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Smeets Y, Soer R, Chatziantoniou E, Preuper RHS, Reneman MF, Wolff AP, Timmerman H. Role of non-invasive objective markers for the rehabilitative diagnosis of central sensitization in patients with fibromyalgia: A systematic review. J Back Musculoskelet Rehabil 2024; 37:525-584. [PMID: 38073369 PMCID: PMC11091570 DOI: 10.3233/bmr-220430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/28/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Central sensitization cannot be demonstrated directly in humans. Therefore, studies used different proxy markers (signs, symptoms and tools) to identify factors assumed to relate to central sensitization in humans, that is, Human Assumed Central Sensitization (HACS). The aims of this systematic review were to identify non-invasive objective markers of HACS and the instruments to assess these markers in patients with fibromyalgia (FM). METHODS A systematic review was conducted with the following inclusion criteria: (1) adults, (2) diagnosed with FM, and (3) markers and instruments for HACS had to be non-invasive. Data were subsequently extracted, and studies were assessed for risk of bias using the quality assessment tools developed by the National Institute of Health. RESULTS 78 studies (n= 5234 participants) were included and the findings were categorized in markers identified to assess peripheral and central manifestations of HACS. The identified markers for peripheral manifestations of HACS, with at least moderate evidence, were pain after-sensation decline rates, mechanical pain thresholds, pressure pain threshold, sound 'pressure' pain threshold, cutaneous silent period, slowly repeated evoked pain sensitization and nociceptive flexion reflex threshold. The identified markers for central manifestations of HACS were efficacy of conditioned pain modulation with pressure pain conditioning and brain perfusion analysis. Instruments to assess these markers are: pin-prick stimulators, cuff-algometry, repetitive pressure stimulation using a pressure algometer, sound, electrodes and neuroimaging techniques. CONCLUSIONS This review provides an overview of non-invasive markers and instruments for the assessment of HACS in patients with FM. Implementing these findings into clinical settings may help to identify HACS in patients with FM.
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Affiliation(s)
- Yasemin Smeets
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Pain Center, Groningen, The Netherlands
| | - Remko Soer
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Pain Center, Groningen, The Netherlands
- mProve Hospitals, Zwolle, The Netherlands
| | - Evangelia Chatziantoniou
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Pain Center, Groningen, The Netherlands
| | - Rita H.R. Schiphorst Preuper
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Michiel F. Reneman
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - André P. Wolff
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Pain Center, Groningen, The Netherlands
| | - Hans Timmerman
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Pain Center, Groningen, The Netherlands
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Dietrich N, Luomajoki H, Hotz-Boendermaker S. The association between mechanical temporal summation, state anxiety at baseline, and persistent low back pain: a 12-month prospective cohort study. BMC Musculoskelet Disord 2023; 24:957. [PMID: 38066474 PMCID: PMC10704673 DOI: 10.1186/s12891-023-07046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Persons with acute low back pain (LBP) have a good prognosis for regaining function, while pain often persists. Neurobiological and psychosocial factors are recognized to amplify pain responses, as reported for central sensitization. This study investigated the combination of mechanical temporal summation (TS) chosen to characterize central sensitization and state anxiety representing a psychological factor and their association with persistent pain. METHODS A longitudinal prospective cohort study including 176 participants aged between 18 and 65 with acute LBP was performed. The following independent variables were analyzed at baseline: The mechanical TS at the lower back, of whom the Wind-up ratio (WUR) was calculated, and the state anxiety level measured with the State and Trait Anxiety Inventory (STAI-S). The outcome pain intensity was assessed at baseline and 2,3,6 and 12 months after the onset of acute LBP with the Numeric Rating Scale 0-10 (NRS). Linear mixed models (LMM) were used to analyze the association of the independent variables with pain intensity over time. RESULTS The mean baseline WUR was 1.3 (SD 0.6) for the right and 1.5 (SD 1.0) for the left side. STAI-S revealed a mean score of 43.1 (SD 5.2). Pain intensity was, on average, 5.4 points (SD 1.6) on the NRS and decreased over one year to a mean of 2.2 (SD 2.4). After one year, 56% of the participants still experienced pain. The LMM revealed a considerable variation, as seen in large confidence intervals. Therefore, associations of the independent variables (WUR and STAI-S) with the course of the outcome pain intensity over one year were not established. CONCLUSION This investigation did not reveal an association of mechanical TS and state anxiety at baseline with pain intensity during the one-year measurement period. Pain persistence, mediated by central sensitization, is a complex mechanism that single mechanical TS and state anxiety cannot capture.
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Affiliation(s)
- Nicole Dietrich
- School of Health Professions, Zurich University of Applied Sciences (ZHAW), Institute of Physiotherapy,, Katharina-Sulzer-Platz 9, Postfach, CH-8401, Winterthur, Switzerland.
- Hirslanden Klinik Linde, Blumenrain 105, CH-2501, Biel, Switzerland.
| | - Hannu Luomajoki
- School of Health Professions, Zurich University of Applied Sciences (ZHAW), Institute of Physiotherapy,, Katharina-Sulzer-Platz 9, Postfach, CH-8401, Winterthur, Switzerland
| | - Sabina Hotz-Boendermaker
- School of Health Professions, Zurich University of Applied Sciences (ZHAW), Institute of Physiotherapy,, Katharina-Sulzer-Platz 9, Postfach, CH-8401, Winterthur, Switzerland
- Pain in Motion Research Group
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Sikdar S, Srbely J, Shah J, Assefa Y, Stecco A, DeStefano S, Imamura M, Gerber LH. A model for personalized diagnostics for non-specific low back pain: the role of the myofascial unit. FRONTIERS IN PAIN RESEARCH 2023; 4:1237802. [PMID: 37901614 PMCID: PMC10606250 DOI: 10.3389/fpain.2023.1237802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Low back pain (LBP) is the leading cause of disability worldwide. Most LBP is non-specific or idiopathic, which is defined as symptoms of unknown origin without a clear specific cause or pathology. Current guidelines for clinical evaluation are based on ruling out underlying serious medical conditions, but not on addressing underlying potential contributors to pain. Although efforts have been made to identify subgroups within this population based on response to treatment, a comprehensive framework to guide assessment is still lacking. In this paper, we propose a model for a personalized mechanism-based assessment based on the available evidence that seeks to identify the underlying pathologies that may initiate and perpetuate central sensitization associated with chronic non-specific low back pain (nsLBP). We propose that central sensitization can have downstream effects on the "myofascial unit", defined as an integrated anatomical and functional structure that includes muscle fibers, fascia (including endomysium, perimysium and epimysium) and its associated innervations (free nerve endings, muscle spindles), lymphatics, and blood vessels. The tissue-level abnormalities can be perpetuated through a vicious cycle of neurogenic inflammation, impaired fascial gliding, and interstitial inflammatory stasis that manifest as the clinical findings for nsLBP. We postulate that our proposed model offers biological plausibility for the complex spectrum of clinical findings, including tissue-level abnormalities, biomechanical dysfunction and postural asymmetry, ecological and psychosocial factors, associated with nsLBP. The model suggests a multi-domain evaluation that is personalized, feasible and helps rule out specific causes for back pain guiding clinically relevant management. It may also provide a roadmap for future research to elucidate mechanisms underlying this ubiquitous and complex problem.
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Affiliation(s)
- Siddhartha Sikdar
- Center for Adaptive Systems of Brain Body Interactions, George Mason University, Fairfax, VA, United States
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - John Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, CA, United States
| | - Jay Shah
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Yonathan Assefa
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Antonio Stecco
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York City, NY, United States
| | | | - Marta Imamura
- Faculty of Medicine, University of São Paolo, São Paulo, Brazil
| | - Lynn H. Gerber
- Center for Adaptive Systems of Brain Body Interactions, George Mason University, Fairfax, VA, United States
- Department of Medicine, INOVA Health System, Fairfax, VA, United States
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Bao JD, Rosser MA, Park SH, Baker AK, Martucci KT. Interplay between noxious heat sensitivity and temporal summation magnitude in patients with fibromyalgia and long-term opioid use. Front Neurosci 2023; 17:1275921. [PMID: 37901425 PMCID: PMC10600517 DOI: 10.3389/fnins.2023.1275921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction In chronic pain conditions such as fibromyalgia (FM), pain amplification within the central nervous system, or "central sensitization," may contribute to the development and maintenance of chronic pain. Chronic pain treatments include opioid therapy, and opioid therapy may maladaptively increase central sensitization, particularly in patients who take opioids long-term. However, it has remained unknown how central sensitization is impacted in patients who use opioids long-term. Methods To investigate how long-term opioid therapy affects central sensitization, we used the validated measure of temporal summation. The temporal summation measurement consists of applying a series of noxious stimuli to a patient's skin and then calculating changes in the patient's pain rating to each stimulus. Using this measurement, we evaluated temporal summation in study participants with fibromyalgia who take opioids long-term (i.e., greater than 90 days duration; n = 24, opioid-FM). We compared opioid-FM responses to 2 control groups: participants with fibromyalgia who do not take opioids (n = 33, non-opioid FM), and healthy controls (n = 31). For the temporal summation measurement, we applied a series of 10 noxious heat stimuli (sensitivity-adjusted temperatures) to the ventral forearm (2s duration of each stimulus, applied once every 3 s). Additionally, we collected responses to standard pain and cognitive-affective questionnaires to assess pain severity and other factors. Results and discussion Group differences in sensitivity-adjusted stimulus temperatures were observed, with only the non-opioid FM group requiring significantly lower stimulus temperatures (The opioid-FM group also required lower temperatures, but not significantly different from the control group). However, all 3 groups exhibited similar magnitudes of temporal summation. Across combined FM groups, temporal summation negatively correlated with pain severity (r = -0.31, p = 0.021). Within the opioid-FM group, higher pain sensitivity to heat (i.e., lower sensitivity-adjusted temperatures) showed a trend relationship with higher opioid dosage (r = -0.45, p = 0.036), potentially reflective of opioid-related hyperalgesia. Our findings also indicated that heightened pain severity may skew sensitivity-adjusted temporal summation, thereby limiting its utility for measuring central sensitization. Overall, in participants taking opioids, temporal summation may be influenced by hypersensitivity to heat pain, which appeared to vary with opioid dosage.
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Affiliation(s)
- Jason D. Bao
- Human Affect and Pain Neuroscience Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, United States
| | - Morgan A. Rosser
- Department of Anesthesiology, Biostatistics Group, Duke University School of Medicine, Durham, NC, United States
| | - Su Hyoun Park
- Human Affect and Pain Neuroscience Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, United States
| | - Anne K. Baker
- Human Affect and Pain Neuroscience Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, United States
| | - Katherine T. Martucci
- Human Affect and Pain Neuroscience Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
- Center for Translational Pain Medicine, Duke University Medical Center, Durham, NC, United States
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Lima D, Pacheco-Barrios K, Slawka E, Camargo L, Castelo-Branco L, Cardenas-Rojas A, Neto MS, Fregni F. The role of symptoms severity, heart rate, and central sensitization for predicting sleep quality in patients with fibromyalgia. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1153-1160. [PMID: 37314968 PMCID: PMC10546479 DOI: 10.1093/pm/pnad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Clinical predictors of sleep quality in patients with fibromyalgia syndrome (FMS) are still unknown. By identifying these factors, we could raise new mechanistic hypotheses and guide management approaches. We aimed to describe the sleep quality of FMS patients and to explore the clinical and quantitative sensory testing (QST) predictors of poor sleep quality and its subcomponents. METHODS This study is a cross-sectional analysis of an ongoing clinical trial. We performed linear regression models between sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and demographic, clinical, and QST variables, controlling for age and gender. Predictors for the total PSQI score and its seven subcomponents were found using a sequential modeling approach. RESULTS We included 65 patients. The PSQI score was 12.78 ± 4.39, with 95.39% classified as poor sleepers. Sleep disturbance, use of sleep medications, and subjective sleep quality were the worst subdomains. We found poor PSQI scores were highly associated with symptom severity (FIQR score and PROMIS fatigue), pain severity, and higher depression levels, explaining up to 31% of the variance. Fatigue and depression scores also predicted the subjective sleep quality and daytime dysfunction subcomponents. Heart rate changes (surrogate of physical conditioning) predicted the sleep disturbance subcomponent. QST variables were not associated with sleep quality or its subcomponents. CONCLUSIONS Symptom severity, fatigue, pain, and depression (but no central sensitization) are the main predictors of poor sleep quality. Heart rate changes independently predicted the sleep disturbance subdomain (the most affected one in our sample), suggesting an essential role of physical conditioning in modulating sleep quality in FMS patients. This underscores the need for multidimensional treatments targeting depression and physical activity to improve the sleep quality of FMS patients.
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Affiliation(s)
- Daniel Lima
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
- Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15023, Peru
| | - Eric Slawka
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Lucas Camargo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
| | - Moacir Silva Neto
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
- Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15023, Peru
- Life Checkup—Medicina Esportiva Avançada, Brasilia 70040, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02141, United States
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De Schoenmacker I, Mollo A, Scheuren PS, Sirucek L, Brunner F, Schweinhardt P, Curt A, Rosner J, Hubli M. Central sensitization in CRPS patients with widespread pain: a cross-sectional study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:974-984. [PMID: 36946277 PMCID: PMC10391588 DOI: 10.1093/pm/pnad040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Widespread pain hypersensitivity and enhanced temporal summation of pain (TSP) are commonly reported in patients with complex regional pain syndrome (CRPS) and discussed as proxies for central sensitization. This study aimed to directly relate such signs of neuronal hyperexcitability to the pain phenotype of CRPS patients. METHODS Twenty-one CRPS patients and 20 healthy controls (HC) were recruited. The pain phenotype including spatial pain extent (assessed in % body surface) and intensity were assessed and related to widespread pain hypersensitivity, TSP, and psychological factors. Quantitative sensory testing (QST) was performed in the affected, the contralateral and a remote (control) area. RESULTS CRPS patients showed decreased pressure pain thresholds in all tested areas (affected: t(34) = 4.98, P < .001, contralateral: t(35) = 3.19, P = .005, control: t(31) = 2.65, P = .012). Additionally, patients showed increased TSP in the affected area (F(3,111) = 4.57, P = .009) compared to HC. TSP was even more enhanced in patients with a high compared to a low spatial pain extent (F(3,51) = 5.67, P = .008), suggesting pronounced spinal sensitization in patients with extended pain patterns. Furthermore, the spatial pain extent positively correlated with the Bath Body Perception Disturbance Scale (ρ = 0.491; P = .048). CONCLUSIONS Overall, we provide evidence that the pain phenotype in CRPS, that is, spatial pain extent, might be related to sensitization mechanism within the central nociceptive system. This study points towards central neuronal excitability as a potential therapeutic target in patients with more widespread CRPS.
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Affiliation(s)
- Iara De Schoenmacker
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Anna Mollo
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Paulina Simonne Scheuren
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Laura Sirucek
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, 8008 Zurich, Switzerland
| | - Florian Brunner
- Physical Medicine and Rheumatology, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, 8008 Zurich, Switzerland
- Alan Edward Center for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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Ioachim G, Warren HJM, Powers JM, Staud R, Pukall CF, Stroman PW. Distinct neural signaling characteristics between fibromyalgia and provoked vestibulodynia revealed by means of functional magnetic resonance imaging in the brainstem and spinal cord. FRONTIERS IN PAIN RESEARCH 2023; 4:1171160. [PMID: 37283704 PMCID: PMC10240076 DOI: 10.3389/fpain.2023.1171160] [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: 02/21/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Fibromyalgia and provoked vestibulodynia are two chronic pain conditions that disproportionately affect women. The mechanisms underlying the pain in these conditions are still poorly understood, but there is speculation that both may be linked to altered central sensitization and autonomic regulation. Neuroimaging studies of these conditions focusing on the brainstem and spinal cord to explore changes in pain regulation and autonomic regulation are emerging, but none to date have directly compared pain and autonomic regulation in these conditions. This study compares groups of women with fibromyalgia and provoked vestibulodynia to healthy controls using a threat/safety paradigm with a predictable noxious heat stimulus. Methods Functional magnetic resonance imaging data were acquired at 3 tesla in the cervical spinal cord and brainstem with previously established methods. Imaging data were analyzed with structural equation modeling and ANCOVA methods during: a period of noxious stimulation, and a period before the stimulation when participants were expecting the upcoming pain. Results The results demonstrate several similarities and differences between brainstem/spinal cord connectivity related to autonomic and pain regulatory networks across the three groups in both time periods. Discussion Based on the regions and connections involved in the differences, the altered pain processing in fibromyalgia appears to be related to changes in how autonomic and pain regulation networks are integrated, whereas altered pain processing in provoked vestibulodynia is linked in part to changes in arousal or salience networks as well as changes in affective components of pain regulation.
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Affiliation(s)
- Gabriela Ioachim
- Center for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | | | - Jocelyn M. Powers
- Center for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Roland Staud
- Department of Medicine, University of Florida, Gainseville, FL, United States
| | - Caroline F. Pukall
- Center for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Psychology, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Patrick W. Stroman
- Center for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
- Department of Physics, Queen's University, Kingston, ON, Canada
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Othman R, Swain N, Tumilty S, Jayakaran P, Mani R. Sensitivity to movement-evoked pain, central sensitivity symptoms, and pro-nociceptive profiles in people with chronic shoulder pain: A parallel-group cross-sectional investigation. Pain Pract 2023; 23:41-62. [PMID: 36617189 DOI: 10.1111/papr.13152] [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: 02/17/2022] [Revised: 06/25/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate whether sensitivity to movement-evoked pain (SMEP), central sensitivity symptom burden, and quantitative sensory testing (QST) outcomes differ between healthy controls and people with chronic shoulder pain. METHODS People with chronic shoulder pain (n = 39) and healthy controls (n = 26) completed validated questionnaires measuring demographic, pain characteristics, psychological factors, social support, sleep quality, central sensitivity inventory (CSI), and physical activity levels. A blinded assessor administered QST measuring pressure pain threshold, temporal summation, conditioned pain modulation, and cold hyperalgesia. All participants performed repeated lifting of weighted canisters and reported severity of pain over successive lifts of the weighted canisters. Between-group differences in the QST, SMEP and CSI scores were investigated. Demographic and psychosocial variables were adjusted in the analyses. RESULTS Dynamic mechanical allodynia, mechanical temporal summation, movement-evoked pain scores, SMEP index, and CSI scores were significantly (p ≤ 0.05) higher in the chronic shoulder pain group than in healthy controls. A significant proportion of people with chronic shoulder pain presented with pro-nociceptive profiles and experienced higher pain severity, interference, and disability. CONCLUSIONS People with chronic shoulder pain displayed symptoms and signs of central sensitization. Future research should investigate the predictive role of central sensitization on clinical outcomes in shoulder pain.
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Affiliation(s)
- Rani Othman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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de la Coba P, Montoro CI, Reyes Del Paso GA, Galvez-Sánchez CM. Algometry for the assessment of central sensitisation to pain in fibromyalgia patients: a systematic review. Ann Med 2022; 54:1403-1422. [PMID: 35579545 PMCID: PMC9122375 DOI: 10.1080/07853890.2022.2075560] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The pathophysiology of fibromyalgia (FM) is related to central sensitisation (CS) to pain. Algometry allows assessing CS based on dynamic evoked pain. However, current algometrýs protocols require optimising, unifying and updating. OBJECTIVES 1) identify the dynamic pain measures used most frequently to effectively assess CS processes in FM, and 2) consider the future of the algometry assessing CS in these patients. METHODS Cochrane Collaboration guidelines and PRISMA statements were followed. The protocol was registered in PROSPERO database (ID: CRD42021270135). The selected articles were evaluated using the Cochrane risk of bias (ROB) assessment tool. The PubMed, Scopus, and Web of Science databases were searched. RESULTS Thirty-four studies were selected, including measures such as temporal summation of pain (TSP), aftersensations (AS), spatial summation of pain (SSP), the noxious flexion reflex (NFR) threshold, conditioned pain modulation (CPM), cutaneous silent period (CuSP), and slowly repeated evoked pain (SREP); and evoked pain combined with neuroimaging. Each measure offered various advantages and limitations. According to ROB, 28 studies were of low quality, 3 of moderate quality, and 3 of high quality. CONCLUSIONS Several pain indicators have been demonstrated to successfully examine CS involvement in FM in the last years. Algometry, especially when it involves diverse body sites and tissues, might provide further insight into (1) the evaluation of psychological factors known to influence pain experience, (2) new dynamic pain indicators, and (3) the simultaneous use of certain neuroimaging techniques. Further research clarifying the mechanisms underlying some of these measures, and homogenisation and optimisation of the algometrýs protocols, are needed. KEY MESSAGESAlgometry allows for assessing Central Sensitisation by applying dynamic evoked pain.The future of algometry could relapse in its combination with neuroimaging.Recently-emerged pain indicators should be considered for algometrýs new protocols.
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Lütolf R, Rosner J, Curt A, Hubli M. Indicators of central sensitization in chronic neuropathic pain after spinal cord injury. Eur J Pain 2022; 26:2162-2175. [PMID: 36008094 PMCID: PMC9826442 DOI: 10.1002/ejp.2028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/01/2022] [Accepted: 08/20/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Central sensitization is considered a key mechanism underlying neuropathic pain (NP) after spinal cord injury (SCI). METHODS Two novel proxies for central sensitization were investigated in thoracic SCI subjects with (SCI-NP) and without NP (SCI-nonNP) compared to healthy controls (HC). Specifically, temporal summation of pain (TSP) was investigated by examining pain ratings during a 2-min tonic heat application to the volar forearm. Additionally, palmar heat-induced sympathetic skin responses (SSR) were recorded in order to reveal changes in pain-autonomic interaction above the lesion level. Pain extent was assessed as the percentage of the body area and the number of body regions being affected by NP. RESULTS Enhanced TSP was observed in SCI-NP (+66%) compared to SCI-nonNP (-75%, p = 0.009) and HC (-59%, p = 0.021). In contrast, no group differences were found (p = 0.685) for SSR habituation. However, pain extent in SCI-NP was positively correlated with deficient SSR habituation (body area: r = 0.561, p = 0.024; body regions: r = 0.564, p = 0.023). CONCLUSIONS These results support the value of TSP and heat-induced SSRs as proxies for central sensitization in widespread neuropathic pain syndromes after SCI. Measures of pain-autonomic interaction emerged as a promising tool for the objective investigation of sensitized neuronal states in chronic pain conditions. SIGNIFICANCE We present two surrogate readouts for central sensitization in neuropathic pain following SCI. On the one hand, temporal summation of tonic heat pain is enhanced in subjects with neuropathic pain. On the other hand, pain-autonomic interaction reveals potential advanced measures in chronic pain, as subjects with a high extent of neuropathic pain showed diminished habituation of pain-induced sympathetic measures. A possible implication for clinical practice is constituted by an improved assessment of neuronal hyperexcitability potentially enabling mechanism-based treatment.
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Affiliation(s)
- Robin Lütolf
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Jan Rosner
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland,Department of NeurologyUniversity Hospital Bern, Inselspital, University of BernBernSwitzerland
| | - Armin Curt
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Michèle Hubli
- Spinal Cord Injury CenterBalgrist University Hospital, University of ZurichZurichSwitzerland
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Lütolf R, De Schoenmacker I, Rosner J, Sirucek L, Schweinhardt P, Curt A, Hubli M. Anti- and Pro-Nociceptive mechanisms in neuropathic pain after human spinal cord injury. Eur J Pain 2022; 26:2176-2187. [PMID: 36000307 PMCID: PMC9826499 DOI: 10.1002/ejp.2029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/01/2022] [Accepted: 08/20/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Deficient endogenous pain modulation and increased nociceptive excitability are key features of central sensitization and can be assessed in humans by conditioned pain modulation (CPM, anti-nociceptive) and temporal summation of pain (TSP, pro-nociceptive), respectively. This study aimed to investigate these measures as proxies for central sensitization in subjects with chronic neuropathic pain (NP) after spinal cord injury (SCI). METHODS In paraplegic subjects with NP (SCI-NP; n = 17) and healthy controls (HC; n = 17), parallel and sequential sham-controlled CPM paradigms were performed using pressure pain threshold at the hand, that is, above lesion level, as test stimulus. The conditioning stimulus was a noxious cold (verum) or lukewarm water bath (sham) applied contralaterally. Regarding pro-nociceptive mechanisms, a TSP protocol with individually-adjusted pressure pain stimuli at the thenar eminence was used. CPM and TSP magnitudes were related to intensity and spatial extent of spontaneous NP. RESULTS Neither the parallel nor sequential sham-controlled CPM paradigm showed any significant inhibition of above-level pressure pain thresholds for SCI-NP or HC. Accordingly, no group difference in CPM capacity was found, however, subjects with more intense spontaneous NP showed lower inhibitory CPM capacity. TSP was observed for both groups but was not enhanced in SCI-NP. CONCLUSIONS Our results do not support altered above-level anti- or pro-nociceptive mechanisms in SCI-NP compared with HC; however, they also highlight the relevance of spontaneous NP intensity with regards to the capacity of endogenous pain modulation in SCI subjects. SIGNIFICANCE Central sensitization encompasses deficient endogenous pain modulation and increased nociceptive excitability. These two mechanisms can be assessed in humans by conditioned pain modulation and temporal summation of pain, respectively. Our data demonstrates a lack of descending pain inhibition only in subjects with severe neuropathic pain which may hint towards central sensitization at spinal and/or supra-spinal levels. Disentangling the mechanisms of endogenous pain modulation and neuronal hyperexcitability might improve mechanism-based treatment of neuropathic pain in subjects with spinal cord injury.
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Affiliation(s)
- Robin Lütolf
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Iara De Schoenmacker
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland,Department of NeurologyUniversity Hospital Bern, Inselspital, University of BernBernSwitzerland
| | - Laura Sirucek
- Integrative Spinal Research, Department of Chiropractic MedicineBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic MedicineBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
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12
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Lepping RJ, McMillan ML, Chadwick AL, Mansour ZM, Martin LE, Gustafson KM. Autonomic nervous system markers of music-elicited analgesia in people with fibromyalgia: A double-blind randomized pilot study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:953118. [PMID: 36185772 PMCID: PMC9521378 DOI: 10.3389/fpain.2022.953118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 01/02/2023]
Abstract
Purpose To investigate the feasibility of using music listening by adults with fibromyalgia (FM) as a potential tool for reducing pain sensitivity. Patients and methods We report results from a double-blind two-arm parallel randomized pilot study (NCT04059042) in nine participants with FM. Pain tolerance and threshold were measured objectively using quantitative sensory tests; autonomic nervous system (ANS) reactivity was measured with an electrocardiogram. Participants were randomized to listen to instrumental Western Classical music or a nature sound control to test whether music listening elicits greater analgesic effects over simple auditory distraction. Participants also completed separate control testing with no sound that was counterbalanced between participants. Results Participants were randomized 1:1 to music or nature sounds (four Music and five Nature). Although the groups were not different on FM scores, the Music group had marginally worse temporal pain summation (p = 0.06), and the Nature group had higher anxiety scores (p < 0.05). Outcome measures showed a significant difference between groups in the magnitude of change in temporal summation between sessions (p < 0.05), revealing that the Nature group had greater pain reduction during audio compared to silence mode, while the Music group had no difference between the sessions. No significant effects were observed for either mechanical pain tolerance or ANS testing. Within the Music group, there was a trend of vagal response increase from baseline to music listening, but it did not reach statistical significance; this pattern was not observed in the Nature group. Conclusion Auditory listening significantly altered pain responses. There may be a greater vagal response to music vs. nature sounds; however, results could be due to group differences in pain and anxiety. This line of study will help in determining whether music could be prophylactic for people with FM when acute pain is expected.
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Affiliation(s)
- Rebecca J. Lepping
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,*Correspondence: Rebecca J. Lepping
| | - Miranda L. McMillan
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Andrea L. Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Zaid M. Mansour
- Department of Physical and Occupational Therapy, The Hashemite University, Zarqa, Jordan
| | - Laura E. Martin
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States,Department for McMillan and Chadwick, Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, United States
| | - Kathleen M. Gustafson
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
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13
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Castelo-Branco L, Cardenas-Rojas A, Rebello-Sanchez I, Pacheco-Barrios K, de Melo PS, Gonzalez-Mego P, Marduy A, Vasquez-Avila K, Costa Cortez P, Parente J, Teixeira PEP, Rosa G, McInnis K, Caumo W, Fregni F. Temporal Summation in Fibromyalgia Patients: Comparing Phasic and Tonic Paradigms. FRONTIERS IN PAIN RESEARCH 2022; 3:881543. [PMID: 35812016 PMCID: PMC9261961 DOI: 10.3389/fpain.2022.881543] [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: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Fibromyalgia (FM) is associated with dysfunctional pain modulation mechanisms, including central sensitization. Experimental pain measurements, such as temporal summation (TS), could serve as markers of central sensitization and have been previously studied in these patients, with conflicting results. Our objective in this study was to explore the relationships between two different protocols of TS (phasic and tonic) and test the associations between these measures and other clinical variables. Materials and Methods In this cross-sectional analysis of a randomized clinical trial, patients were instructed to determine their pain-60 test temperature, then received one train of 15 repetitive heat stimuli and rated their pain after the 1st and 15th stimuli: TSPS-phasic was calculated as the difference between those. We also administered a tonic heat test stimulus at the same temperature continuously for 30 s and asked them to rate their pain levels after 10 s and 30 s, calculating TSPS-tonic as the difference between them. We also collected baseline demographic data and behavioral questionnaires assessing pain, depression, fatigue, anxiety, sleepiness, and quality of life. We performed univariable analyses of the relationship between TSPS-phasic and TSPS-tonic, and between each of those measures and the demographic and clinical variables collected at baseline. We then built multivariable linear regression models to find predictors for TSPS-phasic and TSPS-tonic, while including potential confounders and avoiding collinearity. Results Fifty-two FM patients were analyzed. 28.85% developed summation during the TSPS-phasic protocol while 21.15% developed summation during the TSPS-tonic protocol. There were no variables associated TSPS phasic or tonic in the univariable analyses and both measures were not correlated. On the multivariate model for the TSPS-phasic protocol, we found a weak association with pain variables. BPI-pain subscale was associated with more temporal summation in the phasic protocol (ß = 0.38, p = 0.029), while VAS for pain was associated with less summation in the TSPS-tonic protocol (ß = −0.5, p = 0.009). Conclusion Our results suggest that, using heat stimuli with pain-60 temperatures, a TSPS-phasic protocol and a TSPS-tonic protocol are not correlated and could index different neural responses in FM subjects. Further studies with larger sample sizes would be needed to elucidate whether such responses could help differentiating subjects with FM into specific phenotypes.
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Affiliation(s)
- Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ingrid Rebello-Sanchez
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Paulo S. de Melo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Paola Gonzalez-Mego
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Karen Vasquez-Avila
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Pablo Costa Cortez
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Instituto de Ciencias Biologicas, Departamento de Imunologia Basica e Aplicada, Manaus, Brazil
| | - Joao Parente
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Paulo E. P. Teixeira
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- MGH Institute of Health Professions, Boston, MA, United States
| | - Gleysson Rosa
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kelly McInnis
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Wolnei Caumo
- Pain and Palliative Care Service at Clinical Hospital of Porto Alegre (HCPA), Surgery Department, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- *Correspondence: Felipe Fregni
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14
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Berwick RJ, Andersson DA, Goebel A, Marshall A. After-Sensations and Lingering Pain following Examination in Patients with Fibromyalgia Syndrome. PAIN MEDICINE 2022; 23:1928-1938. [PMID: 35652761 DOI: 10.1093/pm/pnac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/05/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic widespread pain condition with mixed peripheral and central contributions. Patients display hypersensitivities to a spectrum of stimuli. Patients' blunt pressure pain thresholds are typically reduced, and sometimes (∼15%) gentle brushstroke induces allodynia. However, after-sensations following these stimuli have not, to our knowledge, been reported. We examined the perception of blunt pressure and 'pleasant touch' in FMS. Patients were first interviewed and completed standard psychometric questionnaires. We then measured their sensitivity to blunt pressure and perception of pleasant touch including after-sensations; patients were followed for five days evaluating lingering pain from blunt pressure. We recruited 51 FMS patients and 16 pain-free controls (HC) at a UK Pain Management Centre. Forty-four patients completed the after-sensation protocol. Most patients reported pain after application of less mechanical pressure than HCs; median arm and leg thresholds were 167 kPa and 233 kPa. Eighty-four percent (31/37) of patients reported ongoing pain at the site of pressure application one day after testing, and 49% (18/37) still perceived pain at five days. After-sensations following brushstroke were common in the FMS group, reported by 77% (34/44) compared to 25% (4/16) of HCs; 34% (15/44) patients, but no HCs, perceived these after-sensations as uncomfortable. For FMS patients who experienced after-sensations, brushstroke-pleasantness ratings were reduced, and skin was often an important site of pain. Pain after blunt pressure assessment typically lingers for several days. After-sensations following brushstroke stimulation is a previously unreported FMS phenomenon. They are associated with tactile anhedonia and may identify a clinically distinct subgroup.
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Affiliation(s)
- Richard J Berwick
- Pain Research Institute, University of Liverpool, UK.,Walton Centre, Longmore Lane, Liverpool, UK
| | | | - Andreas Goebel
- Pain Research Institute, University of Liverpool, UK.,Walton Centre, Longmore Lane, Liverpool, UK
| | - Andrew Marshall
- Pain Research Institute, University of Liverpool, UK.,Walton Centre, Longmore Lane, Liverpool, UK
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15
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Rodriguez DA, Galor A, Felix ER. Self-Report of Severity of Ocular Pain Due to Light as a Predictor of Altered Central Nociceptive System Processing in Individuals With Symptoms of Dry Eye Disease. THE JOURNAL OF PAIN 2022; 23:784-795. [PMID: 34890797 DOI: 10.1016/j.jpain.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/06/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
Dry eye disease (DED) is a diagnosis given to individuals with a heterogeneous combination of symptoms and/or signs, including spontaneous and evoked ocular pain. Our current study evaluated whether and which ocular pain assessments could serve as screening tools for central sensitization in individuals with DED. A cohort of individuals with DED symptoms (n = 235) were evaluated for ocular pain, DED signs (tear production, evaporation), evoked sensitivity to mechanical stimulation at the cornea, and evidence of central sensitization. Central sensitization was defined for this study as the presence of pain 30 seconds after termination of a thermal noxious temporal summation protocol (ie, aftersensations) presented at a site remote from the eye (ventral forearm). We found that combining ratings of average intensity of ocular pain, ratings of average intensity of pain due to light, response to topical anesthetic eye drops, and corneal mechanical pain thresholds produced the best predictive model for central sensitization (area under the curve of .73). When examining ratings of intensity of ocular pain due to light alone (0-10 numerical rating), a cutoff score of 2 maximized sensitivity (85%) and specificity (48%) for the presence of painful aftersensations at the forearm. Self-reported rating of pain sensitivity to light may serve as a quick screening tool indicating the involvement of central nociceptive system dysfunction in individuals with DED. PERSPECTIVE: This study reveals that clinically-relevant variables, including a simple 0 to 10 rating of ocular pain due to light, can be used to predict the contribution of central sensitization mechanisms in a subgroup of individuals with DED symptoms. These findings can potentially improve patient stratification and management for this complex and painful disease.
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Affiliation(s)
- Daniel A Rodriguez
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida; Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Anat Galor
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida; Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Elizabeth R Felix
- Research Service, Miami Veterans Affairs Medical Center, Miami, Florida; Physical Medicine and Rehabilitation, University of Miami, Miami, Florida.
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16
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Morin M, St-Gelais R, Ketounou KÉ, d'Assomption RML, Ezzaidi H, Fernandes KBP, da Silva RA, Ngomo S. tDCS Task-Oriented Approach Improves Function in Individuals With Fibromyalgia Pain. A Pilot Study. FRONTIERS IN PAIN RESEARCH 2022; 2:692250. [PMID: 35295530 PMCID: PMC8915725 DOI: 10.3389/fpain.2021.692250] [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: 04/08/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Fibromyalgia (FM) is a complex pain syndrome accompanied by physical disability and loss of daily life activities. Evidences suggest that modulation of the primary motor cortex (M1) by transcranial direct current stimulation (tDCS) improves functional physical capacity in chronic pain conditions. However, the gain on physical function in people living with FM receiving tDCS is still unclear. This study aimed to evaluate whether the tDCS task-oriented approach improves function and reduces pain in a single cohort of 10 FM. A total of 10 women with FM (60.4 ± 15.37 years old) were enrolled in an intervention including anodal tDCS delivered on M1 (2 mA from a constant stimulator for 20 min); simultaneously they performed a functional task. The anode was placed on the contralateral hemisphere of the dominant hand. Outcome assessments were done before the stimulation, immediately after stimulation and 30 min after the end of tDCS. The same protocol was applied in subsequent sessions. A total of five consecutive days of tDCS were completed. The main outcomes were the number of repetitions achieved and time in active practice to evaluate functional physical task performance such as intensity of the pain (visual analog scale) and level of fatigue (Borg scale). After 5 days of tDCS, the number of repetitions achieved significantly increased by 49% (p = 0.012). No change was observed in active practice time. No increase in pain was observed despite the mobility of the painful parts of the body. These results are encouraging since an increase in pain due to the mobilization of painful body parts could have been observed at the end of the 5th day of the experiment. These results support the use of tDCS in task-based rehabilitation.
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Affiliation(s)
- Marika Morin
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Raphaël St-Gelais
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Kossi Épiphane Ketounou
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Régis M-L d'Assomption
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Hassan Ezzaidi
- Department of Applied Sciences, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | | | - Rubens A da Silva
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Suzy Ngomo
- Laboratoire de recherche Lab BioNR, Physical Therapy Program, Health Sciences Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
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17
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Campolo M, Correa L, Gabarrón E, Albayrak M, Quintero-Diaz C, Castellote JM, Casanova-Molla J, Valls-Sole J. Adaptation to tonic heat in healthy subjects and patients with sensory polyneuropathy. Eur J Pain 2022; 26:1056-1068. [PMID: 35263818 DOI: 10.1002/ejp.1930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/10/2022] [Accepted: 02/27/2022] [Indexed: 12/11/2022]
Abstract
Adaptation to a constant sensory stimulus involves many sites along the path of sensory volleys towards perception. The evaluation of such phenomenon may be of clinical interest. We studied adaptation to a constant temperature stimulus in healthy subjects to set normative data, and in patients with sensory polyneuropathy (SPN), as proof of concept. Twenty-six healthy subjects and 26 patients with SPN in the context of chemotherapy treatment with oxaliplatin for colon cancer were instructed to express through an electronic VAS system (eVAS) the level of sensation felt when a thermode set at either 39º, 41º, 43º, 45º or 47º was applied to their ventral forearm. The eVAS recordings showed typically an abrupt onset that slowed to approach maximum sensation and continued with a slow decrease indicating adaptation. The time to respond (TR), the velocity of the initial response (VR), the maximum sensation (MA), the time to reach MA (MAt), the onset of adaptation (AO), and the decrease in the sensation level with respect to MA at 30 s after stimulus application (SL30), were dependent on the temperature level in all subjects. However, patients showed significantly delayed TR, slowed VR, decreased MA, delayed AO, and reduced SL30, with respect to healthy subjects. Differences were more pronounced at low temperature levels, with absent AO in 25 patients vs. 2 healthy subjects at temperatures of 39º and 41ºC. The study of adaptation to a constant temperature stimulus can furnish valuable data for the assessment of SPN patients.
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Affiliation(s)
- Michela Campolo
- EMG and Neuropathic Pain Unit, Department of Neurology. Hospital Clínic, Barcelona
| | - Lilia Correa
- Department of Neurology and Neurophysiology. Hospital del Mar, Barcelona
| | - Eva Gabarrón
- EMG and Neuropathic Pain Unit, Department of Neurology. Hospital Clínic, Barcelona
| | - Merve Albayrak
- EMG and Neuropathic Pain Unit, Department of Neurology. Hospital Clínic, Barcelona
| | | | - Juan M Castellote
- Department of Radiology, Rehabilitation and Physiotherapy, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Jordi Casanova-Molla
- EMG and Neuropathic Pain Unit, Department of Neurology. Hospital Clínic, Barcelona.,Institut d'Investigació Biomedica August Pi Sunyer, IDIBAPS. Barcelona.,Department of Medicine, School of Medicine and Health Sciences, University of Barcelona
| | - Josep Valls-Sole
- Institut d'Investigació Biomedica August Pi Sunyer, IDIBAPS. Barcelona.,Department of Medicine, School of Medicine and Health Sciences, University of Barcelona
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18
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Sean M, Coulombe-Lévêque A, Bordeleau M, Vincenot M, Gendron L, Marchand S, Léonard G. Comparison of Thermal and Electrical Modalities in the Assessment of Temporal Summation of Pain and Conditioned Pain Modulation. FRONTIERS IN PAIN RESEARCH 2021; 2:659563. [PMID: 35295416 PMCID: PMC8915752 DOI: 10.3389/fpain.2021.659563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022] Open
Abstract
Temporal summation of pain (TSP) and conditioned pain modulation (CPM) can be measured using a thermode and a cold pressor test (CPT). Unfortunately, these tools are complex, expensive, and are ill-suited for routine clinical assessments. Building on the results from an exploratory study that attempted to use transcutaneous electrical nerve stimulation (TENS) to measure CPM and TSP, the present study assesses whether a “new” TENS protocol can be used instead of the thermode and CPT to measure CPM and TSP. The objective of this study was to compare the thermode/CPT protocol with the new TENS protocol, by (1) measuring the association between the TSP evoked by the two protocols; (2) measuring the association between the CPM evoked by the two protocols; and by (3) assessing whether the two protocols successfully trigger TSP and CPM in a similar number of participants. We assessed TSP and CPM in 50 healthy participants, using our new TENS protocol and a thermode/CPT protocol (repeated measures and randomized order). In the TENS protocol, both the test stimulus (TS) and the conditioning stimulus (CS) were delivered using TENS; in the thermode/CPT protocol, the TS was delivered using a thermode and the CS consisted of a CPT. There was no association between the response evoked by the two protocols, neither for TSP nor for CPM. The number of participants showing TSP [49 with TENS and 29 with thermode (p < 0.001)] and CPM [16 with TENS and 30 with thermode (p = 0.01)] was different in both protocols. Our results suggest that response to one modality does not predict response to the other; as such, TENS cannot be used instead of a thermode/CPT protocol to assess TSP and CPM without significantly affecting the results. Moreover, while at first glance it appears that TENS is more effective than the thermode/CPT protocol to induce TSP, but less so to induce CPM, these results should be interpreted carefully. Indeed, TSP and CPM response appear to be modality-dependent as opposed to an absolute phenomenon, and the two protocols may tap into entirely different mechanisms, especially in the case of TSP.
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Affiliation(s)
- Monica Sean
- Research Centre on Aging, School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Alexia Coulombe-Lévêque
- Research Centre on Aging, School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martine Bordeleau
- Research Centre on Aging, School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Matthieu Vincenot
- Research Centre on Aging, School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Louis Gendron
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Serge Marchand
- Department of Neurosurgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Guillaume Léonard
- Research Centre on Aging, School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- *Correspondence: Guillaume Léonard
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Nim CG, Weber KA, Kawchuk GN, O'Neill S. Spinal manipulation and modulation of pain sensitivity in persistent low back pain: a secondary cluster analysis of a randomized trial. Chiropr Man Therap 2021; 29:10. [PMID: 33627163 PMCID: PMC7903787 DOI: 10.1186/s12998-021-00367-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pain hypersensitivity can be assessed using Quantitative Sensory Testing (QST) and is associated with persistent low back pain. Spinal manipulation appears to modify pain hypersensitivity, and this could function as one mechanism leading to clinical improvements. In the current study, we applied a comprehensive QST battery to assess pain sensitivity in a cohort of low back pain patients before and after spinal manipulation to improve our understanding of the association between QST and clinical improvements. This study addresses two questions: Are clinical improvements following spinal manipulation in low back pain patients contingent on pain hypersensitivity, and does pain sensitivity change following spinal manipulation? METHODS We performed a secondary analysis of data from a randomized clinical trial. One hundred and thirty-two participants with persistent LBP were treated with spinal manipulation four times over two weeks. Patient-reported outcomes and QST were assessed at baseline, after the fourth spinal manipulation session, and 14-days later. The clinical outcomes were changes in low back pain intensity and disability. Using latent profile analysis, we categorized the participants into clusters depending on their baseline QST scores. We used linear mixed models to examine the association between clusters and changes in patient-reported outcomes and QST. RESULTS Two clusters emerged: a Sensitized and a Not sensitized. The former had significantly lower regional pressure and thermal pain thresholds, remote pressure pain tolerance, and lower inhibitory conditioned pain modulation than the Not sensitized group. However, we only found between-cluster differences for regional pressure pain threshold following spinal manipulation. Thus, the clusters were not associated with patient-reported pain and disability changes or the remaining QST outcomes. CONCLUSIONS We report that the baseline QST profile was not associated with clinical improvements following spinal manipulation. We did observe a substantial change for regional pressure pain threshold, which suggests that any effect of spinal manipulation on pain sensitivity is most likely to be observed as changes in regional, mechanical pain threshold. However, the mechanism that invokes clinical improvement and pain sensitivity changes appear distinct. Due to methodological caveats, we advise caution when interpreting the results. TRIAL REGISTRATION Clinical.Trial.gov identifier: NCT04086667 , registered 11 September 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04086667.
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Affiliation(s)
- Casper Glissmann Nim
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østrehougvej 55, 5500, Middelfart, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Kenneth Arnold Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, USA
| | | | - Søren O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østrehougvej 55, 5500, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
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Mueller C, Ness TJ, Younger JW. Low-Dose Dextromethorphan for the Treatment of Fibromyalgia Pain: Results from a Longitudinal, Single-Blind, Placebo-Controlled Pilot Trial. J Pain Res 2021; 14:189-200. [PMID: 33542651 PMCID: PMC7851375 DOI: 10.2147/jpr.s285609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022] Open
Abstract
Objective Fibromyalgia (FM) is a debilitating chronic pain condition with few treatment options. Central sensitization and neuroinflammation have been forwarded as models of FM pathophysiology, both of which indicate dextromethorphan (DXM) as a potential treatment. DXM is an NMDA-receptor antagonist and microglial modulator with anti-neuroinflammatory properties at low doses. It is available for clinical use but has not been tested as a treatment for FM at low dosages. This study evaluated the effectiveness of DXM in treating FM-associated symptoms. Methods In a single-blind, placebo-controlled trial, 14 women meeting the 2010 American College of Rheumatology criteria for FM received a placebo for five weeks, followed by 20 mg DXM for ten weeks, while providing daily symptom reports on a 0–100 scale. Pain and physical activity were the primary and secondary outcomes, respectively. Daily symptom ratings during the last four weeks of placebo were contrasted with ratings during the last four weeks of the active treatment using generalized estimating equations (GEE). Results DXM was well tolerated, and treatment adherence was high. Baseline pain was reduced by at least 20% in six participants. Self-reported daily pain and physical activity in the entire cohort were not significantly different between the placebo and DXM conditions, and the primary hypotheses were not supported. Exploratory analyses using the entire placebo and DXM data showed that pain was significantly lower in the DXM condition than in the placebo condition (b=−9.933, p=0.013). Discussion A strong clinical effect of DXM was not observed at the 20mg/day dosage.
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Affiliation(s)
- Christina Mueller
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy J Ness
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jarred W Younger
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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21
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de la Coba P, Bruehl S, Del Paso GAR. Addition of Slowly Repeated Evoked Pain Responses to Clinical Symptoms Enhances Fibromyalgia Diagnostic Accuracy. PAIN MEDICINE 2020; 21:3479-3487. [PMID: 32022855 DOI: 10.1093/pm/pnz346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Fibromyalgia is a chronic pain syndrome characterized by central sensitization. A novel protocol based on slowly repeated evoked pain (SREP) appears to be a useful marker of pain sensitization in fibromyalgia patients. Whether SREP enhances diagnostic accuracy beyond key clinical symptoms that characterize fibromyalgia has not been examined. METHODS Fifty fibromyalgia patients, 30 rheumatoid arthritis patients, and 50 healthy individuals were evaluated to assess clinical pain, as well as fatigue, insomnia, pain catastrophizing, and negative mood. The SREP protocol consisted of a series of nine low-intensity painful pressure stimuli of five seconds' duration with 30-second interstimulus intervals. SREP sensitization was indexed by increases in pain intensity ratings across stimuli. RESULTS SREP sensitization was observed in fibromyalgia but not in rheumatoid arthritis or healthy individuals. As expected, fibromyalgia patients exhibited a more negative psychosocial profile than did rheumatoid arthritis patients and healthy individuals. SREP was positively associated with clinical pain, fatigue, insomnia, and catastrophizing, but not with negative mood. SREP discriminated fibromyalgia cases from rheumatoid arthritis and healthy individuals even when current clinical pain was included in the analysis. Combining fatigue, insomnia, and SREP led to near perfect diagnostic accuracy (99%) in differentiating fibromyalgia from healthy individuals and 86.3% accuracy in discriminating fibromyalgia from rheumatoid arthritis. CONCLUSIONS These results provide further evidence of SREP as a marker of pain sensitization in fibromyalgia and suggest that it captures aspects of fibromyalgia not fully captured by clinical features. Combining SREP with assessment of clinical features could potentially improve fibromyalgia diagnosis.
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Affiliation(s)
- Pablo de la Coba
- Department of Psychology, University of Jaén, Jaén, Spain; †Institute of Biomedical Research of Lleida, Lleida, Spain
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gustavo A Reyes Del Paso
- Department of Psychology, University of Jaén, Jaén, Spain; †Institute of Biomedical Research of Lleida, Lleida, Spain
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Vase L. Can insights from placebo and nocebo mechanisms studies improve the randomized controlled trial? Scand J Pain 2020; 20:451-467. [PMID: 32609651 DOI: 10.1515/sjpain-2019-0183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Indexed: 11/15/2022]
Abstract
Background and aims The randomized controlled trial (RCT) is currently facing several challenges, one of these being that the placebo response appears to be increasing in RCTs, thereby making it difficult to demonstrate an effect of potentially new treatments over placebo. This problem has primarily been approached by predicting the magnitude of the placebo response via stable factors, such as demographic variables, and/or by developing complex designs aimed at reducing the placebo response in the hope that it will improve the test of the active treatment. Yet, the success of this approach has so far been limited. Methods A new approach toward improving the RCT is put forward based on placebo and nocebo mechanism studies, i.e. studies that investigate the mechanisms underlying placebo analgesia and nocebo hyperalgesia. In a series of meta-analyses the magnitude of placebo and nocebo effects were determined. Experimental studies across nociplastic and neuropathic pain conditions and across pharmacological and acupuncture treatments investigated psychological and neurobiological mechanisms underlying these effects. The obtained results were used to make approximations of expectations to see if that could predict the placebo response in RCTs and function as a new way of tapping into the placebo component of treatment effects. Results The magnitude of placebo and nocebo effects is large and highly variable. Placebo effects exist across chronic pain conditions with varying degrees of known etiology as well as across pharmacological and non-pharmacological treatments. Patients' perception of the treatment, the verbal suggestions given for pain relief, and the patients' expectations toward pain relief contribute to the magnitude of the placebo effect and to pain relief following placebo interventions. Also, unintentional unblinding and patients' perception of a treatment markedly influence the treatment outcome. By making approximations of expectations toward treatment effects it was possible to predict the magnitude of the placebo response in RCTs. Conclusions and implications The new approach of tapping into or directly asking patients about their perception and expectations toward a treatment, along with the account of the natural history of pain, has the potential to improve the information that can be obtained from RCTs. Thus, by interfacing insights from placebo and nocebo mechanism studies, it may be possible to enhance the information that can be obtained from RCTs and to account for a large part of the variability in the placebo component of the overall treatment effect. This approach has the potential to improve the scientific evaluation of treatments, as well as to illustrate how the effect of treatments can be optimized in clinical practice, which is the crux of evidence-based medicine.
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Affiliation(s)
- Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 11, Building 1350, DK-8000 Aarhus C, Denmark
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23
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Tsur N, Defrin R, Shahar G, Solomon Z. Dysfunctional pain perception and modulation among torture survivors: The role of pain personification. J Affect Disord 2020; 265:10-17. [PMID: 31957687 DOI: 10.1016/j.jad.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/05/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Individuals exposed to trauma, especially those who develop posttraumatic stress disorder (PTSD), are at a higher risk of suffering from chronic pain as well as altered pain perception and modulation. However, the underlying mechanisms of these processes are yet to be established. Recent findings have indicated that trauma survivors tend to personify chronic pain that is developed after the exposure, in a way that resonates with the traumatic experience. The aim of this study was to test whether pain personification plays a significant role in explaining the long-term links between trauma, PTSD and pain. METHODS This study is part of a large-scale longitudinal study on ex-prisoners of war (ex-POWs) from the 1973 Yom-Kippur war, who were followed over 35 years after the war. Fifty-nine ex-POWs who were exposed to torture and 44 matched combatants were assessed for PTSD at 18, 30, and 35 post-war. Quantitative somatosensory testing of heat-pain threshold, pain tolerance, conditioned pain modulation (CPM), and temporal summation of pain (TSP), as well as torturing personification, were assessed at 35 years after the war. RESULTS Sequential mediation analyses revealed that the associations between torture and heat pain threshold, as well as pain tolerance were mediated by PTSD at several time-points (-1.43<indirect effect < 1.47). Torturing personification significantly mediated the associations between torture, PTSD, CPM and TSP (-0.16 < indirect effect). CONCLUSIONS These findings point to the effect of trauma on the subjective orientation towards bodily signals as a key factor in dysfunctional pain modulation.
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Affiliation(s)
- Noga Tsur
- The Bob Shapell School of Social Work, Tel Aviv University, Israel.
| | - Ruth Defrin
- Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Golan Shahar
- Stress, Self & Health (STREALTH) Lab, Department of Psychology, Ben-Gurion University of the Negev, Israel
| | - Zahava Solomon
- The Bob Shapell School of Social Work, Tel Aviv University, Israel; I-CORE Research Center for Mass Trauma, Tel Aviv University, Israel
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Osborne NR, Anastakis DJ, Davis KD. Peripheral nerve injuries, pain, and neuroplasticity. J Hand Ther 2019; 31:184-194. [PMID: 29706196 DOI: 10.1016/j.jht.2018.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Peripheral nerve injuries (PNIs) cause both structural and functional brain changes that may be associated with significant sensorimotor abnormalities and pain. PURPOSE OF THE STUDY The aim of this narrative review is to provide hand therapists an overview of PNI-induced neuroplasticity and to explain how the brain changes following PNI, repair, and during rehabilitation. METHODS Toward this goal, we review key aspects of neuroplasticity and neuroimaging and discuss sensory testing techniques used to study neuroplasticity in PNI patients. RESULTS We describe the specific brain changes that occur during the repair and recovery process of both traumatic (eg, transection) and nontraumatic (eg, compression) nerve injuries. We also explain how these changes contribute to common symptoms including hypoesthesia, hyperalgesia, cold sensitivity, and chronic neurogenic pain. In addition, we describe how maladaptive neuroplasticity as well as psychological and personality characteristics impacts treatment outcome. DISCUSSION AND CONCLUSION Greater understanding of the brain's contribution to symptoms in recovering PNI patients could help guide rehabilitation strategies and inform the development of novel techniques to counteract these maladaptive brain changes and ultimately improve outcomes.
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Affiliation(s)
- Natalie R Osborne
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Dimitri J Anastakis
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen D Davis
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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25
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Moore DJ, Meints SM, Lazaridou A, Johnson D, Franceschelli O, Cornelius M, Schreiber K, Edwards RR. The Effect of Induced and Chronic Pain on Attention. THE JOURNAL OF PAIN 2019; 20:1353-1361. [DOI: 10.1016/j.jpain.2019.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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Castelo-Branco L, Uygur Kucukseymen E, Duarte D, El-Hagrassy MM, Bonin Pinto C, Gunduz ME, Cardenas-Rojas A, Pacheco-Barrios K, Yang Y, Gonzalez-Mego P, Estudillo-Guerra A, Candido-Santos L, Mesia-Toledo I, Rafferty H, Caumo W, Fregni F. Optimised transcranial direct current stimulation (tDCS) for fibromyalgia-targeting the endogenous pain control system: a randomised, double-blind, factorial clinical trial protocol. BMJ Open 2019; 9:e032710. [PMID: 31672712 PMCID: PMC6830717 DOI: 10.1136/bmjopen-2019-032710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Fibromyalgia (FM) is a common debilitating condition with limited therapeutic options. Medications have low efficacy and are often associated with adverse effects. Given that FM is associated with a defective endogenous pain control system and central sensitisation, combining interventions such as transcranial direct current stimulation (tDCS) and aerobic exercise (AE) to modulate pain-processing circuits may enhance pain control. METHODS AND ANALYSIS A prospective, randomised (1:1:1:1), placebo-controlled, double-blind, factorial clinical trial will test the hypothesis that optimised tDCS (16 anodal tDCS sessions combined with AE) can restore of the pain endogenous control system. Participants with FM (n=148) will undergo a conditioning exercise period and be randomly allocated to one of four groups: (1) active tDCS and AE, (2) sham tDCS and AE, (3) active tDCS and non-aerobic exercise (nAE) or (4) sham tDCS and nAE. Pain inhibitory activity will be assessed using conditioned pain modulation (CPM) and temporal slow pain summation (TSPS)-primary outcomes. Secondary outcomes will include the following assessments: Transcranial magnetic stimulation and electroencephalography as cortical markers of pain inhibitory control and thalamocortical circuits; secondary clinical outcomes on pain, FM, quality of life, sleep and depression. Finally, the relationship between the two main mechanistic targets in this study-CPM and TSPS-and changes in secondary clinical outcomes will be tested. The change in the primary efficacy endpoint, CPM and TSPS, from baseline to week 4 of stimulation will be tested with a mixed linear model and adjusted for important demographic variables. ETHICS AND DISSEMINATION This study obeys the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of Partners Healthcare under the protocol number 2017P002524. Informed consent will be obtained from participants. Study findings will be reported in conferences and peer-reviewed journal publications. TRIAL REGISTRATION NUMBER NCT03371225.
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Affiliation(s)
- Luis Castelo-Branco
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Uygur Kucukseymen
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dante Duarte
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mirret M El-Hagrassy
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Camila Bonin Pinto
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammed Enes Gunduz
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yiling Yang
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paola Gonzalez-Mego
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anayali Estudillo-Guerra
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ludmilla Candido-Santos
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ines Mesia-Toledo
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Haley Rafferty
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wolnei Caumo
- Laboratory of Pain & Neuromodulation, Hospital de Clinicas de Porto Alegre da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Fregni
- Neuromodulation Center/Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Staud R, Godfrey MM, Mejia M, Ramanlal R, Riley JL, Robinson ME. Usefulness of Ramp & Hold Procedures for Testing of Pain Facilitation in Human Participants: Comparisons With Temporal Summation of Second Pain. THE JOURNAL OF PAIN 2019; 21:390-398. [PMID: 31425887 DOI: 10.1016/j.jpain.2019.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022]
Abstract
Quantitative sensory testing (QST) is used to systematically interrogate normal responding and alterations of nervous system function, including pain-related central sensitization (CS). However, up to now, QST of CS in human subjects has been mostly focused on temporal summation of second pain (TSSP), has been difficult to perform, and has been associated with low reliability. In contrast, slow ramp & hold (RH) procedures are simpler tests of temporal summation and easier to perform. We examined the usefulness of RH procedures as reliable generators of CS using 2 validated QST procedures: decay of pain aftersensations and wind-down. Twenty-seven pain-free subjects (74% female) were enrolled into the study. Trains of sensitivity-adjusted TSSP or RH heat stimuli were applied to the hands of participants to achieve moderate temporal pain summation (50 Numerical Rating Scale [NRS] [0-100]). Fifteen-second aftersensations and 30-second wind-down related to TSSP or RH were used for CS comparisons. Reliability of all test procedures was tested over 24 hours. Use of sensitivity-adjusted TSSP and RH heat stimuli resulted in average pain ratings of 48.2 and 49.6 NRS, respectively. Aftersensations or wind-down decay were not significantly different after either TSSP or RH, (all P > .05), indicating that each procedure achieved similar levels of short-term CS. Sensitivity-adjusted RH stimuli were well tolerated and resulted in reliable pain increases of ∼50 NRS. The magnitude of short-term CS, determined by aftersensations and wind-down was similar after sensitivity-adjusted TSSP and RH stimuli (P > .05), suggesting that pain facilitation of healthy participants and likely chronic pain patients can not only be tested with TSSP but also with RH procedures. PERSPECTIVE: This article examines the ability of RH procedures to generate similar central sensitivity augmentation than TSSP. The results suggest that RH is similarly well suited as TSSP to explore central pain mechanisms in healthy subjects and most likely also in chronic pain patients.
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Affiliation(s)
- Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida.
| | | | - Marlin Mejia
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Riddhi Ramanlal
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Joseph L Riley
- Department of Dentistry, University of Florida, Gainesville, Florida
| | - Michael E Robinson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
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Effects of manipulating the interstimulus interval on heat-evoked temporal summation of second pain across the age span. Pain 2019; 160:95-101. [PMID: 30169423 DOI: 10.1097/j.pain.0000000000001382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the effects of interstimulus interval (ISI) on heat-evoked temporal summation of second pain (TSSP) and tested whether greatest maintenance of TSSP would occur at longer ISIs in older adults. Several lines of evidence support that TSSP is associated with central sensitization and is centrally mediated. The participants were 198 community-dwelling adults divided into 3 age cohorts (18-39, 40-59, and 60-78 years of age). Six TSSP trials used a train of 10 contacts with a preheated probe that made repetitive contact with the volar forearm. Participants completed 2 trials at each ISI of 2.5, 3.5, and 4.5 seconds. The intraclass correlations for each pair of trials support the reliability of the current methodology. Temporal summation of second pain scores declined in a time-dependent manner across ISI. In addition, greater maintenance of TSSP at longer ISIs was observed in middle-aged and older age groups compared with the younger cohort. Significant associations were found between TSSP and measures of recent pain. Greater summation at longer ISIs in older adults would suggest slower decay of excitability in spinal neurons and infer increased risk for central sensitization with advancing age.
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OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity. Toxins (Basel) 2019; 11:toxins11060359. [PMID: 31226803 PMCID: PMC6628414 DOI: 10.3390/toxins11060359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/20/2019] [Accepted: 06/18/2019] [Indexed: 11/17/2022] Open
Abstract
Spasticity is a muscle tone disorder associated with different neurological conditions. Spasticity could be associated with pain, high disability, poor functional recovery, and reduced quality of life. Botulinum neurotoxin type A (BoNT-A) is considered a first-line treatment for spasticity and, more recently, it also represents a therapeutic option for various chronic pain conditions. In this open label study, we aim to evaluate the effect of the BoNT-A on the spinal nociception in patients affected by spasticity of the lower limbs with associated pain with predominantly neuropathic features. Ten patients with stroke, 10 with multiple sclerosis and 5 with spinal cord injury were enrolled in the study. They were tested with clinical scales (neuropathic pain scale inventory (NPSI), numerical rating scale (NRS), modified Ashworth scale (MAS) and with the nociceptive withdrawal reflex at lower limbs to explore the spinal temporal summation threshold at baseline and 30 day after BoNT-A injection. OnabotulinumtoxinA (50 to 200 units per site) was injected in the lower limb muscles according to the distribution of spasticity. No significant differences were found at baseline for neurophysiological features across groups. After the BoNT-A injection, we recorded a significant reduction in MAS and NRS scores. Regarding the neurophysiological parameters, we described a significant increase in the temporal summation threshold after the BoNT-A injection. Our data supports the hypothesis that peripherally injected OnabotulinumtoxinA modulates the excitability of spinal cord nociceptive pathways. This activity may take place irrespective of the effect of the drug on spasticity.
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Slowly Repeated Evoked Pain as a Marker of Central Sensitization in Fibromyalgia: Diagnostic Accuracy and Reliability in Comparison With Temporal Summation of Pain. Psychosom Med 2019; 80:573-580. [PMID: 29742751 DOI: 10.1097/psy.0000000000000599] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study examined the diagnostic accuracy and test-retest reliability of a novel dynamic evoked pain protocol (slowly repeated evoked pain [SREP]) compared with temporal summation of pain (TSP), a standard index of central sensitization. METHODS Thirty-five fibromyalgia (FM) patients and 30 rheumatoid arthritis (RA) patients completed, in pseudorandomized order, a standard mechanical TSP protocol (10 stimuli of 1-second duration at the thenar eminence using a 300-g monofilament with 1 second interstimulus interval) and the SREP protocol (9 suprathreshold pressure stimuli of 5-second duration applied to the fingernail with a 30-second interstimulus interval). To evaluate reliability for both protocols, they were repeated in a second session 4-7 days later. RESULTS Evidence for significant pain sensitization over trials (increasing pain intensity ratings) was observed for SREP in FM (p < .001) but not in RA (p = .35), whereas significant sensitization was observed in both diagnostic groups for the TSP protocol (p < .008). Compared with TSP, SREP demonstrated higher overall diagnostic accuracy (87.7% versus 64.6%), greater sensitivity (0.89 versus 0.57), and greater specificity (0.87 versus 0.73) in discriminating between FM and RA patients. Test-retest reliability of SREP sensitization was good in FM (intraclass correlations = 0.80), and moderate in RA (intraclass correlations = 0.68). CONCLUSIONS SREP seems to be a dynamic evoked pain index tapping into pain sensitization that allows for greater diagnostic accuracy in identifying FM patients compared with a standard TSP protocol. Further research is needed to study mechanisms underlying SREP and the potential utility of adding SREP to standard pain evaluation protocols.
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Jutzeler CR, Sirucek L, Scheuren PS, Bobo T, Anenberg E, Ortiz O, Rosner J, Hubli M, Kramer JLK. New life for an old idea: Assessing tonic heat pain by means of participant controlled temperature. J Neurosci Methods 2019; 321:20-27. [PMID: 30959080 DOI: 10.1016/j.jneumeth.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/20/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Temporal changes of pain perception to prolonged tonic heat pain are conventionally assessed using a computerized visual analog scale. Such a rating-based approach is, however, prone to floor and ceiling effects, which limit the assessment of temporal changes in perception. Thus, alternative methods that overcome these shortcomings are warranted. NEW METHOD The aim of this study was to assess the feasibility and reliability of a psychophysical approach, i.e., participant-controlled temperature (PCT), to evaluate ongoing human perception of tonic heat pain. Fifty participants were presented with a 45 °C stimulus on the non-dominant hand, and were instructed to maintain their initial sensation for two minutes via a feedback controller in the dominant hand. A subset of participants (n = 17) performed PCT tonic heat protocols on two different days to determine the test-retest reliability. As participants controlled temperature to maintain a stable pain perception, any adjustments made reflected shifts in their perception of heat. RESULTS In 33 (71.7%) participants, we observed an initial adaptation (participant increased temperature) followed by temporal summation of pain (participant decreased temperature). Twelve participants (26.1%) showed only adaptation and one (2.2%) only temporal summation. No sex differences were observed, nor did the initial rating of pain have an effect on PCT outcomes. Temporal summation of pain showed moderate to substantial reliability upon retest. CONCLUSIONS PCT represents can be reliably performed using a contact heat stimulator to measure the temporal summation of pain. The standardized setup and overall good reliability of the outcome measures facilitate a sound implementation into the clinical work-up of patients with pain conditions.
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Affiliation(s)
- Catherine R Jutzeler
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland; ICORD, University of British Columbia, Vancouver, British Columbia, Canada; School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Laura Sirucek
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
| | - Paulina S Scheuren
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Tong Bobo
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Eitan Anenberg
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Oscar Ortiz
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jan Rosner
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
| | - Michèle Hubli
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
| | - John L K Kramer
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada; School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wickens R, Wideman TH. Evaluating the novel added value of neurophysiological pain sensitivity within the fear-avoidance model of pain. Eur J Pain 2019; 23:957-972. [PMID: 30648781 DOI: 10.1002/ejp.1364] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/09/2018] [Accepted: 01/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The fear-avoidance model (FAM) is a leading theoretical paradigm for explaining persistent pain following musculoskeletal injury. The model suggests that as injuries heal, pain-related outcomes are increasingly determined by psychological, rather than physiological factors. Increasing literature, however, suggests that neurophysiological processes related to pain sensitivity also play an important role in chronicity. To date, there has been limited research that has specifically explored the role of pain sensitivity within the FAM. This study addresses this gap by evaluating whether clinical measures of pain sensitivity help explain FAM-related outcomes, beyond model-relevant psychological predictors. METHODS The study sample consisted of 80 adults with chronic and widespread musculoskeletal pain. Participants completed a single testing session that included measures of all of the major constructs of the FAM, including pain catastrophizing, pain-related fear, activity avoidance (self-report and functional measures), pain-related disability, depression and pain severity, as well as a battery of quantitative sensory testing that included measures of pressure pain threshold and temporal summation of mechanical pain across eight body sites. RESULTS A series of hierarchical regression analyses revealed that after controlling for the psychological predictors of the FAM, indices of pain sensitivity significantly predicted 4 of the 5 FAM-related outcomes (p < 0.05). Depression was the only outcome not significantly predicted by pain sensitivity. Interestingly, measures of pain sensitivity, but not FAM psychological factors, predicted the functional measure of activity avoidance. CONCLUSIONS These findings provide further evidence for the importance of neurophysiological factors within the FAM and have important clinical and theoretical implications. SIGNIFICANCE This study provides evidence for the unique and added value of neurophysiological factors within the Fear Avoidance Model of pain and for the importance of integrating both sensory and psychological factors within both theoretical paradigms and clinical management strategies.
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Affiliation(s)
- Zakir Uddin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Daniel Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Andrea Aternali
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Rebekah Wickens
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Carriere JS, Martel MO, Meints SM, Cornelius MC, Edwards RR. What do you expect? Catastrophizing mediates associations between expectancies and pain-facilitatory processes. Eur J Pain 2019; 23:800-811. [PMID: 30506913 DOI: 10.1002/ejp.1348] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pain expectancies are associated with altered pain sensitivity in individuals with chronic pain. However, little is known about the processes by which pain expectancies impact pain processing. This study assessed the association between pain expectancies and temporal summation (TS) of pain, and examined whether pain catastrophizing mediated this association. METHODS In this cross-sectional study, participants (437 chronic low back pain [CLBP] patients, 115 controls) completed self-report measures of pain intensity, pain expectancies and pain catastrophizing before undergoing psychophysical pain-testing procedures designed to assess mechanical TS of mechanical pain. Pearson's correlations examined the associations between study variables in CLBP patients and controls. Bootstrapping mediation analyses assessed the mediating role of pain catastrophizing on the association between pain expectancies and TS of pain. RESULTS Temporal summation of pain was significantly associated with pain expectancies (r = 0.113) and pain catastrophizing (r = 0.171) in CLBP patients. Results of mediation analyses revealed that pain catastrophizing mediated the relationship between pain expectancies and TS of pain in CLBP patients (ab = 0.309, 95% CI = 0.1222-0.5604), but not in healthy controls (ab = -0.125, 95% CI = -0.5864 to 0.0244). CONCLUSIONS The findings from this study suggest that compared to controls, CLBP patients show increased sensitivity to mechanical pain procedures and enhanced pain-facilitatory processing, proving further evidence for changes in central nervous system pain processing in CLBP patients. Our results also suggest that pain catastrophizing may be the mechanism by which pain expectancies are associated with TS of pain in CLBP patients. SIGNIFICANCE Individuals with chronic low back pain who expect higher levels of pain and catastrophize about their pain are more likely to experience altered pain sensitivity. Our results point to catastrophizing as a mechanism of action through which psychological factors may operate and lead to the development and maintenance of chronic low back pain.
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Affiliation(s)
- Junie S Carriere
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Marc Olivier Martel
- Faculties of Dentistry and Medicine, McGill University, Montreal, Quebec, Canada
| | - Samantha M Meints
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Marise C Cornelius
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
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Gunendi Z, Polat M, Vuralli D, Cengiz B. Somatosensory temporal discrimination is impaired in fibromyalgia. J Clin Neurosci 2018; 60:44-48. [PMID: 30528354 DOI: 10.1016/j.jocn.2018.10.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Fibromyalgia is the prototypical central sensitivity syndrome which is associated with increased sensitivity to pain and other stimuli. In this study, we aimed to evaluate whether somatosensory temporal discrimination ability, which provides information about central processing of sensory stimuli, was impaired in patients with fibromyalgia. METHODS Fifteen patients with fibromyalgia and 15 healthy subjects participated in the study. Demographic characteristics of participants and severity for fatigue, sleep quality, cognitive symptoms, somatic symptoms and health-related quality of life in fibromyalgia patients were recorded. Somatosensory temporal discrimination thresholds were measured from the dorsum of the dominant hands of the participants by using a constant current stimulator (Medtronic, Keypoint). RESULTS Patients with fibromyalgia had higher somatosensory temporal discrimination thresholds than healthy subjects (p < 0.001). There were significant correlations between STDTs and pain intensity, FIQ scores and symptom severity scale scores in fibromyalgia group (p = 0.006, r = 0.68; p = 0.037, r = 0.54; p = 0.017, r = 0.61 respectively). CONCLUSION Somatosensory temporal discrimination ability is impaired in fibromyalgia patients compared to healthy subjects. Disrupted somatosensory temporal discrimination ability correlates with increased widespread pain and severity of other symptoms including fatigue, sleep quality, cognitive symptoms, somatic symptoms and decreased functional status. The impaired somatosensory temporal discrimination ability indicates an alteration in higher cognitive sensory processing in fibromyalgia patients.
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Affiliation(s)
- Zafer Gunendi
- Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Besevler, 06510 Ankara, Turkey
| | - Musa Polat
- Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Besevler, 06510 Ankara, Turkey
| | - Doga Vuralli
- Gazi University, Faculty of Medicine, Department of Neurology and Algology, Besevler, 06510 Ankara, Turkey.
| | - Bulent Cengiz
- Gazi University, Faculty of Medicine, Department of Neurology, Motor Control Laboratory, Besevler, 06510 Ankara, Turkey
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Interactive effects of conditioned pain modulation and temporal summation of pain—the role of stimulus modality. Pain 2018; 159:2641-2648. [DOI: 10.1097/j.pain.0000000000001376] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Owens MA, Parker R, Rainey RL, Gonzalez CE, White DM, Ata AE, Okunbor JI, Heath SL, Merlin JS, Goodin BR. Enhanced facilitation and diminished inhibition characterizes the pronociceptive endogenous pain modulatory balance of persons living with HIV and chronic pain. J Neurovirol 2018; 25:57-71. [PMID: 30414048 DOI: 10.1007/s13365-018-0686-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/24/2018] [Accepted: 10/10/2018] [Indexed: 12/22/2022]
Abstract
Chronic pain in persons living with HIV (PLWH) may be related to alterations in endogenous pain modulatory processes (e.g., high facilitation and low inhibition of nociception) that promote exaggerated pain responses, known as hyperalgesia, and central nervous system (CNS) sensitization. This observational study examined differences in endogenous pain modulatory processes between 59 PLWH with chronic pain, 51 PLWH without chronic pain, and 50 controls without HIV or chronic pain. Quantitative sensory testing for temporal summation (TS) of mechanical and heat pain as well as conditioned pain modulation (CPM) were used to assess endogenous pain facilitatory and inhibitory processes, respectively. Associations among TS, CPM, and self-reported clinical pain severity were also examined in PLWH with chronic pain. Findings demonstrated significantly greater TS of mechanical and heat pain for PLWH with chronic pain compared to PLWH without chronic pain and controls. CPM effects were present in controls, but not in either PLWH with or without chronic pain. Among PLWH with chronic pain, greater TS of mechanical pain was significantly associated with greater average clinical pain severity. Results of this study suggest that enhanced facilitation and diminished inhibition characterizes the pronociceptive endogenous pain modulatory balance of persons living with HIV and chronic pain.
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Affiliation(s)
- Michael A Owens
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237, Birmingham, AL, 35294, USA
| | - Romy Parker
- Department of Anesthesia & Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Rachael L Rainey
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237, Birmingham, AL, 35294, USA
| | - Cesar E Gonzalez
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237, Birmingham, AL, 35294, USA
| | - Dyan M White
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237, Birmingham, AL, 35294, USA
| | - Anooshah E Ata
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237, Birmingham, AL, 35294, USA
| | - Jennifer I Okunbor
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237, Birmingham, AL, 35294, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica S Merlin
- Divisions of General Internal Medicine and Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall, Room 237, Birmingham, AL, 35294, USA. .,Department of Anesthesiology & Perioperative Medicine, Division of Pain Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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37
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Blood pressure-related pain modulation in fibromyalgia: Differentiating between static versus dynamic pain indicators. Int J Psychophysiol 2018; 134:79-85. [PMID: 30321563 DOI: 10.1016/j.ijpsycho.2018.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/28/2018] [Accepted: 10/10/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Resting blood pressure (BP) has been found to be inversely associated with evoked pain responsiveness in healthy populations. However, some reports suggest that BP-related pain modulation may be dysfunctional in chronic pain patients. This study examined whether BP-related pain modulation, indexed by both static and dynamic evoked pain responses, is altered in fibromyalgia (FM) patients compared to pain-free individuals. METHOD Pain threshold and tolerance as static evoked pain measures and slowly repeated evoked pain (SREP) as a dynamic evoked pain index were measured in 30 FM patients and 27 healthy controls. BP was continuously recorded throughout a 5 minute pre-pain rest period. RESULTS SREP sensitization was observed only in the FM group. Higher BP predicted elevated pain threshold and tolerance in healthy individuals, but not in FM. Conversely, BP was inversely associated with SREP sensitization in FM whereas no association was found in healthy controls. CONCLUSIONS Static evoked pain measures suggested BP-related pain inhibitory dysfunction in FM. In contrast, for pain sensitization as indexed by SREP, FM displayed the expected BP-related inhibitory effects. BP-related pain modulation is manifested in FM differentially for static versus dynamic pain indicators. Use of both types of evoked pain measures may be valuable in the study of mechanisms underlying altered pain modulatory systems in FM.
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38
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Palsson TS, Boudreau SA, Krebs HJ, Graven-Nielsen T. Experimental Referred Pain Extends Toward Previously Injured Location: An Explorative Study. THE JOURNAL OF PAIN 2018; 19:1189-1200. [DOI: 10.1016/j.jpain.2018.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 12/22/2022]
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Tschugg A, Lener S, Hartmann S, Fink V, Neururer S, Wildauer M, Löscher WN, Thome C. Extraforaminal Lumbar Disk Herniations Lead To Neuroplastic Changes: a Study Using Quantitative Sensory Testing. Muscle Nerve 2018; 58:676-680. [DOI: 10.1002/mus.26184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Anja Tschugg
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sara Lener
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sebastian Hartmann
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Valentin Fink
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sabrina Neururer
- Department of Medical Statistics and Health Economics; Innsbruck Medical University; Innsbruck Austria
| | - Matthias Wildauer
- Department of Neuroradiology; Innsbruck Medical University; Innsbruck Austria
| | | | - Claudius Thome
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
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40
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O'Brien AT, Deitos A, Triñanes Pego Y, Fregni F, Carrillo-de-la-Peña MT. Defective Endogenous Pain Modulation in Fibromyalgia: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms. THE JOURNAL OF PAIN 2018; 19:819-836. [DOI: 10.1016/j.jpain.2018.01.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/22/2022]
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41
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Hoegh M, Petersen K, Graven-Nielsen T. Effects of repeated conditioning pain modulation in healthy volunteers. Eur J Pain 2018; 22:1833-1843. [DOI: 10.1002/ejp.1279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2018] [Indexed: 01/07/2023]
Affiliation(s)
- M. Hoegh
- Center for Neuroplasticity and Pain (CNAP), SMI; Aalborg University; Denmark
| | - K.K. Petersen
- Center for Neuroplasticity and Pain (CNAP), SMI; Aalborg University; Denmark
| | - T. Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI; Aalborg University; Denmark
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Megía García Á, Serrano-Muñoz D, Bravo-Esteban E, Ando Lafuente S, Avendaño-Coy J, Gómez-Soriano J. [Analgesic effects of transcutaneous electrical nerve stimulation (TENS) in patients with fibromyalgia: A systematic review]. Aten Primaria 2018; 51:406-415. [PMID: 30029964 PMCID: PMC6837091 DOI: 10.1016/j.aprim.2018.03.010] [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: 10/02/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To determine whether transcutaneous electrical nerve stimulation (TENS) has an analgesic effect greater than placebo or other treatments in patients with fibromyalgia. Furthermore, it was intended to analyze the optimal application parameters to achieve a greater reduction of pain. DESIGN A systematic review. DATA SOURCE Randomized clinical trials on the effect of TENS on fibromyalgia in the databases Pubmed, Cochrane and PEDro until November 2016. SELECTION OF STUDIES 8 studies out of a total of 62 were selected. Controlled clinical trials in which TENS was applied in patients with fibromyalgia were included. DATA EXTRACTION Pain was analyzed as the main variable, although other variables such as fatigue, quality of life and impact, range of motion and depression were also included. RESULTS 6 out of 8 studies obtained a significant decrease of pain. In 2 studies, TENS was applied as complementary treatment to therapeutic exercise with results evidencing a decrease in pain. The rest of the variables studied presented a great variability and conclusive results could not be established. CONCLUSIONS Treatment with TENS is effective for reducing pain in people with fibromyalgia. In addition, the inclusion of TENS in therapeutic exercise programs seems to have a greater effect than practicing therapeutic exercise in isolation. However, no efficacy has been demonstrated in other variables different to pain. Further studies are needed to investigate the optimization of the parameters of the TENS and a greater consensus among the variables used.
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Affiliation(s)
- Álvaro Megía García
- PainClinic C.B. Fisioterapia y Podología Toledo, España; Grupo de Investigación en Fisioterapia Toledo (GIFTO). EUE. Fisioterapia de Toledo, Universidad de Castilla la Mancha, Toledo, España
| | - Diego Serrano-Muñoz
- Grupo de Investigación en Fisioterapia Toledo (GIFTO). EUE. Fisioterapia de Toledo, Universidad de Castilla la Mancha, Toledo, España; Grupo de Función Sensitivomotora, Hospital Nacional de Parapléjicos de Toledo, Toledo, España.
| | - Elisabeth Bravo-Esteban
- Grupo de Investigación en Fisioterapia Toledo (GIFTO). EUE. Fisioterapia de Toledo, Universidad de Castilla la Mancha, Toledo, España
| | - Sara Ando Lafuente
- Grupo de Investigación en Fisioterapia Toledo (GIFTO). EUE. Fisioterapia de Toledo, Universidad de Castilla la Mancha, Toledo, España
| | - Juan Avendaño-Coy
- Grupo de Investigación en Fisioterapia Toledo (GIFTO). EUE. Fisioterapia de Toledo, Universidad de Castilla la Mancha, Toledo, España
| | - Julio Gómez-Soriano
- Grupo de Investigación en Fisioterapia Toledo (GIFTO). EUE. Fisioterapia de Toledo, Universidad de Castilla la Mancha, Toledo, España; Grupo de Función Sensitivomotora, Hospital Nacional de Parapléjicos de Toledo, Toledo, España
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Brill S, Sprecher E, Smith FJD, Geva N, Gruener H, Nahman-Averbuch H, Defrin R. Chronic pain in pachyonychia congenita: evidence for neuropathic origin. Br J Dermatol 2018; 179:154-162. [PMID: 29210461 DOI: 10.1111/bjd.16217] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pachyonychia congenita (PC) is a rare autosomal dominant skin disease, with chronic pain being the most prominent complaint. Histological studies showing alterations in sensory innervation, along with reports on alterations in mechanical sensitivity, suggest that PC may be a form of neuropathy. OBJECTIVES Here, for the first time, we aim to evaluate systematically the sensory function of patients with PC vs. controls, in order to investigate the pathophysiology of PC. METHODS Patients (n = 62) and controls (n = 45) completed the McGill and Douleur Neuropathique-4 (DN4) questionnaires. Sensory testing included detection and pain thresholds, pathological sensations, conditioned pain modulation (CPM) and temporal summation of pain. RESULTS A moderate-to-severe chronic pain in the feet, throbbing and stabbing in quality, was highly prevalent among patients with PC (86%) and was especially debilitating during weight bearing. In addition, the majority of patients had a DN4 score ≥ 4 (62%), static allodynia (55%) and tingling (53%) in the feet. Compared with controls, patients with PC exhibited thermal and mechanical hypoaesthesia and mechanical hyperalgesia in the feet. CPM was reduced among the patients, and was associated with more enhanced mechanical hyperalgesia in the feet. The specific gene and nature of the causative mutation did not affect any of these features. CONCLUSIONS Although thermal and mechanical hypoaesthesia may result from thicker skin, its presentation in painful regions, along with mechanical hyperalgesia and allodynia, point towards the possibility of neuropathic changes occurring in PC. The clinical features and DN4 scores support this possibility and therefore neuropathic pain medications may be beneficial for patients with PC.
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Affiliation(s)
- S Brill
- Center for Pain Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - E Sprecher
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Department of Dermatology, Tel-Aviv University, Tel-Aviv, 69978, Israel
| | - F J D Smith
- Pachyonychia Congenita Project, School of Life Sciences, University of Dundee, Dundee, U.K
| | - N Geva
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 69978, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, 69978, Israel
| | - H Gruener
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 69978, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, 69978, Israel
| | - H Nahman-Averbuch
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, U.S.A
| | - R Defrin
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 69978, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, 69978, Israel
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Depressive Symptoms and Sleep Efficiency Sequentially Mediate Racial Differences in Temporal Summation of Mechanical Pain. Ann Behav Med 2018; 51:673-682. [PMID: 28337602 DOI: 10.1007/s12160-017-9889-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Racial differences in endogenous pain facilitatory processes have been previously reported. Evidence suggests that psychological and behavioral factors, including depressive symptoms and sleep, can alter endogenous pain facilitatory processes. Whether depressive symptoms and sleep might help explain racial differences in endogenous pain facilitatory processes has yet to be determined. PURPOSE This observational, microlongitudinal study examined whether depressive symptoms and sleep were sequential mediators of racial differences in endogenous pain facilitatory processes. METHODS A total of 50 (26 African American and 24 non-Hispanic white) community-dwelling adults without chronic pain (mean 49.04 years; range 21-77) completed the Center for Epidemiological Studies Depression Scale prior to seven consecutive nights of sleep monitoring with actigraphy in the home environment. Participants subsequently returned to the laboratory for assessment of endogenous pain facilitation using a mechanical temporal summation protocol. RESULTS Findings revealed greater depressive symptoms, poorer sleep efficiency, and greater temporal summation of mechanical pain in African Americans compared to non-Hispanic whites. In a sequential mediation model, greater depressive symptoms predicted poorer sleep efficiency (t = -2.55, p = .014), and poorer sleep efficiency predicted enhanced temporal summation of mechanical pain (t = -4.11, p < .001), particularly for African Americans. CONCLUSIONS This study underscores the importance of examining the contribution of psychological and behavioral factors when addressing racial differences in pain processing. Additionally, it lends support for the deleterious impact of depressive symptoms on sleep efficiency, suggesting that both sequentially mediate racial differences in endogenous pain facilitation.
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Arendt‐Nielsen L, Morlion B, Perrot S, Dahan A, Dickenson A, Kress H, Wells C, Bouhassira D, Drewes AM. Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain 2018; 22:216-241. [DOI: 10.1002/ejp.1140] [Citation(s) in RCA: 378] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
AbstractDifferent neuroplastic processes can occur along the nociceptive pathways and may be important in the transition from acute to chronic pain and for diagnosis and development of optimal management strategies. The neuroplastic processes may result in gain (sensitisation) or loss (desensitisation) of function in relation to the incoming nociceptive signals. Such processes play important roles in chronic pain, and although the clinical manifestations differ across condition processes, they share some common mechanistic features. The fundamental understanding and quantitative assessment of particularly some of the central sensitisation mechanisms can be translated from preclinical studies into the clinic. The clinical perspectives are implementation of such novel information into diagnostics, mechanistic phenotyping, prevention, personalised treatment, and drug development. The aims of this paper are to introduce and discuss (1) some common fundamental central pain mechanisms, (2) how they may translate into the clinical signs and symptoms across different chronic pain conditions, (3) how to evaluate gain and loss of function using quantitative pain assessment tools, and (4) the implications for optimising prevention and management of pain. The chronic pain conditions selected for the paper are neuropathic pain in general, musculoskeletal pain (chronic low back pain and osteoarthritic pain in particular), and visceral pain (irritable bowel syndrome in particular). The translational mechanisms addressed are local and widespread sensitisation, central summation, and descending pain modulation.SignificanceCentral sensitisation is an important manifestation involved in many different chronic pain conditions. Central sensitisation can be different to assess and evaluate as the manifestations vary from pain condition to pain condition. Understanding central sensitisation may promote better profiling and diagnosis of pain patients and development of new regimes for mechanism based therapy. Some of the mechanisms underlying central sensitisation can be translated from animals to humans providing new options in development of therapies and profiling drugs under development.
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Affiliation(s)
| | - B. Morlion
- The Leuven Centre for Algology University Hospitals Leuven University of Leuven Belgium
| | - S. Perrot
- INSERM U987 Pain Center Cochin Hospital Paris Descartes University Paris France
| | - A. Dahan
- Department of Anesthesiology Leiden University Medical Center Leiden The Netherlands
| | - A. Dickenson
- Neuroscience Physiology & Pharmacology University College London UK
| | - H.G. Kress
- Department of Special Anaesthesia and Pain Therapy Medizinische Universität/AKH Wien Vienna Austria
| | | | - D. Bouhassira
- INSERM U987 Centre d'Evaluation et de Traitement de la Douleur Hôpital Ambroise Paré Boulogne Billancourt France
| | - A. Mohr Drewes
- Mech‐Sense Department of Gastroenterology and Hepatology Clinical Institute Aalborg University Hospital Aalborg Denmark
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Galor A, Moein HR, Lee C, Rodriguez A, Felix ER, Sarantopoulos KD, Levitt RC. Neuropathic pain and dry eye. Ocul Surf 2018; 16:31-44. [PMID: 29031645 PMCID: PMC5756672 DOI: 10.1016/j.jtos.2017.10.001] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 09/05/2017] [Accepted: 10/07/2017] [Indexed: 02/06/2023]
Abstract
Dry eye is a common, multifactorial disease currently diagnosed by a combination of symptoms and signs. Its epidemiology and clinical presentation have many similarities with neuropathic pain outside the eye. This review highlights the similarities between dry eye and neuropathic pain, focusing on clinical features, somatosensory function, and underlying pathophysiology. Implications of these similarities on the diagnosis and treatment of dry eye are discussed.
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Affiliation(s)
- Anat Galor
- Miami Veterans Administration Medical Center, USA; Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA.
| | - Hamid-Reza Moein
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Charity Lee
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Adriana Rodriguez
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Elizabeth R Felix
- Miami Veterans Administration Medical Center, USA; Physical Medicine and Rehabilitation, University of Miami, USA
| | - Konstantinos D Sarantopoulos
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Roy C Levitt
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA; John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
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47
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Being Adaptive to Pain Enhances Sham Acupuncture Analgesia: A Crossover Healthy Human Study. J Acupunct Meridian Stud 2017; 10:385-395. [PMID: 29275794 DOI: 10.1016/j.jams.2017.10.002] [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: 03/28/2017] [Revised: 09/06/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022] Open
Abstract
We have reported a model that distinguishes pain adaptive individuals (PA) from those who are pain non-adaptive (PNA). The present randomised, cross-over, participant-assessor blinded study aimed to determine the impact of pain adaptability on individuals' response to real and sham acupuncture. Healthy volunteers (nine PA and 13 PNA) were randomly allocated to receive real and sham acupuncture on the left hand and forearm in two separate acupuncture sessions. Pressure pain thresholds (PPTs) were measured at bilateral forearms and right leg before, immediately after and 20 minutes after the end of acupuncture. Ratings to pinprick and suprathreshold PPT were also recorded. The two groups were comparable in their demographic and baseline data. Analgesia induced by real or sham acupuncture did not differ on any outcome measures. PA responded to acupuncture needling better than PNA, and to sham needling (20% increase in PPT) better than to real acupuncture (7.9%). Those differences were at 20 min after end of acupuncture in the areas distant to the needling sites. PNA reported little changes in PPT. Being adaptive to pain was associated with enhanced distant analgesia in response to sham acupuncture. Our finding might partly explain varied acupuncture analgesia in clinical practice and trials.
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48
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Somatosensory Test Responses and Physical and Psychological Functioning of Children and Adolescents with Chronic Non-neuropathic Pain: An Exploratory Study. Clin J Pain 2017; 33:116-125. [PMID: 27110747 DOI: 10.1097/ajp.0000000000000385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study was designed to establish preliminary feasibility testing of a set of inherently benign somatosensory stimulus-response tests (to cutaneous and deep stimuli) for bedside or office evaluation of pain disorders in children and adolescents. Associations between, and the relative influence of, cutaneous somatosensory testing (SST) responses, deep SST responses, and psychological factors (depression, pain-related catastrophizing) on pain outcomes (worst pain intensity, pain-related disability) were considered. METHODS Sixty participants (6 to 18 y) were recruited from the pediatric chronic pain clinic. SST responses were assessed at the pain site (PS) and control sites to diverse stimuli (static/dynamic touch, punctate pressure, vibration, cool, deep pressure) using Colored Analogue Scales (CAS) with modified anchors. Validated measures of depression, pain-related catastrophizing, and pain-related functional interference were administered. RESULTS Responses at the PS were more frequently hypersensitive than hyposensitive for all SST measures except vibration. Deep pressure responses were the only statistically significant predictor of worst pain intensity. Depression and pain-related catastrophizing accounted for a statistically significant amount of variance of pain-related disability, over and above that which was accounted for by SST responses. DISCUSSION Preliminary feasibility of a set of somatosensory stimulus-response tests for bedside or office evaluation of pain disorders in children and adolescents was established. Deep pressure responses contributed unique information in predicting worst pain intensity but not functional interference. Although cutaneous SST responses at the PSs were frequently abnormal, cutaneous SST responses were not confirmed in this study to have clinical utility, but rather might be centrally mediated epiphenomena.
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49
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Kuppens K, Hans G, Roussel N, Struyf F, Fransen E, Cras P, Van Wilgen CP, Nijs J. Sensory processing and central pain modulation in patients with chronic shoulder pain: A case-control study. Scand J Med Sci Sports 2017; 28:1183-1192. [DOI: 10.1111/sms.12982] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- K. Kuppens
- Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Departments of Human Physiology and Physiotherapy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Pain in Motion Research Group
| | - G. Hans
- Pain Center; University Hospital Antwerp; Antwerp Belgium
| | - N. Roussel
- Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - F. Struyf
- Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - E. Fransen
- StatUa Center for Statistics; University of Antwerp; Antwerp Belgium
| | - P. Cras
- Department of Neurology; University Hospital Antwerp; Antwerp Belgium
| | - C. P. Van Wilgen
- Departments of Human Physiology and Physiotherapy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Pain in Motion Research Group
- Transcare, Transdisciplinairy Painmanagement Centre; Groningen The Netherlands
| | - J. Nijs
- Departments of Human Physiology and Physiotherapy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Pain in Motion Research Group
- Department of Physiotherapy and Rehabilitation; University Hospital Brussels; Brussels Belgium
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50
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Fernandes GS, Sarmanova A, Warner S, Harvey H, Akin-Akinyosoye K, Richardson H, Frowd N, Marshall L, Stocks J, Hall M, Valdes AM, Walsh D, Zhang W, Doherty M. Knee pain and related health in the community study (KPIC): a cohort study protocol. BMC Musculoskelet Disord 2017; 18:404. [PMID: 28934932 PMCID: PMC5609004 DOI: 10.1186/s12891-017-1761-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/13/2017] [Indexed: 04/10/2023] Open
Affiliation(s)
- G S Fernandes
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - A Sarmanova
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - S Warner
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - H Harvey
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - K Akin-Akinyosoye
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - H Richardson
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - N Frowd
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - L Marshall
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - J Stocks
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - M Hall
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - A M Valdes
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - D Walsh
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - W Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom. .,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom. .,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom.
| | - M Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
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