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Nanda U, Zhang G, Underhill D, Pangarkar S. Management of Pain and Headache After Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2024; 35:573-591. [PMID: 38945652 DOI: 10.1016/j.pmr.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This article will identify common causes of pain following traumatic brain injury (TBI), discuss current treatment strategies for these complaints, and help tailor treatments for both acute and chronic settings. We will also briefly discuss primary and secondary headache disorders, followed by common secondary pain disorders that may be related to trauma.
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Affiliation(s)
- Udai Nanda
- Department of Physical Medicine and Rehabilitation, Pain Management, Headache Center of Excellence, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Physical Medicine and Rehabilitation, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Grace Zhang
- Division of Physical Medicine and Rehabilitation, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - David Underhill
- Division of Physical Medicine and Rehabilitation, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Sanjog Pangarkar
- Division of Physical Medicine and Rehabilitation, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; Department of Physical Medicine and Rehabilitation, Pain Management, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Borna S, Haider CR, Maita KC, Torres RA, Avila FR, Garcia JP, De Sario Velasquez GD, McLeod CJ, Bruce CJ, Carter RE, Forte AJ. A Review of Voice-Based Pain Detection in Adults Using Artificial Intelligence. Bioengineering (Basel) 2023; 10:bioengineering10040500. [PMID: 37106687 PMCID: PMC10135816 DOI: 10.3390/bioengineering10040500] [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: 03/20/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Pain is a complex and subjective experience, and traditional methods of pain assessment can be limited by factors such as self-report bias and observer variability. Voice is frequently used to evaluate pain, occasionally in conjunction with other behaviors such as facial gestures. Compared to facial emotions, there is less available evidence linking pain with voice. This literature review synthesizes the current state of research on the use of voice recognition and voice analysis for pain detection in adults, with a specific focus on the role of artificial intelligence (AI) and machine learning (ML) techniques. We describe the previous works on pain recognition using voice and highlight the different approaches to voice as a tool for pain detection, such as a human effect or biosignal. Overall, studies have shown that AI-based voice analysis can be an effective tool for pain detection in adult patients with various types of pain, including chronic and acute pain. We highlight the high accuracy of the ML-based approaches used in studies and their limitations in terms of generalizability due to factors such as the nature of the pain and patient population characteristics. However, there are still potential challenges, such as the need for large datasets and the risk of bias in training models, which warrant further research.
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Affiliation(s)
- Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55902, USA
| | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ricardo A Torres
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
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Vlemincx E, Severs L, Ramirez JM. The psychophysiology of the sigh: II: The sigh from the psychological perspective. Biol Psychol 2022; 173:108386. [PMID: 35803439 DOI: 10.1016/j.biopsycho.2022.108386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 02/02/2023]
Abstract
A sigh is a distinct respiratory behavior with specific psychophysiological roles. In two accompanying reviews we will discuss the physiological and psychological functions of the sigh. The present review will focus on the psychological functions of the sigh. We discuss the regulatory effects of a sigh, and argue how these effects may become maladaptive when sighs occur excessively. The adaptive role of a sigh is discussed in the context of regulation of psychophysiological states. We propose that sighs facilitate transitions from one psychophysiological state to the next, and this way contribute to psychophysiological flexibility, via a hypothesized resetting mechanism. We discuss how a sigh resets respiration, by controlling mechanical and metabolic properties of respiration associated with respiratory symptoms. Next, we elaborate on a sigh resetting emotional states by facilitating emotional transitions. We attempt to explain the adaptive and maladaptive functions of a sigh in the framework of stochastic resonance, in which we propose occasional, spontaneous sighs to be noise contributing to psychophysiological regulation, while excessive sighs result in psychophysiological dysregulation. In this context, we discuss how sighs can contribute to therapeutic interventions, either by increasing sighs to improve regulation in case of a lack of sighing, or by decreasing sighs to restore regulation in case of excessive sighing. Finally, a research agenda on the psychology of sighs is presented.
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Affiliation(s)
- Elke Vlemincx
- Department of Health Sciences, Vrije Universiteit Amsterdam, The Netherlands; Health Psychology, KU Leuven, Belgium.
| | - Liza Severs
- Center for Integrative Brain Research, Seattle Children's Research Institute, USA; Department of Neurological Surgery, Department of Physiology and Biophysics, School of Medicine, University of Washington, USA
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, USA; Department of Neurological Surgery, Department of Physiology and Biophysics, School of Medicine, University of Washington, USA
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Kvolik S, Koruga N, Skiljic S. Analgesia in the Neurosurgical Intensive Care Unit. Front Neurol 2022; 12:819613. [PMID: 35185756 PMCID: PMC8848763 DOI: 10.3389/fneur.2021.819613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Acute pain in neurosurgical patients is an important issue. Opioids are the most used for pain treatment in the neurosurgical ICU. Potential side effects of opioid use such as oversedation, respiratory depression, hypercapnia, worsening intracranial pressure, nausea, and vomiting may be problems and could interfere with neurologic assessment. Consequently, reducing opioids and use of non-opioid analgesics and adjuvants (N-methyl-D-aspartate antagonists, α2 -adrenergic agonists, anticonvulsants, corticosteroids), as well as non-pharmacological therapies were introduced as a part of a multimodal regimen. Local and regional anesthesia is effective in opioid reduction during the early postoperative period. Among non-opioid agents, acetaminophen and non-steroidal anti-inflammatory drugs are used frequently. Adverse events associated with opioid use in neurosurgical patients are discussed. Larger controlled studies are needed to find optimal pain management tailored to neurologically impaired neurosurgical patients.
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Affiliation(s)
- Slavica Kvolik
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Anesthesiology and Critical Care, Osijek University Hospital, Osijek, Croatia
- *Correspondence: Slavica Kvolik
| | - Nenad Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Neurosurgery, Osijek University Hospital, Osijek, Croatia
| | - Sonja Skiljic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Anesthesiology and Critical Care, Osijek University Hospital, Osijek, Croatia
- Sonja Skiljic
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Abstract
Breathing is a critical, complex, and highly integrated behavior. Normal rhythmic breathing, also referred to as eupnea, is interspersed with different breathing related behaviors. Sighing is one of such behaviors, essential for maintaining effective gas exchange by preventing the gradual collapse of alveoli in the lungs, known as atelectasis. Critical for the generation of both sighing and eupneic breathing is a region of the medulla known as the preBötzinger Complex (preBötC). Efforts are underway to identify the cellular pathways that link sighing as well as sneezing, yawning, and hiccupping with other brain regions to better understand how they are integrated and regulated in the context of other behaviors including chemosensation, olfaction, and cognition. Unraveling these interactions may provide important insights into the diverse roles of these behaviors in the initiation of arousal, stimulation of vigilance, and the relay of certain behavioral states. This chapter focuses primarily on the function of the sigh, how it is locally generated within the preBötC, and what the functional implications are for a potential link between sighing and cognitive regulation. Furthermore, we discuss recent insights gained into the pathways and mechanisms that control yawning, sneezing, and hiccupping.
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Helmer LM, Weijenberg RA, de Vries R, Achterberg WP, Lautenbacher S, Sampson EL, Lobbezoo F. Crying out in pain-A systematic review into the validity of vocalization as an indicator for pain. Eur J Pain 2020; 24:1703-1715. [PMID: 32573041 PMCID: PMC7587015 DOI: 10.1002/ejp.1623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 06/14/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Vocalization is often used to assess pain, sometimes combined with other behaviours such as facial expressions. Contrary to facial expressions, however, for vocalization, there is little evidence available on the association with pain. The aim of this systematic review was to critically analyse the association between vocalization and pain, to explore if vocalizations can be used as a "stand-alone" indicator for pain. METHODS The search was performed according to the Prisma Guidelines for systematic reviews and meta-analysis. The following terms were used: "Pain Measurement," "Vocalization" and "Verbalization." The study population included verbal and non-verbal individuals, including older people and children. The search was performed in three different databases: PubMed, Embase and CINAHL. A total of 35 studies were selected for detailed investigation. Quality assessments were made using two grading systems: Grading of Recommendations Assessment Development and Evaluation system and the Newcastle-Ottawa scale. RESULTS An association between vocalization and pain was found in most studies, particularly when different types of vocalizations were included in the investigation. Different types of vocalization, but also different types of pain, shape this association. The association is observed within all groups of individuals, although age, amongst others, may have an influence on preferred type of vocalization. CONCLUSIONS There is an association between vocalization and pain. However, vocalization as a "stand-alone" indicator for pain indicates only a limited aspect of this multifactorial phenomenon. Using vocalization as an indicator for pain may be more reliable if other pain indicators are also taken into account. SIGNIFICANCE Vocalizations are frequently used in pain scales, although not yet thoroughly investigated as a "single indicator" for pain, like, e.g. facial expression. This review confirms the role of vocalizations in pain scales, and stresses that vocalizations might be more reliable if used in combination with other pain indicators.
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Affiliation(s)
- Loreine M.L. Helmer
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Roxane A.F. Weijenberg
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ralph de Vries
- Medical LibraryVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Wilco P. Achterberg
- Department of Public Health and Primary careLeiden University Medical CentreLeidenThe Netherlands
| | | | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUniversity College LondonLondonUK
| | - Frank Lobbezoo
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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