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Schwarzenauer M, Rukwied RM, Lampert A, Rolke R, Namer B. Electrical matrix stimulation suppresses acute itch independently of activation of sleeping nociceptors. Eur J Pain 2024; 28:285-296. [PMID: 37715607 DOI: 10.1002/ejp.2177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/24/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Itch can be reduced by pain. Activation of sleeping nociceptors (CMi) is a crucial mechanism for the peripheral component of intense and long-lasting pain. Thus, activation of CMi might be especially effective in itch reduction. Electrical stimulation using sinusoidal pulses activates CMi with tolerable pain intensity, whereas short rectangular pulses with low intensity do not. In humans, histaminergic itch is mediated by histamine-sensitive CMi, whereas other pruritogens activate polymodal nociceptors (CM). METHODS In a psychophysical approach in a balanced crossover repeated-measures design in healthy volunteers, we activated nociceptors by two different electrical stimulation paradigms via a matrix electrode: 4 Hz sinusoidal pulses that activate C-nociceptors including CMi or 4 Hz rectangular stimuli to activate nociceptors excluding CMi. After 5-min stimulation, itch was induced by either histamine iontophoresis or application of cowhage spicules. Itch ratings were assessed via a numerical rating scale (NRS). RESULTS Electrical 4 Hz sine wave stimulation (0.1 mA) with low pain ratings of 1.5 (NRS; 0-10) induced an axon reflex erythema (3 cm2 ), indicating activation of CMi, whereas rectangular 0.2 ms pulses (average 0.91 mA) with the same pain rating did not. Both electrical stimulation paradigms reduced itch magnitude over time evoked by either histamine or cowhage to a similar extent. Peak maximum itch evoked by histamine was reduced by both stimulation paradigms, but not cowhage maximum itch. DISCUSSION Since electrical stimulation with the rectangular pulse paradigm reduces itch to a similar extent as the sine wave stimulation paradigm, the input of CMi is not necessarily required for itch suppression. The input of A-fibres and polymodal nociceptors, similarly, as also achieved by scratching, seems to be sufficient for both forms of chemically evoked itch. SIGNIFICANCE Since activation of CMi does not provide additional benefit for itch suppression, spinal pain pathways transmitted via CM versus CMi have differential effects on itch-processing circuits. This is important knowledge for using electrical matrix stimulation as itch suppressor since activation of sleeping nociceptors either requires significantly painful stimulation paradigms or specialized stimulation paradigms as sinusoidal pulses. An alternative approach using half-sine wave pulses with low pain intensity activating specifically polymodal nociceptors to suppress itch via matrix electrode stimulation may be considered.
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Affiliation(s)
- M Schwarzenauer
- IZKF Research Group Neuroscience, Medical Faculty RWTH Aachen University, Aachen, Germany
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - R M Rukwied
- Department of Experimental Pain Research, Mannheim Center for Translation Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - A Lampert
- Department for Neurophysiology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - R Rolke
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - B Namer
- IZKF Research Group Neuroscience, Medical Faculty RWTH Aachen University, Aachen, Germany
- Department for Neurophysiology, Medical Faculty RWTH Aachen University, Aachen, Germany
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Wagner JF, Cuhls H, Mücke M, Conrad R, Radbruch L, Rolke R. [Postoperative pain experience after proximal femur fracture in dementia]. Schmerz 2023; 37:38-46. [PMID: 35038009 PMCID: PMC9889506 DOI: 10.1007/s00482-021-00619-5] [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: 05/29/2020] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The present study aimed to assess the postoperative pain experience in cognitive deficit patients with special reference to sensory or affective pain quality. METHODS Nineteen patients with normal cognition up to cognitive impairments according to the DemTect screening-tool were studied regarding their postoperative pain experience after proximal femur fracture. The numerical rating scale (NRS), the cognitive DemTect questionnaire, the pain sensation questionnaire (SES), and a quantitative sensory test (QST) were used as examination instruments. RESULTS The mean ± SD age of the patients was 83.8 ± 10.0 years. Of the 19 patients, 6 (31.6%) had normal cognitive abilities. In 4 patients (21.1%) there were indications of mild cognitive impairments, and in 9 patients (47.4%) the suspicions of the presence of dementia arose. The mean postoperative pain intensity (NRS) was 4.0 (1.6). With comparable analgesic therapy, the reported pain intensities did not differ between the three patient groups with different cognitive impairments and the first three postoperative treatment days. There were no statistically significant differences between the groups for the sensory or affective total scores of the pain sensation scale. The QST parameters deep pain (PPT), superficial mechanical pain after needle stimulation (MPT), and the superficial sensitivity to light touch stimuli (MDT) showed a significantly increased sensitivity of the operated side. For the sensation of vibration (VDT) no differences between operated and healthy extremities could be proven. DISCUSSION The postoperative pain experience does not differ between patients with normal and limited cognition. The quantitative sensory testing showed mechanical hyperalgesia in the operated area. The study points to the importance of adequate postoperative pain management even in those with dementia.
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Affiliation(s)
- Jens Felix Wagner
- Akutgeriatrie und Tagesklinik, Helios Klinikum Bonn/Rhein-Sieg, Bonn/Rhein-Sieg, Deutschland
| | - Henning Cuhls
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Martin Mücke
- Institut für Digitale Allgemeinmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland ,Zentrum für Seltene Erkrankungen Aachen (ZSEA), Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Rupert Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Lukas Radbruch
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland ,Zentrum für Palliativmedizin, Helios Klinikum Bonn/Rhein-Sieg, Bonn/Rhein-Sieg, Deutschland
| | - Roman Rolke
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
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Wang JH, Wu C, Lian YN, Liu L, Li XY. Targeting long-term depression of excitatory synaptic transmission for the treatment of neuropathic pain. FEBS J 2022; 289:7334-7342. [PMID: 34528400 DOI: 10.1111/febs.16200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 01/13/2023]
Abstract
Injury or disease in the somatosensory nervous system may cause broad molecular changes and lead to neuropathic pain. Excitatory synaptic transmission in somatosensory pathways conveys the somatosensory information from the peripheral to the central nervous system. Long-term effects of excitatory synaptic transmission on the pain pathway contribute to neuropathic pain hypersensitivity. Synaptic strength is dynamically regulated and undergoes bidirectional changes, manifested by two primary forms of synaptic plasticity, long-term potentiation and long-term depression (LTD), which are mediated by insertion and endocytosis of amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs), respectively. Molecular mechanisms of LTP have been extensively studied; on the other hand, the role of AMPAR endocytosis in the pain-related synaptic enhancement is less well known. Recent research in the anterior cingulate cortex reveals that loss of LTD contributes to the maintenance of neuropathic pain, which provides the novel perspective of the mechanism of LTD also being critical for maintaining neuropathic pain. More importantly, exploring the molecular mechanism of LTD may help with the development of novel analgesic strategies to manage neuropathic pain.
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Affiliation(s)
- Jing-Hua Wang
- Department of Neurobiology, School of Medicine, Zhejiang University, Hangzhou, China.,NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Research and Brain-Machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China
| | - Cheng Wu
- Department of Neurobiology, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan-Na Lian
- Department of Neurobiology, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Liu
- Core Facilities of the School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiang-Yao Li
- Department of Neurobiology, School of Medicine, Zhejiang University, Hangzhou, China.,NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Research and Brain-Machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China.,Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Hangzhou, China
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Hewitt D, Newton-Fenner A, Henderson J, Fallon NB, Brown C, Stancak A. Intensity-dependent modulation of cortical somatosensory processing during external, low-frequency peripheral nerve stimulation in humans. J Neurophysiol 2022; 127:1629-1641. [PMID: 35611988 PMCID: PMC9190739 DOI: 10.1152/jn.00511.2021] [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] [Indexed: 01/20/2023] Open
Abstract
External low-frequency peripheral nerve stimulation (LFS) has been proposed as a novel method for neuropathic pain relief. Previous studies have reported that LFS elicits long-term depression-like effects on human pain perception when delivered at noxious intensities, whereas lower intensities are ineffective. To shed light on cortical regions mediating the effects of LFS, we investigated changes in somatosensory-evoked potentials (SEPs) during four LFS intensities. LFS was applied to the radial nerve (600 pulses, 1 Hz) of 24 healthy participants at perception (1 times), low (5 times), medium (10 times), and high intensities (15 times detection threshold). SEPs were recorded during LFS, and averaged SEPs in 10 consecutive 1-min epochs of LFS were analyzed using source dipole modeling. Changes in resting electroencephalography (EEG) were investigated after each LFS block. Source activity in the midcingulate cortex (MCC) decreased linearly during LFS, with greater attenuation at stronger LFS intensities, and in the ipsilateral operculo-insular cortex during the two lowest LFS stimulus intensities. Increased LFS intensities resulted in greater augmentation of contralateral primary sensorimotor cortex (SI/MI) activity. Stronger LFS intensities were followed by increased α (alpha, 9-11 Hz) band power in SI/MI and decreased θ (theta, 3-5 Hz) band power in MCC. Intensity-dependent attenuation of MCC activity with LFS is consistent with a state of long-term depression. Sustained increases in contralateral SI/MI activity suggests that effects of LFS on somatosensory processing may also be dependent on satiation of SI/MI. Further research could clarify if the activation of SI/MI during LFS competes with nociceptive processing in neuropathic pain.NEW & NOTEWORTHY Somatosensory-evoked potentials during low-frequency stimulation of peripheral nerves were examined at graded stimulus intensities. Low-frequency stimulation was associated with decreased responsiveness in the midcingulate cortex and increased responsiveness in primary sensorimotor cortex. Greater intensities were associated with increased midcingulate cortex θ band power and decreased sensorimotor cortex α band power. Results further previous evidence of an inhibition of somatosensory processing during and after low-frequency stimulation and point toward a potential augmentation of activity in somatosensory processing regions.
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Affiliation(s)
- Danielle Hewitt
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom
| | - Alice Newton-Fenner
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom,2Institute for Risk and Uncertainty, University of Liverpool, Liverpool, United Kingdom
| | - Jessica Henderson
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom
| | - Nicholas B. Fallon
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom
| | - Christopher Brown
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom
| | - Andrej Stancak
- 1Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom,2Institute for Risk and Uncertainty, University of Liverpool, Liverpool, United Kingdom
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Gardetto A, Baur EM, Prahm C, Smekal V, Jeschke J, Peternell G, Pedrini MT, Kolbenschlag J. Reduction of Phantom Limb Pain and Improved Proprioception through a TSR-Based Surgical Technique: A Case Series of Four Patients with Lower Limb Amputation. J Clin Med 2021; 10:jcm10174029. [PMID: 34501477 PMCID: PMC8432479 DOI: 10.3390/jcm10174029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Four patients underwent targeted sensory reinnervation (TSR), a surgical technique in which a defined skin area is first selectively denervated and then surgically reinnervated by another sensory nerve. In our case, either the area of the lateral femoral cutaneous nerve or the saphenous nerve was reinnervated by the sural nerve. Patients were then fitted with a special prosthetic device capable of transferring the sense of pressure from the sole of the prosthesis to the newly wired skin area. Pain reduction after TSR was highly significant in all patients. In three patients, permanent pain medication could even be discontinued, in one patient the pain medication has been significantly reduced. Two of the four patients were completely pain-free after the surgical intervention. Surgical rewiring of existing sensory nerves by TSR can provide the brain with new afferent signals seeming to originate from the missing limb. These signals help to reduce phantom limb pain and to restore a more normal body image. In combination with special prosthetic devices, the amputee can be provided with sensory feedback from the prosthesis, thus improving gait and balance.
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Affiliation(s)
- Alexander Gardetto
- Competence Center for Bionic Prosthetics, Department of Plastic, Aesthetic and Reconstructive Surgery with Hand Surgery, Brixsana Private Clinic, 39042 Bressanone, Italy
- Correspondence:
| | - Eva-Maria Baur
- Department of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Cosima Prahm
- BG Trauma Center Tuebingen, Department of Hand, Plastic, Reconstructive and Burn Surgery, Eberhard Karls University Tuebingen, 72108 Tuebingen, Germany; (C.P.); (J.K.)
| | - Vinzenz Smekal
- AUVA Trauma Center Klagenfurt, Department of Trauma Surgery, 9020 Klagenfurt, Austria;
| | - Johannes Jeschke
- Department of Plastic, Aesthetic and Reconstructive Surgery, Maria Hilf Private Clinic, 9020 Klagenfurt, Austria;
| | - Gerfried Peternell
- Department of Exoprosthetics, AUVA Rehabilitation Clinic, 8144 Tobelbad, Austria;
| | - Michael T. Pedrini
- Department of Internal Medicine, Brixsana Private Clinic, 39042 Bressanone, Italy;
| | - Jonas Kolbenschlag
- BG Trauma Center Tuebingen, Department of Hand, Plastic, Reconstructive and Burn Surgery, Eberhard Karls University Tuebingen, 72108 Tuebingen, Germany; (C.P.); (J.K.)
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Hewitt D, Byrne A, Henderson J, Newton-Fenner A, Tyson-Carr J, Fallon N, Brown C, Stancak A. Inhibition of cortical somatosensory processing during and after low frequency peripheral nerve stimulation in humans. Clin Neurophysiol 2021; 132:1481-1495. [PMID: 34023628 DOI: 10.1016/j.clinph.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Transcutaneous low-frequency stimulation (LFS) elicits long-term depression-like effects on human pain perception. However, the neural mechanisms underlying LFS are poorly understood. We investigated cortical activation changes occurring during LFS and if changes were associated with reduced nociceptive processing and increased amplitude of spontaneous cortical oscillations post-treatment. METHODS LFS was applied to the radial nerve of 25 healthy volunteers over two sessions using active (1 Hz) or sham (0.02 Hz) frequencies. Changes in resting electroencephalography (EEG) and laser-evoked potentials (LEPs) were investigated before and after LFS. Somatosensory-evoked potentials were recorded during LFS and source analysis was carried out. RESULTS Ipsilateral midcingulate and operculo-insular cortex source activity declined linearly during LFS. Active LFS was associated with attenuated long-latency LEP amplitude in ipsilateral frontocentral electrodes and increased resting alpha (8-12 Hz) and beta (16-24 Hz) band power in electrodes overlying operculo-insular, sensorimotor and frontal cortical regions. Reduced ipsilateral operculo-insular cortex source activity during LFS correlated with a smaller post-treatment alpha-band power increase. CONCLUSIONS LFS attenuated somatosensory processing both during and after stimulation. SIGNIFICANCE Results further our understanding of the attenuation of somatosensory processing both during and after LFS.
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Affiliation(s)
- Danielle Hewitt
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Adam Byrne
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK; Institute for Risk and Uncertainty, University of Liverpool, Liverpool, UK
| | - Jessica Henderson
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Alice Newton-Fenner
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK; Institute for Risk and Uncertainty, University of Liverpool, Liverpool, UK
| | - John Tyson-Carr
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Christopher Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Andrej Stancak
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK; Institute for Risk and Uncertainty, University of Liverpool, Liverpool, UK
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7
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Arendsen LJ, Guggenberger R, Zimmer M, Weigl T, Gharabaghi A. Peripheral Electrical Stimulation Modulates Cortical Beta-Band Activity. Front Neurosci 2021; 15:632234. [PMID: 33867919 PMCID: PMC8044771 DOI: 10.3389/fnins.2021.632234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
Low-frequency peripheral electrical stimulation using a matrix electrode (PEMS) modulates spinal nociceptive pathways. However, the effects of this intervention on cortical oscillatory activity have not been assessed yet. The aim of this study was to investigate the effects of low-frequency PEMS (4 Hz) on cortical oscillatory activity in different brain states in healthy pain-free participants. In experiment 1, PEMS was compared to sham stimulation. In experiment 2, motor imagery (MI) was used to modulate the sensorimotor brain state. PEMS was applied either during MI-induced oscillatory desynchronization (concurrent PEMS) or after MI (delayed PEMS) in a cross-over design. For both experiments, PEMS was applied on the left forearm and resting-state electroencephalography (EEG) was recording before and after each stimulation condition. Experiment 1 showed a significant decrease of global resting-state beta power after PEMS compared to sham (p = 0.016), with a median change from baseline of −16% for PEMS and −0.54% for sham. A cluster-based permutation test showed a significant difference in resting-state beta power comparing pre- and post-PEMS (p = 0.018) that was most pronounced over bilateral central and left frontal sensors. Experiment 2 did not identify a significant difference in the change from baseline of global EEG power for concurrent PEMS compared to delayed PEMS. Two cluster-based permutation tests suggested that frontal beta power may be increased following both concurrent and delayed PEMS. This study provides novel evidence for supraspinal effects of low-frequency PEMS and an initial indication that the presence of a cognitive task such as MI may influence the effects of PEMS on beta activity. Chronic pain has been associated with changes in beta activity, in particular an increase of beta power in frontal regions. Thus, brain state-dependent PEMS may offer a novel approach to the treatment of chronic pain. However, further studies are warranted to investigate optimal stimulation conditions to achieve a reduction of pain.
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Affiliation(s)
- Laura J Arendsen
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Robert Guggenberger
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Manuela Zimmer
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Tobias Weigl
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
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Basten-Günther J, Kunz M, Peters M, Lautenbacher S. The effect of optimism on the facial expression of pain: Implications for pain communication. Eur J Pain 2020; 25:817-830. [PMID: 33325605 DOI: 10.1002/ejp.1712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a broad range of evidence on optimism dampening the pain experience, as assessed by subjective self-report. Facial expression of pain conveys supplementary information about the pain experience, is an integral part of pain communication and assists psychosocial pain coping. Nevertheless, the effect of induced optimism on facial activity during pain has to our knowledge not been examined. METHODS In our experiment, 40 healthy participants underwent two blocks of thermal stimulation containing phasic non-painful and painful stimuli. Between the two blocks, the Best Possible Self imagery and writing task was performed to induce situational optimism, while a control group wrote about their typical day. Facial activity and self-report ratings of intensity and unpleasantness were recorded. Facial activity was analysed using the Facial Action Coding System. RESULTS The optimism manipulation was successful in increasing state optimism. It did not affect self-report ratings, but resulted in a stronger facial expression of pain, caused especially by increases in Action Units 4 (furrowed brows) and 6_7 (narrowed eyes). CONCLUSIONS All Action Units, which were affected by the optimism induction, are known to be prevalent during pain stimulation. The increase in facial expression might reflect reduced inhibition of pain communication in temporarily optimistic participants. Optimism might lead to expecting positive and helpful reactions from others and, by that, to great readiness to elicit these reactions by non-verbal social behaviour. SIGNIFICANCE This study is the first to indicate that state optimism increases the facial expression of pain as a social signal for help and empathy without concomitant changes in the subjective pain experience.
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Affiliation(s)
| | - Miriam Kunz
- Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
| | - Madelon Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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Witte JP, Kravchenko D, Marinova M, Küborth K, Radbruch L, Mücke M, Conrad R. Matrix stimulation in chronic pruritus: A randomized controlled study. J Dermatol 2020; 47:1166-1174. [PMID: 32839976 DOI: 10.1111/1346-8138.15492] [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: 03/28/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
Chronic pruritus is one of the main symptoms in dermatology. We investigated a new intervention for chronic pruritus by neurostimulation through matrix electrodes. In this randomized controlled trial, 29 patients with chronic pruritus caused by a variety of dermatological diseases were allocated to an experimental group (EG; n = 14, 4-Hz neurostimulation of the itching area through matrix electrodes) or the control group (CG; n = 15, placement of matrix electrodes without neurostimulation). Outcome measures were the itching sensation as measured by a Numerical Rating Scale immediately after the intervention and the intermediate effect measured by the average itching sensation on the day before the intervention compared with the average itching sensation on day 1, 2 and 3 after the intervention. Regarding the short-term effect on itching, the anova showed a significant interaction effect for the 5-min stimulation with a larger reduction in the EG with a large effect size of d = 1.10. The average reduction in itching intensity was 78.2% for the EG compared with 34.3% for the CG. For the intermediate effect, no significant interaction was found (F = 1.721, P = 0.199). Comparing the itching sensation at day 0 with day 3, the interaction effect showed a statistical trend toward a greater reduction in the EG (F = 3.178, P = 0.086; statistical trend, d = 0.69). This study proved that neurostimulation through matrix electrodes is effective in the short-term reduction of itching in patients with chronic pruritus caused by dermatological diseases. Additional studies are needed with larger patient pools and covering longer study periods.
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Affiliation(s)
- Jan-Philipp Witte
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Dimitrij Kravchenko
- Department of Radiology, Medical School and Hospital, University Hospital Bonn, Bonn, Germany
| | - Milka Marinova
- Department of Radiology, Medical School and Hospital, University Hospital Bonn, Bonn, Germany
| | - Karsten Küborth
- Departments of, Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Martin Mücke
- Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Rupert Conrad
- Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Multimodal Frequency Treatment for Facial Pain Caused by Chronic Rhinosinusitis: A Pilot Study. SINUSITIS 2017. [DOI: 10.3390/sinusitis2030005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Mücke M, Tils M, Conrad R, Kravchenko D, Cuhls H, Radbruch L, Marinova M, Peuckmann-Post V, Rolke R. Matrix stimulation in cancer pain: Methodology, safety and effectiveness. Eur J Pain 2017; 22:58-71. [PMID: 28805336 PMCID: PMC5763394 DOI: 10.1002/ejp.1089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 12/18/2022]
Abstract
Background This feasibility study addresses the applicability of matrix electrodes for the reduction of ongoing pain in cancer patients via low‐frequency electrical stimulation (LFS). Methods Low‐frequency matrix stimulation (4 Hz) was applied to the skin within the ‘Head's zones’ referring to the tumour localization of cancer pain patients. Pain at baseline was compared to a 3‐day treatment interval consisting of 5 min of matrix stimulation in the morning and evening followed by a 3‐day follow‐up period without therapy. Main outcome parameters included numeric rating scale values (rating scale 0–100), painDETECT, HADS, and German pain questionnaire, as well as the opioid intake, calculated as the oral morphine equivalent (OME). Results Twenty patients with cancer pain (aged 64.4 ± 10.3; 9 women) were examined. In the majority of patients, the pain was classified as nociceptive. The mean pain reduction achieved by matrix therapy was 30%, under stable daily controlled‐release opioid doses between 177 and 184 mg/day (OME). Seventeen patients (85%) were responders, defined by a pain reduction of at least 30%, while four responders experienced a pain reduction of over 50%. The only side effect was short‐term erythema. Conclusion Findings are consistent with the concept of synaptic long‐term depression in cancer pain induced after conditioning LFS. Despite the short, but well‐tolerated, treatment duration of 2 × 5 min/day, effects persisted throughout the 3‐day follow‐up. Significance Cutaneous neuromodulation using LFS via a matrix electrode has been shown to be a safe intervention for effectively reducing cancer pain in palliative care patients.
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Affiliation(s)
- M Mücke
- Department of General Practice and Family Medicine, University Hospital Bonn, Germany.,Department of Palliative Medicine, University Hospital Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Germany
| | - M Tils
- Department of Palliative Medicine, University Hospital Bonn, Germany
| | - R Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany
| | - D Kravchenko
- Department of Palliative Medicine, University Hospital Bonn, Germany
| | - H Cuhls
- Department of Palliative Medicine, University Hospital Bonn, Germany
| | - L Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Germany.,Centre for Palliative Care, Malteser Hospital Bonn/Rhein-Sieg, Germany
| | - M Marinova
- Department of Radiology, Medical School & Hospital, University Hospital Bonn, Germany
| | - V Peuckmann-Post
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Germany
| | - R Rolke
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Germany
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Mücke M, Schulze H, Radbruch L, Marinova M, Cuhls H, Kravchenko D, Conrad R, Rolke R. [Neuromodulation using matrix stimulation : A treatment for acute pain?]. Schmerz 2017; 31:594-600. [PMID: 28674829 DOI: 10.1007/s00482-017-0233-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is currently a lack of studies that evaluate the effects of matrix electrode neuromodulation on acute pain. In this prospective and randomized cross-over study, we investigated the efficacy of 4 Hz-matrix stimulation on venipuncture-induced pain in 30 healthy subjects. METHODS We compared two conditions of neurostimulation: in EC1 (experimental condition 1), we performed venipuncture during stimulation, with 2.5 min of prestimulation with 600 stimuli; in EC2 (experimental condition 2), the length of stimulation was 5 min, at 1200 stimuli, with subsequent venipuncture. A group with no stimulation was used as control condition. RESULTS The EC2 group did not only show a 77% reduction in puncture pain when compared to the control group (p < 0.001; effect size [ES] d = 1.45), but also had a significant effect compared with EC1 (p < 0.001; ES d = 1.33). EC1, on the other hand, did not demonstrate a significant difference to the control group. The status of the veins was evaluated based on visibility and did not differ significantly between the conditions. CONCLUSION The results of this study showed for the first time that pre-emptive matrix stimulation could be an effective way to reduce acute pain. The duration of stimulation seems to play a key role in the effectiveness of the neurophysiological mechanism of action. Matrix stimulation is a therapeutic intervention with very few side effects, which could, in the future, expand our pain-management options for the treatment of acute pain.
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Affiliation(s)
- M Mücke
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Institut für Hausarztmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Bonn, Deutschland.
| | - H Schulze
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
- Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Deutschland
| | - M Marinova
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - H Cuhls
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - D Kravchenko
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Rolke
- Klinik für Palliativmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
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Johnson S, Goebel A, Richey R, Holmes E, Hughes D. A randomised, patient-assessor blinded, sham-controlled trial of external non-invasive peripheral nerve stimulation for chronic neuropathic pain following peripheral nerve injury (EN-PENS trial): study protocol for a randomised controlled trial. Trials 2016; 17:574. [PMID: 27919285 PMCID: PMC5139024 DOI: 10.1186/s13063-016-1709-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Eight percent of people in the UK are estimated to have persistent (chronic) neuropathic pain, and for many there is no effective treatment. Medications are the most common first-line treatment but often have limited benefit or adverse events. Surgical treatments, such as spinal cord stimulation, are then often considered. External non-invasive peripheral nerve stimulation (EN-PENS) is a form of electrical stimulation that involves placing a pen-shaped electrode onto the skin, which can be easily self-administered by patients. Observational studies suggest that EN-PENS may relieve pain for people with localised neuropathic pain; however, there is currently no evidence from controlled trials to confirm the efficacy and confidently determine the effect size for patients with longstanding neuropathic pain. Methods EN-PENS is a single-site, blinded, randomised controlled parallel-group superiority add-on trial with a 1:1 allocation ratio, designed to evaluate the efficacy of treatment versus control treatment in 76 patients with longstanding neuropathic pain following peripheral nerve injury. Patients with moderate to -severe neuropathic pain following peripheral nerve injury will be randomised to receive either the active or control treatment, followed by an optional treatment extension or treatment switch to the alternative treatment arm. The primary outcome is average 24-h pain intensity recorded on an 11-point (0–10) numerical rating scale, averaged over the last 7 days of treatment. Discussion Study results will be used to inform potential treatment efficacy and cost-effectiveness of EN-PENS for this population group. Trial registration ISRCTN53432663. Registered on 7 July 2016.
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Affiliation(s)
- Selina Johnson
- The Walton Centre NHS Trust, Liverpool, UK. .,The University of Liverpool, Liverpool, L69 3BX, UK.
| | - Andreas Goebel
- The Walton Centre NHS Trust, Liverpool, UK.,The University of Liverpool, Liverpool, L69 3BX, UK
| | | | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, LL57 2PZ, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, LL57 2PZ, UK
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