conclusion, oscillatory synchrony within the pain-related network and default mode network corresponded to altered neurophysiological processes in patients with chronic migraine. Thus, these networks can serve as pivotal signatures in the model for identifying patients with chronic migraine, providing reliable and generalisable results. This approach may facilitate the objective and individualised diagnosis of migraine.
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Affiliation(s)
- Fu-Jung Hsiao
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Wei-Ta Chen
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, 201, Shih Pai Rd Sec 2, Taipei, 11217, Taiwan
- Department of Neurology, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Yu-Te Wu
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ling Hope Pan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, 201, Shih Pai Rd Sec 2, Taipei, 11217, Taiwan
| | - Shih-Pin Chen
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, 201, Shih Pai Rd Sec 2, Taipei, 11217, Taiwan
| | - Kuan-Lin Lai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, 201, Shih Pai Rd Sec 2, Taipei, 11217, Taiwan
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, 201, Shih Pai Rd Sec 2, Taipei, 11217, Taiwan.
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4
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Liu H, Dong M, Liu K, Jia Z, Gui W, Cheng Y, Lv Y, Qu K, Zhao H, Chen J, Zhang D, Fan Z, Yang X, Hu D, Xie H, Li M, Wen B, Chen S, Xu P, Rong Q, He Q, Ren Z, Yan F, Zhao H, Chen M, Yu T, Qu H, An X, Guo H, Zhang X, Pan X, Wang X, Qiu S, Zhang L, Zhao H, Pan X, Wan Q, Yan L, Liu J, Yu Z, Zhang M, Ran Y, Han X, Yu S, Dong Z. Status of diagnosis and preventative treatment for primary headache disorders: real-world data of unmet needs in China. J Headache Pain 2023; 24:119. [PMID: 37653478 PMCID: PMC10472552 DOI: 10.1186/s10194-023-01654-6] [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: 05/26/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Headache disorders are widely prevalent and pose a considerable economic burden on individuals and society. Globally, misdiagnosis and inadequate treatment of primary headache disorders remain significant challenges, impeding the effective management of such conditions. Despite advancements in headache management over the last decade, a need for comprehensive evaluations of the status of primary headache disorders in China regarding diagnosis and preventative treatments persists. METHODS In the present study, we analyzed the established queries in the Survey of Fibromyalgia Comorbidity with Headache (SEARCH), focusing on previous diagnoses and preventative treatment regimens for primary headache disorders. This cross-sectional study encompassed adults diagnosed with primary headache disorders who sought treatment at 23 hospitals across China between September 2020 to May 2021. RESULTS The study comprised 2,868 participants who were systematically examined. Migraine and tension-type headaches (TTH) constituted a majority of the primary headache disorders, accounting for 74.1% (2,124/2,868) and 23.3% (668/2,868) of the participants, respectively. Medication overuse headache (MOH) affected 8.1% (231/2,868) of individuals with primary headache disorders. Over half of the individuals with primary headache disorders (56.6%, 1,624/2,868) remained undiagnosed. The previously correct diagnosis rates for migraine, TTH, TACs, and MOH were 27.3% (580/2,124), 8.1% (54/668), 23.2% (13/56), and 3.5% (8/231), respectively. The misdiagnosis of "Nervous headache" was found to be the most prevalent among individuals with migraine (9.9%, 211/2,124), TTH (10.0%, 67/668), trigeminal autonomic cephalalgias (TACs) (17.9%, 10/56), and other primary headache disorders (10.0%, 2/20) respectively. Only a minor proportion of individuals with migraine (16.5%, 77/468) and TTH (4.7%, 2/43) had received preventive medication before participating in the study. CONCLUSIONS While there has been progress made in the rate of correct diagnosis of primary headache disorders in China compared to a decade ago, the prevalence of misdiagnosis and inadequate treatment of primary headaches remains a veritable issue. As such, focused efforts are essential to augment the diagnosis and preventive treatment measures related to primary headache disorders in the future.
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Affiliation(s)
- Huanxian Liu
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ming Dong
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, 130021, China
| | - Kaiming Liu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, 310009, China
| | - Zhihua Jia
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wei Gui
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Lujiang Road 17, Hefei, 230001, China
| | - Yingying Cheng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, 130021, China
| | - Yudan Lv
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, 130021, China
| | - Kang Qu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, 130021, China
| | - Hongru Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Jiangsu, 215006, China
| | - Jianjun Chen
- Department of Neurology, Lishui Municipal Central Hospital, Zhejiang, 323000, China
| | - Dan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang, 310020, China
| | - Zhiliang Fan
- Department of Neurology, Xing Tai People's Hospital, Hebei, 054001, China
| | - Xiaosu Yang
- Department of Neurology, Xiangya Hospital, Central South University, Hunan, 410013, China
| | - Dongmei Hu
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Shandong, 271000, China
| | - Hongyan Xie
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Shandong, 271000, China
| | - Mingxin Li
- Department of Neurology, Qilu Hospital, Shandong, 250012, China
| | - Bing Wen
- Department of Neurology, Qilu Hospital, Shandong, 250012, China
| | - Sufen Chen
- Department of Neurology, Changsha Central Hospital Affiliated to the University of South China, Hunan, 410004, China
| | - Peng Xu
- Department of Neurology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Qingqing Rong
- Department of Neurology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Qiu He
- Department of Neurology, The People's Hospital of Liaoning Province, Liaoning, 110016, China
| | - Zhanxiu Ren
- Department of Neurology, The People's Hospital of Liaoning Province, Liaoning, 110016, China
| | - Fanhong Yan
- Department of Neurology, Linyi Jinluo Hospital, Shandong, 276036, China
| | - Heling Zhao
- Department of Neurology, Linyi Jinluo Hospital, Shandong, 276036, China
| | - Min Chen
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Henan, 450052, China
| | - Tingmin Yu
- Department of Neurology, The Second Hospital of Jilin University, Jilin, 130041, China
| | - Hongli Qu
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Jilin, 130041, China
| | - Xingkai An
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Jilin, 130041, China
| | - Huailian Guo
- Department of Neurology, People's Hospital, Peking University, Beijing, 100044, China
| | - Xinhua Zhang
- Department of Neurology, People's Hospital, Peking University, Beijing, 100044, China
| | - Xiaoping Pan
- Department of Neurology, Guangzhou First People's Hospital, Guangdong, 510180, China
| | - Xiaojuan Wang
- Department of Neurology, Guangzhou First People's Hospital, Guangdong, 510180, China
| | - Shi Qiu
- Department of Neurology, Aerospace Center Hospital, Beijing, 100049, China
| | - Lvming Zhang
- Department of Neurology, Aerospace Center Hospital, Beijing, 100049, China
| | - Hongling Zhao
- Department of Neurology, Da Lian Municipal Central Hospital, Liaoning, 116033, China
| | - Xin Pan
- Department of Neurology, Da Lian Municipal Central Hospital, Liaoning, 116033, China
| | - Qi Wan
- Department of Neurology, Jiangsu Province Hospital, Jiangsu, 210029, China
| | - Lanyun Yan
- Department of Neurology, Jiangsu Province Hospital, Jiangsu, 210029, China
| | - Jing Liu
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhe Yu
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Mingjie Zhang
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ye Ran
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xun Han
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Shengyuan Yu
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Zhao Dong
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China.
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5
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Onan D, Younis S, Wellsgatnik WD, Farham F, Andruškevičius S, Abashidze A, Jusupova A, Romanenko Y, Grosu O, Moldokulova MZ, Mursalova U, Saidkhodjaeva S, Martelletti P, Ashina S. Debate: differences and similarities between tension-type headache and migraine. J Headache Pain 2023; 24:92. [PMID: 37474899 PMCID: PMC10360340 DOI: 10.1186/s10194-023-01614-0] [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: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
Tension-type headache (TTH) and migraine are two common primary headaches distinguished by clinical characteristics according to the 3rd edition of the International Classification of Headache Disorders. Migraine is identified by specific features such as being more prevalent in females, being aggravated by physical activity, certain genetic factors, having photophobia, phonophobia, nausea, vomiting, or aura, and responding to specific drugs. Nonetheless, TTH and migraine share some common characteristics, such as onset occurring in the 20 s, and being triggered by psychological factors like stress, moderate pain severity, and mild nausea in chronic TTH. Both conditions involve the trigeminovascular system in their pathophysiology. However, distinguishing between TTH and migraine in clinical practice, research, and epidemiological studies can be challenging, as there is a lack of specific diagnostic tests and biomarkers. Moreover, both conditions may coexist, further complicating the diagnostic process. This review aims to explore the similarities and differences in the pathophysiology, epidemiology, burden and disability, comorbidities, and responses to pharmacological and non-pharmacological treatments of TTH and migraine. The review also discusses future research directions to address the diagnostic challenges and improve the understanding and management of these conditions.
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Affiliation(s)
- Dilara Onan
- Spine Health Unit, Faculty of Physical Therapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Samaira Younis
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark
| | | | - Fatemeh Farham
- Department of Headache, Iranian Centre of Neurological Researchers, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saulius Andruškevičius
- Center of Neurology and Center of Anesthesiology, Intensive Care and Pain Management, Vilnius University Hospital SantarosKlinikos, Vilnius, Lithuania
| | - Ana Abashidze
- Department of Neuroscience, Caucasus Medical Centre, Tbilisi, Georgia
| | - Asel Jusupova
- Department of Neurology and Clinical Genetics, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | | | - Oxana Grosu
- Diomid Gherman Institute of Neurology and Neurosurgery, Headache Center, Chisinau, Moldova
| | | | | | - Saida Saidkhodjaeva
- Department of Neurology, Child Neurology and Medical Genetics, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Sait Ashina
- Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, BIDMC Comprehensive Headache Center, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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6
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Edwards RR, Schreiber KL, Dworkin RH, Turk DC, Baron R, Freeman R, Jensen TS, Latremoliere A, Markman JD, Rice ASC, Rowbotham M, Staud R, Tate S, Woolf CJ, Andrews NA, Carr DB, Colloca L, Cosma-Roman D, Cowan P, Diatchenko L, Farrar J, Gewandter JS, Gilron I, Kerns RD, Marchand S, Niebler G, Patel KV, Simon LS, Tockarshewsky T, Vanhove GF, Vardeh D, Walco GA, Wasan AD, Wesselmann U. Optimizing and Accelerating the Development of Precision Pain Treatments for Chronic Pain: IMMPACT Review and Recommendations. THE JOURNAL OF PAIN 2023; 24:204-225. [PMID: 36198371 PMCID: PMC10868532 DOI: 10.1016/j.jpain.2022.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/01/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
Large variability in the individual response to even the most-efficacious pain treatments is observed clinically, which has led to calls for a more personalized, tailored approach to treating patients with pain (ie, "precision pain medicine"). Precision pain medicine, currently an aspirational goal, would consist of empirically based algorithms that determine the optimal treatments, or treatment combinations, for specific patients (ie, targeting the right treatment, in the right dose, to the right patient, at the right time). Answering this question of "what works for whom" will certainly improve the clinical care of patients with pain. It may also support the success of novel drug development in pain, making it easier to identify novel treatments that work for certain patients and more accurately identify the magnitude of the treatment effect for those subgroups. Significant preliminary work has been done in this area, and analgesic trials are beginning to utilize precision pain medicine approaches such as stratified allocation on the basis of prespecified patient phenotypes using assessment methodologies such as quantitative sensory testing. Current major challenges within the field include: 1) identifying optimal measurement approaches to assessing patient characteristics that are most robustly and consistently predictive of inter-patient variation in specific analgesic treatment outcomes, 2) designing clinical trials that can identify treatment-by-phenotype interactions, and 3) selecting the most promising therapeutics to be tested in this way. This review surveys the current state of precision pain medicine, with a focus on drug treatments (which have been most-studied in a precision pain medicine context). It further presents a set of evidence-based recommendations for accelerating the application of precision pain methods in chronic pain research. PERSPECTIVE: Given the considerable variability in treatment outcomes for chronic pain, progress in precision pain treatment is critical for the field. An array of phenotypes and mechanisms contribute to chronic pain; this review summarizes current knowledge regarding which treatments are most effective for patients with specific biopsychosocial characteristics.
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Affiliation(s)
| | | | | | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, House D, 24105 Kiel, Germany
| | - Roy Freeman
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | - Nick A Andrews
- Salk Institute for Biological Studies, San Diego, California
| | | | | | | | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
| | - Luda Diatchenko
- Department of Anesthesia and Faculty of Dentistry, McGill University, Montreal, California
| | - John Farrar
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Robert D Kerns
- Yale University, Departments of Psychiatry, Neurology, and Psychology, New Haven, Connecticut
| | | | | | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | | | | | | | | | - Gary A Walco
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Ajay D Wasan
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ursula Wesselmann
- Department of Anesthesiology/Division of Pain Medicine, Neurology and Psychology, The University of Alabama at Birmingham, Birmingham, Alabama
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7
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Wang D, Frey-Law LA. Multisensory sensitivity differentiates between multiple chronic pain conditions and pain-free individuals. Pain 2023; 164:e91-e102. [PMID: 35588150 PMCID: PMC11075969 DOI: 10.1097/j.pain.0000000000002696] [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: 02/18/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT Multisensory sensitivity (MSS) to nonpainful stimuli has been identified as a risk factor for the presence of coexisting chronic pain conditions. However, it remains unclear whether MSS can differentiate pain phenotypes involving different levels of central sensitivity. Both pain-free and those with chronic pain, particularly fibromyalgia (FM), migraine, or low back pain (LBP) were recruited, with pain comorbidities assessed. MSS was highest in FM, followed by migraine, then LBP, and lowest in pain-free individuals (adjusted between condition Cohen d = 0.32-1.2, P ≤ 0.0007). However, when secondly grouping patients by the total number of pain comorbidities reported, those with a single pain condition (but not FM) did not have significantly elevated MSS vs pain-free individuals (adj d= 0.17, P = 0.18). Elevated MSS scores produced increased odds of having 2 or more pain comorbidities; OR [95% CI] =2.0 [1.15, 3.42], without, and 5.6 [2.74, 11.28], with FM ( P ≤ 0.0001). Furthermore, those with low MSS levels were 55% to 87% less likely to have ≥ 2 pain comorbidities with or without FM (OR 0.45 [0.22, 0.88]-0.13 [0.05, 0.39]; P ≤ 0.0001). Our findings support that MSS can differentiate between pain phenotypes with different degrees of expected central mechanism involvement and also serve as a risk and resilience marker for total coexisting chronic pain conditions. This supports the use of MSS as a marker of heightened central nervous system processing and thus may serve as a clinically feasible assessment to better profile pain phenotypes with the goal of improving personalized treatment.
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Affiliation(s)
- Dan Wang
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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8
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Dong Z, Liu K, Liu H, Jia Z, Gui W, Dong M, Cheng Y, Lv Y, Qu K, Zhao H, Chen J, Zhang D, Fan Z, Yang X, Hu D, Zhang Y, Xie H, Li M, Wen B, Chen S, Xu P, Rong Q, He Q, Ren Z, Yan F, Zhao H, Chen M, Yu T, Qu H, An X, Guo H, Zhang X, Pan X, Wang X, Qiu S, Zhang L, Zhao H, Pan X, Wan Q, Yan L, Liu J, Yu Z, Zhang M, Ran Y, Han X, Yu S. The prevalence and clinical features of fibromyalgia in Chinese hospital patients with primary headache: The survey of fibromyalgia comorbid with headache. Headache 2023; 63:62-70. [PMID: 36651491 DOI: 10.1111/head.14443] [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: 08/13/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aims were to explore the prevalence and clinical features of fibromyalgia in Chinese hospital patients with primary headache. BACKGROUND Studies done in non-Chinese populations suggest that around one-third of patients with primary headache have fibromyalgia, but data from mainland China are limited. Investigations into the prevalence and clinical features of fibromyalgia in Chinese patients with primary headache would improve our understanding of these two complex disease areas and help guide future clinical practice. METHODS This cross-sectional study included adults with primary headache treated at 23 Chinese hospitals from September 2020 to May 2021. Fibromyalgia was diagnosed using the modified 2010 American College of Rheumatology criteria. Mood and insomnia were evaluated employing the Hospital Anxiety and Depression Scale and the Insomnia Severity Index. RESULTS A total of 2782 participants were analyzed. The fibromyalgia prevalence was 6.0% (166/2782; 95% confidence interval: 5.1%, 6.8%). Compared to primary headache patients without combined fibromyalgia, patients with primary headache combined with fibromyalgia were more likely to be older (47.8 vs. 41.7 years), women (83.7% [139/166] vs. 72.8% [1904/2616]), less educated (65.1% [108/166] vs. 45.2% [1183/2616]), and with longer-duration headache (10.0 vs. 8.0 years). Such patients were more likely to exhibit comorbid depression (34.3% [57/166] vs. 9.9% [260/2616]), anxiety (16.3% [27/166] vs. 2.7% [70/2612]), and insomnia (58.4% [97/166] vs. 17.1% [447/2616]). Fibromyalgia was more prevalent in those with chronic (rather than episodic) migraine (11.1% [46/414] vs. 4.4% [72/1653], p < 0.001) and chronic (rather than episodic) tension-type headache (11.5% [27/235] vs. 4.6% [19/409], p = 0.001). Most fibromyalgia pain was in the shoulders, neck, and upper back. CONCLUSIONS The prevalence of fibromyalgia in mainland Chinese patients with primary headache was 6.0%. Fibromyalgia was more common in those with chronic rather than episodic headache. The most common sites of fibromyalgia pain were the neck, shoulders, and back.
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Affiliation(s)
- Zhao Dong
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,International Headache Center, Chinese PLA General Hospital, Beijing, China
| | - Kaiming Liu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Huanxian Liu
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,International Headache Center, Chinese PLA General Hospital, Beijing, China
| | - Zhihua Jia
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,International Headache Center, Chinese PLA General Hospital, Beijing, China
| | - Wei Gui
- Department of Neurology, The First Affiliated Hospital of USTC, Anhui, China
| | - Ming Dong
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, China
| | - Yingying Cheng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, China
| | - Yudan Lv
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, China
| | - Kang Qu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, China
| | - Hongru Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Jianjun Chen
- Department of Neurology, Lishui Municipal Central Hospital, Zhejiang, China
| | - Dan Zhang
- Department of Neurology, Sir Run Shaw Hospital, Zhejiang, China
| | - Zhiliang Fan
- Department of Neurology, Xingtai People's Hospital, Hebei, China
| | - Xiaosu Yang
- Department of Neurology, Xiangya Hospital, Central South University, Hunan, China
| | - Dongmei Hu
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Shandong, China
| | - Yanbo Zhang
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Shandong, China
| | - Hongyan Xie
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Shandong, China
| | - Mingxin Li
- Department of Neurology, Qilu Hospital, Shandong, China
| | - Bing Wen
- Department of Neurology, Qilu Hospital, Shandong, China
| | - Sufen Chen
- Department of Neurology, Changsha Central Hospital Affiliated to University of South China, Changsha, China
| | - Peng Xu
- Department of Neurology, Affiliated Hospital of Jining Medical University, Shandong, China
| | - Qingqing Rong
- Department of Neurology, Affiliated Hospital of Jining Medical University, Shandong, China
| | - Qiu He
- Department of Neurology, The People's Hospital of Liaoning Province, Liaoning, China
| | - Zhanxiu Ren
- Department of Neurology, The People's Hospital of Liaoning Province, Liaoning, China
| | - Fanhong Yan
- Department of Neurology, Linyi Jinluo Hospital, Shandong, China
| | - Heling Zhao
- Department of Neurology, Linyi Jinluo Hospital, Shandong, China
| | - Min Chen
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Henan, China
| | - Tingmin Yu
- Department of Neurology, The Second Hospital of Jilin University, Jilin, China
| | - Hongli Qu
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Fujian, China
| | - Xingkai An
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Fujian, China
| | - Huailian Guo
- Department of Neurology, People's Hospital, Peking University, Beijing, China
| | - Xinhua Zhang
- Department of Neurology, People's Hospital, Peking University, Beijing, China
| | - Xiaoping Pan
- Department of Neurology, Guangzhou First People's Hospital, Guangdong, China
| | - Xiaojuan Wang
- Department of Neurology, Guangzhou First People's Hospital, Guangdong, China
| | - Shi Qiu
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Lvming Zhang
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Hongling Zhao
- Department of Neurology, Dalian Municipal Central Hospital, Liaoning, China
| | - Xin Pan
- Department of Neurology, Dalian Municipal Central Hospital, Liaoning, China
| | - Qi Wan
- Department of Neurology, Jiangsu Province Hospital, Jiangsu, China
| | - Lanyun Yan
- Department of Neurology, Jiangsu Province Hospital, Jiangsu, China
| | - Jing Liu
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,International Headache Center, Chinese PLA General Hospital, Beijing, China
| | - Zhe Yu
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,International Headache Center, Chinese PLA General Hospital, Beijing, China
| | - Mingjie Zhang
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,International Headache Center, Chinese PLA General Hospital, Beijing, China
| | - Ye Ran
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,International Headache Center, Chinese PLA General Hospital, Beijing, China
| | - Xun Han
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,International Headache Center, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,International Headache Center, Chinese PLA General Hospital, Beijing, China
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9
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Pereira A, Fuentes L, Almoguera B, Chaves P, Vaquero G, Perez-Medina T. Understanding the Female Physical Examination in Patients with Chronic Pelvic and Perineal Pain. J Clin Med 2022; 11:jcm11247490. [PMID: 36556104 PMCID: PMC9783077 DOI: 10.3390/jcm11247490] [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: 11/20/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: The objective was to compare the exploration of chronic pelvic pain syndrome (CPPS) patients in different locations and establish the role of physical examination in CPPS patients. (2) Methods: We reviewed clinical data from 107 female patients with CPPS unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain, from May 2018 to June 2022. Patients were classified into three groups: (a) pelvic pain; (b) anorectal pain; or (c) vulvar/perineal pain. (3) Results: Although the demographics of patients with CPPS were different, their physical examinations were strikingly similar. Our study observed a comorbidity rate of 36% and 79% of central sensitization of pain. Seventy-one percent of patients had vulvar allodynia/hyperalgesia. Pain on examination was identified in any pelvic floor muscle, in any pelvic girdle structure, and neuropathic pain in 98%, 96%, and 89%, respectively. Patients with vulvar and perineal pain were more different from the other groups; these patients were younger and had fewer comorbidities and less central sensitization, less anorectal pain, more pain during intercourse, and greater nulliparity (p = 0.022; p = 0.040; p = 0.048; p = 0.000; p = 0.006; p = 0.005). (4) Conclusions: The findings of this study are related to the understanding of the pathophysiology of CPPS. The physical examination confirms the central sensitization of female patients with CPPS, helps us to determine the therapeutic management of the patient, and can be considered as a prognostic factor of the disease.
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10
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Henningsen P, Hausteiner-Wiehle C, Häuser W. Migraine in the context of chronic primary pain, chronic overlapping pain disorders, and functional somatic disorders: A narrative review. Headache 2022; 62:1272-1280. [PMID: 36373821 DOI: 10.1111/head.14419] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To contextualize migraine as the most common primary headache disorder in relation to other chronic primary pain and non-pain functional somatic and mental conditions. BACKGROUND Migraine is increasingly understood as a sensory processing disorder within a broader spectrum of symptom disorders. This has implications for diagnosis and treatment. METHOD Narrative review based on a search of the literature of the last 15 years on the overlap of migraine with other symptom disorders. RESULTS Migraine as the prototypical primary headache disorder not only comprises many non-headache symptoms in itself, it also shows high comorbidity with other chronic pain and non-pain conditions (e.g., fibromyalgia syndrome, irritable bowel syndrome, functional non-epileptic seizures, depression, anxiety, and posttraumatic stress disorder). Such "symptom disorders" share several etiological factors (e.g., female preponderance, psychological vulnerability) and psychophysiological mechanisms (e.g., altered sensory processing, pain expectancy). These facts are acknowledged by several recent integrative conceptualizations such as chronic primary pain, chronic overlapping pain conditions, or functional somatic disorders. Accordingly, migraine management increasingly addresses the total symptom burden and individual contributors to symptom experience, and thus incorporates centrally acting pharmacological and non-pharmacological, that is, psychological and behavioral, treatment approaches. CONCLUSIONS Migraine and also other primary headache disorders should be seen as particular phenotypes within a broader spectrum of symptom perception and processing disorders that require integrative diagnostics and treatment. A harmonization of classifications and better interdisciplinary collaboration are desirable.
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Affiliation(s)
- Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Constanze Hausteiner-Wiehle
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany.,Department of Neurology, BG Trauma Center Murnau, Murnau, Germany
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany.,Department of Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany
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11
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Evcili G, Yabalak A. Effectiveness of peripheral nerve blockage on the symptoms of both diseases in patients with fibromyalgia and chronic migraine coexistence. Rev Assoc Med Bras (1992) 2022; 68:1064-1067. [PMID: 36000602 PMCID: PMC9574977 DOI: 10.1590/1806-9282.20220202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Peripheral nerve blockage treatments reduce central sensitization and are effective in patients with migraine. We wanted to evaluate the efficacy of peripheral nerve blockage in patients with fibromyalgia and migraine whose etiology may be responsible for central sensitization, and their associations are common. METHODS The files of patients with chronic migraine who had peripheral nerve blockage treatment in our clinic and had fibromyalgia were scanned. The patients underwent bilateral great occipital nerve, lesser occipital nerve, and supraorbital nerve blockage at baseline and in the second week. The revised Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, Visual Analog Scale scores, the number of days in pain, and the number of analgesics taken in the last month were recorded. RESULTS In the third month, Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, and Visual Analog Scale scores were significantly lower from baseline. While Fibromyalgia Impact Questionnaire scores in the third month were significantly lower than in the first month, no significant difference was observed between Visual Analog Scale scores. In the third month, the number of days in pain and the number of analgesics taken in the last month was significantly lower than the baseline but higher than the first month. CONCLUSION Peripheral nerve blockage has been found to be an effective treatment for the symptoms of both diseases in patients with migraine and fibromyalgia coexistence.
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Affiliation(s)
- Gokhan Evcili
- Health Sciences University Kocaeli Derince Training and Research Hospital, Department of Neurology - Kocaeli, Turkey
| | - Ahmet Yabalak
- Düzce University Medical Faculty, Department of Neurology - Düzce, Turkey
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12
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Fortes YML, Souza WPDO, Silva-Néto RP. Fibromyalgia in patients with migraine: A literature review in the last 20 years. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
IntroductionPossibly fibromyalgia and migraine share similar pathophysiological mechanisms, generatingan imbalance of neurotransmitters involved in pain modulation, with increased neuronal excitability. The association between these two conditions is frequent, increasing the disability of both.ObjectivesWe aimed to review articles published in the last 20 years about the presence of fibromyalgiain patients with migraine and to analyze the quality of life of these patients.MethodsBased on a literature search in the major medical databases and using the descriptors “migraine” and “fibromyalgia” we include articles published between 2001 and 2021. We found 387 articles, but only five met the inclusion criteria.ResultsIn five articles analyzed, 429 patients with migraine were found, in which fibromyalgiawas present in 31.5% of them, predominantly in women (p<0.0001). In this association, there was a higher risk for depression and worse quality of life.ConclusionsThe association of fibromyalgia in patients with migraine is frequent, increasing the disabilityof these two diseases and generating great social impact. Knowledge of this association and the management of its consequences are necessary in medical practice.
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13
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Ford J, Nichols RM, Ye W, Tockhorn-Heidenreich A, Cotton S, Jackson J. Patient-Reported Outcomes for Migraine in the US and Europe: Burden Associated with Multiple Preventive Treatment Failures. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:647-660. [PMID: 34285524 PMCID: PMC8286727 DOI: 10.2147/ceor.s304158] [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: 02/09/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate patient-reported outcomes (PROs) among patients with migraine, including those who were preventive-naïve and preventive-treated. Methods This was a point-in-time, real-world study of patients with migraine in the US and EU5 (France, Germany, Spain, Italy, and UK) and their physicians using data from the Adelphi Migraine Disease Specific Programme (DSP™). Physicians completed patient record forms (PRFs) for the next nine consulting patients with migraine plus a tenth patient, who did not need to be consecutive, for whom prior preventive migraine treatments had failed at least once, in order to achieve oversampling of such patients. Patients were given self-completion (PSC) forms that included the Migraine-Specific Quality of Life Questionnaire v2.1 (MSQ), Migraine Disability Assessment Scale (MIDAS), and Work Productivity and Activity Impairment (WPAI) questionnaire. Populations of interest included preventive-naïve and preventive-treated patients defined by the number of treatment lines (1–2 or 3+ preventive regimens). Continuous variables were compared using t-test or ANOVA if normally distributed and Mann–Whitney if not. Chi-squared was used for categorical variables. Results During August–December 2017, 615 physicians (359 PCPs, 256 neurologists) completed PRFs for 5785 patients (71% female; mean age 40 (±14) years; 65% in full- or part-time employment). Of these, 2798 completed a PSC (preventive-naïve/1–2/3+ preventive lines, n=1707/1034/57). Preventive-treated patients had a greater patient-reported burden across multiple measures versus preventive-naïve patients. Preventive-treated patients had lower MSQ scores indicating greater functional impairment, higher MIDAS scores indicating greater migraine-associated disability, and higher WPAI scores indicating greater overall work and activity impairment than preventive-naïve patients. The magnitude of difference was greatest for the 3+ preventive-treatments cohort. Patterns were similar in the US and EU5. Conclusion Among patients with migraine who are preventive-treated, including those with multiple lines of therapy, there remain considerable unmet needs in terms of restoring patient function.
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Affiliation(s)
- Janet Ford
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
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14
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Subjective Cognitive Symptoms and Dizziness Handicap Inventory (DHI) Performance in Patients With Vestibular Migraine and Menière's Disease. Otol Neurotol 2021; 42:883-889. [PMID: 33606474 DOI: 10.1097/mao.0000000000003081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cognitive symptoms in patients with vestibular disorders are far from rare, but identification of patients at risk for cognitive impairment remains poor. The Dizziness Handicap Inventory (DHI) is a widely used patient-reported outcome questionnaire for dizzy patients with several questions that address cognitive function. However, the relationship between subjective cognitive symptomatology in patients with vestibular disorders and performance on DHI is poorly characterized. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care vestibular clinic. SUBJECTS Individuals with diagnoses of vestibular migraine (VM), Menière's disease (MD), and concomitant vestibular migraine and Menière's disease (VMMD) presenting to clinic between January 2007 and December 2019. RESULTS Of 761 subjects, 365 had VM, 311 had MD, and 85 had VMMD. Symptoms of brain fog and chronic fatigue occurred more frequently in the VM and VMMD groups compared with the MD group (χ2 (df = 2, n = 761) = 67.8, 20.9, respectively, p < 0.0001). DHI scores were significantly higher in patients with VM and VMMD compared with those with MD (F[2,758] = 63.5, p < 0.001). A DHI score ≥ 13 suggested that the patient suffered from brain fog (sensitivity = 47.4%, specificity = 72.3%), whereas a score ≥ 15 indicated that the patient complained of chronic fatigue (sensitivity = 81.5%, specificity = 57.7%). CONCLUSION Our results indicate a high prevalence of interictal cognitive symptoms in patients with episodic vestibular disorders. The DHI cannot be reliably used to differentiate between vestibular disorders nor detect cognitive impairment in these patient populations. Alternative methods must be used to identify vestibulopathic patients with cognitive symptoms to initiate strategies for prevention and treatment.
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15
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Mohiuddin M, Park R, Wesselmann U, Pukall C, Jarvi K, Nickel C, Doiron C, Gilron I. Efficacy and Safety of Drug Combinations for Chronic Pelvic Pain: Protocol for a Systematic Review. JMIR Res Protoc 2021; 10:e21909. [PMID: 33999006 PMCID: PMC8167620 DOI: 10.2196/21909] [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: 06/28/2020] [Revised: 02/24/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic pelvic pain with various etiologies and mechanisms affects men and women and is a major challenge. Monotherapy is often unsuccessful for chronic pelvic pain, and combinations of different classes of medications are frequently prescribed, with the expectation of improved outcomes. Although a number of combination trials for chronic pelvic pain have been reported, we are not aware of any systematic reviews of the available evidence on combination drug therapy for chronic pelvic pain. Objective We have developed a protocol for a systematic review to evaluate available evidence of the efficacy and safety of drug combinations for chronic pelvic pain. Methods This systematic review will involve a detailed search of randomized controlled trials investigating drug combinations to treat chronic pelvic pain in adults. The databases searched will include the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE from their inception until the date the searches are run to identify relevant studies. The primary outcome will be pain relief measured using validated scoring tools. Secondary outcomes, where reported, will include the following: adverse events, serious adverse events, sexual function, quality of life, and depression and anxiety. Methodological quality of each included study will be assessed using the Cochrane Risk of Bias Tool. Results The systematic review defined by this protocol is expected to synthesize available good quality evidence on combination drug therapy in chronic pelvic pain, which may help guide future research and treatment choices for patients and their health care providers. Conclusions This review will provide a clearer understanding of the efficacy and safety of combination pharmacological therapy for chronic pelvic pain. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020192231; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192231 International Registered Report Identifier (IRRID) PRR1-10.2196/21909
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Affiliation(s)
- Mohammed Mohiuddin
- Department of Anesthesiology & Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Rex Park
- Department of Anesthesiology & Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ursula Wesselmann
- Departments of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Neurology and Psychology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Caroline Pukall
- Department of Psychology, Centre for Neuroscience Studies, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
| | | | - Ian Gilron
- Department of Anesthesiology & Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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16
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Yin JH, Lin YK, Yang CP, Liang CS, Lee JT, Lee MS, Tsai CL, Lin GY, Ho TH, Yang FC. Prevalence and association of lifestyle and medical-, psychiatric-, and pain-related comorbidities in patients with migraine: A cross-sectional study. Headache 2021; 61:715-726. [PMID: 33818765 DOI: 10.1111/head.14106] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Migraine has been associated with many comorbidities. However, lifestyle factors and the presence of comorbid diseases have not previously been extensively studied in the same sample. This study aimed to compare the prevalence of unhealthy lifestyle factors and comorbid diseases between patients with migraine and migraine-free controls with subgroup analyses to determine the pathophysiology and possible consequences. METHODS This cross-sectional study recruited 1257 patients with migraine between the ages of 20 and 65 years from a headache outpatient clinic in Taiwan and 496 non-migraine controls. All participants completed questionnaires regarding demographics, migraine diagnosis, sleep, headache burden, and medical, pain, and psychiatric conditions. Participants also underwent a structured interview. The associations between comorbidities and migraine were investigated and further stratified by sex and aura. RESULTS Patients with migraine with aura had an unhealthier lifestyle compared with controls in the form of current smoking status (15.5% [67/431] vs. 11.5% [57/496], p = 0.013). Furthermore, medical- (e.g., thyroid disease; 7.2% [91/1257 vs. 2.8% [14/496]; p = 0.006), psychiatric- (e.g., depression; 6% [76/1257 vs. 2.6% [13/496]; p = 0.031), and pain-related (e.g., fibromyalgia; 8% [101/1257 vs. 3.2% [16/496]; p = 0.006) comorbidities were more prevalent in patients compared with controls. Subgroup analyses revealed that chronic migraine, migraine with aura, and female sex were associated with a greater number of significant comorbidities than episodic migraine, migraine without aura, and male patients with migraine, respectively. CONCLUSION Individuals seeking treatment for migraine reported greater levels of smoking and medical, psychiatric, and pain conditions than non-treatment-seeking healthy controls who were recruited from the community. Understanding the relationship between migraine and comorbid diseases may improve medical care as well as the quality of life.
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Affiliation(s)
- Jiu-Haw Yin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Division of Neurology, Department of Internal Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Yu-Kai Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Pai Yang
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan.,Department of Nutrition, Huang-Kuang University, Taichung, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Lin Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Guan-Yu Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsung-Han Ho
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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17
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Goadsby PJ, Lantéri-Minet M, Michel MC, Peres M, Shibata M, Straube A, Wijeratne T, Ebel-Bitoun C, Constantin L, Hitier S. 21st century headache: mapping new territory. J Headache Pain 2021; 22:19. [PMID: 33794761 PMCID: PMC8015309 DOI: 10.1186/s10194-021-01233-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background With headache experienced by up to 75% of adults worldwide in the last year, primary headache disorders constitute a major public health problem, yet they remain under-diagnosed and under-treated. Headache prevalence and burden is changing as society evolves, with headache now occurring earlier in life. Contributing factors, mostly associated with changing life style, such as stress, bad posture, physical inactivity, sleep disturbance, poor diet and excess use of digital technology may be associated with the phenomenon that could be labelled as ‘21st century headache’. This is especially notable in workplace and learning environments where headache impacts mental clarity and therefore cognitive performance. The headache-related impact on productivity and absenteeism negatively influences an individual’s behaviour and quality of life, and is also associated with a high economic cost. Since the majority of sufferers opt to self-treat rather than seek medical advice, substantial knowledge on headache prevalence, causation and burden is unknown globally. Mapping the entire population of headache sufferers can close this knowledge gap, leading to better headache management. The broad use of digital technology to gather real world data on headache triggers, burden and management strategies, in self-treated population will allow these sufferers to access appropriate support and medication, and therefore improve quality of life. Conclusion These data can yield important insights into a substantial global healthcare issue and form the basis for improved patient awareness, professional education, clinical study design and drug development.
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Affiliation(s)
- Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, SE5 9PJ, UK. .,Department of Neurology, University of California, Los Angeles, USA.
| | - Michel Lantéri-Minet
- Pain Department and FHU InovPain, CHU Nice - Côte Azur Université, Nice, France.,INSERM U1107 Migraine and Trigeminal Pain, Auvergne University, Clermont-Ferrand, France
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
| | - Mario Peres
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mamoru Shibata
- Department of Neurology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
| | - Tissa Wijeratne
- AIMSS, Department of Neurology, Melbourne Medical School, Sunshine Hospital, Western Health, The University of Melbourne, Melbourne, Australia
| | | | | | - Simon Hitier
- Sanofi, 82, Avenue Raspail, 94255, Gentilly Cedex, France
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18
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de la Coba P, Bruehl S, Del Paso GAR. Slowly repeated evoked pain (SREP) as a central sensitization marker in episodic migraine patients. Sci Rep 2021; 11:4582. [PMID: 33633294 PMCID: PMC7907059 DOI: 10.1038/s41598-021-84157-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/09/2021] [Indexed: 01/31/2023] Open
Abstract
Migraine headache is a pain condition characterized by severe and recurrent unilateral head pain. Among other mechanisms, central pain sensitization processes seem to be involved in the disorder. An experimental protocol based on slowly repeated evoked pain (SREP) has been shown to indicate pain sensitization in fibromyalgia patients and differentiate these patients from healthy individuals and rheumatoid arthritis patients. This study examined SREP sensitization in migraine patients and explored its potential usefulness as a central sensitization marker. The SREP protocol was administered to 40 episodic migraine (EM) patients not currently experiencing a headache and 40 healthy controls. SREP consisted of a series of 9 suprathreshold painful pressure stimuli of 5 s duration and a 30 s interstimulus interval. SREP sensitization was indexed by the increase in pain ratings across the stimuli. Pain threshold, pain tolerance and temporal summation of pain were also assessed. SREP sensitization was observed in EM, but not in healthy individuals (p < .001). SREP differentiated between EM and healthy individuals with up to 75% diagnostic accuracy. Pain threshold, pain tolerance and temporal summation of pain did not show significant discriminative ability. An SREP index value of 0.5 was the most sensitive cut-off for detecting central pain sensitization when prioritizing diagnostic sensitivity (0.88). Results provide evidence for SREP as a possible central sensitization marker with potential clinical utility in migraine patients. Inclusion of SREP in Quantitative Sensory Testing protocols may enhance the assessment of altered pain modulation in different pain conditions.
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Affiliation(s)
- Pablo de la Coba
- Department of Psychology, University of Jaén, 23071, Jaén, Spain.
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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19
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Phan VT, Stratton P, Tandon HK, Sinaii N, Aredo JV, Karp BI, Merideth MA, Shah JP. Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: A cross-sectional study. Eur J Pain 2021; 25:831-840. [PMID: 33326662 DOI: 10.1002/ejp.1713] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/12/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment. OBJECTIVE Characterize the presence and distribution of pain, myofascial dysfunction and sensitisation beyond the pelvis in women with endometriosis-associated chronic pelvic pain. METHODS Cross-sectional study of 30 women prior to participation in a clinical trial. Evaluation included pain-focused abdominopelvic gynaecologic examination with the identification of pelvic floor muscle spasm. Neuro-musculoskeletal examination assessed paraspinal allodynia and hyperalgesia bilaterally and myofascial trigger points in 13 paired muscles. Pressure-pain thresholds were measured over interspinous ligaments and trigger points. Women completed the body territories element of the Body Pain Index. RESULTS All women had a pelvic floor muscle spasm that they self-identified as a major focus of pain. Twenty of 30 women described their pelvic pain as focal. However, all demonstrated widespread myofascial dysfunction with low pressure-pain thresholds and trigger points in over two-thirds of 26 assessed regions. Widespread spinal segmental sensitisation was present in 17/30, thoracic in 21/30 and lumbosacral/pelvic in 18/30. Cervical sensitisation manifested as low pressure-pain thresholds with 23/30 also reporting recurrent, severe headaches and 21/30 experiencing orofacial pain. Those reporting diffuse pelvic pain were more likely to have widespread (p = .024) and lumbosacral/pelvic (p = .036) sensitisation and report over 10 painful body areas (p = .009). CONCLUSIONS Women with endometriosis-associated chronic pelvic pain often have myofascial dysfunction and sensitisation beyond the pelvic region that may be initiated or maintained by on-going pelvic floor spasm. These myofascial and nervous system manifestations warrant consideration when managing pain in this population. Clinicaltrials.gov identifier: NCT01553201. SIGNIFICANCE Women with endometriosis often have pelvic pain persisting after surgery despite hormonal therapies and these women have regional pelvic sensitisation and myofascial dysfunction. Pelvic floor muscle spasm is a major pain focus in this population. Sensitisation and myofascial dysfunction are widespread, beyond the pelvic region. On-going pelvic floor spasm may initiate or maintain sensitisation. Myofascial/sensitisation manifestations warrant consideration when managing pain in this population.
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Affiliation(s)
- Vy T Phan
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Pamela Stratton
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Hannah K Tandon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ninet Sinaii
- Biostatistics & Clinical Epidemiology Service, Intramural Research Program, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Barbara I Karp
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Melissa A Merideth
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jay P Shah
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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20
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Ren K. Grand Challenges in Musculoskeletal Pain Research: Chronicity, Comorbidity, Immune Regulation, Sex Differences, Diagnosis, and Treatment Opportunities. FRONTIERS IN PAIN RESEARCH 2020; 1. [PMID: 34296207 PMCID: PMC8294784 DOI: 10.3389/fpain.2020.575479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Ke Ren
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, United States.,Program in Neuroscience, University of Maryland, Baltimore, MD, United States
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21
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He J, Dun W, Han F, Wang K, Yang J, Ma S, Zhang M, Liu J, Liu H. Abnormal white matter microstructure along the thalamus fiber pathways in women with primary dysmenorrhea. Brain Imaging Behav 2020; 15:2061-2068. [PMID: 33033985 DOI: 10.1007/s11682-020-00400-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/19/2022]
Abstract
Primary dysmenorrhea (PDM) is a cyclic menstrual pain in the absence of pelvic anomalies, and women with PDM have an increased sensitivity to pain than the internal and external areas associated with menstrual pain. However, the brain abnormality in the ascending pain pathways in dysmenorrhea remains largely unclear. As the thalamus plays a significant role in transmission of nociceptive input, we examined whether white matter microstructure of the thalamus-related fiber tracts obtained by DTI in women with PDM (n = 47) differs from healthy controls. A novel tractography atlas-based analysis method that detects tract integrity and altered microstructural properties along selected fibers was employed. The fiber bundles of interest contained the thalamus- primary somatosensory cortex (SI), thalamus- dorsal anterior cingulate cortex (dACC)/supplementary motor area (SMA), thalamus-insula, and thalamus-ACC. As compared with controls, abnormal white matter microstructures were found along the thalamus-related white matter fiber tracts. Additionally, the intensity of menstrual pain was significantly associated with diffusion measures of thalamus-SI fiber connections. Our study suggested that the thalamus-related pain processing pathways had altered white matter integrity that persisted beyond the time of menstruation, and the white matter microstructure of the thalamus-SI pathways was closely related to menstrual pain in the intensity by women with PDM.
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Affiliation(s)
- Juan He
- Department of Rehabilitation Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wanghuan Dun
- Department of Rehabilitation Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fang Han
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ke Wang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Yang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shaohui Ma
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ming Zhang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jixin Liu
- School of Life Science and Technology, Xidian University, Xi'an, China.
| | - Hongjuan Liu
- Department of Intensive Care Unit, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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22
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Sumelahti ML, Sumanen M, Sumanen MS, Tuominen S, Vikkula J, Honkala SM, Rosqvist S, Korolainen MA. My Migraine Voice survey: disease impact on healthcare resource utilization, personal and working life in Finland. J Headache Pain 2020; 21:118. [PMID: 32993489 PMCID: PMC7526198 DOI: 10.1186/s10194-020-01185-4] [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: 07/07/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A global My Migraine Voice survey was conducted in 31 countries among 11,266 adults who suffered from ≥4 monthly migraine days (MMD). The aim of this retrospective observational survey-based study was to analyse the country specific results in Finland in order to understand the impact of migraine based on disease severity. METHODS The included participants (3%, n = 338/11,266) were stratified by mean MMDs into 4 ≤ MMD < 8 (n = 133), 8 ≤ MMD < 15 (n = 139) and MMD ≥ 15 (n = 66) subgroups. Comorbidities, migraine-related emotional burden and impact on daily living and work productivity and activity impairment (WPAI) were assessed. Subgroup analysis on healthcare resource utilization (HCRU) due to migraine was assessed by visits to healthcare practitioners (HCPs) during the past 6 months and by hospitalizations and emergency room (ER) visits during the past 12 months. The group difference was tested using the one-way ANOVA and for categorical variables using the Chi-squared test. The association between HCRU and MMD and number of comorbidities was assessed using negative binomial regression analysis. RESULTS Mean age was 44 years, 93% were women and 67% (n = 227) were employed. Chronic migraine (CM, MMD ≥ 15) was reported in 19.5% of the respondents. The negative impact on daily functioning and emotional burden increased significantly by migraine frequency. Mean number of comorbidities was 2.4, and mean number of HCP visits during the previous 6 months was 5.9. Increase in migraine frequency and comorbidities was associated with higher HCRU. Eighty-eight percent of the respondents reported negative impact on working life and 52% experienced overall work productivity impairment. Over previous month, the mean number of missed working days for all respondents was 2.8 days of which 54% were paid sick leave days, and in CM up to 6.0 days and 30%, respectively. Both absenteeism and presenteeism were higher in the CM group. CONCLUSIONS The emotional and functional burden was high, and the societal burden increased by frequency and severity of migraine, as shown by higher HCRU and reduced work productivity. There is a need to improve quality of care in migraine and improve migraine management related issues in both healthcare and society in Finland.
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Affiliation(s)
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Merika S Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | | | | | | | - Minna A Korolainen
- Novartis Finland Oy, Espoo, Finland.,Present address: Orion Pharma, Orion Corporation, Espoo, Finland
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23
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Rivera-Mancilla E, Villalón CM, MaassenVanDenBrink A. CGRP inhibitors for migraine prophylaxis: a safety review. Expert Opin Drug Saf 2020; 19:1237-1250. [DOI: 10.1080/14740338.2020.1811229] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Eduardo Rivera-Mancilla
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Costantini R, Affaitati G, Fiordaliso M, Giamberardino MA. Viscero-visceral hyperalgesia in dysmenorrhoea plus previous urinary calculosis: Role of myofascial trigger points and their injection treatment in the referred area. Eur J Pain 2020; 24:933-944. [PMID: 32034979 DOI: 10.1002/ejp.1542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/02/2020] [Accepted: 02/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Women with dysmenorrhoea plus symptomatic urinary calculosis experience enhanced pain and referred muscle hyperalgesia from both conditions than women with one condition only (viscero-visceral hyperalgesia). The study aimed at verifying if enhanced dysmenorrhoea persists after urinary stone elimination in comorbid women and if local anaesthetic inactivation of myofascial trigger points (TrPs) in the lumbar area (of urinary pain referral) also relieves dysmenorrhoea. METHODS Thirty-one women with dysmenorrhoea plus previous urinary calculosis (Dys+PrCal) and lumbar TrPs, and 33 women with dysmenorrhoea without calculosis (Dys) underwent a 1-year assessment of menstrual pain and muscle hyperalgesia in the uterus-referred area (electrical pain threshold measurement in rectus abdominis, compared with thresholds of 33 healthy controls). At the end of the year, 16 comorbid patients underwent inactivation of TrPs through anaesthetic injections, whereas the remaining 12 received no TrP treatment. Both groups were monitored for another year at the end of which thresholds were re-measured. RESULTS In year1, Dys+PrCal presented significantly more painful menstrual cycles and lower abdominal thresholds than Dys, thresholds of both groups being significantly lower than normal (p < .001). Anaesthetic treatment versus no treatment of the lumbar TrP significantly reduced the number of painful cycles during year2 and significantly increased the abdominal thresholds (p < .0001). CONCLUSION Viscero-visceral hyperalgesia between uterus and urinary tract may persist after stone elimination due to nociceptive inputs from TrPs in the referred urinary area, since TrPs treatment effectively reverses the enhanced menstrual symptoms. The procedure could represent an integral part of the management protocol in these conditions. SIGNIFICANCE A past pain process from an internal organ can continue enhancing pain expression from a painful disease in another neuromerically connected organ (viscero-visceral hyperalgesia) if secondary myofascial trigger points (TrPs) developed in the referred area at the time of the previous visceral disease. Inactivation of these TrPs reverts the enhancement. Assessment and treatment of TrPs in referred areas from past visceral pain conditions should be systematically carried out to better control pain from current diseases in other viscera.
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Affiliation(s)
- Raffaele Costantini
- Institute of Surgical Pathology, Department of Medical, Oral and Biotechnological Sciences, "G D'Annunzio" University of Chieti, Chieti, Italy
| | - Giannapia Affaitati
- Geriatrics Clinic, Department of Medicine and Science of Aging, "G D'Annunzio" University of Chieti, Chieti, Italy
| | - Michele Fiordaliso
- Kliniske Abteilung für Allgemeine Viszeral und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt, Germany
| | - Maria Adele Giamberardino
- Geriatrics Clinic, Department of Medicine and Science of Aging, "G D'Annunzio" University of Chieti, Chieti, Italy
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25
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26
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Co-occurrence of pain syndromes. J Neural Transm (Vienna) 2019; 127:625-646. [DOI: 10.1007/s00702-019-02107-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/17/2019] [Indexed: 12/17/2022]
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27
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Ford JH, Ye W, Nichols RM, Foster SA, Nelson DR. Treatment patterns and predictors of costs among patients with migraine: evidence from the United States medical expenditure panel survey. J Med Econ 2019; 22:849-858. [PMID: 30977712 DOI: 10.1080/13696998.2019.1607358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aim: Within a treated migraine population, to evaluate if the sub-group meeting criteria for high disease-specific total costs is significantly different to the sub-group with medium and/or low-costs, and to identify the associated risk factors. Methods: Data from the Household Component of Medical Expenditure Panel Survey (MEPS-HC, 2008-2012), a nationally representative survey of non-institutionalized civilians in the US, were analyzed. Key inclusion criteria were migraine diagnosis (ICD-9 code: 346.XX) and prescribed treatment for migraine. Patients were categorized into high (>top 10th percentile), low (<bottom 10th percentile), and medium (between high and low) cost sub-groups per migraine-specific total costs. Logistic regression models were applied to identify predictors of high vs medium and medium vs low-costs. Preventive eligibility, defined as (i) past/current use of migraine preventives or (ii) overuse of acute medications, was compared to non-preventive eligibility. Results: Within the treated migraine cohort (n = 1,735), the mean age was 39 years, 80% were female, and the majority were in the medium-cost sub-group (n = 1,360) (low-cost n = 190, high-cost n = 195). Significant predictors of high vs medium-costs were low SF-12 Physical Composite Scores (OR = 0.95; 95% CI = 0.92-0.97), low SF-6D health utility index scores (OR = 0.019; 95% CI = 0.002-0.193), preventive eligibility-i (OR = 0.019; 95% CI = 0.002-0.193), and preventive-eligibility-ii (OR = 3.10; 95% CI = 1.62-5.91). Statistically significant (p < 0.05) predictors of medium vs low-costs included anxiety, Fleishman score, preventive-eligible-i, and preventive-eligible-ii. Conclusions: Among patients treated for migraine, distinct characteristics, including patient-functioning measures and comorbidities, are predictive of high vs medium-costs, and medium vs low-costs. Preventive eligibility is a predictor of being in the higher cost sub-groups; however, preventive treatments that improve functioning and reduce acute medication use have the potential to reduce migraine-specific costs. Limitations: The results are limited to a population that is diagnosed and treated for migraine. Over-the-counter medication use, and migraine headache frequency and severity were not captured.
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Affiliation(s)
- Janet H Ford
- a Eli Lilly and Company , Indianapolis , IN , USA
| | - Wenyu Ye
- a Eli Lilly and Company , Indianapolis , IN , USA
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28
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Levesque A, Riant T, Ploteau S, Rigaud J, Labat JJ. Clinical Criteria of Central Sensitization in Chronic Pelvic and Perineal Pain (Convergences PP Criteria): Elaboration of a Clinical Evaluation Tool Based on Formal Expert Consensus. PAIN MEDICINE 2019. [PMID: 29522121 PMCID: PMC7372934 DOI: 10.1093/pm/pny030] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The evaluation of chronic pelvic and perineal pain (CPP) is often complex. The patient’s description of the pain often appears to be disproportionate to the limited findings on physical examination and/or complementary investigations. The concept of central sensitization may allow better understanding and management of patients with CPP. Objective The aim of this study was to elaborate a clinical evaluation tool designed to simply identify sensitization in pelvic pain. Methods A list of 63 items was submitted to 22 international CPP experts according to the Delphi method. Results Ten clinical criteria were adopted for the creation of a clinical evaluation tool: 1) pain influenced by bladder filling and/or urination, 2) pain influenced by rectal distension and/or defecation, 3) pain during sexual activity, 4) perineal and/or vulvar pain in response to normally nonpainful stimulation, 5) pelvic trigger points (e.g., in the piriformis, obturator internus, and/or levator ani muscles), 6) pain after urination, 7) pain after defecation, 8) pain after sexual activity, 9) variable (fluctuating) pain intensity and/or variable pain distribution, 10) migraine or tension headaches and/or fibromyalgia and/or chronic fatigue syndrome and/or post-traumatic stress disorder and/or restless legs syndrome and/or temporomandibular joint dysfunction and/or multiple chemical sensitivity. Conclusions This process resulted in the elaboration of a clinical evaluation tool designed to identify and appropriately manage patients with CPP comprising a sensitization component.
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Affiliation(s)
- Amélie Levesque
- Federative Pelvic Pain Center, Department of Urology, Nantes University Hospital, Nantes, France
| | - Thibault Riant
- Federative Pelvic Pain Center, Department of Urology, Nantes University Hospital, Nantes, France.,Department of Pain Management, Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
| | - Stéphane Ploteau
- Federative Pelvic Pain Center, Department of Urology, Nantes University Hospital, Nantes, France.,Department of Gynecology-Obstetrics and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | - Jérôme Rigaud
- Federative Pelvic Pain Center, Department of Urology, Nantes University Hospital, Nantes, France
| | - Jean-Jacques Labat
- Federative Pelvic Pain Center, Department of Urology, Nantes University Hospital, Nantes, France
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Marchi L, Marzetti F, Orrù G, Lemmetti S, Miccoli M, Ciacchini R, Hitchcott PK, Bazzicchi L, Gemignani A, Conversano C. Alexithymia and Psychological Distress in Patients With Fibromyalgia and Rheumatic Disease. Front Psychol 2019; 10:1735. [PMID: 31417462 PMCID: PMC6685004 DOI: 10.3389/fpsyg.2019.01735] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is a chronic rheumatologic disease characterized by widespread musculoskeletal pain and other psychopathological symptoms which have a negative impact on patients' quality of life. FMS is frequently associated with alexithymia, a multidimensional construct characterized by difficulty in identifying feelings (DIF) and verbally communicating them difficulty describing feelings (DDF) and an externally oriented cognitive thinking style (EOT). The aim of the present study was to investigate the relationship between alexithymia, anxious and depressive symptoms and pain perception, in patients with FMS and other rheumatic diseases (RD). METHODS The sample consisted of 127 participants (M = 25, F = 102; mean age: 51.97; SD: 11.14), of which 48 with FMS, 41 with RD and 38 healthy control group (HC). All groups underwent to a test battery investigating anxiety and depressive symptoms (HADS), pain (VAS; QUID-S/-A) and alexithymia (TAS-20). RESULTS A high prevalence of alexithymia (TAS ≥ 61) was found in FMS (47.9%) and RD (41.5%) patients, compared to the HC group (2.6%). FMS patients showed significant higher scores than HC on DIF, DDF, EOT, anxiety and depression. The clinical sample, FMS and RD groups combined (n = 89), alexithymic patients (AL, n = 40) exhibited higher scores in pain and psychological distress compared to non-alexithymic patients (N-AL, n = 34). Regression analysis found no relationship between alexithymia and pain in AL, meanwhile pain intensity was predicted by anxiety in N-AL. CONCLUSION While increasing clinical symptoms (pain intensity and experience, alexithymia, anxiety, and depression) in patients with fibromyalgia or rheumatic diseases, correlations were found on the one side, between alexithymia and psychological distress, on the other side, between pain experience and intensity. Meanwhile, when symptoms of psychological distress and alexithymia were subthreshold, correlations with pain experience and intensity became stronger.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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30
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Juvenile Fibromyalgia and Headache Comorbidity in Children and Adolescents: A Literature Review. Pain Res Manag 2019; 2019:3190829. [PMID: 31281557 PMCID: PMC6589204 DOI: 10.1155/2019/3190829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/16/2019] [Indexed: 11/17/2022]
Abstract
Juvenile fibromyalgia (JFM) is a chronic pain syndrome with onset in developmental age, characterized by widespread musculoskeletal pain associated with other neurological or nonneurological symptoms. Headache is one of the most frequent comorbid conditions with JFM, but this association is still poorly studied in the juvenile population. The literature review was conducted searching through PubMed, Scopus, and Web of Science with a combination of the following free-text terms: "fibromyalgia," "juvenile fibromyalgia," "headache," "primary headache," "migraine," "children," "adolescents," and "comorbidity." The research resulted only in two specific studies regarding comorbidity JFM + Juvenile Headache (JH). From each study, we extracted data about sample features, clinical characteristics of both JFM and PH, and assessment tools. The clinical approach to JFM and JH should include a complete examination of the main causes of comorbid diseases, thus improving the therapeutic approach to the patient in developmental age.
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31
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Fernández-de-Las-Peñas C, Ambite-Quesada S, Florencio LL, Palacios-Ceña M, Ordás-Bandera C, Arendt-Nielsen L. Catechol-O-Methyltransferase Val158Met Polymorphism Is Associated with Anxiety, Depression, and Widespread Pressure Pain Sensitivity in Women with Chronic, but Not Episodic, Migraine. PAIN MEDICINE 2019; 20:1409-1417. [PMID: 30481348 DOI: 10.1093/pm/pny237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To analyze the association between the rs4680 catechol-O-methyltransferase Val158Met polymorphism and to determine the association of this polymorphism with clinical, psychological, and pain sensitivity variables in women with episodic or chronic migraine. METHODS Fifty women with episodic migraine, 50 with chronic migraine, and 50 matched healthy women participated. After amplifying the Val158Met polymorphism by polymerase chain reaction, we assessed genotype frequencies and allele distributions. Participants were classified according to the Val158Met polymorphism genotype into Val/Val, Val/Met, or Met/Met. A headache diary was used for collecting migraine pain features. Disability was assessed with the Migraine Disability Assessment Scale, trait/state anxiety levels with the State-Trait Anxiety Inventory, and depression/anxiety with the Hospital Anxiety and Depression Scale. Pressure pain thresholds (PPTs) were bilaterally assessed over the temporalis, the upper trapezius, the second metacarpal, and the tibialis anterior. RESULTS The distribution of the rs4680 Val158Met genotype was not significantly different between women with and without migraine (P = 0.157). No differences in migraine features were found to be dependent on the Val158Met genotype. Women with the Met/Met genotype showed higher migraine-related disability than those with the Val/Val or Val/Met genotype in both migraine groups (P < 0.01). Women with chronic, but not episodic, migraine with the Met/Met genotype exhibited higher depressive and anxiety levels and lower PPTs than those with the Val/Val or Val/Met genotype. CONCLUSIONS The Val158Met rs4680 polymorphism does not appear to be involved in predisposition to suffer from migraine; however, this genetic factor may be involved in the phenotypic expression of chronic migraine, as anxiety, depression, and widespread pressure pain sensitivity were greater in those women with chronic, but not episodic, migraine with the Met/Met genotype.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Silvia Ambite-Quesada
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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Koverech A, Cicione C, Lionetto L, Maestri M, Passariello F, Sabbatini E, Capi M, De Marco CM, Guglielmetti M, Negro A, Di Menna L, Simmaco M, Nicoletti F, Martelletti P. Migraine and cluster headache show impaired neurosteroids patterns. J Headache Pain 2019; 20:61. [PMID: 31132992 PMCID: PMC6734521 DOI: 10.1186/s10194-019-1005-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background Perturbation of neuronal excitability contributes to migraine. Neurosteroids modulate the activity of γ-aminobutyric acid A and N-methyl-d-aspartate receptors, and might be involved in the pathogenesis of migraine. Here, we measured plasma levels of four neurosteroids, i.e., allopregnanolone, epiallopregnanolone, dehydroepiandrosterone and deydroepiandrosterone sulfate, in patients affected by episodic migraine, chronic migraine, or cluster headache. Methods Nineteen female patients affected by episodic migraine, 51 female patients affected by chronic migraine, and 18 male patients affected by cluster headache were recruited to the study. Sex- and age-matched healthy control subjects (31 females and 16 males) were also recruited. Patients were clinically characterized by using validated questionnaires. Plasma neurosteroid levels were measured by liquid chromatography-tandem mass spectrometry. Results We found disease-specific changes in neurosteroid levels in our study groups. For example, allopregnanolone levels were significantly increased in episodic migraine and chronic migraine patients than in control subjects, whereas they were reduced in patients affected by cluster headache. Dehydroepiandrosterone and dehydroepiandrosterone sulfate levels were reduced in patients affected by chronic migraine, but did not change in patients affected by cluster headache. Conclusion We have shown for the first time that large and disease-specific changes in circulating neurosteroid levels are associated with chronic headache disorders, raising the interesting possibility that fluctuations of neurosteroids at their site of action might shape the natural course of migraine and cluster headache. Whether the observed changes in neurosteroids are genetically determined or rather result from exposure to environmental or intrinsic stressors is unknown. This might also be matter for further investigation because stress is a known triggering factor for headache attacks in both migraineurs and cluster headache patients.
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Affiliation(s)
- Angela Koverech
- Department of Clinical and Molecular Medicine, Sapienza University and Regional Referral Headache Centre, Sant'Andrea Hospital, via di Grottarossa 1035-1039, 00189, Rome, Italy.,Residency Program of Internal Medicine, School of Medicine and Psychology, Sapienza University, 00189, Rome, Italy.,Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University, 00189, Rome, Italy
| | - Claudia Cicione
- Laboratory of Advanced Molecular Diagnostics, IRCSS Istituto Dermopatico dell'Immacolata, 00167, Rome, Italy
| | - Luana Lionetto
- Laboratory of Advanced Molecular Diagnostics, IRCSS Istituto Dermopatico dell'Immacolata, 00167, Rome, Italy.,Advanced Molecular Diagnostics Unit, Sant'Andrea Hospital, 00189, Rome, Italy
| | - Marta Maestri
- Department of Clinical and Molecular Medicine, Sapienza University and Regional Referral Headache Centre, Sant'Andrea Hospital, via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Francesco Passariello
- Department of Clinical and Molecular Medicine, Sapienza University and Regional Referral Headache Centre, Sant'Andrea Hospital, via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Elisabetta Sabbatini
- Department of Clinical and Molecular Medicine, Sapienza University and Regional Referral Headache Centre, Sant'Andrea Hospital, via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Matilde Capi
- Laboratory of Experimental Immunology, IRCSS Istituto Dermopatico dell'Immacolata, 00167, Rome, Italy.,Advanced Molecular Diagnostics Unit, Sant'Andrea Hospital, 00189, Rome, Italy
| | | | - Martina Guglielmetti
- Regional Referral Headache Centre, Sant'Andrea Hospital, 00189, Rome, Italy.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University and Regional Referral Headache Centre, Sant'Andrea Hospital, via di Grottarossa 1035-1039, 00189, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, 00189, Rome, Italy
| | | | - Maurizio Simmaco
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, 00189, Rome, Italy.,Advanced Molecular Diagnostics Unit, Sant'Andrea Hospital, 00189, Rome, Italy
| | - Ferdinando Nicoletti
- IRCCS Neuromed, 86077, Pozzilli (IS), Italy.,Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University, 00189, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University and Regional Referral Headache Centre, Sant'Andrea Hospital, via di Grottarossa 1035-1039, 00189, Rome, Italy. .,Residency Program of Internal Medicine, School of Medicine and Psychology, Sapienza University, 00189, Rome, Italy. .,Regional Referral Headache Centre, Sant'Andrea Hospital, 00189, Rome, Italy.
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Chronic Widespread Pain and Fibromyalgia Syndrome: Life-Course Risk Markers in Young People. Pain Res Manag 2019; 2019:6584753. [PMID: 31191788 PMCID: PMC6525804 DOI: 10.1155/2019/6584753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
Although the life-course concept of risk markers as potential etiological influences is well established in epidemiology, it has not featured in academic publications or clinical practice in the context of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). Studies of risk markers are required considerations for evaluation of patients and for research because there is no single cause, pathological feature, laboratory finding, or biomarker for CWP or FMS. The early-life risk markers identified by extensive literature review with best evidence for potential causal influence on the development and progression of CWP and FMS include genetic factors, premature birth, female sex, early childhood adversity, cognitive and psychosocial influences, impaired sleep, primary pain disorders, multiregional pain, physical trauma, infectious illness, obesity and inactivity, hypermobility of joints, iron deficiency, and small-fiber polyneuropathy. The case history illustrates the potential etiological influence of multiple risk markers offset by personal resilience.
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34
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Penn IW, Chuang E, Chuang TY, Lin CL, Kao CH. Bidirectional association between migraine and fibromyalgia: retrospective cohort analyses of two populations. BMJ Open 2019; 9:e026581. [PMID: 30962236 PMCID: PMC6500182 DOI: 10.1136/bmjopen-2018-026581] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Fibromyalgia (FM) and migraine are common pain disorders that tend to coexist. This study determined whether these two conditions exhibited any mutual influences. SETTING Cohort study. PARTICIPANTS A retrospective, longitudinal cohort study was conducted using data obtained from a nationwide healthcare database. This study had two arms. Arm 1 comprised 33 216 patients with FM and arm 2 consisted of 7420 patients with migraine; all of these patients were diagnosed between 2000 and 2010. Using the aforementioned database, control subjects who had neither FM nor migraine and were matched with the FM and migraine patients by sex, age and index date of diagnosis were recruited. Each control cohort was four times the size of the corresponding study cohort. Follow-up for the control and study cohorts was conducted until the end of 2011. RESULTS The incidence rates of FM and migraine were calculated in arms 1 and 2, respectively. The overall incidence of migraine was greater in the FM cohort than in the corresponding control cohort (4.39 vs 2.07 per 1000 person-years (PY)); crude HR=2.12, 95% CI=1.96 to 2.30; adjusted HR (aHR)=1.89, 95% CI=1.75 to 2.05). After adjustment for sex, age and comorbidities, the overall incidence of FM in the migraine cohort was 1.57 times greater than that in the corresponding control cohort (7.01 vs 4.49 per 1000 PY; aHR=1.52, 95% CI=1.39 to 1.65). CONCLUSIONS The present study revealed a bidirectional link between FM and migraine.
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Grants
- This work was supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW108-TDU-B-212-133004), China Medical University Hospital (DMR-107-192), Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 107-2321-B-039 -004-), Tseng-Lien Lin Foundation, Taichung, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation o
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Affiliation(s)
- I-Wen Penn
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, FuJen Catholic University Hospital, Fu Jen Catholic University, NewTaipei City, Taiwan
| | - Eric Chuang
- Intended B.S. Molecular and Cell Biology, University of California Berkeley, Berkeley, California, USA
| | - Tien-Yow Chuang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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35
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Maasumi K, Michael RL, Rapoport AM. CGRP and Migraine: The Role of Blocking Calcitonin Gene-Related Peptide Ligand and Receptor in the Management of Migraine. Drugs 2019; 78:913-928. [PMID: 29869205 DOI: 10.1007/s40265-018-0923-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Migraine is a highly prevalent, complex neurological disorder. The burden of disease and the direct/indirect annual costs are enormous. Thus far, treatment options have been inadequate and mostly based on trial and error, leaving a significant unmet need for effective therapies. While the underlying pathophysiology of migraine is incompletely understood, blocking the calcitonin gene-related peptide (CGRP) using monoclonal antibodies targeting CGRP or its receptor and small molecule CGRP receptor antagonists (gepants) have emerged as a promising therapeutic opportunity for the management of migraine. In this review, we discuss new concepts in the pathophysiology of migraine and the role of CGRP, the current guidelines for treating migraine preventively, the medications that are being used, and their limitations. We then discuss small molecule CGRP receptor antagonists, monoclonal antibodies to CGRP ligand and receptor, as well as the detailed results of Phase II and III trials involving these novel treatments. We conclude with a discussion of the implications of blocking CGRP and its receptor.
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Affiliation(s)
- Kasra Maasumi
- Department of Neurology, University of California, San Francisco, USA.
| | - Rebecca L Michael
- Department of Neurology, University of California, San Francisco, USA
| | - Alan M Rapoport
- Department of Neurology, University of California, Los Angeles, USA
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Fricova J, Janatova M, Anders M, Albrecht J, Rokyta R. Thermovision: a new diagnostic method for orofacial pain? J Pain Res 2018; 11:3195-3203. [PMID: 30588071 PMCID: PMC6300380 DOI: 10.2147/jpr.s183096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Infrared thermography can be used to obtain more complete information about a patient's condition. The method can be used in various medical applications for monitoring acute and chronic orofacial pain syndrome. With this diagnostic method, thermal differences in the examined region are usually compared to the same reference region on the opposite side of the body. METHODS Infrared quantitative thermography is a non-invasive method for contactless monitoring of dynamic thermal fields on a surface, or in this case, the human body. This method is based on detection of infrared radiation, which is naturally emitted from the surface of the body. In a pilot project with a patient having orofacial pain, changes before and after repetitive transcranial magnetic brain stimulation treatment were assessed. RESULTS First-day measurements found significantly higher maximum, minimum, and average temperatures, before and after therapy, in the area where the patient subjectively reported pain. The fifth and final measurements, before and after therapy, found only a slight elevation of the maximum temperature of the assessed regions, relative to the same regions on the opposite side of the face. CONCLUSION During the measurements on the fifth day, a thermal difference greater than 0.4°C was only observed relative to the minimum temperatures associated with the regions of self-reported pain before and after therapy. For validation of the effects, this method will need to be tested using a randomized, double-blind study with a larger number of patients.
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Affiliation(s)
- Jitka Fricova
- Charles University, 1st Faculty of Medicine, General University Hospital, Department of Anesthesiology, Resuscitation and Intensive Medicine, Pain Management Center, Prague, Czech Republic,
- Charles University, 3rd Faculty of Medicine, Department of Normal, Pathological and Clinical Physiology, Prague, Czech Republic, ,
| | - Marketa Janatova
- Charles University, 1st Faculty of Medicine, General University Hospital, Department of Rehabilitation Medicine, Prague, Czech Republic
| | - Martin Anders
- Charles University, 1st Faculty of Medicine, General University Hospital, Department of Psychiatry, Prague, Czech Republic
| | - Jakub Albrecht
- Charles University, 1st Faculty of Medicine, General University Hospital, Department of Psychiatry, Prague, Czech Republic
| | - Richard Rokyta
- Charles University, 3rd Faculty of Medicine, Department of Normal, Pathological and Clinical Physiology, Prague, Czech Republic, ,
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Martelletti P, Giamberardino MA. Advances in orally administered pharmacotherapy for the treatment of migraine. Expert Opin Pharmacother 2018; 20:209-218. [DOI: 10.1080/14656566.2018.1549223] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
| | - Maria Adele Giamberardino
- Headache and Fibromyalgia Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-Met, “G. D’Annunzio” University of Chieti, Chieti, Italy
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39
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Affaitati G, Costantini R, Tana C, Lapenna D, Schiavone C, Cipollone F, Giamberardino MA. Effects of topical vs injection treatment of cervical myofascial trigger points on headache symptoms in migraine patients: a retrospective analysis. J Headache Pain 2018; 19:104. [PMID: 30409108 PMCID: PMC6755551 DOI: 10.1186/s10194-018-0934-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/16/2018] [Indexed: 12/23/2022] Open
Abstract
Background In migraine patients with cervical myofascial trigger points whose target areas coincide with migraine sites (M + cTrPs), TrP anesthetic injection reduces migraine symptoms, but the procedure often causes discomfort. This study evaluated if a topical TrP treatment with 3% nimesulide gel has similar efficacy as the injection but produces lesser discomfort with higher acceptability by the patients. Methods Retrospective analysis of medical charts of M + cTrPs patients in the period January 2012–December 2016 at a single Headache Center. Three groups of 25 patients each were included, all receiving migraine prophylaxis (flunarizine 5 mg/day) for 3 months and symptomatic treatment on demand. Group 1 received no TrP treatment, group 2 received TrP injections (bupivacaine 5 mg/ml at basis, 3rd, 10th, 30th and 60th day), group 3 received daily TrP topical treatment with 1.5 g of 3% nimesulide gel for 15 consecutive days, 15 days interruption and again 15 consecutive days. The following were evaluated: monthly number of migraine attacks and rescue medications, migraine intensity; pain thresholds to skin electrical stimulation (EPTs) and muscle pressure stimulation (PPTs) in TrP and target (basis, 30th, 60th and 180th days); discomfort from, acceptability of and willingness to repeat treatment (end of study). ANOVA for repeated measures and 1-way ANOVA were used to assess temporal trends in each group and comparisons among groups, respectively. Significance level was set at p < 0.05. Results Migraine improved over time in all groups, but significantly more and earlier in those receiving TrP treatment vs no TrP treatment (0.02 < p < 0.0001, 30–180 days for intensity and rescue medication, 60–180 days for number). All thresholds in the non-TrP-treated group did not change over time, while significantly improving in both the injection and nimesulide gel groups (0.01 < p < 0.0001, 30–180 days). Improvement of migraine and thresholds did not differ in the two TrP-treated groups. Discomfort was significantly lower, acceptability and willingness to repeat treatment significantly higher (0.05 < p < 0.0001) with gel than injection. Conclusion In migraine patients, topical treatment of cervical TrPs with 5% nimesulide gel proves equally effective as TrP injection with local anesthetics but more acceptable by the patients. This treatment could be effectively associated to standard migraine prophylaxis to improve therapeutic outcomes.
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Affiliation(s)
- Giannapia Affaitati
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-Met, G. D'Annunzio University of Chieti, 66100, Chieti, Italy.
| | - Raffaele Costantini
- Institute of Surgical Pathology, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Domenico Lapenna
- Department of Medicine and Science of Aging, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Cosima Schiavone
- Department of Medicine and Science of Aging, G. D'Annunzio University of Chieti, Chieti, Italy
| | | | - Maria Adele Giamberardino
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-Met, G. D'Annunzio University of Chieti, 66100, Chieti, Italy
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Grazzi L, Tassorelli C, de Tommaso M, Pierangeli G, Martelletti P, Rainero I, Geppetti P, Ambrosini A, Sarchielli P, Liebler E, Barbanti P. Practical and clinical utility of non-invasive vagus nerve stimulation (nVNS) for the acute treatment of migraine: a post hoc analysis of the randomized, sham-controlled, double-blind PRESTO trial. J Headache Pain 2018; 19:98. [PMID: 30340460 PMCID: PMC6742918 DOI: 10.1186/s10194-018-0928-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/03/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The PRESTO study of non-invasive vagus nerve stimulation (nVNS; gammaCore®) featured key primary and secondary end points recommended by the International Headache Society to provide Class I evidence that for patients with an episodic migraine, nVNS significantly increases the probability of having mild pain or being pain-free 2 h post stimulation. Here, we examined additional data from PRESTO to provide further insights into the practical utility of nVNS by evaluating its ability to consistently deliver clinically meaningful improvements in pain intensity while reducing the need for rescue medication. METHODS Patients recorded pain intensity for treated migraine attacks on a 4-point scale. Data were examined to compare nVNS and sham with regard to the percentage of patients who benefited by at least 1 point in pain intensity. We also assessed the percentage of attacks that required rescue medication and pain-free rates stratified by pain intensity at treatment initiation. RESULTS A significantly higher percentage of patients who used acute nVNS treatment (n = 120) vs sham (n = 123) reported a ≥ 1-point decrease in pain intensity at 30 min (nVNS, 32.2%; sham, 18.5%; P = 0.020), 60 min (nVNS, 38.8%; sham, 24.0%; P = 0.017), and 120 min (nVNS, 46.8%; sham, 26.2%; P = 0.002) after the first attack. Similar significant results were seen when assessing the benefit in all attacks. The proportion of patients who did not require rescue medication was significantly higher with nVNS than with sham for the first attack (nVNS, 59.3%; sham, 41.9%; P = 0.013) and all attacks (nVNS, 52.3%; sham, 37.3%; P = 0.008). When initial pain intensity was mild, the percentage of patients with no pain after treatment was significantly higher with nVNS than with sham at 60 min (all attacks: nVNS, 37.0%; sham, 21.2%; P = 0.025) and 120 min (first attack: nVNS, 50.0%; sham, 25.0%; P = 0.018; all attacks: nVNS, 46.7%; sham, 30.1%; P = 0.037). CONCLUSIONS This post hoc analysis demonstrated that acute nVNS treatment quickly and consistently reduced pain intensity while decreasing rescue medication use. These clinical benefits provide guidance in the optimal use of nVNS in everyday practice, which can potentially reduce use of acute pharmacologic medications and their associated adverse events. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02686034 .
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Affiliation(s)
- Licia Grazzi
- Neuroalgology Unit, Carlo Besta Neurological Institute and Foundation, Milan, Italy
- Department of Fondazione IRCCS Istituto Neurologico C. Besta, U.O. Neurologia III – Cefalee e Neuroalgologia, Via Celoria 11, 20133 Milan, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marina de Tommaso
- Neurophysiology and Pain Unit, University of Bari Aldo Moro, Bari, Italy
| | - Giulia Pierangeli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | | | | | | | - Paola Sarchielli
- Neurologic Clinic, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele Pisana, Rome, Italy
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Do TP, Heldarskard GF, Kolding LT, Hvedstrup J, Schytz HW. Myofascial trigger points in migraine and tension-type headache. J Headache Pain 2018; 19:84. [PMID: 30203398 PMCID: PMC6134706 DOI: 10.1186/s10194-018-0913-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A myofascial trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. It has been suggested that myofascial trigger points take part in chronic pain conditions including primary headache disorders. The aim of this narrative review is to present an overview of the current imaging modalities used for the detection of myofascial trigger points and to review studies of myofascial trigger points in migraine and tension-type headache. FINDINGS Different modalities have been used to assess myofascial trigger points including ultrasound, microdialysis, electromyography, infrared thermography, and magnetic resonance imaging. Ultrasound is the most promising of these modalities and may be used to identify MTrPs if specific methods are used, but there is no precise description of a gold standard using these techniques, and they have yet to be evaluated in headache patients. Active myofascial trigger points are prevalent in migraine patients. Manual palpation can trigger migraine attacks. All intervention studies aiming at trigger points are positive, but this needs to be further verified in placebo-controlled environments. These findings may imply a causal bottom-up association, but studies of migraine patients with comorbid fibromyalgia syndrome suggest otherwise. Whether myofascial trigger points contribute to an increased migraine burden in terms of frequency and intensity is unclear. Active myofascial trigger points are prevalent in tension-type headache coherent with the hypothesis that peripheral mechanisms are involved in the pathophysiology of this headache disorder. Active myofascial trigger points in pericranial muscles in tension-type headache patients are correlated with generalized lower pain pressure thresholds indicating they may contribute to a central sensitization. However, the number of active myofascial trigger points is higher in adults compared with adolescents regardless of no significant association with headache parameters. This suggests myofascial trigger points are accumulated over time as a consequence of TTH rather than contributing to the pathophysiology. CONCLUSIONS Myofascial trigger points are prevalent in both migraine and tension-type headache, but the role they play in the pathophysiology of each disorder and to which degree is unclarified. In the future, ultrasound elastography may be an acceptable diagnostic test.
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Affiliation(s)
- Thien Phu Do
- Headache Diagnostic Laboratory, Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - Gerda Ferja Heldarskard
- Headache Diagnostic Laboratory, Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - Lærke Tørring Kolding
- Headache Diagnostic Laboratory, Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - Jeppe Hvedstrup
- Headache Diagnostic Laboratory, Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - Henrik Winther Schytz
- Headache Diagnostic Laboratory, Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
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Zhu Y, Liu Y, Zhao J, Han Q, Liu L, Shen X. The efficacy and safety of calcitonin gene-related peptide monoclonal antibody for episodic migraine: a meta-analysis. Neurol Sci 2018; 39:2097-2106. [PMID: 30182284 DOI: 10.1007/s10072-018-3547-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/21/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This meta-analysis was performed to evaluate the efficacy and safety of monoclonal antibodies against calcitonin gene-related peptide (CGRP) for episodic migraine prevention. METHODS MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched from inception to April 2018. Studies considered to be eligible were randomized controlled trials about efficacy and safety of calcitonin gene-related peptide monoclonal antibody for episodic migraine prevention. RESULTS Eight randomized controlled trials involving 2292 patients were included. The outcomes of this meta-analysis presented that CGRP monoclonal antibodies for preventive treatment of episodic migraine significantly reduced the monthly migraine days from baseline [weighted mean difference (WMD) = - 1.52; 95%CI, - 1.92 to - 1.11; Z = 7.40; P < 0.001] and monthly acute migraine-specific medication consumption from baseline [WMD = - 1.45; 95%CI, - 2.17 to - 0.72; Z = 3.93; P < 0.001], as compared with placebo group. CGRP monoclonal antibodies for preventive treatment of episodic migraine significantly increased the ≥ 50% reduction from baseline in migraine days per month [RR = 1.54; 95%CI, 1.38 to1.71; Z = 7.88; P < 0.001]. The adverse events were similar between the CGRP monoclonal antibody group and placebo group (P = 0.998). The outcomes of subgroup analysis showed that erenumab, galcanezumab, and fremanezumab significantly reduced the monthly migraine days from baseline and increased the ≥ 50% reduction from baseline in migraine days per month. Both erenumab and fremanezumab significantly reduced from baseline. CONCLUSIONS Based on the results of this meta-analysis, CGRP monoclonal antibodies significantly reduced the monthly migraine days and acute migraine-specific medication. CGRP monoclonal antibodies were effective and safe for preventive treatment of episodic migraine.
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Affiliation(s)
- Yuhan Zhu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | | | - Jing Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Qingqing Han
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Lei Liu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Xiaoxu Shen
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
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Chen CY, Chen SP, Fuh JL, Lirng JF, Chang FC, Wang YF, Wang SJ. Vascular wall imaging in reversible cerebral vasoconstriction syndrome - a 3-T contrast-enhanced MRI study. J Headache Pain 2018; 19:74. [PMID: 30167985 PMCID: PMC6117223 DOI: 10.1186/s10194-018-0906-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/13/2018] [Indexed: 01/03/2023] Open
Abstract
Background Limited histopathology studies have suggested that reversible cerebral vasoconstriction syndromes (RCVS) does not present with vascular wall inflammation. Previous vascular imaging studies have had inconsistent vascular wall enhancement findings in RCVS patients. The aim of this study was to determine whether absence of arterial wall pathology on imaging is a universal finding in patients with RCVS. Methods We recruited patients with RCVS from Taipei Veterans General Hospital prospectively from 2010 to 2012, with follow-up until 2017 (n = 48). We analyzed the characteristics of vascular wall enhancement in these patients without comparisons to a control group. All participants received vascular wall imaging by contrasted T1 fluid-attenuated inversion recovery with a 3-T magnetic resonance machine. The vascular wall enhancement was rated as marked, mild or absent. Results Of 48 patients with RCVS, 22 (45.8%) had vascular wall enhancement (5 marked and 17 mild). Demographics, clinical profiles, and cerebral artery flow velocities were similar across patients with versus without vascular wall enhancement, except that patients with vascular wall enhancement had fewer headache attacks than those without (p = 0.04). Follow-up imaging completed in 14 patients (median interval, 7 months) showed reduced enhancement in 9 patients, but persistent enhancement in 5. Conclusion Almost half of our RCVS patients exhibited imaging enhancement of diseased vessels, and it was persistent for approximately a third of those patients with follow-up imaging. Both acute and persistent vascular wall enhancement may be unhelpful for differentiating RCVS from central nervous system vasculitis or subclinical atherosclerosis.
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Affiliation(s)
- Chun-Yu Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan. .,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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Al-Nimer MSM, Mohammad TAM, Alsakeni RA. Serum levels of serotonin as a biomarker of newly diagnosed fibromyalgia in women: Its relation to the platelet indices. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:71. [PMID: 30181753 PMCID: PMC6116663 DOI: 10.4103/jrms.jrms_859_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 03/10/2018] [Accepted: 03/21/2018] [Indexed: 12/13/2022]
Abstract
Background: This study aimed to assess the serum serotonin levels in the newly diagnosed fibromyalgia (FM) and to relate these levels to the presenting signs and symptoms. Materials and Methods: This case–control study included 35 healthy women (Group I) served as controls and 130 women with newly diagnosed FM (Group II). The diagnosis of FM was confirmed by the diagnostic criteria of the American College of Rheumatology-10. The assessment of pain using a revised fibromyalgia impact questionnaire and tender points scoring, blood platelet indices, and serum serotonin levels were determined. Results: Group II patients had significantly (P < 0.001) higher values of mean platelet volume (MPV) (10.60 ± 1.57fL) and platelet width distribution (16.25 ± 1.45%) than the corresponding values in Group I (8.73 ± 0.81fL and 15.0 ± 1.15%). Significant low-serum serotonin levels observed in Group II patients compared with Group I healthy individuals (187.3 ± 50.3 ng/ml vs. 219.5 ± 78.3 ng/ml, P = 0.026). Multiple linear regression analysis showed the nonsignificant correlations between serum serotonin levels and platelet indices in Group II patients. Conclusion: Newly diagnosed FM women have significantly low-serum serotonin levels, which does not correlate with a significant increment of the platelet activity expressed as increase MPV and platelet width distribution percentage. Therefore, this study highlighted that the correction of serum serotonin level by medicines could help the patients.
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Affiliation(s)
- Marwan S M Al-Nimer
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,Department of Clinical Pharmacology and Therapeutics, Al-Mustansiriya University, Baghdad, Iraq
| | - Talar A Merza Mohammad
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Riyadh A Alsakeni
- Department of Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
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45
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Hung CI, Liu CY, Yang CH, Wang SJ. Migraine and greater pain symptoms at 10-year follow-up among patients with major depressive disorder. J Headache Pain 2018; 19:56. [PMID: 30019214 PMCID: PMC6049843 DOI: 10.1186/s10194-018-0884-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/02/2018] [Indexed: 12/16/2022] Open
Abstract
Background No study has investigated the associations of migraine with pain symptoms over a ten-year period among outpatients with major depressive disorder (MDD). This study aimed to investigate this issue. Methods At baseline, the study enrolled 290 outpatients with MDD and followed-up the patients at six-month, two-year, and ten-year time points. MDD and anxiety comorbidities were diagnosed using the Structured Clinical Interview for DSM-IV-text revision. Migraine was diagnosed based on the International Classification of Headache Disorders. The bodily pain subscale of the Short Form 36 (SF-BP) and the pain subscale (PS) of the Depression and Somatic Symptoms scale were also used. Generalized Estimating Equation models were employed to investigate the longitudinal impacts of migraine on pain symptoms. Results MDD patients with migraine had lower SF-BP and higher PS scores than those without. Depression, anxiety, and headache indices were significantly correlated with SF-BP and PS scores. The higher the frequency of migraine, the more often patients suffered from pain symptoms. Patients with migraine at all investigated time points suffered from pain symptoms most of the time (ranging from 60.0% to 73.7%) over the 10 years. After controlling for depression and anxiety, migraine was independently associated with a decreased SF-BP score (by 8.93 points) and an increased PS score (by 1.33 points). Conclusion Migraine was an important comorbidity associated with greater severities of pain symptoms during long-term follow-up. Migraine treatment should be integrated into the treatment of depression to improve pain symptoms and quality of life in the pain dimension.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine and Brain Research Center, National Yang-Ming University and Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Neurology, Taipei Veterans General Hospital, No. 201 Shi-Pai Road, Section 2, Taipei, 112, Taiwan.
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Dianat I, Alipour A, Asghari Jafarabadi M. Multigroup latent class model of musculoskeletal pain combinations in children/adolescents: identifying high-risk groups by gender and age. J Headache Pain 2018; 19:52. [PMID: 30006760 PMCID: PMC6045525 DOI: 10.1186/s10194-018-0880-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/02/2018] [Indexed: 12/14/2022] Open
Abstract
Background To investigate the combinations of Musculoskeletal pain (MSP) (neck, shoulder, upper and low back pain) among a sample of Iranian school children. Methods The MSP combinations was modeled by latent class analysis (LCA) to find the clusters of high–risk individuals and multigroup LCA taking into account the gender and age (≤ 13 years and ≥ 14 years of age categories). Results The lowest and highest prevalence of MSP was 14.2% (shoulder pain in boys aged ≥14 years) and 40.4% (low back pain in boys aged ≤13 years), respectively. The likelihood of synchronized neck and low back pain (9.4–17.7%) was highest, while synchronized shoulder and upper back pain (4.5–9.4%) had the lowest probability. The probability of pain at three and four locations was significantly lower in boys aged ≥14 years than in other gender–age categories. The LCA divided the children into minor, moderate, and major pain classes. The likelihood of shoulder and upper back pain in the major pain class was higher in boys than in girls, while the likelihood of neck pain in the moderate pain class and low back pain in the major pain class were higher in children aged ≥14 years than those aged ≤13 years. Gender–age specific clustering indicated a higher likelihood of experiencing major pain in children aged ≤13 years. Conclusions The findings highlight the importance of gender– and age–specific data for a more detailed understanding of the MSP combinations in children and adolescents, and identifying high-risk clusters in this regard.
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Affiliation(s)
- Iman Dianat
- Department of Occupational Health and Ergonomics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezou Alipour
- Department of Occupational Health and Ergonomics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Centre, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, 14711, Iran.
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Toriyama T, Horiuchi T, Hongo K. Characterization of migraineurs presenting interictal widespread pressure hyperalgesia identified using a tender point count: a cross-sectional study. J Headache Pain 2017; 18:117. [PMID: 29285568 PMCID: PMC5745372 DOI: 10.1186/s10194-017-0824-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/20/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Migraineurs exhibit pain hypersensitivity throughout the body during and between migraine headaches. Migraine is classified as a central sensitivity syndrome, typified by fibromyalgia showing widespread pressure hyperalgesia determined by a tender point. This study was performed to examine whether: 1) there is a subgroup of episodic migraineurs with widespread pressure hyperalgesia during and between attacks; 2) if such a subgroup exists, what is the prevalence and what is the difference between groups with interictal widespread hyperalgesia and acute allodynia regarding the demographic and clinical characteristics of migraine. METHODS This was a cross-sectional study. A total of 176 consecutive episodic migraineurs and 132 age- and sex-matched controls were recruited. The presence of widespread pressure hyperalgesia was investigated using manual tender point survey. To classify a subject's response as widespread pressure hyperalgesia, the cutoff value for responders was defined as the positive tender point count below which 95% of controls responded. RESULTS Based on the number of positive tender points in controls, the cutoff value of tender point count for pressure hyperalgesia responders was 7. Of the 176 subjects, interictal widespread pressure hyperalgesia and acute allodynia were observed in 74 (42%) and 115 (65.3%) patients, respectively. Univariate analysis indicated that risk factors associated with interictal widespread pressure hyperalgesia were female gender, younger age at migraine onset, higher frequency of migraine attacks, severe headache impact, cutaneous allodynia and depression. Multivariate logistic regression analysis confirmed that independent risk factors associated with interictal widespread pressure hyperalgesia were female gender, higher frequency of migraine attack and younger age at onset. CONCLUSION Interictal widespread pressure hyperalgesia was common (42%) in the episodic migraineurs and was associated with younger age at onset, female gender, and higher frequency of headache, but not duration of migraine illness. Presence of interictal widespread pressure hyperalgesia is assumed to be an indicator of genetic susceptibility to migraine attacks. We expect that a tender point count, as an alternative to quantitative sensory testing, will become useful as a diagnostic indicator of interictal hyperalgesia in migraineurs to predict susceptibility to migraine attacks and to permit tailored treatment.
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Affiliation(s)
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan.
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
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Atzeni F, Gerardi MC, Masala IF, Alciati A, Batticciotto A, Sarzi-Puttini P. An update on emerging drugs for fibromyalgia treatment. Expert Opin Emerg Drugs 2017; 22:357-367. [PMID: 29250975 DOI: 10.1080/14728214.2017.1418323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Fibromyalgia (FM) is a chronic disorder whose symptoms of pain, fatigue, sleep disturbances and depression have a devastating effect on patients' lives as it limits their ability to engage in everyday working and social activities, and make it difficult to maintain normal relationships with family, friends and employers. None of the currently available drugs are fully effective against the whole spectrum of symptoms. The aim of this narrative review is to summarise the data relating to the new therapeutic options that have become available over the last few years. Areas covered: Increasing efforts by the pharmaceutical industry have led to the introduction of new investigational drugs and new formulations of older drugs, and studies have been carried out in order to investigate the possibility of using drugs that are currently used for other diseases. Expert opinion: Slight improvements in the health of FM patients treated with drugs targeting a range of molecular mechanisms have been observed, but there is still no single drug that is capable of offering substantial efficacy against all of the characteristic symptoms of FM. The identification of new and improved therapies for FM requires consideration of the heterogeneity of the condition, which suggests the existence of different patient subgroups, a relationship between central and peripheral aspects of the pathophysiology, and the need for combined treatment with drugs targeting multiple molecular mechanisms.
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Affiliation(s)
- Fabiola Atzeni
- a Rheumatology Unit , University of Messina , Messina , Italy
| | | | | | - Alessandra Alciati
- d Department of Clinical Neurosciences , Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi , Como , Italy
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Giamberardino MA, Affaitati G, Costantini R, Cipollone F, Martelletti P. Calcitonin gene-related peptide receptor as a novel target for the management of people with episodic migraine: current evidence and safety profile of erenumab. J Pain Res 2017; 10:2751-2760. [PMID: 29263689 PMCID: PMC5727105 DOI: 10.2147/jpr.s128143] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Migraine is a highly disabling neurological condition, and preventative treatment still remains problematic, due to aspecificity of the majority of the currently available prophylactic drugs. Calcitonin-gene-related peptide (CGRP) plays a crucial role in migraine pathophysiology; agents aimed at blocking its activity have, therefore, been developed in recent years, among which are monoclonal antibodies (mAbs) against CGRP, to prevent migraine. Erenumab is the only mAb that targets the CGRP receptor instead of the ligand, with high specificity and affinity of binding. This review will report on the most recent data on erenumab characteristics and on the results of clinical trials on its employment in the prevention of episodic migraine (4–14 monthly migraine days): one Phase II and two Phase III trials (completed) and one Phase III trial (ongoing). Monthly subcutaneous administration (70 mg or 140 mg) of erenumab vs placebo for 3–6 months showed significantly higher efficacy in reducing the mean monthly number of migraine days and the use of migraine-specific medication, and in decreasing physical impairment and impact of migraine on everyday activities (P<0.001). A favorable safety profile was demonstrated by the lack of significant differences in the occurrence of adverse events in erenumab-treated vs placebo-treated patients. Global results so far obtained point to erenumab as a new promising candidate for the preventative treatment of episodic migraine. Licence applications for erenumab were recently submitted to the Food and Drug Administration in the USA and European Medicines Agency in Europe (May/June 2017).
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Affiliation(s)
- Maria Adele Giamberardino
- Department of Medicine and Science of Aging, Headache Center, Geriatrics Clinic and Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Giannapia Affaitati
- Department of Medicine and Science of Aging, Headache Center, Geriatrics Clinic and Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Raffaele Costantini
- Department of Medical, Oral and Biotechnological Sciences, Institute of Surgical Pathology, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Science of Aging, Medical Clinic and Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Regional Referral Headache Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Guy N, Voisin D, Mulliez A, Clavelou P, Dallel R. Medication overuse reinstates conditioned pain modulation in women with migraine. Cephalalgia 2017; 38:1148-1158. [DOI: 10.1177/0333102417727545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study investigated the effects of medication overuse and withdrawal on modulation of pain processing in women with migraine. Temporal summation of laser-evoked thermal pain was used to measure the effects of conditioned pain modulation. Methods 36 female participants (12 healthy volunteers, 12 with episodic migraine and 12 with medication overuse headache) were included in a two session protocol. Medication overuse headache subjects were also tested three weeks after medication overuse headache withdrawal. Mechanical and laser-evoked thermal pain thresholds were measured on the back of the non-dominant hand where, later, temporal summation of laser-evoked thermal pain to repetitive thermal stimuli was elicited for 30 min, at an intensity producing moderate pain. Between the 10th and 20th minutes, the contralateral foot was immersed into a water bath at a not painful (30℃) or painfully cold (8℃; conditioned pain modulation) temperature. Results Episodic migraine, medication overuse headache and medication overuse headache withdrawal were associated with an increase in extracephalic temporal summation of laser-evoked thermal pain as compared to healthy volunteer subjects, while there was no alteration of laser-evoked thermal and mechanical extracephalic pain thresholds in these subjects. Conditioned pain modulation was highly efficient in temporal summation of laser-evoked thermal pain in healthy volunteer subjects, with a solid post-effect (reduction of pain). Conditioned pain modulation was still present, but reduced, in episodic migraine. By contrast, conditioned pain modulation was normal in medication overuse headache and strongly reduced in medication overuse headache withdrawal. Furthermore, in medication overuse headache withdrawal, the post-effect was no longer a decrease, but a facilitation of pain. Conclusions These data show that a decrease in conditioned pain modulation does not underlie medication overuse headache in women. On the contrary, medication overuse reinstated conditioned pain modulation in female migraine patients. They also identify different phenotypes of pain modulation in migraine patients. Registration number N° 2008-A00471-54.
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Affiliation(s)
- Nathalie Guy
- Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Clermont-Ferrand, France
- Inserm U1107, Neuro-Dol, Clermont-Ferrand, France
| | - Daniel Voisin
- Neurocentre Magendie, Inserm U1215, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | | | - Pierre Clavelou
- Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Clermont-Ferrand, France
- Inserm U1107, Neuro-Dol, Clermont-Ferrand, France
| | - Radhouane Dallel
- Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Clermont-Ferrand, France
- Inserm U1107, Neuro-Dol, Clermont-Ferrand, France
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