1
|
McCloy K, Herrero Babiloni A, Sessle BJ. Sleep disorders and orofacial pain: insights for dental practice. Aust Dent J 2024. [PMID: 39304335 DOI: 10.1111/adj.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 09/22/2024]
Abstract
In dental sleep medicine several sleep disorders commonly coexist with pain, contributing to complex clinical presentations which might affect the provision of appropriate and timely treatment. There are associations between sleep disorders and pain in general, as well as with specific orofacial pain conditions. As many as five of six patients with orofacial pain can present with sleep problems. The comorbidity of orofacial pain and sleep disorders overlays a complex web of altered neurobiological mechanisms that predispose to the chronification of orofacial pain. This review discusses the relationship between orofacial pain and sleep disorders and highlights their interactions and the neurobiological mechanisms underlying those relationships.
Collapse
Affiliation(s)
- K McCloy
- Pain Management and Research Institute Sydney University, Sydney, New South Wales, Australia
| | - A Herrero Babiloni
- Faculty of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - B J Sessle
- Faculty of Dentistry, Faculty of Medicine Department of Physiology, and Centre for the Study of Pain, University of Toronto, Toronto, Canada
| |
Collapse
|
2
|
Reid MJ, Hamilton KR, Nilsson SJ, Owens MA, Phillips JL, Finan PH, Campbell CM, Giagtzis A, Abhishek D, Haythornthwaite JA, Smith MT. Elevated pain sensitivity is associated with reduced rapid eye movement (REM) sleep in females with comorbid temporomandibular disorder and insomnia. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:434-443. [PMID: 38548665 PMCID: PMC11224587 DOI: 10.1093/pm/pnae022] [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: 08/04/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE Patients with chronic pain disorders, including Temporomandibular Disorders (TMDs) endorse high levels of sleep disturbances, frequently reporting reduced sleep quality. Despite this, little is known about the effect that daytime pain has on the microstructure and macro-architecture of sleep. Therefore, we aimed to examine the extent to which daytime pain sensitivity, measured using quantitative sensory testing (QST), is associated with objective sleep parameters the following night, including sleep architecture and power spectral density, in women with TMD. METHODS 144 females with myalgia and arthralgia by examination using the Diagnostic criteria for TMD completed a comprehensive QST battery consisting of General Pain Sensitivity, Central Sensitization Index, and Masseter Pressure Pain Threshold assessments. Polysomnography was collected the same night to measure sleep architecture and calculate relative power in delta, theta, alpha, sigma, and beta power bands. RESULTS Central Sensitization (B = -3.069, P = .009), General Pain Sensitivity Indices (B = -3.069, P = .007), and Masseter Pain Pressure Threshold (B = 0.030, P = .008) were significantly associated with lower REM% both before and after controlling for covariates. Pain sensitivity measures were not significantly associated with relative power in any of the spectral bands nor with any other sleep architectural stages. CONCLUSIONS Our findings demonstrate that higher generalized pain sensitivity, masseter pain pressure threshold, as well as central sensitization were associated with a lower percentage of REM in participants with myofascial pain and arthralgia of the masticatory system. These findings provide an important step toward understanding the mechanistic underpinnings of how chronic pain interacts with sleep physiology.
Collapse
Affiliation(s)
- Matthew J Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21224, United States
| | - Katrina R Hamilton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21224, United States
| | - Sophie J Nilsson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21224, United States
| | - Michael Alec Owens
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21224, United States
| | - Jane L Phillips
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland Baltimore, School of Dentistry, Baltimore, MD 21201, United States
| | - Patrick H Finan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA 22903, United States
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21224, United States
| | | | - Dave Abhishek
- Department of Cognitive Sciences, University of California, Irvine, CA 92617, United States
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21224, United States
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21224, United States
| |
Collapse
|
3
|
Wang Y, Varghese J, Muhammed S, Lavigne G, Finan P, Colloca L. Clinical Phenotypes Supporting the Relationship Between Sleep Disturbance and Impairment of Placebo Effects. THE JOURNAL OF PAIN 2024; 25:819-831. [PMID: 37871682 PMCID: PMC10922511 DOI: 10.1016/j.jpain.2023.10.013] [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: 07/11/2023] [Revised: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
Lack of good sleep or insomnia can lead to many health issues, including an elevated risk of cardiovascular disease, obesity, fatigue, low mood, and pain. While chronic pain negatively impacts sleep quality, the relationship between descending pain modulatory systems like placebo effects and sleep quality is not thoroughly known. We addressed this aspect in a cross-sectional study in participants with chronic pain. Placebo effects were elicited in a laboratory setting using thermal heat stimulations delivered with visual cues using classical conditioning and verbal suggestions. We estimated the levels of insomnia severity with the Insomnia Severity Index and the sleep quality with the Pittsburg Sleep Quality Index. The previous night's sleep continuity was assessed as total sleep time, sleep efficiency, and sleep midpoint the night before the experiment. 277 people with chronic pain and 189 pain-free control individuals participated. Participants with chronic pain and insomnia showed smaller placebo effects than those with chronic pain without insomnia. Similarly, poor sleep quality was associated with reduced placebo effects among participants with chronic pain. Clinical anxiety measured by Depression Anxiety Stress Scales partially mediated these effects. In contrast, placebo effects were not influenced by the presence of insomnia or poor sleep quality in pain-free participants. Sleep continuity the night before the experiment did not influence the placebo effects. Our results indicate that participants who experience insomnia and/or poor sleep quality and chronic pain have smaller placebo effects, and that the previous night sleep continuity does not influence the magnitude of placebo effects. PERSPECTIVE: This study examined the relationship between sleep disturbances and experimentally induced placebo effects. We found that individuals with chronic pain who experience insomnia and poor sleep quality demonstrated reduced placebo effects compared to their counterparts with good sleep quality and no insomnia.
Collapse
Affiliation(s)
- Yang Wang
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
| | - Jeril Varghese
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
| | - Salim Muhammed
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
| | - Gilles Lavigne
- Faculty of Dental medicine, Université de Montreal, and Center for Advance Research in Sleep Medicine, CIUSSS Nord Ile de Montreal, Montreal, Quebec, Canada
| | - Patrick Finan
- Department of Anesthesiology, School of Medicine, University of Virginia, Charlottesville, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
- Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, University of Maryland, Baltimore, USA
| |
Collapse
|
4
|
Blythe JS, Thomaidou MA, Peerdeman KJ, van Laarhoven AI, van Schothorst MM, Veldhuijzen DS, Evers AW. Placebo effects on cutaneous pain and itch: a systematic review and meta-analysis of experimental results and methodology. Pain 2023; 164:1181-1199. [PMID: 36718994 PMCID: PMC10184563 DOI: 10.1097/j.pain.0000000000002820] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/14/2022] [Accepted: 10/20/2022] [Indexed: 02/01/2023]
Abstract
ABSTRACT Placebo effects, positive treatment outcomes that go beyond treatment processes, can alter sensations through learning mechanisms. Understanding how methodological factors contribute to the magnitude of placebo effects will help define the mechanisms by which these effects occur. We conducted a systematic review and meta-analysis of experimental placebo studies in cutaneous pain and itch in healthy samples, focused on how differences in methodology contribute to the resulting placebo effect magnitude. We conducted meta-analyses by learning mechanism and sensation, namely, for classical conditioning with verbal suggestion, verbal suggestion alone, and observational learning, separately for pain and itch. We conducted subgroup analyses and meta-regression on the type of sensory stimuli, placebo treatment, number of acquisition and evocation trials, differences in calibrated intensities for placebo and control stimuli during acquisition, age, and sex. We replicated findings showing that a combination of classical conditioning with verbal suggestion induced larger placebo effects on pain ( k = 68, g = 0 . 59) than verbal suggestion alone ( k = 39, g = 0.38) and found a smaller effect for itch with verbal suggestion alone ( k = 7, g = 0.14). Using sham electrodes as placebo treatments corresponded with larger placebo effects on pain than when topical gels were used. Other methodological and demographic factors did not significantly affect placebo magnitudes. Placebo effects on pain and itch reliably occur in experimental settings with varied methods, and conditioning with verbal suggestion produced the strongest effects. Although methods may shape the placebo effect to some extent, these effects appear robust overall, and their underlying learning mechanisms may be harnessed for applications outside the laboratory.
Collapse
Affiliation(s)
- Joseph S. Blythe
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Mia A. Thomaidou
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Kaya J. Peerdeman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Antoinette I.M. van Laarhoven
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Dieuwke S. Veldhuijzen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Andrea W.M. Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
- Medical Delta Healthy Society, Leiden University, Technical University Delft, and Erasmus University Rotterdam, Rotterdam, the Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
5
|
Kourbanova K, Alexandre C, Latremoliere A. Effect of sleep loss on pain-New conceptual and mechanistic avenues. Front Neurosci 2022; 16:1009902. [PMID: 36605555 PMCID: PMC9807925 DOI: 10.3389/fnins.2022.1009902] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Sleep disturbances increase pain sensitivity in clinical and preclinical settings, but the precise mechanisms are unknown. This represents a major public health issue because of the growing sleep deficiency epidemic fueled by modern lifestyle. To understand the neural pathways at the intersection between sleep and pain processes, it is critical to determine the precise nature of the sleep disruptions that increase pain and the specific component of the pain response that is targeted. Methods We performed a review of the literature about sleep disturbances and pain sensitivity in humans and rodents by taking into consideration the targeted sleep stage (REMS, non-NREMS, or both), the amount of sleep lost, and the different types of sleep disruptions (partial or total sleep loss, duration, sleep fragmentation or interruptions), and how these differences might affect distinct components of the pain response. Results We find that the effects of sleep disturbances on pain are highly conserved among species. The major driver for pain hypersensitivity appears to be the total amount of sleep lost, while REMS loss by itself does not seem to have a direct effect on pain sensitivity. Sleep loss caused by extended wakefulness preferentially increases pain perception, whereas interrupted and limited sleep strongly dysregulates descending controls such as DNIC, especially in women. Discussion We discuss the possible mechanisms involved, including an increase in inflammatory processes, a loss of nociceptive inhibitory pathways, and a defect in the cognitive processing of noxious input.
Collapse
Affiliation(s)
- Kamila Kourbanova
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Chloe Alexandre
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Alban Latremoliere
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States
| |
Collapse
|
6
|
Proulx-Bégin L, Herrero Babiloni A, Bouferguene S, Roy M, Lavigne GJ, Arbour C, De Beaumont L. Conditioning to Enhance the Effects of Repetitive Transcranial Magnetic Stimulation on Experimental Pain in Healthy Volunteers. Front Psychiatry 2022; 13:768288. [PMID: 35273527 PMCID: PMC8901579 DOI: 10.3389/fpsyt.2022.768288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In this proof-of-concept study we sought to explore whether the combination of conditioning procedure based on a surreptitious reduction of a noxious stimulus (SRPS) could enhance rTMS hypoalgesic effects [i.e., increase heat pain threshold (HPT)] and augment intervention expectations in a healthy population. METHODS Forty-two healthy volunteers (19-35 years old) were enrolled in a randomized crossover-controlled study and were assigned to one of two groups: (1) SRPS and (2) No SRPS. Each participant received two consecutive sessions of active or sham rTMS over the M1 area of the right hand on two visits (1) active, (2) sham rTMS separated by at least one-week interval. HPT and the temperature needed to elicit moderate heat pain were measured before and after each rTMS intervention on the right forearm. In the SRPS group, conditioning consisted of deliberately decreasing thermode temperature by 3°C following intervention before reassessing HPT, while thermode temperature was held constant in the No SRPS group. Intervention expectations were measured before each rTMS session. RESULTS SRPS conditioning procedure did not enhance hypoalgesic effects of rTMS intervention, neither did it modify intervention expectations. Baseline increases in HPT were found on the subsequent intervention session, suggesting variability of this measure over time, habituation or a possible "novelty effect." CONCLUSION Using a SRPS procedure in healthy volunteers did not enhance rTMS modulating effects on experimental pain sensation (i.e., HPT). Future studies are therefore needed to come up with a conditioning procedure which allows significant enhancement of rTMS pain modulating effects in healthy volunteers.
Collapse
Affiliation(s)
- Léa Proulx-Bégin
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Alberto Herrero Babiloni
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Sabrina Bouferguene
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Gilles J Lavigne
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Caroline Arbour
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Louis De Beaumont
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
7
|
Ahmadi-Soleimani SM, Azizi H, Abbasi-Mazar A. Intermittent REM sleep deprivation attenuates the development of morphine tolerance and dependence in male rats. Neurosci Lett 2021; 748:135735. [PMID: 33592307 DOI: 10.1016/j.neulet.2021.135735] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 02/04/2023]
Abstract
Opioid agonists are used in clinic for pain management, however this application is challenged by development of tolerance and dependence following prolonged exposure. Various approaches have been suggested to address this concern, however, there is still no consensus among the researchers. Neural processing of sleep and nociception are co-regulated through shared brain regions having bidirectional interplays. Thus, we aimed to investigate whether application of REM sleep deprivation (REM-SD) could affect morphine analgesic tolerance and dependence. To this end, adult male rats underwent sleep deprivation during light and dark phases (LSD and DSD, respectively) using the inverted flower pot method and then tolerance and dependence was induced by repeated injection of morphine for 7 days (10 mg/kg, daily, i.p.). Results indicated that REM-SD delays the development of tolerance to morphine during both phases; however this effect was more potent following LSD. Moreover, LSD decreased the baseline thermal threshold and total withdrawal score. One possible hypothesis for our observations is REM-SD-induced attenuation of orexin system which is still controversial among the researchers. Other stronger possibilities might be down-regulation of opioid receptors in response to sleep loss experience. Finally, it seems that modification of sleep periods may assist to decrease the severity of opioid tolerance and dependence.
Collapse
Affiliation(s)
- S Mohammad Ahmadi-Soleimani
- Deparment of Physiology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Neuroscience Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Hossein Azizi
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Alireza Abbasi-Mazar
- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| |
Collapse
|
8
|
Pandey A, Oliver R, Kar SK. Differential Gene Expression in Brain and Liver Tissue of Wistar Rats after Rapid Eye Movement Sleep Deprivation. Clocks Sleep 2020; 2:442-465. [PMID: 33114225 PMCID: PMC7711450 DOI: 10.3390/clockssleep2040033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Sleep is essential for the survival of most living beings. Numerous researchers have identified a series of genes that are thought to regulate "sleep-state" or the "deprived state". As sleep has a significant effect on physiology, we believe that lack of total sleep, or particularly rapid eye movement (REM) sleep, for a prolonged period would have a profound impact on various body tissues. Therefore, using the microarray method, we sought to determine which genes and processes are affected in the brain and liver of rats following nine days of REM sleep deprivation. Our findings showed that REM sleep deprivation affected a total of 652 genes in the brain and 426 genes in the liver. Only 23 genes were affected commonly, 10 oppositely, and 13 similarly across brain and liver tissue. Our results suggest that nine-day REM sleep deprivation differentially affects genes and processes in the brain and liver of rats.
Collapse
Affiliation(s)
- Atul Pandey
- School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
- Department of Ecology, Evolution, and Behavior, The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
| | - Ryan Oliver
- Department of Ecology, Evolution, and Behavior, The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
| | - Santosh K Kar
- School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
- Nano Herb Research Laboratory, Kalinga Institute of Industrial Technology (KIIT) Technology Bio Incubator, Campus-11, KIIT Deemed to be University, Bhubaneswar, Odisha 751024, India
| |
Collapse
|
9
|
Herrero Babiloni A, De Koninck BP, Beetz G, De Beaumont L, Martel MO, Lavigne GJ. Sleep and pain: recent insights, mechanisms, and future directions in the investigation of this relationship. J Neural Transm (Vienna) 2019; 127:647-660. [DOI: 10.1007/s00702-019-02067-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022]
|
10
|
Ree A, Nilsen KB, Knardahl S, Sand T, Matre D. Sleep restriction does not potentiate nocebo‐induced changes in pain and cortical potentials. Eur J Pain 2019; 24:110-121. [DOI: 10.1002/ejp.1466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/30/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Anbjørn Ree
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine University of Oslo Oslo Norway
| | - Kristian Bernhard Nilsen
- Department of Neurology Oslo University Hospital Oslo Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI) Oslo University Hospital Oslo Norway
| | - Stein Knardahl
- Department of Work Psychology and Physiology National Institute of Occupational Health Oslo Norway
| | - Trond Sand
- Department of Neurology and Clinical Neurophysiology St. Olavs Hospital Trondheim Norway
- Department of Neuromedicine and movement science Norwegian University of Science and Technology Trondheim Norway
| | - Dagfinn Matre
- Department of Work Psychology and Physiology National Institute of Occupational Health Oslo Norway
| |
Collapse
|
11
|
Brain and psychological determinants of placebo pill response in chronic pain patients. Nat Commun 2018; 9:3397. [PMID: 30209286 PMCID: PMC6135815 DOI: 10.1038/s41467-018-05859-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 07/12/2018] [Indexed: 12/18/2022] Open
Abstract
The placebo response is universally observed in clinical trials of pain treatments, yet the individual characteristics rendering a patient a ‘placebo responder’ remain unclear. Here, in chronic back pain patients, we demonstrate using MRI and fMRI that the response to placebo ‘analgesic’ pills depends on brain structure and function. Subcortical limbic volume asymmetry, sensorimotor cortical thickness, and functional coupling of prefrontal regions, anterior cingulate, and periaqueductal gray were predictive of response. These neural traits were present before exposure to the pill and most remained stable across treatment and washout periods. Further, psychological traits, including interoceptive awareness and openness, were also predictive of the magnitude of response. These results shed light on psychological, neuroanatomical, and neurophysiological principles determining placebo response in RCTs in chronic pain patients, and they suggest that the long-term beneficial effects of placebo, as observed in clinical settings, are partially predictable. People vary in the extent to which they feel better after taking an inert, placebo, treatment, but the basis for individual placebo response is unclear. Here, the authors show how brain structural and functional variables, as well as personality traits, predict placebo response in those with chronic back pain.
Collapse
|
12
|
Flaten MA, Bjørkedal E, Lyby PS, Figenschau Y, Aslaksen PM. Failure to Find a Conditioned Placebo Analgesic Response. Front Psychol 2018; 9:1198. [PMID: 30104988 PMCID: PMC6077950 DOI: 10.3389/fpsyg.2018.01198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/21/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Associative learning has, in several studies, been modulated by the sex of the participant. Consistent with this, a recent review found that conditioned nocebo effects are stronger in females than in males. Purpose: It has been suggested that conditioned placebo responses are stronger in females, and this hypothesis was investigated in the present study. Cortisol and measures of negative emotions were taken to investigate if these processes could mediate any conditioned placebo effects. Methods: Cold pain was applied to the volar forearm. The Conditioned group received inert capsules prior to two presentations of less painful stimulations, to associate intake of the capsules with reduced pain. The pain control group received the same painful stimulation as the Conditioned group, but no capsules. The Capsule control group received the capsules in the same way as the Conditioned group, but no decrease in the painful stimulation. Participant sex was crossed across groups. It was hypothesized that in the Conditioned group, an expectation of reduced pain should be induced after administration of the capsules, and this should generate placebo analgesia, and mostly so in females. Results: The Conditioned group reported lower pain during conditioning, and rated the capsules as more effective painkillers than the capsule control group. However, placebo analgesia was not reliably observed in the Conditioned group. Conclusion: The placebo capsules were rated as effective painkillers, but this did not translate into a placebo analgesic effect. This could be due to violation of response expectancies, too few conditioning trials, and differences in pain ratings in the pre-test that could be due to previous experience with painkillers.
Collapse
Affiliation(s)
- Magne A Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Espen Bjørkedal
- Department of Psychology, University of Tromsø, Tromsø, Norway
| | - Peter S Lyby
- Department of Psychology, University of Tromsø, Tromsø, Norway
| | - Yngve Figenschau
- Department of Medical Biochemistry, University of Tromsø, Tromsø, Norway.,Department of Medical Biochemistry, University Hospital of North Norway, Tromsø, Norway
| | - Per M Aslaksen
- Department of Psychology, University of Tromsø, Tromsø, Norway
| |
Collapse
|
13
|
The Role of Sleep in Learning Placebo Effects. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 139:321-355. [DOI: 10.1016/bs.irn.2018.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
14
|
Lavigne G, Sessle B. The Neurobiology of Orofacial Pain and Sleep and Their Interactions. J Dent Res 2016; 95:1109-16. [DOI: 10.1177/0022034516648264] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article provides an overview of the neurobiology of orofacial pain as well as the neural processes underlying sleep, with a particular focus on the mechanisms that underlie pain and sleep interactions including sleep disorders. Acute pain is part of a hypervigilance system that alerts the individual to injury or potential injury of tissues. It can also disturb sleep. Disrupted sleep is often associated with chronic pain states, including those that occur in the orofacial region. The article presents many insights that have been gained in the last few decades into the peripheral and central mechanisms involved in orofacial pain and its modulation, as well as the circuits and processes in the central nervous system that underlie sleep. Although it has become clear that sleep is essential to preserve and maintain health, it has also been found that pain, particularly chronic pain, is commonly associated with disturbed sleep. In the presence of chronic pain, a circular relationship may prevail, with mutual deleterious influences causing an increase in pain and a disruption of sleep. This article also reviews findings that indicate that reducing orofacial pain and improving sleep need to be targeted together in the management of acute to chronic orofacial pain states in order to improve an orofacial pain patient’s quality of life, to prevent mood alterations or exacerbation of sleep disorder (e.g., insomnia, sleep-disordered breathing) that can negatively affect their pain, and to promote healing and optimize their health.
Collapse
Affiliation(s)
- G.J. Lavigne
- Faculties of Dental Medicine and Medicine, University of Montréal, Montréal, Québec, Canada
- Centre for Advanced Research in Sleep Medicine and Trauma Unit, Surgery Department, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - B.J Sessle
- Faculties of Dentistry and Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|