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Bäumler P, Brenske A, Winkelmann A, Irnich D, Averbeck B. Strong and aversive cold processing and pain facilitation in fibromyalgia patients relates to augmented thermal grill illusion. Sci Rep 2023; 13:15982. [PMID: 37749154 PMCID: PMC10520026 DOI: 10.1038/s41598-023-42288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/07/2023] [Indexed: 09/27/2023] Open
Abstract
The thermal grill illusion (TGI) is assumed to result from crosstalk between the thermoreceptive and nociceptive pathways. To elucidate this further, we compared 40 female fibromyalgia patients to 20 healthy women in an exploratory cross-sectional study. Sensations (cold, warm/heat, unpleasantness, pain and burning) evoked by 20 °C, 40 °C and alternating 20 °C/40 °C (TGI) and somatosensory profiles according to standardized quantitative sensory testing (QST) were assessed on the palm of the dominant hand. Compared to healthy controls, fibromyalgia patients reported stronger thermal grill-evoked cold, warm, unpleasantness and pain as well as stronger and more aversive 20 °C- and 40 °C-evoked sensations. They showed a loss in warm, mechanical and vibration detection, a gain in thermal pain thresholds and higher temporal summation (TS). Among QST parameters higher TS in fibromyalgia patients was most consistently associated with an augmented TGI. Independently, an increased TGI was linked to cold (20 °C) but less to warm (40 °C) perception. In fibromyalgia patients all thermal grill-evoked sensations were positively related to a higher 20 °C-evoked cold sensation and/or 20 °C-evoked unpleasantness. In conclusion, the TGI appears to be driven mainly by the cold-input. Aversive cold processing and central pain facilitation in fibromyalgia patients seem to independently augment the activation of the pain pathway.
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Affiliation(s)
- Petra Bäumler
- Multidisciplinary Pain Center, Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Brenske
- Multidisciplinary Pain Center, Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
- Walter Brendel Center of Experimental Medicine (WBex), Biomedical Center Munich (BMC), LMU Munich, Großhaderner Str. 9, 82152, Planegg-Martinsried, Germany
| | - Andreas Winkelmann
- Multidisciplinary Pain Center, Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Dominik Irnich
- Multidisciplinary Pain Center, Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Beate Averbeck
- Walter Brendel Center of Experimental Medicine (WBex), Biomedical Center Munich (BMC), LMU Munich, Großhaderner Str. 9, 82152, Planegg-Martinsried, Germany.
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2
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Uragami S, Osumi M. Cortical oscillatory changes during thermal grill illusion. Neuroreport 2023; 34:205-208. [PMID: 36719830 PMCID: PMC10516167 DOI: 10.1097/wnr.0000000000001874] [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: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The thermal grill illusion (TGI) can cause a burning pain sensation when the skin is subjected to simultaneously harmless hot and cold stimuli, and the pain is reported to be similar to central neuropathic pain. Although electroencephalography (EEG) is commonly used in pain research, no reports have revealed EEG activity during TGI. METHODS One healthy subject was enrolled, and EEG activity was recorded during the experience of the TGI and a warm sensation. Independent component analysis (ICA) was applied to preprocessed EEG data, which was divided into several clusters. RESULTS Theta and alpha bands in the insular cortex and parietal operculum clusters were significantly more desynchronized under the TGI condition than under the warm condition ( P < 0.05). Additionally, theta, alpha and beta bands in the frontal (middle and inferior frontal gyrus) cluster showed significantly more desynchronization under the TGI condition than under the warm condition ( P < 0.05). CONCLUSION EEG oscillations in these brain areas could be useful markers of central neuropathic pain.
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Affiliation(s)
- Shinji Uragami
- Neurorehabilitation Research Center, Kio University, Nara
- Japan Community Health care Organization Hoshigaoka Medical Center, Osaka, Japan
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3
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Oono Y, Kubo H, Takagi S, Wang K, Arendt-Nielsen L, Kohase H. Conditioned pain modulation is not associated with thermal pain illusion. Scand J Pain 2023; 23:175-183. [PMID: 35607757 DOI: 10.1515/sjpain-2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/25/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Paradoxical sensations, known as thermal pain illusions, can be evoked by painful cold-heat pulse stimulation. They may provide diagnostic value; however, the possible interaction between conditioned pain modulation and thermal pain illusions has not been explored. The present study examined: (1) whether conditioned pain modulation could be induced by alternating tonic painful cold-heat pulse stimulation; and (2) whether the presence of thermal pain illusions during the conditioning stimulus influences the degree of conditioned pain modulation. METHODS This study was approved by the Ethics Committee of Meikai University (A1507). Conditioned pain modulation was provoked using alternating painful cold-heat pulses delivered at 20-s intervals applied to the forearm. Thermal pain illusions were qualitatively evaluated, and conditioned pain modulation was assessed quantitatively using the pressure pain threshold as a test stimulus. Differences in the conditioned pain modulation effect between the participants who experienced thermal pain illusions and those who did not were analysed using Student's t-test. RESULTS A significant positive conditioned pain modulation effect (51.0 ± 4.7%, overall effect) was detected. There was no significant difference in conditioned pain modulation between the participants who experienced thermal pain illusions and those who did not (44.3 ± 6.0% and 55.5 ± 6.8%, respectively; p = 0.255). CONCLUSIONS Conditioned pain modulation induced by alternating painful conditioning cold-heat pulse stimulation was identical during the conditioning stimulation in volunteers with and without thermal pain illusions. Conditioning cold-heat pulse stimulation is useful to evaluate conditioned pain modulation. Moreover, conditioned pain modulation is not influenced by the presence of thermal pain illusions, indicating partially different underlying supraspinal, neuronal networks.
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Affiliation(s)
- Yuka Oono
- Department of Diagnostic and Therapeutic Sciences, Division of Dental Anesthesiology, Meikai University School of Dentistry, Sakado, Japan
| | - Hidenori Kubo
- Department of Diagnostic and Therapeutic Sciences, Division of Dental Anesthesiology, Meikai University School of Dentistry, Sakado, Japan
| | - Saori Takagi
- Department of Diagnostic and Therapeutic Sciences, Division of Dental Anesthesiology, Meikai University School of Dentistry, Sakado, Japan
| | - Kelun Wang
- Center for Sensory-Motor Interaction (SMI), Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, SMI, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Hikaru Kohase
- Department of Diagnostic and Therapeutic Sciences, Division of Dental Anesthesiology, Meikai University School of Dentistry, Sakado, Japan
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Osumi M, Sumitani M, Nobusako S, Sato G, Morioka S. Pain quality of thermal grill illusion is similar to that of central neuropathic pain rather than peripheral neuropathic pain. Scand J Pain 2022; 22:40-47. [PMID: 34019750 DOI: 10.1515/sjpain-2021-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Application of spatially interlaced innocuous warm and cool stimuli to the skin elicits illusory pain, known as the thermal grill illusion (TGI). This study aimed to discriminate the underlying mechanisms of central and peripheral neuropathic pain focusing on pain quality, which is considered to indicate the underlying mechanism(s) of pain. We compared pain qualities in central and peripheral neuropathic pain with reference to pain qualities of TGI-induced pain. METHODS Experiment 1:137 healthy participants placed their hand on eight custom-built copper bars for 60 s and their pain quality was assessed by the McGill Pain Questionnaire. Experiment 2: Pain quality was evaluated in patients suffering from central and peripheral neuropathic pain (42 patients with spinal cord injury, 31 patients with stroke, 83 patients with trigeminal neuralgia and 131 patients with postherpetic neuralgia). RESULTS Experiment 1: Two components of TGI-induced pain were found using principal component analysis: component 1 included aching, throbbing, heavy and burning pain, component 2 included itching, electrical-shock, numbness, and cold-freezing. Experiment 2: Multiple correspondence analysis (MCA) and cross tabulation analysis revealed specific pain qualities including aching, hot-burning, heavy, cold-freezing, numbness, and electrical-shock pain were associated with central neuropathic pain rather than peripheral neuropathic pain. CONCLUSIONS We found similar qualities between TGI-induced pain in healthy participants and central neuropathic pain rather than peripheral neuropathic pain. The mechanism of TGI is more similar to the mechanism of central neuropathic pain than that of neuropathic pain.
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Affiliation(s)
- Michihiro Osumi
- Graduate School of Health Science, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Nobusako
- Graduate School of Health Science, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Gosuke Sato
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Graduate School of Health Science, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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5
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Hur MH, Choi HS. Effects of a Thermoelectric Element Band on Venipuncture-associated Pain and Anxiety: A Randomized Controlled Trial. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:337-344. [PMID: 34923170 DOI: 10.1016/j.anr.2021.12.003] [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: 08/18/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Venipuncture is an invasive procedure for diagnosis and treatment, which is often attributed to pain and anxiety. In this study, a thermoelectric element (TEE) band was developed to apply heat therapy (40∼45°C), cold therapy (0∼10°C), or thermal grill illusion (TGI) therapy (40∼45°C, 0∼10°C) to cause an illusion of pain by simultaneously applying heat and cold. This band was subsequently used to investigate its effect on patient pain, anxiety, and satisfaction. METHODS This was a randomized controlled study. Participants, who were to undergo venipuncture, were randomly assigned to the heat therapy, cold therapy, TGI therapy, or control groups. Each group had 30 participants. The interventions were employed for 10 seconds during venipuncture, and the pain, anxiety, and satisfaction were measured before and after the procedure. RESULTS Subjective pain, anxiety, and physiological responses after TEE band intervention were not significantly different between the four groups. However, there was a significant difference in satisfaction (F = 4.21, p = .007) between the four groups, and the cold therapy group showed the highest satisfaction. CONCLUSION In this study, when heat, cold, and TGI therapy were applied with a TEE band, pain and anxiety relief effects were not confirmed, but satisfaction was high. TEE band is a newly developed product that can easily apply hot and cold treatments without using ice packs or hot water packs. Further studies with various individual characteristics of chronic pain or repeated venipuncture are warranted to evaluate the effect of TEE.
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Affiliation(s)
- Myung-Haeng Hur
- College of Nursing, Eulji University, Gyeonggi-do, Republic of Korea
| | - Hee-Soo Choi
- Department of Nursing, Gyeongbuk College of Health, Gyeonsangbuk-do, Republic of Korea.
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Oono Y, Kubo H, Takagi S, Wang K, Arendt-Nielsen L, Kohase H. Painful cold-heat segmental pulse stimulation provokes the thermal pain illusion. Somatosens Mot Res 2021; 39:1-9. [PMID: 34674603 DOI: 10.1080/08990220.2021.1986382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE/AIM The thermal grill illusion is a paradoxical pain sensation induced by simultaneous exposure to spatially separated, non-painful, cold, and warm stimuli. This study aimed to determine whether paradoxical sensations are also evoked by simultaneous exposure to painful cold-heat stimuli and whether the mechanism involves modulation by segmental and extra-segmental spatial integration. MATERIALS AND METHODS Sensory perceptions were triggered by simultaneous application of painful cold-heat pulse stimuli using a developed bedside tool equipped with quantitative thermal stimulator devices. Four conditions were investigated: (1) one device placed on the forearm (condition 1, control); (2) two devices placed on the forearm (condition 2, ipsilateral segmental integration); (3) two devices placed on the forearm and ipsilateral thigh (condition 3, extra-segmental integration); and (4) two devices placed bilaterally on the forearms (condition 4, contralateral segmental integration). The evoked perceptions of paradoxical heat sensation and the loss of cold or heat sensation were evaluated. RESULTS The aforementioned phenomena were experienced by 11(35.4%), 3(9.7%), 3(9.7%), and 0(0.0%) subjects for conditions 1-4, respectively. Fisher's exact test revealed significant differences (p=.001) among the four conditions. However, Bonferroni post hoc analysis revealed significant differences only between conditions 1 and 4 (p=.005). CONCLUSIONS Simultaneous painful cold-heat pulse stimulation can induce paradoxical sensations similar to those shown for non-painful thermal (cold and heat) stimuli. They were predominantly evoked by ipsilateral integration. Paradoxical sensations have diagnostic value, and quantifying them using a simple bedside tool may be useful in the clinical setting.
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Affiliation(s)
- Yuka Oono
- Department of Diagnostic and Therapeutic Sciences, Division of Dental Anesthesiology, Meikai University School of Dentistry, Sakado, Japan
| | - Hidenori Kubo
- Department of Diagnostic and Therapeutic Sciences, Division of Dental Anesthesiology, Meikai University School of Dentistry, Sakado, Japan
| | - Saori Takagi
- Department of Diagnostic and Therapeutic Sciences, Division of Dental Anesthesiology, Meikai University School of Dentistry, Sakado, Japan
| | - Kelun Wang
- Department of Health Science and Technology, School of Medicine, Center for Neuroplasticity and Pain, SMI, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, School of Medicine, Center for Neuroplasticity and Pain, SMI, Aalborg University, Aalborg, Denmark
| | - Hikaru Kohase
- Department of Diagnostic and Therapeutic Sciences, Division of Dental Anesthesiology, Meikai University School of Dentistry, Sakado, Japan
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Kong Y, Posada-Quintero HF, Chon KH. Real-Time High-Level Acute Pain Detection Using a Smartphone and a Wrist-Worn Electrodermal Activity Sensor. SENSORS (BASEL, SWITZERLAND) 2021; 21:3956. [PMID: 34201268 PMCID: PMC8227650 DOI: 10.3390/s21123956] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/02/2023]
Abstract
The subjectiveness of pain can lead to inaccurate prescribing of pain medication, which can exacerbate drug addiction and overdose. Given that pain is often experienced in patients' homes, there is an urgent need for ambulatory devices that can quantify pain in real-time. We implemented three time- and frequency-domain electrodermal activity (EDA) indices in our smartphone application that collects EDA signals using a wrist-worn device. We then evaluated our computational algorithms using thermal grill data from ten subjects. The thermal grill delivered a level of pain that was calibrated for each subject to be 8 out of 10 on a visual analog scale (VAS). Furthermore, we simulated the real-time processing of the smartphone application using a dataset pre-collected from another group of fifteen subjects who underwent pain stimulation using electrical pulses, which elicited a VAS pain score level 7 out of 10. All EDA features showed significant difference between painless and pain segments, termed for the 5-s segments before and after each pain stimulus. Random forest showed the highest accuracy in detecting pain, 81.5%, with 78.9% sensitivity and 84.2% specificity with leave-one-subject-out cross-validation approach. Our results show the potential of a smartphone application to provide near real-time objective pain detection.
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Affiliation(s)
| | | | - Ki H. Chon
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06269, USA; (Y.K.); (H.F.P.-Q.)
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Arai K, Matsumuro M, Hashiguchi S, Shibata F, Kimura A. Hot-Cold Confusion: Inverse Thermal Sensation When Hot and Cold Stimuli Coexist in a Thermal Localization Task. Perception 2021; 50:508-523. [PMID: 33888020 DOI: 10.1177/03010066211004055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We focused on the inverse thermal sensation caused by the presence of both hot and cold stimuli, which we named hot-cold confusion. Some researchers have shown that when participants touch a thermal stimulus simultaneously with two opposite thermal stimuli on both sides, the outer temperatures dominate the center temperature; for example, a hot stimulus between two cold stimuli is perceived as cold. However, there has not been sufficient research on the effect of the center stimulus on the outer stimuli. In the current study, we placed a participant's forearm on an alignment where hot and cold stimuli were alternately placed in three locations and found that the participants sometimes selected the inverse thermal sensation of the presented surface not only at the center but also at the outer locations. Namely, opposite thermal stimuli applied at multiple locations affected each other, and the participants sometimes perceived the hot stimulus at the outer location as cold even when the two of three stimuli were hot, and vice versa. In addition, using various alignments of thermal stimuli, we revealed a directional bias of the effect from the cold stimulus and a difference in strength according to its location on the forearm.
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Affiliation(s)
| | - Miki Matsumuro
- Ritsumeikan University, Japan.,Ritsumeikan University, Japan
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9
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Rivel M, Achiron A, Dolev M, Stern Y, Zeilig G, Defrin R. Central neuropathic pain in multiple sclerosis is associated with impaired innocuous thermal pathways and neuronal hyperexcitability. PAIN MEDICINE 2021; 22:2311-2323. [PMID: 33734398 DOI: 10.1093/pm/pnab103] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE About a third of patients with multiple sclerosis (MS) suffer from chronic and excruciating central neuropathic pain (CNP). The mechanism underlying CNP in MS is not clear, since previous studies are scarce and their results are inconsistent. Our aim was to determine whether CNP in MS is associated with impairment of the spinothalamic-thalamocortical pathways (STTCs) and/or increased excitability of the pain system. DESIGN Cross sectional study. SETTING General hospital. SUBJECTS 47 MS patients with CNP, 42 MS patients without CNP, and 32 healthy controls. METHODS Sensory testing included the measurement of temperature, pain, and touch thresholds and the thermal grill illusion (TGI) for evaluating STTCs function, and hyperpathia and allodynia as indicators of hyperexcitability. CNP was characterized using interviews and questionnaires. RESULTS The CNP group had higher cold and warm thresholds (p < 0.01), as well as higher TGI perception thresholds (p < 0.05), especially in painful body regions compared to controls, whereas touch and pain thresholds values were normal. The CNP group also had a significantly greater prevalence of hyperpathia and allodynia. Regression analysis revealed that whereas presence of CNP was associated with a higher cold threshold, CNP intensity, and the number of painful body regions were associated with allodynia and hyperpathia, respectively. CONCLUSIONS CNP in MS is characterized by a specific impairment of STTC function; the innocuous thermal pathways, and by pain hyperexcitability. Whereas CNP presence is associated with STTC impairment, its severity and extent are associated with pain hyperexcitability. Interventions that reduce excitability level may therefore mitigate CNP severity.
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Affiliation(s)
- Michal Rivel
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine Tel Aviv University.,Sagol School of Neuroscience, Tel-Aviv University
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer
| | - Yael Stern
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer
| | - Gaby Zeilig
- Sackler Faculty of Medicine, Tel-Aviv University.,Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine Tel Aviv University.,Sagol School of Neuroscience, Tel-Aviv University
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Forstenpointner J, Berry D, Baron R, Borsook D. The cornucopia of central disinhibition pain - An evaluation of past and novel concepts. Neurobiol Dis 2020; 145:105041. [PMID: 32800994 DOI: 10.1016/j.nbd.2020.105041] [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: 06/20/2020] [Revised: 07/18/2020] [Accepted: 08/08/2020] [Indexed: 12/12/2022] Open
Abstract
Central disinhibition (CD), as applied to pain, decreases thresholds of endogenous systems. This provokes onset of spontaneous or evoked pain in an individual beyond the ability of the nervous system to inhibit pain resulting from a disease or tissue damage. The original CD concept as proposed by Craig entails a shift from the lateral pain pathway (i.e. discriminative pain processing) towards the medial pain pathway (i.e. emotional pain processing), within an otherwise neurophysiological intact environment. In this review, the original CD concept as proposed by Craig is extended by the primary "nociceptive pathway damage - CD" concept and the secondary "central pathway set point - CD". Thereby, the original concept may be transferred into anatomical and psychological non-functional conditions. We provide examples for either primary or secondary CD concepts within different clinical etiologies as well as present surrogate models, which directly mimic the underlying pathophysiology (A-fiber block) or modulate the CD pathway excitability (thermal grill). The thermal grill has especially shown promising advancements, which may be useful to examine CD pathway activation in the future. Therefore, within this topical review, a systematic review on the thermal grill illusion is intended to stimulate future research. Finally, the authors review different mechanism-based treatment approaches to combat CD pain.
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Affiliation(s)
- Julia Forstenpointner
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Delany Berry
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
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11
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Posada-Quintero HF, Kong Y, Nguyen K, Tran C, Beardslee L, Chen L, Guo T, Cong X, Feng B, Chon KH. Using electrodermal activity to validate multilevel pain stimulation in healthy volunteers evoked by thermal grills. Am J Physiol Regul Integr Comp Physiol 2020; 319:R366-R375. [PMID: 32726157 DOI: 10.1152/ajpregu.00102.2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have tested the feasibility of thermal grills, a harmless method to induce pain. The thermal grills consist of interlaced tubes that are set at cool or warm temperatures, creating a painful "illusion" (no tissue injury is caused) in the brain when the cool and warm stimuli are presented collectively. Advancement in objective pain assessment research is limited because the gold standard, the self-reporting pain scale, is highly subjective and only works for alert and cooperative patients. However, the main difficulty for pain studies is the potential harm caused to participants. We have recruited 23 subjects in whom we induced electric pulses and thermal grill (TG) stimulation. The TG effectively induced three different levels of pain, as evidenced by the visual analog scale (VAS) provided by the subjects after each stimulus. Furthermore, objective physiological measurements based on electrodermal activity showed a significant increase in levels as stimulation level increased. We found that VAS was highly correlated with the TG stimulation level. The TG stimulation safely elicited pain levels up to 9 out of 10. The TG stimulation allows for extending studies of pain to ranges of pain in which other stimuli are harmful.
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Affiliation(s)
| | | | | | - Cara Tran
- University of Connecticut, Storrs, Connecticut
| | - Luke Beardslee
- Emory University School of Medicine Department of Surgery, Atlanta, Georgia
| | - Longtu Chen
- University of Connecticut, Storrs, Connecticut
| | | | | | - Bin Feng
- University of Connecticut, Storrs, Connecticut
| | - Ki H Chon
- University of Connecticut, Storrs, Connecticut
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12
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The Cerebral Localization of Pain: Anatomical and Functional Considerations for Targeted Electrical Therapies. J Clin Med 2020; 9:jcm9061945. [PMID: 32580436 PMCID: PMC7355617 DOI: 10.3390/jcm9061945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
Millions of people in the United States are affected by chronic pain, and the financial cost of pain treatment is weighing on the healthcare system. In some cases, current pharmacological treatments may do more harm than good, as with the United States opioid crisis. Direct electrical stimulation of the brain is one potential non-pharmacological treatment with a long history of investigation. Yet brain stimulation has been far less successful than peripheral or spinal cord stimulation, perhaps because of our limited understanding of the neural circuits involved in pain perception. In this paper, we review the history of using electrical stimulation of the brain to treat pain, as well as contemporary studies identifying the structures involved in pain networks, such as the thalamus, insula, and anterior cingulate. We propose that the thermal grill illusion, an experimental pain model, can facilitate further investigation of these structures. Pairing this model with intracranial recording will provide insight toward disentangling the neural correlates from the described anatomic areas. Finally, the possibility of altering pain perception with brain stimulation in these regions could be highly informative for the development of novel brain stimulation therapies for chronic pain.
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Fardo F, Beck B, Allen M, Finnerup NB. Beyond labeled lines: A population coding account of the thermal grill illusion. Neurosci Biobehav Rev 2020; 108:472-479. [DOI: 10.1016/j.neubiorev.2019.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
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14
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Patwardhan S, Kawazoe A, Kerr D, Nakatani M, Visell Y. Dynamics and Perception in the Thermal Grill Illusion. IEEE TRANSACTIONS ON HAPTICS 2019; 12:604-614. [PMID: 30869631 DOI: 10.1109/toh.2019.2904226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A basic challenge in perception research is to understand how sensory inputs from physical environments and the body are integrated in order to facilitate perceptual inferences. Thermal perception, which arises through heat transfer between extrinsic sources and body tissues, is an integral part of natural haptic experiences, and thermal feedback technologies have potential applications in wearable computing, virtual reality, and other areas. While physics dictates that thermal percepts can be slow, often unfolding over timescales measured in seconds, much faster perceptual responses can occur in the thermal grill illusion. The latter refers to a burning-like sensation that can be evoked when innocuous warm and cool stimuli are applied to the skin in juxtaposed fashion. Here, we show that perceptual response times to the thermal grill illusion decrease systematically with perceived intensity. Using results from behavioral experiments in combination with a physics-based description of tissue heating, we develop a simple model explaining the perception of the illusion through the evolution of internal tissue temperatures. The results suggest that improved understanding of the physical mechanisms of tissue heating may aid our understanding of thermal perception, as exemplified by the thermal grill illusion, and might point toward more efficient methods for thermal feedback.
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King M, Carnahan H. Revisiting the brain activity associated with innocuous and noxious cold exposure. Neurosci Biobehav Rev 2019; 104:197-208. [DOI: 10.1016/j.neubiorev.2019.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/29/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022]
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Fardo F, Finnerup NB, Haggard P. Organization of the Thermal Grill Illusion by Spinal Segments. Ann Neurol 2018; 84:463-472. [PMID: 30063258 PMCID: PMC6175302 DOI: 10.1002/ana.25307] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/31/2022]
Abstract
Objective A common symptom of neuropathy is the misperception of heat and pain from cold stimuli. Similar cold allodynic sensations can be experimentally induced using the thermal grill illusion (TGI) in humans. It is currently unclear whether this interaction between thermosensory and nociceptive signals depends on spinal or supraspinal integration mechanisms. To address this issue, we developed a noninvasive protocol to assess thermosensory integration across spinal segments. Methods We leveraged anatomical knowledge regarding dermatomes and their spinal projections to investigate potential contributions of spinal integration to the TGI. We simultaneously stimulated a pair of skin locations on the arm or lower back using 1 cold (∼20°C) and 1 warm thermode (∼40°C). The 2 thermodes were always separated by a fixed physical distance on the skin, but elicited neural activity across a varying number of spinal segments, depending on which dermatomal boundaries the 2 stimuli spanned. Results Participants consistently overestimated the actual cold temperature on the skin during combined cold and warm stimulation, confirming the TGI effect. The TGI was present when cold and warm stimuli were delivered within the same dermatome, or across dermatomes corresponding to adjacent spinal segments. In striking contrast, no TGI effect was found when cold and warm stimuli projected to nonadjacent spinal segments. Interpretation These results demonstrate that the strength of the illusion is modulated by the segmental distance between cold and warm afferents. This suggests that both temperature perception and thermal–nociceptive interactions depend upon low‐level convergence mechanisms operating within a single spinal segment and its immediate neighbors. Ann Neurol 2018;84:463–472
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Affiliation(s)
- Francesca Fardo
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom.,Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Interacting Minds Center, Aarhus University, Aarhus, Denmark
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
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17
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Averbeck B, Seitz L, Kolb FP, Kutz DF. Sex differences in thermal detection and thermal pain threshold and the thermal grill illusion: a psychophysical study in young volunteers. Biol Sex Differ 2017; 8:29. [PMID: 28859684 PMCID: PMC5579939 DOI: 10.1186/s13293-017-0147-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/01/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sex-related differences in human thermal and pain sensitivity are the subject of controversial discussion. The goal of this study in a large number of subjects was to investigate sex differences in thermal and thermal pain perception and the thermal grill illusion (TGI) as a phenomenon reflecting crosstalk between the thermoreceptive and nociceptive systems. The thermal grill illusion is a sensation of strong, but not necessarily painful, heat often preceded by transient cold upon skin contact with spatially interlaced innocuous warm and cool stimuli. METHODS The TGI was studied in a group of 78 female and 58 male undergraduate students and was evoked by placing the palm of the right hand on the thermal grill (20/40 °C interleaved stimulus). Sex-related thermal perception was investigated by a retrospective analysis of thermal detection and thermal pain threshold data that had been measured in student laboratory courses over 5 years (776 female and 476 male undergraduate students) using the method of quantitative sensory testing (QST). To analyse correlations between thermal pain sensitivity and the TGI, thermal pain threshold and the TGI were determined in a group of 20 female and 20 male undergraduate students. RESULTS The TGI was more pronounced in females than males. Females were more sensitive with respect to thermal detection and thermal pain thresholds. Independent of sex, thermal detection thresholds were dependent on the baseline temperature with a specific progression of an optimum curve for cold detection threshold versus baseline temperature. The distribution of cold pain thresholds was multi-modal and sex-dependent. The more pronounced TGI in females correlated with higher cold sensitivity and cold pain sensitivity in females than in males. CONCLUSIONS Our finding that thermal detection threshold not only differs between the sexes but is also dependent on the baseline temperature reveals a complex processing of "cold" and "warm" inputs in thermal perception. The results of the TGI experiment support the assumption that sex differences in cold-related thermoreception are responsible for sex differences in the TGI.
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Affiliation(s)
- Beate Averbeck
- Department of Physiology, University of Munich, Munich, Germany
- Department of Physiology, Biomedical Center Munich (BMC), University of Munich, Planegg-Martinsried, D-82152 Germany
| | - Lena Seitz
- Department of Physiology, University of Munich, Munich, Germany
| | - Florian P. Kolb
- Department of Physiology, University of Munich, Munich, Germany
| | - Dieter F. Kutz
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Science, Chemnitz University of Technology, Chemnitz, Germany
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Scheuren R, Sütterlin S, Anton F. Vagally Mediated Heart Rate Variability Promotes the Perception of Paradoxical Pain. J PSYCHOPHYSIOL 2017. [DOI: 10.1027/0269-8803/a000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Self-regulation mechanisms are governed by prefrontal inhibitory processes and play a crucial role in the modulation of pain. In the present study the thermal grill paradigm was used to investigate the association of vagally mediated resting heart rate variability, a psychophysiological marker of trait self-regulatory capacity, with paradoxical pain sensations induced by non-noxious stimulation. This thermal grill illusion is only perceived by part of the tested individuals. The mechanisms underlying the observed interindividual differences in paradoxical pain sensitivity are largely unknown. During the experimental task, a temperature combination of 15 °C and 41 °C was set at the glass tubes of the thermal grill. The 52 healthy participants placed their dominant hand on the grill for a duration of one min. The magnitude of sensory and affective pain sensations perceived during stimulation was assessed with numerical rating scales. Before stimulation, a short-term electrocardiogram was recorded to compute vagally mediated heart rate variability at rest. Logistic regression analyses revealed that participants with higher vagal tone were significantly more likely to perceive the thermal grill illusion than subjects displaying lower resting heart rate variability. Paradoxical pain sensations were primarily predicted by normalized respiratory sinus arrhythmia. Our results confirm that the magnitude of vagally mediated resting heart rate variability is associated with the individual disposition to illusive pain perceptions. Since the latter is considered to be a marker of trait self-regulation ability, the present findings may corroborate and complement previous evidence for an impact of psychological characteristics on paradoxical pain sensitivity.
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Affiliation(s)
- Raymonde Scheuren
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg, Esch-Alzette, Luxembourg
| | - Stefan Sütterlin
- Section of Psychology, Lillehammer University College, Norway
- Department of Psychosomatic Medicine, Division of Surgery and Clinical Neuroscience, Oslo University Hospital – Rikshospitalet, Oslo, Norway
| | - Fernand Anton
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg, Esch-Alzette, Luxembourg
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Song X, Qian S, Liu K, Zhou S, Zhu H, Zou Q, Liu Y, Sun G, Gao JH. Resting-state BOLD oscillation frequency predicts vigilance task performance at both normal and high environmental temperatures. Brain Struct Funct 2017; 222:4065-4077. [PMID: 28600679 DOI: 10.1007/s00429-017-1449-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/17/2017] [Indexed: 11/26/2022]
Abstract
Hyperthermia may impair vigilance functions and lead to slower reaction times (RTs) in the psychomotor vigilance task (PVT) and possibly disturbing cerebral hemodynamic rhythms. To test these hypotheses, we acquired the resting-state BOLD and cerebral blood flow (CBF) data, as well as PVTRTs from 15 participants in two simulated environmental thermal conditions (50 °C/25 °C). We adopted a data-driven method, frequency component analysis, to quantify the mean frequency of the BOLD series of each voxel. Across-subject correlation analysis was employed to detect the brain areas whose BOLD oscillation frequency was correlated with the RTs. Significant changes of BOLD frequency and CBF within these areas were compared between hyperthermia and normothermia conditions. Spatial correlations between BOLD frequency and CBF were calculated within different brain areas for each subject under both thermal conditions. Results showed that, under both thermal conditions, the RTs correlated with the BOLD frequency positively in the default mode network (DMN) and negatively in the sensorimotor network (SMN). The increase of BOLD frequency in the thalamus and ventral medial prefrontal cortex was correlated with the increase of RTs in hyperthermia compared with normothermia. Hyperthermia decreased BOLD frequency and CBF in the SMN, while it increased CBF in the thalamus and posterior cingulate. In both thermal conditions, the spatial distribution of CBF negatively correlated with the spatial distribution of BOLD oscillation frequency in most cortical areas, especially in cingulate cortices, precuneus, and primary visual cortex. These results suggest that hyperthermia might deteriorate task performance by interfering with the resting-state CBF, and with BOLD rhythms. The overlapping of the thermoregulatory and vigilance functions in the SMN and DMN might underlie the neural mechanisms of the cognitive-behavioral impairments induced by hyperthermia.
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Affiliation(s)
- Xiaopeng Song
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, 100871, China
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Shaowen Qian
- Department of Medical Imaging, Jinan Military General Hospital, Shandong, China
| | - Kai Liu
- Department of Medical Imaging, Jinan Military General Hospital, Shandong, China
| | - Shuqin Zhou
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, 100871, China
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Huaiqiu Zhu
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, 100871, China
| | - Qihong Zou
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Yijun Liu
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, 100871, China
| | - Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital, Shandong, China.
| | - Jia-Hong Gao
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China.
- McGovern Institute for Brain Research, Peking University, Beijing, 100871, China.
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, 100871, China.
- Shenzhen Institute of Neuroscience, Shenzhen, China.
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Harper D, Hollins M. Conditioned pain modulation dampens the thermal grill illusion. Eur J Pain 2017; 21:1591-1601. [DOI: 10.1002/ejp.1060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 11/07/2022]
Affiliation(s)
- D.E. Harper
- Department of Psychology and Neuroscience; University of North Carolina at Chapel Hill; USA
- Department of Anesthesiology; Chronic Pain and Fatigue Research Center; University of Michigan; Ann Arbor USA
| | - M. Hollins
- Department of Psychology and Neuroscience; University of North Carolina at Chapel Hill; USA
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21
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Van Auken RM, Hagoski BK, Chiang DP, Chang S. On-demand driver vigilance enhancement without explicit drowsiness detection-Further analysis of the pilot study results. TRAFFIC INJURY PREVENTION 2017; 18:S64-S70. [PMID: 28318305 DOI: 10.1080/15389588.2017.1306854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/10/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE A new active safety concept that engages the driver's psychosensory pain-processing mechanism to automatically trigger vigilance enhancement on-demand was proposed in Chang (2012). This concept is based on the hypothesis that a human's pain threshold will decline as he or she becomes drowsy, consequently triggering the vigilance enhancer. The objective of this pilot study was to develop methods to test this hypothesis, the results of which could lead to further refinement of the hypothesis and methods, with the ultimate goal of developing new active safety concepts that exploit the driver's endogenous psychosensory pain-processing mechanisms. Preliminary results from a pilot study designed to test this hypothesis were presented in Chang (2016). This article presents further analysis of the pilot study data. METHODS Perceived pain responses of six healthy male participants were measured when their vigilance would be under stress. A time-varying thermal grill illusion (TGI) of pain was created using a custom steering wheel with an array of Peltier elements held in the participant's palm. The participant's pain responses to the TGI stimulus were recorded while changes in his vigilance were monitored using pre- and post-session Psychomotor Vigilance Task (PVT) tests, in-session Percent Eyelid Closure (PERCLOS), and subjective Karolinska Sleepiness Scale (KSS) ratings. The probability of pain response versus TGI temperature stimulus and vigilance measures were then estimated using logistic regression analysis. RESULTS The results indicate that the probability of pain response is correlated with the temperature stimuli and the vigilance state. The pain threshold tends to move up or down versus KSS depending on the participant for high-vigilance conditions, but tends to increase when the participant becomes increasing drowsy in low-vigilance conditions. These results were statistically significant for four of the six study participants. CONCLUSIONS This limited pilot study observed that one's pain threshold may or may not initially decrease as originally hypothesized depending on the participant, but then increases as one becomes drowsier. While not definitive, the methods and results of this study may help to refine our hypotheses and design future studies in pursuit of detector-free on-demand driver vigilance enhancement that exploits our body's endogenous alert mechanism.
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Affiliation(s)
| | | | | | - Shane Chang
- b Honda Research Institute USA, Inc. , Mountain View , California
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22
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Systematic Review of fMRI Compatible Devices: Design and Testing Criteria. Ann Biomed Eng 2017; 45:1819-1835. [DOI: 10.1007/s10439-017-1853-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/10/2017] [Indexed: 12/22/2022]
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Boettger MK, Ditze G, Bär KJ, Krüdewagen EM, Schaible HG. Humans, but not animals, perceive the thermal grill illusion as painful. Behav Brain Res 2016; 313:172-176. [DOI: 10.1016/j.bbr.2016.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 01/01/2023]
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Brönnimann B, Meier ML, Hou MY, Parkinson C, Ettlin DA. Novel Air Stimulation MR-Device for Intraoral Quantitative Sensory Cold Testing. Front Hum Neurosci 2016; 10:335. [PMID: 27445771 PMCID: PMC4928459 DOI: 10.3389/fnhum.2016.00335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/17/2016] [Indexed: 12/23/2022] Open
Abstract
The advent of neuroimaging in dental research provides exciting opportunities for relating excitation of trigeminal neurons to human somatosensory perceptions. Cold air sensitivity is one of the most frequent causes of dental discomfort or pain. Up to date, devices capable of delivering controlled cold air in an MR-environment are unavailable for quantitative sensory testing. This study therefore aimed at constructing and evaluating a novel MR-compatible, computer-controlled cold air stimulation apparatus (CASA) that produces graded air puffs. CASA consisted of a multi-injector air jet delivery system (AJS), a cold exchanger, a cooling agent, and a stimulus application construction. Its feasibility was tested by performing an fMRI stimulation experiment on a single subject experiencing dentine cold sensitivity. The novel device delivered repetitive, stable air stimuli ranging from room temperature (24.5°C ± 2°C) to -35°C, at flow rates between 5 and 17 liters per minute (l/min). These cold air puffs evoked perceptions similar to natural stimuli. Single-subject fMRI-analysis yielded brain activations typically associated with acute pain processing including thalamus, insular and cingulate cortices, somatosensory, cerebellar, and frontal brain regions. Thus, the novel CASA allowed for controlled, repetitive quantitative sensory testing by using air stimuli at graded temperatures (room temperature down to -35°C) while simultaneously recording brain responses. No MR-compatible stimulation device currently exists that is capable of providing non-contact natural-like stimuli at a wide temperature range to tissues in spatially restricted areas such as the mouth. The physical characteristics of this novel device thus holds promise for advancing the field of trigeminal and spinal somatosensory research, namely with respect to comparing therapeutic interventions for dentine hypersensitivity.
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Affiliation(s)
- Ben Brönnimann
- Pain Research Lab, Center of Dental Medicine, University of Zurich Zurich, Switzerland
| | - Michael L Meier
- Pain Research Lab, Center of Dental Medicine, University of ZurichZurich, Switzerland; Interdisciplinary Spinal Pain Research ISR, Balgrist University HospitalZurich, Switzerland
| | - Mei-Yin Hou
- Pain Research Lab, Center of Dental Medicine, University of Zurich Zurich, Switzerland
| | | | - Dominik A Ettlin
- Pain Research Lab, Center of Dental Medicine, University of Zurich Zurich, Switzerland
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Abstract
Supplemental Digital Content is Available in the Text. The thermal grill illusion is reduced in borderline personality disorder. This suggests that the deficits in pain perception in this group are of central origin. It is well documented that borderline personality disorder (BPD) is characterized by reduced pain sensitivity, which might be related to nonsuicidal self-injury and dissociative experiences in patients with BPD. However, it remains an open question whether this insensitivity relies at least partly on altered sensory integration or on an altered evaluation of pain or a combination of both. In this study, we used the thermal grill illusion (TGI), describing a painful sensation induced by the application of alternating cold and warm nonnoxious stimuli, in patients with either current or remitted BPD as well as matched healthy controls. Two additional conditions, applying warm or cold temperatures only, served as control. We further assessed thermal perception, discrimination, and pain thresholds. We found significantly reduced heat and cold pain thresholds for the current BPD group, as well as reduced cold pain thresholds for the remitted BPD group, as compared with the HC group. Current BPD patients perceived a less-intense TGI in terms of induced pain and unpleasantness, while their general ability to perceive this kind of illusion seemed to be unaffected. Thermal grill illusion magnitude was negatively correlated with dissociation and traumatization only in the current BPD patients. These results indicate that higher-order pain perception is altered in current BPD, which seems to normalize after remission. We discuss these findings against the background of neurophysiological evidence for the TGI in general and reduced pain sensitivity in BPD and suggest a relationship to alterations in N-methyl-D-aspartate neurotransmission.
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27
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Scheuren R, Duschek S, Schulz A, Sütterlin S, Anton F. Blood pressure and the perception of illusive pain. Psychophysiology 2016; 53:1282-91. [DOI: 10.1111/psyp.12658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/11/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Raymonde Scheuren
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
| | - Stefan Duschek
- Institute of Psychology, UMIT-University for Health Sciences, Medical Informatics and Technology; Hall in Tirol Austria
| | - André Schulz
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
| | - Stefan Sütterlin
- Section of Psychology, Lillehammer University College; Lillehammer Norway
- Department of Psychosomatic Medicine, Division of Surgery and Clinical Neuroscience; Oslo University Hospital-Rikshospitalet; Oslo Norway
| | - Fernand Anton
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
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Patel R, Brice NL, Lewis RJ, Dickenson AH. Ionic mechanisms of spinal neuronal cold hypersensitivity in ciguatera. Eur J Neurosci 2015; 42:3004-11. [PMID: 26454262 PMCID: PMC4744673 DOI: 10.1111/ejn.13098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/14/2015] [Accepted: 10/04/2015] [Indexed: 01/24/2023]
Abstract
Cold hypersensitivity is evident in a range of neuropathies and can evoke sensations of paradoxical burning cold pain. Ciguatoxin poisoning is known to induce a pain syndrome caused by consumption of contaminated tropical fish that can persist for months and include pruritus and cold allodynia; at present no suitable treatment is available. This study examined, for the first time, the neural substrates and molecular components of Pacific ciguatoxin-2-induced cold hypersensitivity. Electrophysiological recordings of dorsal horn lamina V/VI wide dynamic range neurones were made in non-sentient rats. Subcutaneous injection of 10 nm ciguatoxin-2 into the receptive field increased neuronal responses to innocuous and noxious cooling. In addition, neuronal responses to low-threshold but not noxious punctate mechanical stimuli were also elevated. The resultant cold hypersensitivity was not reversed by 6-({2-[2-fluoro-6-(trifluoromethyl)phenoxy]-2-methylpropyl}carbamoyl)pyridine-3-carboxylic acid, an antagonist of transient receptor potential melastatin 8 (TRPM8). Both mechanical and cold hypersensitivity were completely prevented by co-injection with the Nav 1.8 antagonist A803467, whereas the transient receptor potential ankyrin 1 (TRPA1) antagonist A967079 only prevented hypersensitivity to innocuous cooling and partially prevented hypersensitivity to noxious cooling. In naive rats, neither innocuous nor noxious cold-evoked neuronal responses were inhibited by antagonists of Nav 1.8, TRPA1 or TRPM8 alone. Ciguatoxins may confer cold sensitivity to a subpopulation of cold-insensitive Nav 1.8/TRPA1-positive primary afferents, which could underlie the cold allodynia reported in ciguatera. These data expand the understanding of central spinal cold sensitivity under normal conditions and the role of these ion channels in this translational rat model of ciguatoxin-induced hypersensitivity.
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Affiliation(s)
- Ryan Patel
- Department of Neuroscience, Physiology and PharmacologyUniversity College LondonGower StreetLondonWC1E 6BTUK
| | | | - Richard J. Lewis
- Institute for Molecular BioscienceThe University of QueenslandSt LuciaQLDAustralia
| | - Anthony H. Dickenson
- Department of Neuroscience, Physiology and PharmacologyUniversity College LondonGower StreetLondonWC1E 6BTUK
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Abstract
This review presents a general model for the understanding of pain, placebo, and chronification of pain in the framework of cognitive neuroscience. The concept of a computational cost-function underlying the functional imaging responses to placebo manipulations is put forward and demonstrated to be compatible with the placebo literature including data that demonstrate that placebo responses as seen on the behavioural level may be elicited on all levels of the neuroaxis. In the same vein, chronification of pain is discussed as a consequence of brain mechanisms for learning and expectation. Further studies are necessary on the reversal of chronic pain given the weak effects of treatment but also due to alarming findings that suggest morphological changes in the brain pain regulatory systems concurrent with the chronification process. The burden of chronic pain is devastating both on the individual level and society level and affects more than one-quarter of the world's population. Women are greatly overrepresented in patients with chronic pain. Hence, both from a general standpoint and from reasons of health equity, it is of essence to advance research and care efforts. Success in these efforts will only be granted with better theoretical concepts of chronic pain mechanisms that maps into the framework of cognitive neuroscience.
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30
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Transforming the Thermal Grill Effect by Crossing the Fingers. Curr Biol 2015; 25:1069-73. [DOI: 10.1016/j.cub.2015.02.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/02/2015] [Accepted: 02/19/2015] [Indexed: 11/20/2022]
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31
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Relationships between the paradoxical painful and nonpainful sensations induced by a thermal grill. Pain 2014; 155:2612-2617. [DOI: 10.1016/j.pain.2014.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/13/2014] [Accepted: 09/22/2014] [Indexed: 12/29/2022]
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Patel R, Gonçalves L, Leveridge M, Mack SR, Hendrick A, Brice NL, Dickenson AH. Anti-hyperalgesic effects of a novel TRPM8 agonist in neuropathic rats: a comparison with topical menthol. Pain 2014; 155:2097-107. [PMID: 25083927 PMCID: PMC4220012 DOI: 10.1016/j.pain.2014.07.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/21/2014] [Accepted: 07/25/2014] [Indexed: 11/27/2022]
Abstract
Menthol has historically been used topically to alleviate various pain conditions. At low concentrations, this non-selective TRPM8 agonist elicits a cooling sensation, however higher concentrations result in cold hyperalgesia in normal subjects and paradoxically analgesia in neuropathic patients. Through behavioural and electrophysiological means, we examined whether this back-translated into a pre-clinical rodent model. Menthol was applied topically to the hind paws of naive and spinal nerve-ligated (SNL) rats. In behavioural assays, menthol did not affect withdrawal thresholds to mechanical stimulation and 10% and 40% menthol rarely sensitised withdrawals to innocuous cooling in naïve rats. However, in SNL rats, 10% and 40% menthol alleviated cold hypersensitivity. This was partly corroborated by in vivo electrophysiological recordings of dorsal horn lamina V/VI neurones. As several studies have implicated TRPM8 in analgesia, we examined whether a novel systemically available TRPM8 agonist, M8-Ag, had more potent anti-hyperalgesic effects than menthol in neuropathic rats. In vitro, M8-Ag activates TRPM8, expressed in HEK293 cells, with an EC50 of 44.97 nM. In vivo, M8-Ag inhibited neuronal responses to innocuous and noxious cooling in SNL rats with no effect in sham-operated rats. This effect was modality selective; M8-Ag did not alter neuronal responses to mechanical, heat or brush stimulation. In addition, M8-Ag attenuated behavioural hypersensitivity to innocuous cooling but not mechanical stimulation. These data suggest that menthol induced hyperalgesia is not consistently replicable in the rat and that the analgesic properties are revealed by injury. Systemic TRPM8 agonists might be beneficial in neuropathy without affecting normal cold sensitivity.
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Affiliation(s)
- Ryan Patel
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK.
| | - Leonor Gonçalves
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | | | | | | | | | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
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Scheuren R, Sütterlin S, Anton F. Rumination and interoceptive accuracy predict the occurrence of the thermal grill illusion of pain. BMC Psychol 2014; 2:22. [PMID: 25815193 PMCID: PMC4363063 DOI: 10.1186/2050-7283-2-22] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/11/2014] [Indexed: 02/08/2023] Open
Abstract
Background While the neurophysiological mechanisms underlying the thermal grill illusion of pain (TGI) have been thoroughly studied, psychological determinants largely remain unknown. The present study aimed to investigate whether cognitive and affective personality traits encompassing rumination, interoception, and suggestibility may be identified as characteristics favouring the elicitation of paradoxical pain experiences. Methods The dominant hand of 54 healthy volunteers was stimulated with a water-bath driven thermal grill providing an interlaced temperature combination of 15 and 41°C. Pain intensity and pain unpleasantness perceptions were rated on a combined verbal-numerical scale (NRS). Traits were assessed via questionnaires, the heartbeat-tracking task, and warmth suggestions. Results Logistic regression analyses uncovered trait rumination and interoceptive accuracy (IA) as major predictors of the likelihood of the illusive pain occurrence (all p < .05). Rumination and suggestibility had an impact on unpleasant pain perceptions. Conclusion Our findings allowed identifying psychological factors substantially involved in the individual pre-disposition to reporting painful sensations in the thermal grill paradigm. These psychological characteristics may also be relevant in the context of central neuropathic pain, which to a large extent incorporates the same neural pathways.
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Affiliation(s)
- Raymonde Scheuren
- Institute of Health and Behaviour, Integrative Research Unit on Social and Individual Development, University of Luxembourg, Luxembourg, Grand-Duchy of Luxembourg
| | - Stefan Sütterlin
- Section of Psychology, Lillehammer University College, Lillehammer, Norway ; Research Group Health Psychology, University of Leuven, Leuven, Belgium ; Department of Psychosomatic Medicine, Division of Surgery and Clinical Neuroscience, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Fernand Anton
- Institute of Health and Behaviour, Integrative Research Unit on Social and Individual Development, University of Luxembourg, Luxembourg, Grand-Duchy of Luxembourg
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Hunter J, Dranga R, van Wyk M, Dostrovsky J. Unique influence of stimulus duration and stimulation site (glabrous vs. hairy skin) on the thermal grill-induced percept. Eur J Pain 2014; 19:202-15. [DOI: 10.1002/ejp.538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2014] [Indexed: 12/17/2022]
Affiliation(s)
- J. Hunter
- Department of Physical Therapy; University of Toronto; Canada
| | - R. Dranga
- The Institute of Biomaterials & Biomedical Engineering (IBBME); University of Toronto; Canada
| | - M. van Wyk
- Department of Physical Therapy; University of Toronto; Canada
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Sumracki NM, Buisman-Pijlman FTA, Hutchinson MR, Gentgall M, Rolan P. Reduced Response to the Thermal Grill Illusion in Chronic Pain Patients. PAIN MEDICINE 2014; 15:647-60. [DOI: 10.1111/pme.12379] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Leung A, Shukla S, Li E, Duann JR, Yaksh T. Supraspinal characterization of the thermal grill illusion with fMRI. Mol Pain 2014; 10:18. [PMID: 24612493 PMCID: PMC3995740 DOI: 10.1186/1744-8069-10-18] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 03/02/2014] [Indexed: 12/22/2022] Open
Abstract
Background Simultaneous presentation of non-noxious warm (40°C) and cold (20°C) stimuli in an interlacing fashion results in a transient hot burning noxious sensation (matched at 46°C) known as the thermal grill (TG) illusion. Functional magnetic resonance imaging and psychophysical assessments were utilized to compare the supraspinal events related to the spatial summation effect of three TG presentations: 20°C/20°C (G2020), 20°C/40°C (G2040) and 40°C/40°C (G4040) with corresponding matched thermode stimuli: 20°C (P20), 46°C (P46) and 40°C (P40) and hot pain (HP) stimuli. Results For G2040, the hot burning sensation was only noted during the initial off-line assessment. In comparison to P40, G4040 resulted in an equally enhanced response from all supraspinal regions associated with both pain sensory/discriminatory and noxious modulatory response. In comparison to P20, G2020 presentation resulted in a much earlier diminished/sedative response leading to a statistically significantly (P < 0.01) higher degree of deactivation in modulatory supraspinal areas activated by G4040. Granger Causality Analysis showed that while thalamic activation in HP may cast activation inference in all hot pain related somatosensory, affective and modulatory areas, similar activation in G2040 and G2020 resulted in deactivation inference in the corresponding areas. Conclusions In short, the transient TG sensation is caused by a dissociated state derived from non-noxious warm and cold spatial summation interaction. The observed central dissociated state may share some parallels in certain chronic neuropathic pain states.
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Affiliation(s)
- Albert Leung
- Department of Anesthesiology, University of California, San Diego, School of Medicine, 9500 Gilman Drive, MC 0818, 92093 La Jolla, CA, USA.
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Garcia-Larrea L, Peyron R. Pain matrices and neuropathic pain matrices: A review. Pain 2013; 154 Suppl 1:S29-S43. [PMID: 24021862 DOI: 10.1016/j.pain.2013.09.001] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 08/19/2013] [Accepted: 09/02/2013] [Indexed: 01/18/2023]
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Stiasny-Kolster K, Pfau DB, Oertel WH, Treede RD, Magerl W. Hyperalgesia and functional sensory loss in restless legs syndrome. Pain 2013; 154:1457-63. [DOI: 10.1016/j.pain.2013.05.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/19/2013] [Accepted: 05/03/2013] [Indexed: 11/17/2022]
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Abstract
Once there was a day when all type C nonmyelinated neurons were indistinguishable. That time of histologic analysis has passed, and we have entered an era of unparalleled technological insight into the mechanisms of pain and pruritus. Since the description of the capsaicin receptor, transient receptor protein vanilloid 1 (TRPV1), in 1997, we have seen the number of related sensor ion channels, G protein-coupled receptors, and signaling proteins explode. Specific nociceptive pathways have been identified based on their sensitivity to mechanical, heat, chemical, and cold stimuli. Pruritus is now recognized to have both histamine-sensitive and histamine-independent afferent arcs. Cross-talk between C-fibre systems and myelinated neural pathways has become more complex, but through complexity, a new reality of sensory coding is emerging. A multitude of novel therapeutics have been and are in planning and production stages. These will almost certainly revolutionize our understanding and treatment of pain and itch by the end of this decade.
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