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Hamadeh S, Lambert GW, Willetts G, Garvey L. Pain management of adult sedated and ventilated patients in the intensive care units: A survey with free text responses. Intensive Crit Care Nurs 2024; 84:103770. [PMID: 39032213 DOI: 10.1016/j.iccn.2024.103770] [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: 11/30/2023] [Revised: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Pain management of sedated and ventilated patients in intensive care units lacks consistency. OBJECTIVES To investigate nurses' training, governance, practices, knowledge and attitudes relating to pain management in consideration of published guidelines and explore nurses' perspectives. METHODS A survey design, using an online questionnaire with free text responses, was employed. Quantitative and qualitative data from nurses working across different hospitals were collated and saved on Qualtrics platform. Quantitative data were analysed non-parametrically and narrative responses thematically. CROSS and SRQR reporting guidelines were adhered to. OUTCOME MEASURES Demographics, training, governance, clinical practice, knowledge, and attitudes. RESULTS/FINDINGS 108 nurses participated with ninety-two completed surveys analysed. Analgesia was used to complete nursing tasks regardless of comfort needs (n = 49, 53.3 %). Changes in vital signs prompted opioid administration (n = 48, 52.1 %). Choice of analgesia depended on doctor's preference (n = 63, 68.5 %). Non-opioid therapy was administered before opioids (n = 42, 45.7 %). Sedatives were used to alleviate agitation(n = 50,54.3 %). No statistically significant difference in nurses' knowledge existed between hospitals. Weak positive relationship: r = [0.081], p = [0.441] between "knowledge scores" and "years of ICU experience" and weak negative relationship r = [-0.119], p = [0.260] between "knowledge scores" and "hours of clinical practice" was detected. Lack of training, resources, policies, high patient acuity and casual employment were acknowledged barriers to pain management. Two overarching themes emerged from narrative responses: "Pain assessment, where is it?" And "Priorities of critical illness." CONCLUSION The study uncovered pain management situation and examined nurses' demographics, training, governance, practices, knowledge and attitudes. Narrative responses highlighted barriers to pain management. IMPLICATIONS FOR CLINICAL PRACTICE Health organisations should provide education, institute governance and develop policies to inform pain management. Nurses' role encompasses updating knowledge, adhering to interventions and overcoming biases. This subsequently manifests as improvement in patient outcomes.
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Affiliation(s)
- Samira Hamadeh
- Institute of Health and Wellbeing, Federation University, Australia. https://federation.edu.au/
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia. https://twitter.com/glamb30004
| | - Georgina Willetts
- Institute of Health and Wellbeing, Federation University, Australia. https://twitter.com/GeorgiWilletts
| | - Loretta Garvey
- Assessment Transformation, Federation University, Australia. https://twitter.com/LorettaGarvey
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Stearns SA, Xun H, Haddad A, Rinkinen J, Bustos VP, Lee BT. Therapeutic Options for Migraines in the Microsurgical Patient: A Scoping Review. Plast Reconstr Surg 2024; 153:988e-1001e. [PMID: 37337332 DOI: 10.1097/prs.0000000000010861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND There exists an increasing array of treatments proposed to prevent, alleviate, and abort symptoms of a migraine; however, for patients who undergo reconstructive microsurgery, caution must be taken to preserve vascular integrity. This study is the first-to-date scoping review of vascular and bleeding risk of current migraine therapies, with the purpose of identifying potential therapeutic agents for postoperative migraine management appropriate for microsurgical patients. METHODS Currently available migraine therapeutics were compiled from the UpToDate software system and the American Academy of Family Physicians. A PubMed literature review was performed for each therapeutic's effect on bleeding or vascular involvement. Data were compiled into tables of abortive, symptom-controlling and prophylactic, and nonpharmacologic treatments. Expert microsurgeons reviewed the data to provide recommendations for optimized patient care. RESULTS Triptans and other ergot derivatives demonstrated strong evidence of vasoconstriction and were greatly advised against for immediate postmicrosurgical use. Novel pharmaceutical therapies such as lasmiditan and calcitonin gene-related peptide antagonists have no literature indicating potential for vasoconstriction or hematoma and remain an investigational option for abortive medical treatment. For symptom control, acetaminophen appears the safest option, with clinical judgment and further research needed for use of nonsteroidal antiinflammatory drugs. Alternative treatment techniques may include migraine prophylaxis with botulinum toxin injection or nutraceutical treatment by means of magnesium supplementation or coenzyme Q10 administration, minimizing the need for additional medication in the postoperative setting. CONCLUSIONS Patients undergoing reconstructive microsurgery have a unique medical profile limiting the therapeutic options available to treat migraines. This review provides preliminary evidence to be considered as a guide for prescribing therapeutics for migraine in the postoperative setting.
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Affiliation(s)
| | - Helen Xun
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Anthony Haddad
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Jacob Rinkinen
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Valeria P Bustos
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Bernard T Lee
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
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3
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Jia J, Chen T, Chen C, Si T, Gao C, Fang Y, Sun J, Wang J, Zhang Z. Astrocytes in preoptic area regulate acute nociception-induced hypothermia through adenosine receptors. CNS Neurosci Ther 2024; 30:e14726. [PMID: 38715251 PMCID: PMC11076694 DOI: 10.1111/cns.14726] [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] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/27/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024] Open
Abstract
AIMS The preoptic area (POA) of the hypothalamus, crucial in thermoregulation, has long been implicated in the pain process. However, whether nociceptive stimulation affects body temperature and its mechanism remains poorly studied. METHODS We used capsaicin, formalin, and surgery to induce acute nociceptive stimulation and monitored rectal temperature. Optical fiber recording, chemical genetics, confocal imaging, and pharmacology assays were employed to confirm the role and interaction of POA astrocytes and extracellular adenosine. Immunofluorescence was utilized for further validation. RESULTS Acute nociception could activate POA astrocytes and induce a decrease in body temperature. Manipulation of astrocytes allowed bidirectional control of body temperature. Furthermore, acute nociception and astrocyte activation led to increased extracellular adenosine concentration within the POA. Activation of adenosine A1 or A2A receptors contributed to decreased body temperature, while inhibition of these receptors mitigated the thermo-lowering effect of astrocytes. CONCLUSION Our results elucidate the interplay between acute nociception and thermoregulation, specifically highlighting POA astrocyte activation. This enriches our understanding of physiological responses to painful stimuli and contributes to the analysis of the anatomical basis involved in the process.
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Affiliation(s)
- Junke Jia
- Department of Anesthesiology, Zhongnan HospitalWuhan UniversityWuhanChina
| | - Ting Chen
- Department of Anesthesiology, Zhongnan HospitalWuhan UniversityWuhanChina
| | - Chang Chen
- Department of Anesthesiology, Zhongnan HospitalWuhan UniversityWuhanChina
| | - Tengxiao Si
- Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and TechnologyChinese Academy of SciencesWuhanChina
| | - Chenyi Gao
- Department of Anesthesiology, Zhongnan HospitalWuhan UniversityWuhanChina
| | - Yuanyuan Fang
- Department of Anesthesiology, Zhongnan HospitalWuhan UniversityWuhanChina
| | - Jiahui Sun
- Department of Anesthesiology, Zhongnan HospitalWuhan UniversityWuhanChina
| | - Jie Wang
- Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and TechnologyChinese Academy of SciencesWuhanChina
- Institute of Neuroscience and Brain Diseases, Xiangyang Central HospitalAffiliated Hospital of Hubei University of Arts and ScienceXiangyangChina
- Shanghai Key Laboratory of Emotions and Affective Disorders, Shanghai Jiao Tong University School of MedicineSongjiang Hospital and Songjiang Research InstituteShanghaiChina
| | - Zongze Zhang
- Department of Anesthesiology, Zhongnan HospitalWuhan UniversityWuhanChina
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Hassanpour S, Algitami H, Umraw M, Merletti J, Keast B, Stroman PW. Investigating Descending Pain Regulation in Fibromyalgia and the Link to Altered Autonomic Regulation by Means of Functional MRI Data. Brain Sci 2024; 14:450. [PMID: 38790429 PMCID: PMC11118798 DOI: 10.3390/brainsci14050450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/15/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Fibromyalgia syndrome (FM) is a chronic pain condition that affects a significant portion of the population; yet, this condition is still poorly understood. Prior research has suggested that individuals with FM display a heightened sensitivity to pain and signs of autonomic dysfunction. Recent advances in functional MRI analysis methods to model blood-oxygenation-level-dependent (BOLD) responses across networks of regions, and structural and physiological modeling (SAPM) have shown the potential to provide more detailed information about altered neural activity than was previously possible. Therefore, this study aimed to apply novel analysis methods to investigate altered neural processes underlying pain sensitivity in FM in functional magnetic resonance imaging (fMRI) data from the brainstem and spinal cord. Prior fMRI studies have shown evidence of functional differences in fibromyalgia (FM) within brain regions associated with pain's motivational aspects, as well as differences in neural activity related to pain regulation, arousal, and autonomic homeostatic regulation within the brainstem and spinal cord regions. We, therefore, hypothesized that nociceptive processing is altered in FM compared to healthy controls (HCs) in the brainstem and spinal cord areas linked to autonomic function and descending pain regulation, including the parabrachial nuclei (PBN) and nucleus tractus solitarius (NTS). We expected that new details of this altered neural signaling would be revealed with SAPM. The results provide new evidence of altered neural signaling in FM related to arousal and autonomic homeostatic regulation. This further advances our understanding of the altered neural processing that occurs in women with FM.
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Affiliation(s)
- Shima Hassanpour
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (S.H.); (H.A.); (M.U.); (J.M.); (B.K.)
| | - Hannan Algitami
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (S.H.); (H.A.); (M.U.); (J.M.); (B.K.)
| | - Maya Umraw
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (S.H.); (H.A.); (M.U.); (J.M.); (B.K.)
| | - Jessica Merletti
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (S.H.); (H.A.); (M.U.); (J.M.); (B.K.)
| | - Brieana Keast
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (S.H.); (H.A.); (M.U.); (J.M.); (B.K.)
| | - Patrick W. Stroman
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON K7L 3N6, Canada; (S.H.); (H.A.); (M.U.); (J.M.); (B.K.)
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
- Department of Physics, Queen’s University, Kingston, ON K7L 3N6, Canada
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Jeong J, Hu Y, Zanuzzi M, DaCosta D, Li S, Park J. Autonomic Modulation with Mindfulness-Based Stress Reduction in Chronic Kidney Disease: A Randomized Controlled Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.17.24306000. [PMID: 38699306 PMCID: PMC11065017 DOI: 10.1101/2024.04.17.24306000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Chronic kidney disease (CKD) is characterized by overactivation of the sympathetic nervous system (SNS) that leads to increased cardiovascular disease risk. Despite the deleterious consequences of SNS overactivity, there are very few therapeutic options available to combat sympathetic overactivity. Aim To evaluate the effects of Mindfulness-Based Stress Reduction (MBSR) on SNS activity in CKD patients. Method Participants with CKD stages III-IV were randomized to an 8-week MBSR program or Health Education Program (HEP; a structurally parallel, active control group). Primary outcomes were direct intraneural measures of SNS activity directed to muscle (MSNA) via microneurography at rest and during stress maneuvers. Results 28 participants (63 ±9 years; 86% males) completed the intervention with 16 in MBSR and 12 in HEP. There was a significant Group (MBSR vs. HEP) by Time (baseline vs. post-intervention) interaction in the change in MSNA reactivity to mental stress (p=0.026), with a significant reduction in the mean change in MSNA over 3 minutes of mental arithmetic at post-intervention (10.6 ± 7.1 to 5.0 ± 5.7 bursts/min, p<0.001), while no change was observed within the HEP group (p=0.773). Conclusions In this randomized controlled trial, patients with CKD had an amelioration of sympathetic reactivity during mental stress following 8-weeks of MBSR but not after HEP. Our findings demonstrate that mindfulness training is feasible and may have clinically beneficial effects on autonomic function in CKD.
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Affiliation(s)
- Jinhee Jeong
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Yingtian Hu
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Matias Zanuzzi
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Dana DaCosta
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Sabrina Li
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Veterans Affairs Health Care System, Decatur, Georgia
- Center for Visual and Neurocognitive Rehabilitation, Department of Veterans Affairs Health Care System, Decatur, Georgia, USA
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Xu Z, Anai R, Hirano H, Soh Z, Tsuji T. Noninvasive characterization of peripheral sympathetic activation across sensory stimuli using a peripheral arterial stiffness index. Front Physiol 2024; 14:1294239. [PMID: 38260092 PMCID: PMC10801023 DOI: 10.3389/fphys.2023.1294239] [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: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction: The peripheral arterial stiffness index has been proposed and validated as a noninvasive measure quantifying stimulus intensity based on amplitude changes induced by sympathetic innervation of vascular tone. However, its temporal response characteristics remain unclear, thus hindering continuous and accurate monitoring of the dynamic process of sympathetic activation. This paper presents a study aimed at modeling the transient response of the index across sensory stimuli to characterize the corresponding peripheral sympathetic activation. Methods: The index was measured using a continuous arterial pressure monitor and a pulse oximeter during experiments with local pain and local cooling stimuli designed to elicit different patterns of sympathetic activation. The corresponding response of the index was modeled to clarify its transient response characteristics across stimuli. Results: The constructed transfer function accurately depicted the transient response of the index to local pain and local cooling stimuli (Fit percentage: 78.4% ± 11.00% and 79.92% ± 8.79%). Differences in dead time (1.17 ± 0.67 and 0.99 ± 0.56 s, p = 0.082), peak time (2.89 ± 0.81 and 2.64 ± 0.68 s, p = 0.006), and rise time (1.81 ± 0.50 and 1.65 ± 0.48 s, p = 0.020) revealed different response patterns of the index across stimuli. The index also accurately characterized similar vasomotor velocities at different normalized peak amplitudes (0.19 ± 0.16 and 0.16 ± 0.19 a.u., p = 0.007). Discussion: Our findings flesh out the characterization of peripheral arterial stiffness index responses to different sensory stimuli and demonstrate its validity in characterizing peripheral sympathetic activation. This study valorizes a noninvasive method to characterize peripheral sympathetic activation, with the potential to use this index to continuously and accurately track sympathetic activators.
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Affiliation(s)
- Ziqiang Xu
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Reiji Anai
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Harutoyo Hirano
- Department of Medical Equipment Engineering, Clinical Collaboration Unit, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Zu Soh
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
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Dilrukshi EAC, Nishiyama Y, Ito K, Nomura S. Alleviation of acute stress response by black pepper aroma administration. J Physiol Anthropol 2024; 43:3. [PMID: 38167228 PMCID: PMC10759736 DOI: 10.1186/s40101-023-00352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Black pepper is one of the most popular spices globally. As black pepper essential oil has not yet been used in the context of aromatherapy, this study examined the effect of black pepper aroma on cardiac and peripheral autonomic nervous system (ANS) activity under stressful conditions using an olfactometer to administer aroma in a precise and controlled manner to ensure reproducibility. METHODS A within-participant design experiment was conducted with 20 male university students who performed a 30-min calculation task as a short-term stressor under three aroma conditions: black pepper, ginger, and dipropylene glycol (DPG) (scentless air as a control). Each aroma was sporadically delivered (first 20 s of each 1-min interval) with the olfactometer during the task. Electrocardiograms and skin conductance level (SCL) were measured to evaluate ANS's physiological acute stress response. Subjective evaluations for the given stressful task and impressions on the types of aromas were assessed. RESULTS The physiological acute stress response induced by the short-term stressor, which is characterized by the enhancement of the heart rate (HR) and SCL and decreases in the heart rate variability (HRV), was suppressed with black pepper: the increase in HR and reduction in HRV from the baseline were 38.9% (p = 0.048 when compared with DPG) and 32.9% smaller (p = 0.002 for multiple comparisons) than those in DPG, respectively, and the increase of SCL was 15.5% smaller (p = 0.005 for multiple comparisons) than that in ginger. However, there was no significant difference in subjective scores among the conditions. CONCLUSION Although black pepper is a stimulative agent, the study findings showed that black pepper aroma alleviated the physiological acute stress response, which can be beneficial in aromatherapy under stressful conditions.
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Affiliation(s)
- E A Chayani Dilrukshi
- Graduate School of Engineering, Nagaoka University of Technology, Nagaoka, Niigata, 940-2188, Japan
- Department of Industrial Management, Faculty of Applied Sciences, Wayamba University of Sri Lanka, Kuliyapitiya, 60200, Sri Lanka
| | - Yuta Nishiyama
- Graduate School of Engineering, Nagaoka University of Technology, Nagaoka, Niigata, 940-2188, Japan
| | - Kanetoshi Ito
- Corporate Research & Development, Takasago International Corporation, Hiratsuka, Kanagawa, 254-0073, Japan
| | - Shusaku Nomura
- Graduate School of Engineering, Nagaoka University of Technology, Nagaoka, Niigata, 940-2188, Japan.
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Xian H, Guo H, Liu YY, Zhang JL, Hu WC, Yu MJ, Zhao R, Xie RG, Zhang H, Cong R. Peripheral BDNF Regulates Somatosensory-Sympathetic Coupling in Brachial Plexus Avulsion-Induced Neuropathic Pain. Neurosci Bull 2023; 39:1789-1806. [PMID: 37335428 PMCID: PMC10661543 DOI: 10.1007/s12264-023-01075-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/19/2023] [Indexed: 06/21/2023] Open
Abstract
Brachial plexus avulsion (BPA) is a combined injury involving the central and peripheral nervous systems. Patients with BPA often experience severe neuropathic pain (NP) in the affected limb. NP is insensitive to the existing treatments, which makes it a challenge to researchers and clinicians. Accumulated evidence shows that a BPA-induced pain state is often accompanied by sympathetic nervous dysfunction, which suggests that the excitation state of the sympathetic nervous system is correlated with the existence of NP. However, the mechanism of how somatosensory neural crosstalk with the sympathetic nerve at the peripheral level remains unclear. In this study, through using a novel BPA C7 root avulsion mouse model, we found that the expression of BDNF and its receptor TrκB in the DRGs of the BPA mice increased, and the markers of sympathetic nervous system activity including α1 and α2 adrenergic receptors (α1-AR and α2-AR) also increased after BPA. The phenomenon of superexcitation of the sympathetic nervous system, including hypothermia and edema of the affected extremity, was also observed in BPA mice by using CatWalk gait analysis, an infrared thermometer, and an edema evaluation. Genetic knockdown of BDNF in DRGs not only reversed the mechanical allodynia but also alleviated the hypothermia and edema of the affected extremity in BPA mice. Further, intraperitoneal injection of adrenergic receptor inhibitors decreased neuronal excitability in patch clamp recording and reversed the mechanical allodynia of BPA mice. In another branch experiment, we also found the elevated expression of BDNF, TrκB, TH, α1-AR, and α2-AR in DRG tissues from BPA patients compared with normal human DRGs through western blot and immunohistochemistry. Our results revealed that peripheral BDNF is a key molecule in the regulation of somatosensory-sympathetic coupling in BPA-induced NP. This study also opens a novel analgesic target (BDNF) in the treatment of this pain with fewer complications, which has great potential for clinical transformation.
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Affiliation(s)
- Hang Xian
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, 710032, China
| | - Huan Guo
- Pain and Related Diseases Research Laboratory, Medical College of Shantou University, Shantou, 515041, China
- Department of Neurobiology, School of Basic Medicine, The Air Force Medical University, Xi'an, 710032, China
| | - Yuan-Ying Liu
- School of Life Science and Research Center for Resource Peptide Drugs, Shaanxi Engineering and Technological Research Center for Conversation and Utilization of Regional Biological Resources, Yanan University, Yanan, 716000, China
- Department of Neurobiology, School of Basic Medicine, The Air Force Medical University, Xi'an, 710032, China
| | - Jian-Lei Zhang
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, 710032, China
| | - Wen-Chao Hu
- Department of Neurobiology, School of Basic Medicine, The Air Force Medical University, Xi'an, 710032, China
- The Sixth Regiment, School of Basic Medicine, The Air Force Medical University, Xi'an, 710032, China
| | - Ming-Jun Yu
- The Tenth Squadron of the Third Regiment, School of Basic Medicine, The Air Force Medical University, Xi'an, 710032, China
| | - Rui Zhao
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, 710032, China
| | - Rou-Gang Xie
- Department of Neurobiology, School of Basic Medicine, The Air Force Medical University, Xi'an, 710032, China.
| | - Hang Zhang
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, 710032, China.
| | - Rui Cong
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, 710032, China.
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Rodriguez ST, Makarewicz N, Wang EY, Zuniga-Hernandez M, Titzler J, Jackson C, Suen MY, Rosales O, Caruso TJ. Virtual reality facilitated exercise improves pain perception: A crossover study. J Clin Anesth 2023; 91:111257. [PMID: 37708601 DOI: 10.1016/j.jclinane.2023.111257] [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: 04/07/2023] [Revised: 07/26/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
STUDY OBJECTIVE Both virtual reality (VR) and exercise are recognized for their analgesic and anxiolytic properties. The purpose of this study is to evaluate the ability of VR-facilitated exercise to modulate pain. DESIGN Within-subject cross-over clinical trial. SETTING The Stanford Chariot Program conducted this study at Lucile Packard Children's Hospital Stanford (LCPHS). PATIENTS Healthy participants meeting inclusion criteria were recruited by volunteer solicitation from LCPHS. INTERVENTIONS Participants were randomized by hand dominance and subjected to a standardized cold pressor test with no VR or exercise. After a 5-min wash-out period, participants repeated the test on their other hand while experiencing a VR-facilitated exercise condition. Pain sensitivity, pain tolerance, and sympathetic activation data were collected during both conditions. MEASUREMENTS Pain sensitivity was scored 0-10 and collected every 30 s. Pain tolerance was recorded as the duration a participant could endure the painful stimuli. Sympathetic activation was measured by skin conductance response density (SCRD) and recorded in 30 s epochs by a biosensor. In all analyses, data were nested by participant. MAIN RESULTS Forty-one participants completed both interventions. Pain sensitivity was reduced in the VR-facilitated exercise condition (p < 0.0001). There was no difference in pain tolerance between conditions. While both conditions resulted in an increase in sympathetic activity, SCRD was higher at all time points in the VR-facilitated exercise condition. CONCLUSIONS The reduction in pain sensitivity indicates VR-facilitated exercise results in improved pain perception. VR-facilitated exercise may be especially useful for patients with chronic pain or other conditions requiring physical therapy, where pain may be exacerbated by exercise.
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Affiliation(s)
- Samuel T Rodriguez
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Nathan Makarewicz
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA; Stanford University School of Medicine, Stanford, CA, USA
| | - Ellen Y Wang
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Michelle Zuniga-Hernandez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Janet Titzler
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Christian Jackson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Man Yee Suen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Oswaldo Rosales
- Stanford University Graduate School of Education, Stanford, CA, USA
| | - Thomas J Caruso
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA.
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10
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Fernandez Rojas R, Hirachan N, Brown N, Waddington G, Murtagh L, Seymour B, Goecke R. Multimodal physiological sensing for the assessment of acute pain. FRONTIERS IN PAIN RESEARCH 2023; 4:1150264. [PMID: 37415829 PMCID: PMC10321707 DOI: 10.3389/fpain.2023.1150264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023] Open
Abstract
Pain assessment is a challenging task encountered by clinicians. In clinical settings, patients' self-report is considered the gold standard in pain assessment. However, patients who are unable to self-report pain are at a higher risk of undiagnosed pain. In the present study, we explore the use of multiple sensing technologies to monitor physiological changes that can be used as a proxy for objective measurement of acute pain. Electrodermal activity (EDA), photoplethysmography (PPG), and respiration (RESP) signals were collected from 22 participants under two pain intensities (low and high) and on two different anatomical locations (forearm and hand). Three machine learning models were implemented, including support vector machines (SVM), decision trees (DT), and linear discriminant analysis (LDA) for the identification of pain. Various pain scenarios were investigated, identification of pain (no pain, pain), multiclass (no pain, low pain, high pain), and identification of pain location (forearm, hand). Reference classification results from individual sensors and from all sensors together were obtained. After feature selection, results showed that EDA was the most informative sensor in the three pain conditions, 93.2±8% in identification of pain, 68.9±10% in the multiclass problem, and 56.0±8% for the identification of pain location. These results identify EDA as the superior sensor in our experimental conditions. Future work is required to validate the obtained features to improve its feasibility in more realistic scenarios. Finally, this study proposes EDA as a candidate to design a tool that can assist clinicians in the assessment of acute pain of nonverbal patients.
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Affiliation(s)
- Raul Fernandez Rojas
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
| | - Niraj Hirachan
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
| | - Nicholas Brown
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gordon Waddington
- Australian Institute of Sport, Canberra, ACT, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, ACT, Australia
| | - Luke Murtagh
- Department of Anaesthesia, Pain and Perioperative Medicine, The Canberra Hospital, Canberra, ACT, Australia
| | - Ben Seymour
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, John Radcliffe Hospital, Headington, UK
- Oxford Institute for Biomedical Engineering, University of Oxford, Headington, UK
| | - Roland Goecke
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
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Mohamed AA, Khaled E, Hesham A, Khalf A. Effectiveness and safety of subthreshold vibration over suprathreshold vibration in treatment of muscle fatigue in elderly people. World J Clin Cases 2023; 11:3434-3443. [PMID: 37383890 PMCID: PMC10294188 DOI: 10.12998/wjcc.v11.i15.3434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/29/2023] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Muscle fatigue is common in many populations, particularly elderlies. Aging increases the incidence of muscle fatigue and delays its recovery. There is a huge debate about the current treatments for muscle fatigue, particularly in elderlies. Recently, it has been discovered that mechanoreceptors have an important role as a sensory system in sensing muscle fatigue which could enhance the body's response to muscle fatigue. The function of mechanoreceptors could be enhanced by applying either suprathreshold or subthreshold vibration. Although suprathreshold vibration improves muscle fatigue, it can cause desensitization of cutaneous receptors, discomfort, and paresthesia, which are barriers to clinical use. Subthreshold vibration has been approved as a safe and effective method of training for mechanoreceptors; however, its use and effectiveness in muscle fatigue have never been tested or explained. Possible physiological effects of subthreshold vibration in the treatment of muscle fatigue include: (1) Enhancing the function of mechanoreceptors themselves; (2) Increasing the firing rate and function of alpha motor neurons; (3) Increasing blood flow to fatigued muscles; (4) Decreasing the rate of muscle cell death in elderlies (sarcopenia); and (5) Driving motor commands and allow better performance of muscles to decrease fatigue incidence. In conclusion, the use of subthreshold vibration could be a safe and effective treatment for muscle fatigue in elderlies. It could enhance recovery from muscle fatigue. Finally, Subthreshold Vibration is safe and effective in treating muscle fatigue in comparison to suprathreshold vibration.
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Affiliation(s)
- Ayman A Mohamed
- Physical Therapy, Nahda University, Beni Suef 23435, Egypt
- Physical Therapy, Beni-Suef University, Beni Suef 32456, Egypt
| | - Esraa Khaled
- Physical Therapy, Nahda University, Beni Suef 23435, Egypt
| | - Asmaa Hesham
- Physical Therapy, Nahda University, Beni Suef 23435, Egypt
| | - Ahmed Khalf
- Physical Therapy, Nahda University, Beni Suef 23435, Egypt
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12
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Fernandez Rojas R, Brown N, Waddington G, Goecke R. A systematic review of neurophysiological sensing for the assessment of acute pain. NPJ Digit Med 2023; 6:76. [PMID: 37100924 PMCID: PMC10133304 DOI: 10.1038/s41746-023-00810-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/30/2023] [Indexed: 04/28/2023] Open
Abstract
Pain is a complex and personal experience that presents diverse measurement challenges. Different sensing technologies can be used as a surrogate measure of pain to overcome these challenges. The objective of this review is to summarise and synthesise the published literature to: (a) identify relevant non-invasive physiological sensing technologies that can be used for the assessment of human pain, (b) describe the analytical tools used in artificial intelligence (AI) to decode pain data collected from sensing technologies, and (c) describe the main implications in the application of these technologies. A literature search was conducted in July 2022 to query PubMed, Web of Sciences, and Scopus. Papers published between January 2013 and July 2022 are considered. Forty-eight studies are included in this literature review. Two main sensing technologies (neurological and physiological) are identified in the literature. The sensing technologies and their modality (unimodal or multimodal) are presented. The literature provided numerous examples of how different analytical tools in AI have been applied to decode pain. This review identifies different non-invasive sensing technologies, their analytical tools, and the implications for their use. There are significant opportunities to leverage multimodal sensing and deep learning to improve accuracy of pain monitoring systems. This review also identifies the need for analyses and datasets that explore the inclusion of neural and physiological information together. Finally, challenges and opportunities for designing better systems for pain assessment are also presented.
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Affiliation(s)
- Raul Fernandez Rojas
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia.
| | - Nicholas Brown
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gordon Waddington
- Australian Institute of Sport, Canberra, ACT, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, ACT, Australia
| | - Roland Goecke
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
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13
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TRPV1 is involved in abdominal hyperalgesia in a mouse model of lipopolysaccharide-induced peritonitis and influences the immune response via peripheral noradrenergic neurons. Life Sci 2023; 317:121472. [PMID: 36750138 DOI: 10.1016/j.lfs.2023.121472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/12/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
AIMS The transient receptor potential vanilloid subfamily 1 (TRPV1) not only plays a role as a nociceptor but also has some regulatory effects on the immune system. We investigated the effects of TRPV1 on abdominal pain and the immune system in lipopolysaccharide (LPS)-induced peritonitis and the association between TRPV1 and peripheral noradrenergic neurons. MAIN METHODS Experiments were performed in 8- to 14-week-old male wild-type (WT) and TRPV1 knockout (KO) mice. The mice were intraperitoneally injected with a non-lethal dose of LPS. Pain assessment and investigation of changes in the immune system were performed. Denervation of sympathetic nerves and the noradrenergic splenic nerve was induced by intraperitoneal administration of 6-hydroxydopamine. KEY FINDINGS The levels of serum cytokines were not significantly different in WT mice and TRPV1 KO mice. Abdominal mechanical hyperalgesia was greater in WT mice than in TRPV1 KO mice from 6 h to 3 days. The numbers of macrophages, neutrophils, dendritic cells, and CD4 T cells in the spleens of TRPV1 KO mice were significantly increased compared to those in WT mice 4 days after LPS administration. By noradrenergic denervation, the numbers of those cells in WT mice increased to levels comparable to those in TRPV1 KO mice. SIGNIFICANCE In LPS-induced peritonitis, abdominal inflammatory pain was transmitted via TRPV1. In addition, TRPV1 had an anti-inflammatory effect on the spleen in the late phase of peritonitis. This anti-inflammatory effect was thought to be mediated by activation of the sympathetic nervous system and/or noradrenergic splenic nerve induced by TRPV1 activation.
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14
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Sympathetic System in Wound Healing: Multistage Control in Normal and Diabetic Skin. Int J Mol Sci 2023; 24:ijms24032045. [PMID: 36768369 PMCID: PMC9916402 DOI: 10.3390/ijms24032045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
In this review, we discuss sympathetic regulation in normal and diabetic wound healing. Experimental denervation studies have confirmed that sympathetic nerve endings in skin have an important and complex role in wound healing. Vasoconstrictor neurons secrete norepinephrine (NE) and neuropeptide Y (NPY). Both mediators decrease blood flow and interact with inflammatory cells and keratinocytes. NE acts in an ambiguous way depending on receptor type. Beta2-adrenoceptors could be activated near sympathetic endings; they suppress inflammation and re-epithelialization. Alpha1- and alpha2-adrenoceptors induce inflammation and activate keratinocytes. Sudomotor neurons secrete acetylcholine (ACh) and vasoactive intestinal peptide (VIP). Both induce vasodilatation, angiogenesis, inflammation, keratinocytes proliferation and migration. In healthy skin, all effects are important for successful healing. In treatment of diabetic ulcers, mediator balance could be shifted in different ways. Beta2-adrenoceptors blockade and nicotinic ACh receptors activation are the most promising directions in treatment of diabetic ulcers with neuropathy, but they require further research.
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Differences in the regulatory mechanism of blood flow in the orofacial area mediated by neural and humoral systems. J Comp Physiol B 2023; 193:109-124. [PMID: 36436073 DOI: 10.1007/s00360-022-01470-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
Marked blood flow (BF) changes mediated by the autonomic neural and humoral systems may be important for orofacial hemodynamics and functions. However, it remains questionable whether differences in the autonomic vasomotor responses mediated by neural and humoral systems exist in the orofacial area. This study examined whether there are differences in changes in the BF and vascular conductance (VC) between the masseter muscle and lower lip mediated by autonomic neural and humoral systems in urethane-anesthetized rats. Electrical stimulation of the central cut end of the lingual nerve elicited BF increases in the masseter (mainly cholinergic) and lower lip (mainly non-cholinergic), accompanied by an increase in arterial blood pressure (ABP), while cervical sympathetic trunk stimulation consistently decreased BF at both sites. The lingual nerve stimulation induced a biphasic change in the VC in the masseter, consisting of an initial decrease and a successive increase. This decrease in VC was positively correlated with changes in ABP and diminished by guanethidine. Cervical vagus nerve stimulation also induced BF increases at both sites; the increases were greater in the masseter than in the lower lip. Adrenal nerve stimulation and isoproterenol administration induced BF increases in the masseter but not in the lower lip. These results indicate that cholinergic parasympathetic-mediated hemodynamics evoked by trigeminal somatosensory inputs are closely related to ABP changes. The sympathetic nervous system, including the sympathoadrenal system and visceral inputs, may be more involved in hemodynamics in the muscles than in epithelial tissues in the orofacial area.
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16
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Affiliation(s)
- John S McNeil
- University of Virginia School of Medicine, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia,
| | - Michael A Mazzeffi
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Kenichi A Tanaka
- Department of Anesthesiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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17
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Bogdanova OV, Bogdanov VB, Pizano A, Bouvard M, Cazalets JR, Mellen N, Amestoy A. The Current View on the Paradox of Pain in Autism Spectrum Disorders. Front Psychiatry 2022; 13:910824. [PMID: 35935443 PMCID: PMC9352888 DOI: 10.3389/fpsyt.2022.910824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/17/2022] [Indexed: 01/18/2023] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder, which affects 1 in 44 children and may cause severe disabilities. Besides socio-communicational difficulties and repetitive behaviors, ASD also presents as atypical sensorimotor function and pain reactivity. While chronic pain is a frequent co-morbidity in autism, pain management in this population is often insufficient because of difficulties in pain evaluation, worsening their prognosis and perhaps driving higher mortality rates. Previous observations have tended to oversimplify the experience of pain in autism as being insensitive to painful stimuli. Various findings in the past 15 years have challenged and complicated this dogma. However, a relatively small number of studies investigates the physiological correlates of pain reactivity in ASD. We explore the possibility that atypical pain perception in people with ASD is mediated by alterations in pain perception, transmission, expression and modulation, and through interactions between these processes. These complex interactions may account for the great variability and sometimes contradictory findings from the studies. A growing body of evidence is challenging the idea of alterations in pain processing in ASD due to a single factor, and calls for an integrative view. We propose a model of the pain cycle that includes the interplay between the molecular and neurophysiological pathways of pain processing and it conscious appraisal that may interfere with pain reactivity and coping in autism. The role of social factors in pain-induced response is also discussed. Pain assessment in clinical care is mostly based on subjective rather than objective measures. This review clarifies the strong need for a consistent methodology, and describes innovative tools to cope with the heterogeneity of pain expression in ASD, enabling individualized assessment. Multiple measures, including self-reporting, informant reporting, clinician-assessed, and purely physiological metrics may provide more consistent results. An integrative view on the regulation of the pain cycle offers a more robust framework to characterize the experience of pain in autism.
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Affiliation(s)
- Olena V. Bogdanova
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
| | - Volodymyr B. Bogdanov
- Laboratoire EA 4136 – Handicap Activité Cognition Santé HACS, Collège Science de la Sante, Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, Bordeaux, France
| | - Adrien Pizano
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
- Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Bordeaux, France
| | - Manuel Bouvard
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
- Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Bordeaux, France
| | - Jean-Rene Cazalets
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
| | - Nicholas Mellen
- Department of Neurology, University of Louisville, Louisville, KY, United States
| | - Anouck Amestoy
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
- Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Bordeaux, France
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18
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Razi A, Farrokhi E, Lotfabadi P, Hosseini SS, Saadati H, Haghighi R, Rameshrad M. Dexamethasone and ketorolac compare with ketorolac alone in acute renal colic: A randomized clinical trial. Am J Emerg Med 2022; 58:245-250. [DOI: 10.1016/j.ajem.2022.05.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022] Open
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Quantifying virtual reality pain modulation in healthy volunteers: A randomized, crossover study. J Clin Anesth 2022; 80:110876. [PMID: 35525050 DOI: 10.1016/j.jclinane.2022.110876] [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: 12/22/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE Virtual reality (VR) is an emerging tool to reduce pain and anxiety during procedures. Although VR's clinical benefits are reported, biometric data quantifying VR's effect on pain tolerance is lacking. We used time-lapse, subjective, and biometric data to evaluate VR's effect on modulating pain. DESIGN Randomized, controlled crossover within-subject clinical trial. SETTING This study was conducted in the Chariot Lab at Lucile Packard Children's Hospital and outdoors at Stanford University School of Medicine. PATIENTS 156 healthy volunteers were included. INTERVENTIONS Participants underwent pain-inducing ice immersions while connected to biometric sensors. Participants were randomized to immerse their dominant or non-dominant hand with VR or control (no VR) for one immersion, and then crossed-over to the other hand for the second immersion. We instructed participants to submerge their hand until they reached their pain tolerance or until four minutes elapsed. MEASUREMENTS Outcomes included ice immersion duration, perceived pain scores, and skin conductance response density (SCRD), a marker of sympathetic arousal. We used survival analysis and mixed effects models to compare measurements with and without VR. MAIN RESULTS 153 participants were included in the analysis. Participants with VR were 64% less likely to remove their hands from the ice bath throughout the immersion's duration compared to control (P < 0.001). Participants with VR reported significantly lower pain scores after controlling for dominant hand treatment assignment, VR vs. no VR treatment order, and gender (P < 0.001). SCRD increased as time progressed for both VR and control groups (P = 0.047 combined), with no significant mean group differences. CONCLUSIONS Participants with VR were more likely to survive the 4-min ice bath challenge longer and with lower levels of pain perception, supporting VR's effectiveness as a distraction tool during painful procedures. We observed no differences in sympathetic response when comparing VR to no VR.
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Rafiei M, Afsahi M, Karbalaeikhani A, Kheradmand B, Hazrati E. Lidocaine Plus Morphine Versus Lidocaine Plus Paracetamol for Bier Block: A Double-Blind Randomized Controlled Trial. J Perianesth Nurs 2022; 37:380-385. [DOI: 10.1016/j.jopan.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
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21
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Whibley D, Williams DA, Clauw DJ, Sliwinski M, Kratz AL. Within-day rhythms of pain and cognitive function in people with and without fibromyalgia: synchronous or syncopated? Pain 2022; 163:474-482. [PMID: 34393201 PMCID: PMC8669069 DOI: 10.1097/j.pain.0000000000002370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cognitive dysfunction is a common fibromyalgia (FM) symptom and can impact on the daily lives of those affected. We investigated whether within-day pain intensity ratings were associated with contemporaneous objective and subjective measures of cognitive function and whether within-day increases in pain intensity preceded increases in cognitive dysfunction or vice versa. Inclusion of a non-FM group allowed us to examine whether effects were specific to FM. Fifty people with FM and 50 non-FM controls provided 7 days of data. Cognitive tests (processing speed and working memory) and ecological momentary assessments (pain intensity and self-reported cognitive functioning) were conducted ×5/day. Three-level multilevel models examined contemporaneous and within-day 1-lag pain intensity-cognitive functioning associations. Interaction terms assessed possible moderating effects of FM status. Momentary increase in pain was associated with increased self-reported cognitive dysfunction, more strongly so for those with FM (B = 0.27, 95% confidence interval 0.22-0.32; non-FM B = 0.17, 95% confidence interval 0.10-0.23). For the FM group, higher pain was associated with longer processing speed; for the non-FM group, higher pain was associated with shorter processing speed. Pain increase did not precede change in subjective or objective cognitive function in the FM group, but reduction in working memory preceded increase in pain intensity. This finding warrants further research attention and, if replicated, could hold prognostic and/or therapeutic potential.
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Affiliation(s)
- Daniel Whibley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - David A. Williams
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J. Clauw
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Sliwinski
- Center for Healthy Aging, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Anna L. Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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22
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Hori A, Hotta N, Fukazawa A, Estrada JA, Katanosaka K, Mizumura K, Sato J, Ishizawa R, Kim HK, Iwamoto GA, Vongpatanasin W, Mitchell JH, Smith SA, Mizuno M. Insulin potentiates the response to capsaicin in dorsal root ganglion neurons in vitro and muscle afferents ex vivo in normal healthy rodents. J Physiol 2022; 600:531-545. [PMID: 34967443 PMCID: PMC8810710 DOI: 10.1113/jp282740] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 02/03/2023] Open
Abstract
Systemic insulin administration evokes sympathoexcitatory actions, but the mechanisms underlying these observations are unknown. We reported that insulin sensitizes the response of thin-fibre primary afferents, as well as the dorsal root ganglion (DRG) that subserves them, to mechanical stimuli. However, little is known about the effects of insulin on primary neuronal responses to chemical stimuli. TRPV1, whose agonist is capsaicin (CAP), is widely expressed on chemically sensitive metaboreceptors and/or nociceptors. The aim of this investigation was to determine the effects of insulin on CAP-activated currents in small DRG neurons and CAP-induced action potentials in thin-fibre muscle afferents of normal healthy rodents. Additionally, we investigated whether insulin potentiates sympathetic nerve activity (SNA) responses to CAP. In whole-cell patch-clamp recordings from cultured mice DRG neurons in vitro, the fold change in CAP-activated current from pre- to post-application of insulin (n = 13) was significantly (P < 0.05) higher than with a vehicle control (n = 14). Similar results were observed in single-fibre recording experiments ex vivo as insulin potentiated CAP-induced action potentials compared to vehicle controls (n = 9 per group, P < 0.05). Furthermore, insulin receptor blockade with GSK1838705 significantly suppressed the insulin-induced augmentation in CAP-activated currents (n = 13) as well as the response magnitude of CAP-induced action potentials (n = 9). Likewise, the renal SNA response to CAP after intramuscular injection of insulin (n = 8) was significantly (P < 0.05) greater compared to vehicle (n = 9). The findings suggest that insulin potentiates TRPV1 responsiveness to CAP at the DRG and muscle tissue levels, possibly contributing to the augmentation in sympathoexcitation during activities such as physical exercise. KEY POINTS: Evidence suggests insulin centrally activates the sympathetic nervous system, and a chemical stimulus to tissues activates the sympathetic nervous system via thin fibre muscle afferents. Insulin is reported to modulate putative chemical-sensitive channels in the dorsal root ganglion neurons of these afferents. In the present study, it is demonstrated that insulin potentiates the responsiveness of thin fibre afferents to capsaicin at muscle tissue levels as well as at the level of dorsal root ganglion neurons. In addition, it is demonstrated that insulin augments the sympathetic nerve activity response to capsaicin in vivo. These data suggest that sympathoexcitation is peripherally mediated via insulin-induced chemical sensitization. The present study proposes a possible physiological role of insulin in the regulation of chemical sensitivity in somatosensory thin fibre muscle afferents.
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Affiliation(s)
- Amane Hori
- Graduate School of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan;,Japan Society for the Promotion of Science, Tokyo 102-8472, Japan
| | - Norio Hotta
- Graduate School of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan;,College of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan
| | - Ayumi Fukazawa
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Juan A. Estrada
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kimiaki Katanosaka
- Graduate School of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan;,College of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan
| | - Kazue Mizumura
- Department of Physiology, Nihon University School of Dentistry, Tokyo 101-8310, Japan
| | - Jun Sato
- Graduate School of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan;,College of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan
| | - Rie Ishizawa
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Han-Kyul Kim
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Gary A. Iwamoto
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Wanpen Vongpatanasin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jere H. Mitchell
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Scott A. Smith
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Masaki Mizuno
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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23
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Maksymchuk N, Sakurai A, Cox DN, Cymbalyuk G. Transient and Steady-State Properties of Drosophila Sensory Neurons Coding Noxious Cold Temperature. Front Cell Neurosci 2022; 16:831803. [PMID: 35959471 PMCID: PMC9358291 DOI: 10.3389/fncel.2022.831803] [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: 12/08/2021] [Accepted: 06/09/2022] [Indexed: 12/04/2022] Open
Abstract
Coding noxious cold signals, such as the magnitude and rate of temperature change, play essential roles in the survival of organisms. We combined electrophysiological and computational neuroscience methods to investigate the neural dynamics of Drosophila larva cold-sensing Class III (CIII) neurons. In response to a fast temperature change (-2 to -6°C/s) from room temperature to noxious cold, the CIII neurons exhibited a pronounced peak of a spiking rate with subsequent relaxation to a steady-state spiking. The magnitude of the peak was higher for a higher rate of temperature decrease, while slow temperature decrease (-0.1°C/s) evoked no distinct peak of the spiking rate. The rate of the steady-state spiking depended on the magnitude of the final temperature and was higher at lower temperatures. For each neuron, we characterized this dependence by estimating the temperature of the half activation of the spiking rate by curve fitting neuron's spiking rate responses to a Boltzmann function. We found that neurons had a temperature of the half activation distributed over a wide temperature range. We also found that CIII neurons responded to decrease rather than increase in temperature. There was a significant difference in spiking activity between fast and slow returns from noxious cold to room temperature: The CIII neurons usually stopped activity abruptly in the case of the fast return and continued spiking for some time in the case of the slow return. We developed a biophysical model of CIII neurons using a generalized description of transient receptor potential (TRP) current kinetics with temperature-dependent activation and Ca2+-dependent inactivation. This model recapitulated the key features of the spiking rate responses found in experiments and suggested mechanisms explaining the transient and steady-state activity of the CIII neurons at different cold temperatures and rates of their decrease and increase. We conclude that CIII neurons encode at least three types of cold sensory information: the rate of temperature decrease by a peak of the firing rate, the magnitude of cold temperature by the rate of steady spiking activity, and direction of temperature change by spiking activity augmentation or suppression corresponding to temperature decrease and increase, respectively.
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Affiliation(s)
- Natalia Maksymchuk
- Neuroscience Institute, Georgia State University, Atlanta, GA, United States
| | - Akira Sakurai
- Neuroscience Institute, Georgia State University, Atlanta, GA, United States
| | - Daniel N Cox
- Neuroscience Institute, Georgia State University, Atlanta, GA, United States
| | - Gennady Cymbalyuk
- Neuroscience Institute, Georgia State University, Atlanta, GA, United States.,Department of Physics and Astronomy, Georgia State University, Atlanta, GA, United States
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van Etten ES, Kaushik K, Jolink WMT, Koemans EA, Ekker MS, Rasing I, Voigt S, Schreuder FHBM, Cannegieter SC, Rinkel GJE, Lijfering WM, Klijn CJM, Wermer MJH. Trigger Factors for Spontaneous Intracerebral Hemorrhage: A Case-Crossover Study. Stroke 2021; 53:1692-1699. [PMID: 34911344 DOI: 10.1161/strokeaha.121.036233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether certain activities can trigger spontaneous intracerebral hemorrhage (ICH) remains unknown. Insights into factors that trigger vessel rupture resulting in ICH improves knowledge on the pathophysiology of ICH. We assessed potential trigger factors and their risk for ICH onset. METHODS We included consecutive patients diagnosed with ICH between July 1, 2013, and December 31, 2019. We interviewed patients on their exposure to 12 potential trigger factors (eg, Valsalva maneuvers) in the (hazard) period soon before onset of ICH and their normal exposure to these trigger factors in the year before the ICH. We used the case-crossover design to calculate relative risks (RR) for potential trigger factors. RESULTS We interviewed 149 patients (mean age 64, 66% male) with ICH. Sixty-seven (45%) had a lobar hemorrhage, 60 (40%) had a deep hemorrhage, 19 (13%) had a cerebellar hemorrhage, and 3 (2%) had an intraventricular hemorrhage. For ICH in general, there was an increased risk within an hour after caffeine consumption (RR=2.5 [95% CI=1.8-3.6]), within an hour after coffee consumption alone (RR=4.8 [95% CI=3.3-6.9]), within an hour after lifting >25 kg (RR=6.6 [95% CI=2.2-19.9]), within an hour after minor head trauma (RR=10.1 [95% CI=1.7-60.2]), within an hour after sexual activity (RR=30.4 [95% CI=16.8-55.0]), within an hour after straining for defecation (RR=37.6 [95% CI=22.4-63.4]), and within an hour after vigorous exercise (RR=21.8 [95% CI=12.6-37.8]). Within 24 hours after flu-like disease or fever, the risk for ICH was also increased (RR=50.7 [95% CI=27.1-95.1]). Within an hour after Valsalva maneuvers, the RR for deep ICH was 3.5 (95% CI=1.7-6.9) and for lobar ICH the RR was 2.0 (95% CI=0.9-4.2). CONCLUSIONS We identified one infection and several blood pressure related trigger factors for ICH onset, providing new insights into the pathophysiology of vessel rupture resulting in ICH.
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Affiliation(s)
- Ellis S van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Kanishk Kaushik
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Wilmar M T Jolink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.)
| | - Emma A Koemans
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Merel S Ekker
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Ingeborg Rasing
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Suzanne C Cannegieter
- Department of Epidemiology, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Department of Internal Medicine, Section Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands. (S.C.C.)
| | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.)
| | - Willem M Lijfering
- Department of Epidemiology, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.)
| | - Catharina J M Klijn
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.).,Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
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De Lorenzis E, Di Giorgio A, Natalello G, Nesci A, Tanti G, Rubortone P, Lucchetti D, Magurano MR, Di Mario C, Tolusso B, Peluso G, Santoliquido A, Gremese E. Depression and Endothelial Dysfunction in Psoriatic Arthritis: Is There Any Possible Relationship? Front Med (Lausanne) 2021; 8:669397. [PMID: 34513861 PMCID: PMC8429609 DOI: 10.3389/fmed.2021.669397] [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: 02/18/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cardiovascular events (CVEs) are the first cause of death in patients with psoriatic arthritis (PsA). Depression is a recognized risk factor in cardiovascular events and is frequently associated with PsA. Flow-mediated dilatation (FMD) is a widely used method for assessing endothelial dysfunction, a parameter with strong prognostic implications for CVEs. The study aims to explore the relationship between FMD, depressive symptoms and serum cytokines in a cohort of patients with PsA. Patients and Methods: FMD was assessed in 50 consecutive PsA patients aged between 30 and 75 years without known cerebrovascular and coronary heart disease or diabetes. Depressive symptoms were reported using the related subscale of the Hospital Anxiety and Depression Scale (HDS). Disease features, activity indexes, and adjusted Framingham risk score (aFRS) were calculated. Serum level of IL-6, TNF-α, and IL-17A were also assessed. Results: In PsA patients (age 50.7 ± 10.2 years, male 42%, disease duration 5.9 ± 3.3 years, Disease Activity in PSoriatic Arthritis (DAPSA) score 14.0 ± 9.4) FMD inversely correlated with the severity of depressive symptoms according to HDS (ρ = -0.339, p = 0.016), age (ρ = -0.507, p = 0.001), aFRS (rs = -0.453, p < 0.001), duration of PsA (ρ = -0.507, p = 0.001), intensity of pain (ρ = -0.507, p = 0.001), and DAPSA (ρ = -0.507, p = 0.001). No statistically significant correlation was found between FMD or HDS and serum cytokines concentrations. HDS predicted FMD in a model adjusted for age, aFRS, PsA duration, and pain intensity (β = -0.271, p = 0.008), with depressive symptoms contributing directly to 6.4% of the variance. Conclusions: Depressive symptoms correlate with endothelial dysfunction with an exposure-response pattern in our cohort of PsA patients.
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Affiliation(s)
- Enrico De Lorenzis
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.,PhD Program in Biomolecular Medicine - Cycle XXXV, University of Verona, Verona, Italy
| | - Angela Di Giorgio
- Department of Internal Medicine, Angiology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Gerlando Natalello
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Nesci
- Department of Internal Medicine, Angiology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Giacomo Tanti
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Rubortone
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Donatella Lucchetti
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Rosaria Magurano
- Unit of Clinical Psychology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Clara Di Mario
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giusy Peluso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelo Santoliquido
- Department of Internal Medicine, Angiology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Gremese
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.,Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Nordness MF, Hayhurst CJ, Pandharipande P. Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit. J Pain Res 2021; 14:1733-1744. [PMID: 34163231 PMCID: PMC8214553 DOI: 10.2147/jpr.s256406] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Critical illness is often painful, both from the underlying source of illness, as well as necessary procedures performed for the monitoring and care of these patients. Pain is often under-recognized in the critically ill, especially among those who cannot self-report, so accurate assessment and management continue to be major consideration in their care. Pain management in the intensive care unit (ICU) is an evolving practice, with a focus on accurate and frequent pain assessment, and targeted pharmacologic and non-pharmacologic treatment methods to maximize analgesia and minimize sedation. In this review, we will evaluate several validated methods of pain assessment in the ICU and present management options. We will review the evidence-based recommendations put forth by the largest critical care societies and several high-quality studies related to both the in-hospital approach to pain, as well as the short- and long-term consequences of untreated pain in ICU patients. We conclude with future directions.
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Affiliation(s)
- Mina F Nordness
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina J Hayhurst
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pratik Pandharipande
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Ahmed A, Lotfy A, Elkholy J, Abdelhamid B, Ollaek M. Perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy: a cohort study. J Clin Monit Comput 2021; 36:795-801. [PMID: 33891250 DOI: 10.1007/s10877-021-00710-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
Postoperative pain in children is usually undertreated because of their inability to complain. While several pain assessment scales have been developed, they have shortcomings such as subjectivity and being observer-dependent. This study aimed to assess the validity of the perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy. Children aged 3-7 years were enrolled. The Children's Hospital of Eastern Ontario Scale (CHEOPS) was used to assess postoperative pain. The perfusion index was measured at the same time intervals as CHEOPS. The highest CHEOPS before rescue analgesia was administered and CHEOPS when the patients became pain-free were recorded with the corresponding perfusion index. The primary outcome was the correlation between the postoperative CHEOPS and the corresponding postoperative perfusion index. The secondary outcomes were the ability of perfusion index changes to predict the presence of postoperative pain and patients' response to analgesics. The postoperative perfusion index was negatively correlated with CHEOPS at 30 and 90 min postoperatively. The change in the preoperative baseline perfusion index (ΔPI-pre) was moderately correlated with the highest CHEOPS (CHEOPS-1) (r = 0.61, p = 0.001). The change in the postoperative perfusion index (ΔPI-po) was negatively correlated with the change in the CHEOPS (ΔCHEOPS) (r = - 0.53, P = 0.0001). The ΔPI-pre was an excellent predictor of postoperative pain (AUROC 0.83 with 71% sensitivity, 83% specificity, and a cut-off value of ≥ 0.26). The perfusion index is a good objective measure for predicting the presence of postoperative pain in children undergoing adenotonsillectomy under general anesthesia. Trial registration: ClinicalTrials.gov; ID: (NCT03854604) registered on February 2019.
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Affiliation(s)
- Abeer Ahmed
- Department of Anesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, 1-Al saraya st, Almanial, Cairo, Egypt.
| | - Abdelrahman Lotfy
- Department of Anesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, 1-Al saraya st, Almanial, Cairo, Egypt
| | - Jehan Elkholy
- Department of Anesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, 1-Al saraya st, Almanial, Cairo, Egypt
| | - Bassant Abdelhamid
- Department of Anesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, 1-Al saraya st, Almanial, Cairo, Egypt
| | - Mohamed Ollaek
- Department of Anesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, 1-Al saraya st, Almanial, Cairo, Egypt
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28
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Leroux A, Rzasa-Lynn R, Crainiceanu C, Sharma T. Wearable Devices: Current Status and Opportunities in Pain Assessment and Management. Digit Biomark 2021; 5:89-102. [PMID: 34056519 PMCID: PMC8138140 DOI: 10.1159/000515576] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION We investigated the possibilities and opportunities for using wearable devices that measure physical activity and physiometric signals in conjunction with ecological momentary assessment (EMA) data to improve the assessment and treatment of pain. METHODS We considered studies with cross-sectional and longitudinal designs as well as interventional or observational studies correlating pain scores with measures derived from wearable devices. A search was also performed on studies that investigated physical activity and physiometric signals among patients with pain. RESULTS Few studies have assessed the possibility of incorporating wearable devices as objective tools for contextualizing pain and physical function in free-living environments. Of the studies that have been conducted, most focus solely on physical activity and functional outcomes as measured by a wearable accelerometer. Several studies report promising correlations between pain scores and signals derived from wearable devices, objectively measured physical activity, and physical function. In addition, there is a known association between physiologic signals that can be measured by wearable devices and pain, though studies using wearable devices to measure these signals and associate them with pain in free-living environments are limited. CONCLUSION There exists a great opportunity to study the complex interplay between physiometric signals, physical function, and pain in a real-time fashion in free-living environments. The literature supports the hypothesis that wearable devices can be used to develop reproducible biosignals that correlate with pain. The combination of wearable devices and EMA will likely lead to the development of clinically meaningful endpoints that will transform how we understand and treat pain patients.
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Affiliation(s)
- Andrew Leroux
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Rachael Rzasa-Lynn
- Department of Anesthesiology, University of Colorado, Aurora, Colorado, USA
| | - Ciprian Crainiceanu
- Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tushar Sharma
- Department of Anesthesiology, University of Colorado, Aurora, Colorado, USA
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Association Between Pain, Blood Pressure, and Medication Intensification in Primary Care: an Observational Study. J Gen Intern Med 2020; 35:3549-3555. [PMID: 32959353 PMCID: PMC7728880 DOI: 10.1007/s11606-020-06208-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treating hypertension is important but physicians often do not intensify blood pressure (BP) treatment in the setting of pain. OBJECTIVE To identify whether reporting pain is associated with (1) elevated BP at the same visit, (2) medication intensification, and (3) elevated BP at the subsequent visit. DESIGN Retrospective cohort SETTING: Integrated health system PARTICIPANTS: Adults seen in primary care EXPOSURE: Pain status based on numerical scale: mild (1-3), moderate (4-6), or severe (≥ 7). MAIN MEASURES We defined elevated BP as ≥ 140/80 mmHg and medication intensification as increasing the dose or adding a new antihypertensive medication. Multilevel regression models were used to find the association between pain and (1) elevated BP at the index visit; (2) medication intensification at the index visit; and (3) elevated BP at the subsequent visit. Models adjusted for demographics, chronic conditions, and clustering within physician. In the third model, we adjusted for initial systolic BP as well. KEY RESULTS Our population included 56,322 patients; 3155 (6%) reported mild pain, 5050 (9%) reported moderate pain, and 4647 (8%) reported severe pain at the index visit. Compared with no pain, the adjusted odds ratios of elevated BP were 1.38 (95% CI: 1.28-1.48) for severe pain, 1.06 (95% CI: 0.99-1.14) for moderate pain, and 1.02 (95% CI: 0.93-1.12) for mild pain. Adjusted odds ratios of medication intensification at the index visit were 0.65 (95% CI: 0.54-0.80) for mild pain, 0.61 (95% CI: 0.52-0.72) for moderate pain, and 0.55 (95% CI: 0.47-0.64) for severe pain. Among patients with elevated BP at the index visit, reporting pain at the index visit was not associated with elevated BP at the subsequent visit. CONCLUSIONS When patients reported pain, physicians were less likely to intensify antihypertensive treatment; nevertheless, patients reporting pain were not more likely to have elevated BP at the subsequent visit.
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Lapin BR, Pantalone KM, Milinovich A, Morrison S, Schuster A, Boulos F, Johnson K, Thakore NJ. Pain in Patients With Type 2 Diabetes-Related Polyneuropathy Is Associated With Vascular Events and Mortality. J Clin Endocrinol Metab 2020; 105:5861640. [PMID: 32575118 DOI: 10.1210/clinem/dgaa394] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Type 2 diabetes-related polyneuropathy (DPN) is associated with increased vascular events and mortality, but determinants and outcomes of pain in DPN are poorly understood. We sought to examine the effect of neuropathic pain on vascular events and mortality in patients without DPN, DPN with pain (DPN + P), and DPN without pain (DPN-P). METHODS A retrospective cohort study was conducted within a large health system of adult patients with type 2 diabetes from January 1, 2009 through December 31, 2016. Using an electronic algorithm, patients were classified as no DPN, DPN + P, or DPN-P. Primary outcomes included number of vascular events and time to mortality. Independent associations with DPN + P were evaluated using multivariable negative binomial and Cox proportional hazards regression models, adjusting for demographics, socioeconomic characteristics, and comorbidities. RESULTS Of 43 945 patients with type 2 diabetes (age 64.6 ± 14.0 years; 52.1% female), 13 910 (31.7%) had DPN: 9104 DPN + P (65.4%) vs 4806 DPN-P (34.6%). Vascular events occurred in 4538 (15.1%) of no DPN patients, 2401 (26.4%) DPN + P, and 1006 (20.9%) DPN-P. After adjustment, DPN + P remained a significant predictor of number of vascular events (incidence rate ratio [IRR] = 1.55, 95% CI, 1.29-1.85), whereas no DPN was protective (IRR = 0.70, 95% CI, 0.60-0.82), as compared to DPN-P. Compared to DPN-P, DPN + P was also a significant predictor of mortality (hazard ratio = 1.42, 95% CI, 1.25-1.61). CONCLUSIONS Our study found a significant association between pain in DPN and an increased risk of vascular events and mortality. This observation warrants longitudinal study of the risk factors and natural history of pain in DPN.
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Affiliation(s)
- Brittany R Lapin
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kevin M Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alex Milinovich
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shannon Morrison
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrew Schuster
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fernanda Boulos
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Kristen Johnson
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Nimish J Thakore
- Department of Neurology/Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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31
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Larsen RG, Thomsen JM, Hirata RP, Steffensen R, Poulsen ER, Frøkjaer JB, Graven-Nielsen T. Impaired microvascular reactivity after eccentric muscle contractions is not restored by acute ingestion of antioxidants or dietary nitrate. Physiol Rep 2020; 7:e14162. [PMID: 31293100 PMCID: PMC6640596 DOI: 10.14814/phy2.14162] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022] Open
Abstract
Unaccustomed eccentric exercise leads to impaired microvascular function but the underlying mechanism is unknown. In this study, we evaluated the role of oxidative stress and of nitric oxide (NO) bioavailability. Thirty young men and women performed eccentric contractions of the tibialis anterior (TA) muscle (ECC), with the contralateral leg serving as nonexercising control (CON). Participants were randomized into three groups ingesting an antioxidant cocktail (AO), beetroot juice (BR) or placebo 46 h postexercise. At baseline and 48 h postexercise, hyperemic responses to brief muscle contractions and 5 min of cuff occlusion were assessed bilaterally in the TA muscles using blood oxygen level dependent (BOLD) magnetic resonance imaging. Eccentric contractions resulted in delayed time-to-peak (~22%; P < 0.001), blunted peak (~21%; P < 0.001) and prolonged time-to-half relaxation (~12%, P < 0.001) in the BOLD response to brief contractions, with no effects of AO or BR, and no changes in CON. Postocclusive time-to-peak was also delayed (~54%; P < 0.001) in ECC, with no effects of AO or BR, and no changes in CON. Impaired microvascular reactivity after eccentric contractions is confined to the exercised tissue, and is not restored with acute ingestion of AO or BR. Impairments in microvascular reactivity after unaccustomed eccentric contractions may result from structural changes within the microvasculature that can diminish muscle blood flow regulation during intermittent activities requiring prompt adjustments in oxygen delivery.
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Affiliation(s)
- Ryan G Larsen
- Sports Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jens M Thomsen
- Sports Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Rogerio P Hirata
- Department of Health Science and Technology, SMI, Aalborg University, Aalborg, Denmark
| | - Rudi Steffensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Eva R Poulsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens B Frøkjaer
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, SMI, Aalborg University, Aalborg, Denmark
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Rezaee Z, Dutta A. Transcranial Direct Current Stimulation of the Leg Motor Area - is it partly somatosensory? ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:4764-4767. [PMID: 30441414 DOI: 10.1109/embc.2018.8513195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Non-invasive brain stimulation such as transcranial direct current stimulation (tDCS) involves passing low currents through the brain and is a promising tool for the modulation of cortical excitability. We computationally investigated the effects of the size of the anode in the conventional montage (contralateral supraorbital cathode) using finite element analysis (FEA) for the targeted leg area of the motor cortex where tDCS is challenging due to the depth and orientation of the leg motor area in the inter-hemispheric fissure. We used FEA to develop two anode sizes (same cathode size) with the same current density but different electric field magnitude at the targeted leg area of the motor cortex. Then, we evaluated the effects of the two anode sizes via neurophysiological testing on twelve healthy subjects, seven males and five females (age: 21-36 years, all right-leg dominant). Here, conventional anodal tDCS electrode montage for the leg area of the motor cortex used a large-anode (5cmx7cm, current strength 2mA) which was compared based on transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEP) with a small-anode (3.5cmx1cm at 0.2mA) montage of the same current density at the skin-electrode interface and identical contralateral supraorbital cathode placement. Small-anode decreased the electric field magnitude by almost one-tenth but still got a similar statistically significant $(\mathrm {P}<0.05)$ increase in the cortical excitability (MEP) at the targeted leg motor area when compared to sham tDCS. Since the electric field magnitude was similar at the scalp (skin-electrode interface) level but differed significantly at the leg motor area in the inter-hemispheric fissure, so a possible contribution of scalp sensory nerve responses to electrocutaneous stimulation is proposed.
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Rassu AL, Chenini S, Barateau L, Lopez R, Evangelista E, Guiraud L, Jaussent I, Dauvilliers Y. Increased blood pressure during the suggested immobilization test in Restless Legs Syndrome. Sleep 2019; 43:5602988. [DOI: 10.1093/sleep/zsz263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/13/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To investigate the relationship between sensory discomfort/motor component and cardiovascular autonomic response by continuous beat-to-beat blood pressure monitoring (CBPM) during the suggested immobilization test (SIT) in patients with restless legs syndrome (RLS).
Methods
Thirty-two drug-free patients with primary RLS (10 men; mean age 60.29 ± 10.81 years) and 17 healthy controls (2 men; mean age 58.82 ± 11.86 years) underwent a 1-hour SIT starting at 8 pm with concomitant CBPM to measure the heart rate (HR) and systolic/diastolic blood pressure (SBP, DBP). In all subjects, the presence of sensory discomfort and motor component during the SIT (S-SIT+ and M-SIT+, respectively) was quantified. Mixed regression models were used to compare the SBP, DBP, and HR profiles during the SIT by taking into account the repeated measures (6 time periods of 10 minutes).
Results
In patients with S-SIT+ (n = 17), SBP (p < 0.0001), DBP (p = 0.0007), and HR (p = 0.03) increased during the SIT compared with other patients and controls. Seventeen patients had M-SIT+ (none among healthy controls). Classifying patients in 4 groups in function of the presence/absence of the SIT sensory and motor components revealed that SDB and DBP increased throughout the SIT in patients with S-SIT+, independently of the motor component (p < 0.0001 and p = 0.0008 for SBD; p < 0.0001 and p = 0.01 for DBP in the S-SIT+/M-SIT− and S-SIT+/M-SIT+ groups, respectively).
Conclusion
During the SIT, BP concomitantly increased only in patients with RLS and sensory discomfort, with or without motor component. This highlights the link between evening sensory RLS symptoms, autonomic activation, and potential long-term cardiovascular consequences.
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Affiliation(s)
- Anna Laura Rassu
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Sofiène Chenini
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Lucie Barateau
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Regis Lopez
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Elisa Evangelista
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Lily Guiraud
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Isabelle Jaussent
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Yves Dauvilliers
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
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Hotta N, Katanosaka K, Mizumura K, Iwamoto GA, Ishizawa R, Kim HK, Vongpatanasin W, Mitchell JH, Smith SA, Mizuno M. Insulin potentiates the response to mechanical stimuli in small dorsal root ganglion neurons and thin fibre muscle afferents in vitro. J Physiol 2019; 597:5049-5062. [PMID: 31468522 DOI: 10.1113/jp278527] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/27/2019] [Indexed: 01/23/2023] Open
Abstract
KEY POINTS Insulin is known to activate the sympathetic nervous system centrally. A mechanical stimulus to tissues activates the sympathetic nervous system via thin fibre afferents. Evidence suggests that insulin modulates putative mechanosensitive channels in the dorsal root ganglion neurons of these afferents. In the present study, we report the novel finding that insulin augments the mechanical responsiveness of thin fibre afferents not only at dorsal root ganglion, but also at muscle tissue levels. Our data suggest that sympathoexcitation is mediated via the insulin-induced mechanical sensitization peripherally. The present study proposes a novel physiological role of insulin in the regulation of mechanical sensitivity in somatosensory thin fibre afferents. ABSTRACT Insulin activates the sympathetic nervous system, although the mechanism underlying insulin-induced sympathoexcitation remains to be determined. A mechanical stimulus to tissues such as skin and/or skeletal muscle, no matter whether the stimulation is noxious or not, activates the sympathetic nervous system via thin fibre afferents. Evidence suggests that insulin modulates putative mechanosensitive channels in the dorsal root ganglion (DRG) neurons of these afferents. Accordingly, we investigated whether insulin augments whole-cell current responses to mechanical stimuli in small DRG neurons of normal healthy mice. We performed whole-cell patch clamp recordings using cultured DRG neurons and observed mechanically-activated (MA) currents induced by mechanical stimuli applied to the cell surface. Local application of vehicle solution did not change MA currents or mechanical threshold in cultured DRG neurons. Insulin (500 mU mL-1 ) significantly augmented the amplitude of MA currents (P < 0.05) and decreased the mechanical threshold (P < 0.05). Importantly, pretreatment with the insulin receptor antagonist, GSK1838705, significantly suppressed the insulin-induced potentiation of the mechanical response. We further examined the impact of insulin on thin fibre muscle afferent activity in response to mechanical stimuli in normal healthy rats in vitro. Using a muscle-nerve preparation, we recorded single group IV fibre activity to a ramp-shaped mechanical stimulation. Insulin significantly decreased mechanical threshold (P < 0.05), although it did not significantly increase the response magnitude to the mechanical stimulus. In conclusion, these data suggest that insulin augments the mechanical responsiveness of small DRG neurons and potentially sensitizes group IV afferents to mechanical stimuli at the muscle tissue level, possibly contributing to insulin-induced sympathoexcitation.
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Affiliation(s)
- Norio Hotta
- College of Life and Health Sciences, Chubu University, Kasugai, Japan.,Departments of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kazue Mizumura
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Gary A Iwamoto
- Departments of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rie Ishizawa
- Departments of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Han-Kyul Kim
- Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Wanpen Vongpatanasin
- Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jere H Mitchell
- Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott A Smith
- Departments of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Masaki Mizuno
- Departments of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Stofkova A, Murakami M. Neural activity regulates autoimmune diseases through the gateway reflex. Bioelectron Med 2019; 5:14. [PMID: 32232103 PMCID: PMC7098223 DOI: 10.1186/s42234-019-0030-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022] Open
Abstract
The brain, spinal cord and retina are protected from blood-borne compounds by the blood-brain barrier (BBB), blood-spinal cord barrier (BSCB) and blood-retina barrier (BRB) respectively, which create a physical interface that tightly controls molecular and cellular transport. The mechanical and functional integrity of these unique structures between blood vessels and nervous tissues is critical for maintaining organ homeostasis. To preserve the stability of these barriers, interplay between constituent barrier cells, such as vascular endothelial cells, pericytes, glial cells and neurons, is required. When any of these cells are defective, the barrier can fail, allowing blood-borne compounds to encroach neural tissues and cause neuropathologies. Autoimmune diseases of the central nervous system (CNS) and retina are characterized by barrier disruption and the infiltration of activated immune cells. Here we review our recent findings on the role of neural activity in the regulation of these barriers at the vascular endothelial cell level in the promotion of or protection against the development of autoimmune diseases. We suggest nervous system reflexes, which we named gateway reflexes, are fundamentally involved in these diseases. Although their reflex arcs are not completely understood, we identified the activation of specific sensory neurons or receptor cells to which barrier endothelial cells respond as effectors that regulate gateways for immune cells to enter the nervous tissue. We explain this novel mechanism and describe its role in neuroinflammatory conditions, including models of multiple sclerosis and posterior autoimmune uveitis.
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Affiliation(s)
- Andrea Stofkova
- 1Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- 2Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-0815 Japan
| | - Masaaki Murakami
- 2Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-0815 Japan
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36
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A preliminary investigation about the observation of regional skin temperatures following cumulative training loads in triathletes during training camp. J Therm Biol 2019; 84:431-438. [DOI: 10.1016/j.jtherbio.2019.07.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/28/2019] [Accepted: 07/28/2019] [Indexed: 11/20/2022]
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Perceptual and motor responses directly and indirectly mediate the effects of noxious stimuli on autonomic responses. Pain 2019; 160:2811-2818. [DOI: 10.1097/j.pain.0000000000001661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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38
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Miyawaki H, Ogata H, Nakamoto S, Kaneko T, Ueki R, Kariya N, Tatara T, Hirose M. Effects of Thoracic Paravertebral Block on Nociceptive Levels After Skin Incision During Video-Assisted Thoracoscopic Surgery. Med Sci Monit 2019; 25:3140-3145. [PMID: 31030206 PMCID: PMC6503748 DOI: 10.12659/msm.914354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Regional anesthesia provides excellent analgesic effects after surgery. However, the effects of regional anesthesia on nociceptive levels during surgery under general anesthesia have not been quantitatively evaluated. To reveal the effects of thoracic paravertebral block (PVB) on nociceptive levels after skin incision during general anesthesia, we performed a retrospective cohort study in patients without serious preoperative conditions or comorbidities undergoing elective video-assisted thoracoscopic surgery (VATS). Nociceptive levels during general anesthesia were calculated using our previously determined Nociceptive Response (NR) equation, which utilizes common hemodynamic parameters. Material/Methods Data on 77 adult patients who underwent VATS from May 2018 to August 2018 were retrospectively obtained from our institutional database. We then performed propensity score matching between patients who received thoracic PVB (PVB group: n=29) and those who did not (Control group: n=48). The averaged values of systolic blood pressure (SBP), heart rate (HR), perfusion index (PI), bispectral index (BIS), and NR from 10 to 5 minutes before skin incision (T0), 5 to 10 minutes (T1), 10 to 15 minutes (T2), 15 to 20 minutes (T3), and 20 to 25 minutes after skin incision (T4), were calculated. Results Twenty-four propensity score-matched patients in each group were analyzed. Mean NR values at T1 and T2 in the PVB group were significantly lower than those in the Control group. SBP, HR, PI, and BIS, however, showed no significant differences between the 2 groups, except for SBP at T2. Conclusions Thoracic PVB prevented an increase in NR values, which quantitatively represent nociceptive levels under general anesthesia, in patients undergoing VATS.
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Affiliation(s)
- Hiroki Miyawaki
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroki Ogata
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shiroh Nakamoto
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takahiko Kaneko
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ryusuke Ueki
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Nobutaka Kariya
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tsuneo Tatara
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Munetaka Hirose
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Smith LJ, Macefield VG, Birznieks I, Burton AR. Effects of tonic muscle pain on fusimotor control of human muscle spindles during isometric ankle dorsiflexion. J Neurophysiol 2019; 121:1143-1149. [DOI: 10.1152/jn.00862.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Studies on anesthetized animals have revealed that nociceptors can excite fusimotor neurons and thereby change the sensitivity of muscle spindles to stretch; such nociceptive reflexes have been suggested to underlie the mechanisms that lead to chronic musculoskeletal pain syndromes. However, the validity of the “vicious cycle” hypothesis in humans has yielded results contrasting with those found in animals. Given that spindle firing rates are much lower in humans than in animals, it is possible that some of the discrepancies between human experimental data and those obtained in animals could be explained by differences in background fusimotor drive when the leg muscles are relaxed. We examined the effects of tonic muscle pain during voluntary contractions of the ankle dorsiflexors. Unitary recordings were obtained from 10 fusimotor-driven muscle spindle afferents (6 primary, 4 secondary) supplying the ankle dorsiflexors via a microelectrode inserted percutaneously into the common peroneal nerve. A series of 1-min weak contractions was performed at rest and during 1 h of muscle pain induced by intramuscular infusion of 5% hypertonic saline into the tibialis anterior muscle. We did not observe any statistically significant increases in muscle spindle firing rates of six afferents followed during tonic muscle pain, although discharge variability increased slightly. Furthermore, a participant’s capacity to maintain a constant level of force, while relying on proprioceptive feedback in the absence of visual feedback, was not compromised during pain. We conclude that nociceptive inputs from contracting muscle do not excite fusimotor neurons during voluntary isometric contractions in humans. NEW & NOTEWORTHY Data obtained in the cat have shown that muscle pain causes a marked increase in the firing of muscle spindles, attributed to a nociceptor-driven fusimotor reflex. However, our studies of muscle spindles in relaxed leg muscles failed to find any effect on spindle discharge. Here we showed that experimental muscle pain failed to increase the firing of muscle spindle afferents during weak voluntary contractions, when fusimotor drive sufficient to increase their firing is present.
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Affiliation(s)
- Lyndon J. Smith
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Vaughan G. Macefield
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ingvars Birznieks
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Alexander R. Burton
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
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Sarhan M, Land WG, Tonnus W, Hugo CP, Linkermann A. Origin and Consequences of Necroinflammation. Physiol Rev 2018; 98:727-780. [PMID: 29465288 DOI: 10.1152/physrev.00041.2016] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
When cells undergo necrotic cell death in either physiological or pathophysiological settings in vivo, they release highly immunogenic intracellular molecules and organelles into the interstitium and thereby represent the strongest known trigger of the immune system. With our increasing understanding of necrosis as a regulated and genetically determined process (RN, regulated necrosis), necrosis and necroinflammation can be pharmacologically prevented. This review discusses our current knowledge about signaling pathways of necrotic cell death as the origin of necroinflammation. Multiple pathways of RN such as necroptosis, ferroptosis, and pyroptosis have been evolutionary conserved most likely because of their differences in immunogenicity. As the consequence of necrosis, however, all necrotic cells release damage associated molecular patterns (DAMPs) that have been extensively investigated over the last two decades. Analysis of necroinflammation allows characterizing specific signatures for each particular pathway of cell death. While all RN-pathways share the release of DAMPs in general, most of them actively regulate the immune system by the additional expression and/or maturation of either pro- or anti-inflammatory cytokines/chemokines. In addition, DAMPs have been demonstrated to modulate the process of regeneration. For the purpose of better understanding of necroinflammation, we introduce a novel classification of DAMPs in this review to help detect the relative contribution of each RN-pathway to certain physiological and pathophysiological conditions.
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Affiliation(s)
- Maysa Sarhan
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna , Vienna , Austria ; INSERM UMR_S 1109, Laboratory of Excellence Transplantex, University of Strasbourg , Strasbourg , France ; German Academy of Transplantation Medicine, Munich , Germany ; and Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden , Dresden , Germany
| | - Walter G Land
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna , Vienna , Austria ; INSERM UMR_S 1109, Laboratory of Excellence Transplantex, University of Strasbourg , Strasbourg , France ; German Academy of Transplantation Medicine, Munich , Germany ; and Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden , Dresden , Germany
| | - Wulf Tonnus
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna , Vienna , Austria ; INSERM UMR_S 1109, Laboratory of Excellence Transplantex, University of Strasbourg , Strasbourg , France ; German Academy of Transplantation Medicine, Munich , Germany ; and Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden , Dresden , Germany
| | - Christian P Hugo
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna , Vienna , Austria ; INSERM UMR_S 1109, Laboratory of Excellence Transplantex, University of Strasbourg , Strasbourg , France ; German Academy of Transplantation Medicine, Munich , Germany ; and Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden , Dresden , Germany
| | - Andreas Linkermann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna , Vienna , Austria ; INSERM UMR_S 1109, Laboratory of Excellence Transplantex, University of Strasbourg , Strasbourg , France ; German Academy of Transplantation Medicine, Munich , Germany ; and Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden , Dresden , Germany
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Kobuch S, Henderson LA, Macefield VG, Brown R. The effects of audiovisual distraction on the muscle sympathetic responses to experimental muscle pain. Exp Brain Res 2018; 236:1919-1925. [PMID: 29696315 DOI: 10.1007/s00221-018-5271-x] [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: 07/14/2017] [Accepted: 04/20/2018] [Indexed: 11/30/2022]
Abstract
Pain elicited by intramuscular infusion of hypertonic saline solution causes muscle sympathetic nerve activity (MSNA) to increase in some subjects, yet decrease in others. Although the direction of the response is not predictable based on baseline physiological and psychological parameters, we know that it results from sustained functional changes in specific brain regions that are responsible for the behavioral and cardiovascular responses to psychological stressors, as well as those involved in attention. The aim of this study was to investigate whether MSNA responses to experimental muscle pain in humans could be altered with an audiovisual stimulus that served to distract them from the pain. MSNA was recorded from the left common peroneal nerve of 20 young healthy individuals during a 45-min intramuscular infusion of hypertonic saline solution into the ipsilateral tibialis anterior muscle. The distracting stimulus commenced 15 min after the start of the infusion and lasted for 15 min. Fifteen subjects showed an increase in mean burst amplitude of MSNA (to 176.4 ± 7.9% of baseline), while five showed a decrease (to 73.1 ± 5.2% of baseline); distraction had no effect on these profiles. These results indicate that even though the subjects were attending to the audiovisual stimulus, and were presumably distracted from the pain, it failed to alter the MSNA responses to muscle pain.
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Affiliation(s)
- Sophie Kobuch
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Luke A Henderson
- Department of Anatomy and Histology, University of Sydney, Sydney, Australia
| | - Vaughan G Macefield
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Neuroscience Research Australia, Sydney, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - R Brown
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Neuroscience Research Australia, Sydney, Australia
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Kunz SN, Calkins HG, Adamec J, Kroll MW. Adrenergic and metabolic effects of electrical weapons: review and meta-analysis of human data. Int J Legal Med 2018; 132:1469-1475. [DOI: 10.1007/s00414-018-1771-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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Han X, Liu X, Li L, Xie B, Fan B, Qiu Y, Liu T, Li L. Neural Activation During Tonic Pain and Interaction Between Pain and Emotion in Bipolar Disorder: An fMRI Study. Front Psychiatry 2018; 9:555. [PMID: 30459652 PMCID: PMC6232121 DOI: 10.3389/fpsyt.2018.00555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Objective: Pain and affective disorders have clear clinical relevance; however, very few studies have investigated the association between pain and bipolar disorder. This study investigated the brain activity of patients with bipolar disorder (BPs) undergoing tonic pain and assessed the interaction between pain and emotion. Methods: Ten BPs and ten healthy controls (HCs) were exposed to emotional pictures (positive, neutral, or negative), tonic pain only (pain session), and emotional pictures along with tonic pain (combined session). A moderate tonic pain was induced by the infusion of hypertonic saline (5% NaCl) into the right masseter muscle with a computer-controlled system. Whole-brain blood oxygenation level dependent (BOLD) signals were acquired using 3T functional resonance imaging (fMRI). Results: Ten BPs and ten healthy participants were included in the final analysis. During the pain session, BPs accepted more saline, but showed lower pain rating scores than HCs. When experiencing pain, BPs showed a significant decrease in the BOLD signal in the bilateral insula, left inferior frontal gyrus (IFG), and left cerebellum as compared with HCs. In the combined session, the activated regions for positive mood (pain with positive mood > baseline) in BPs were the left cerebellum, right temporal gyrus, and left occipital gyrus; the activated regions for negative mood (pain with negative mood > baseline) were the right occipital gyrus, left insula, left IFG, and bilateral precentral gyrus. Conclusions: This study presents the preliminary finding of the interaction between pain and emotion in BPs. BPs exhibited lower sensitivity to pain, and the activation of insula and IFG may reflect the interaction between emotion and pain stimulus.
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Affiliation(s)
- Xue Han
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xiaowu Liu
- Neuroengineering Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Linling Li
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Bo Xie
- Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Beifang Fan
- Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yunhai Qiu
- Research Center for Intelligent Biosensing, Research Institute of Tsinghua University in Shenzhen, Shenzhen, China
| | - Tiebang Liu
- Shenzhen Key Lab for Psychological Healthcare, Shenzhen Mental Health Centre, Shenzhen, China
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China.,Shenzhen Key Lab for Psychological Healthcare, Shenzhen Mental Health Centre, Shenzhen, China.,Clinical Psychiatry Center, National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
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Abstract
Pain is essential for avoidance of tissue damage and for promotion of healing. Notwithstanding the survival value, pain brings about emotional suffering reflected in fear and anxiety, which in turn augment pain thus giving rise to a self-sustaining feedforward loop. Given such reciprocal relationships, the present article uses neuroscientific conceptualizations of fear and anxiety as a theoretical framework for hitherto insufficiently understood pathophysiological mechanisms underlying chronic pain. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain and nociception plus amygdala, anxiety, cognitive, fear, sensory, and unconscious. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) parallelism between acute pain and fear and between chronic pain and anxiety; (2) all are related to the evasion of sensory-perceived threats and are subserved by subcortical circuits mediating automatic threat-induced physiologic responses and defensive actions in conjunction with higher order corticolimbic networks (e.g., thalamocortical, thalamo-striato-cortical and amygdalo-cortical) generating conscious representations and valuation-based adaptive behaviors; (3) some instances of chronic pain and anxiety conditions are driven by the failure to diminish or block respective nociceptive information or unconscious treats from reaching conscious awareness; and (4) the neural correlates of pain-related conscious states and cognitions may become autonomous (i.e., dissociated) from the subcortical activity/function leading to the eventual chronicity. Identifying relative contributions of the diverse neuroanatomical sources, thus, offers prospects for the development of novel preventive, diagnostic, and therapeutic strategies in chronic pain patients.
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Affiliation(s)
- Igor Elman
- Boonshoft School of Medicine, Wright State University, Dayton VA Medical Center, Dayton, OH, United States
| | - David Borsook
- Harvard Medical School, Center for Pain and the Brain, Boston Children's Hospital, Massachusetts General Hospital, McLean Hospital, Boston, MA, United States
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Walters ET. How is chronic pain related to sympathetic dysfunction and autonomic dysreflexia following spinal cord injury? Auton Neurosci 2017; 209:79-89. [PMID: 28161248 DOI: 10.1016/j.autneu.2017.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 12/29/2022]
Abstract
Autonomic dysreflexia (AD) and neuropathic pain occur after severe injury to higher levels of the spinal cord. Mechanisms underlying these problems have rarely been integrated in proposed models of spinal cord injury (SCI). Several parallels suggest significant overlap of these mechanisms, although the relationships between sympathetic function (dysregulated in AD) and nociceptive function (dysregulated in neuropathic pain) are complex. One general mechanism likely to be shared is central sensitization - enhanced responsiveness and synaptic reorganization of spinal circuits that mediate sympathetic reflexes or that process and relay pain-related information to the brain. Another is enhanced sensory input to spinal circuits caused by extensive alterations in primary sensory neurons. Both AD and SCI-induced neuropathic pain are associated with spinal sprouting of peptidergic nociceptors that might increase synaptic input to the circuits involved in AD and SCI pain. In addition, numerous nociceptors become hyperexcitable, hypersensitive to chemicals associated with injury and inflammation, and spontaneously active, greatly amplifying sensory input to sensitized spinal circuits. As discussed with the aid of a preliminary functional model, these effects are likely to have mutually reinforcing relationships with each other, and with consequences of SCI-induced interruption of descending excitatory and inhibitory influences on spinal circuits, with SCI-induced inflammation in the spinal cord and in DRGs, and with activity in sympathetic fibers within DRGs that promotes local inflammation and spontaneous activity in sensory neurons. This model suggests that interventions selectively targeting hyperactivity in C-nociceptors might be useful for treating chronic pain and AD after high SCI.
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Affiliation(s)
- Edgar T Walters
- Department of Integrative Biology and Pharmacology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA.
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Jewson JL, Lambert EA, Docking S, Storr M, Lambert GW, Gaida JE. Pain duration is associated with increased muscle sympathetic nerve activity in patients with Achilles tendinopathy. Scand J Med Sci Sports 2016; 27:1942-1949. [DOI: 10.1111/sms.12820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 12/19/2022]
Affiliation(s)
- J. L. Jewson
- Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Vic. Australia
| | - E. A. Lambert
- Human Neurotransmitters Laboratory; Baker IDI Heart and Diabetes Institute; Melbourne Vic. Australia
- Department of Physiology; Monash University; Melbourne Vic. Australia
| | - S. Docking
- Department of Physiotherapy; Monash University; Melbourne Vic. Australia
- Australian Centre for Research into Injury in Sport and its Prevention; Federation University; Ballarat Vic. Australia
| | - M. Storr
- Department of Physiotherapy; Monash University; Melbourne Vic. Australia
| | - G. W. Lambert
- Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Vic. Australia
- Human Neurotransmitters Laboratory; Baker IDI Heart and Diabetes Institute; Melbourne Vic. Australia
| | - J. E. Gaida
- Department of Physiotherapy; Monash University; Melbourne Vic. Australia
- University of Canberra Research Institute for Sport and Exercise (UC-RISE); Canberra ACT Australia
- Discipline of Physiotherapy; University of Canberra; Canberra ACT Australia
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Strzalkowski NDJ, Incognito AV, Bent LR, Millar PJ. Cutaneous Mechanoreceptor Feedback from the Hand and Foot Can Modulate Muscle Sympathetic Nerve Activity. Front Neurosci 2016; 10:568. [PMID: 28008306 PMCID: PMC5143677 DOI: 10.3389/fnins.2016.00568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/24/2016] [Indexed: 01/07/2023] Open
Abstract
Stimulation of high threshold mechanical nociceptors on the skin can modulate efferent sympathetic outflow. Whether low threshold mechanoreceptors from glabrous skin are similarly capable of modulating autonomic outflow is unclear. Therefore, the purpose of this study was to examine the effects of cutaneous afferent feedback from the hand palm and foot sole on efferent muscle sympathetic nerve activity (MSNA). Fifteen healthy young participants (9 male; 25 ± 3 years [range: 22-29]) underwent microneurographic recording of multi-unit MSNA from the right fibular nerve during 2 min of baseline and 2 min of mechanical vibration (150 Hz, 220 μm peak-to-peak) applied to the left hand or foot. Each participant completed three trials of both hand and foot stimulation, each separated by 5 min. MSNA burst frequency decreased similarly during the 2 min of both hand (20.8 ± 8.9 vs. 19.3 ± 8.6 bursts/minute [Δ -8%], p = 0.035) and foot (21.0 ± 8.3 vs. 19.5 ± 8.3 bursts/minute [Δ -8%], p = 0.048) vibration but did not alter normalized mean burst amplitude or area (All p > 0.05). Larger reductions in burst frequency were observed during the first 10 s (onset) of both hand (20.8 ± 8.9 vs. 17.0 ± 10.4 [Δ -25%], p < 0.001) and foot (21.0 ± 8.3 vs. 18.3 ± 9.4 [Δ -16%], p = 0.035) vibration, in parallel with decreases in normalized mean burst amplitude (hand: 0.45 ± 0.06 vs. 0.36 ± 0.14% [Δ -19%], p = 0.03; foot: 0.47 ± 0.07 vs. 0.34 ± 0.19% [Δ -27%], p = 0.02) and normalized mean burst area (hand: 0.42 ± 0.05 vs. 0.32 ± 0.12% [Δ -25%], p = 0.003; foot: 0.47 ± 0.05 vs. 0.34 ± 0.16% [Δ -28%], p = 0.01). These results demonstrate that tactile feedback from the hands and feet can influence efferent sympathetic outflow to skeletal muscle.
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Affiliation(s)
| | - Anthony V Incognito
- Department of Human Health and Nutritional Science, University of Guelph Guelph, ON, Canada
| | - Leah R Bent
- Department of Human Health and Nutritional Science, University of Guelph Guelph, ON, Canada
| | - Philip J Millar
- Department of Human Health and Nutritional Science, University of GuelphGuelph, ON, Canada; Toronto General Research Institute, Toronto General HospitalToronto, ON, Canada
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Kobuch S, Fazalbhoy A, Brown R, Henderson LA, Macefield VG. Central circuitry responsible for the divergent sympathetic responses to tonic muscle pain in humans. Hum Brain Mapp 2016; 38:869-881. [PMID: 27696604 DOI: 10.1002/hbm.23424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 12/18/2022] Open
Abstract
Experimentally induced tonic muscle pain evokes divergent muscle vasoconstrictor responses, with some individuals exhibiting a sustained increase in muscle sympathetic nerve activity (MSNA), and others a sustained decrease. These patterns cannot be predicted from an individual's baseline physiological or psychological measures. The aim of this study was to investigate whether the different muscle sympathetic responses to tonic muscle pain were associated with differential changes in regional brain activity. Functional magnetic resonance imaging (fMRI) of the brain was performed concurrently with microelectrode recording of MSNA from the peroneal nerve during a 40-min infusion of hypertonic saline into the ipsilateral tibialis anterior muscle. MSNA increased in 26 and decreased in 11 of 37 subjects during tonic muscle pain. Within the prefrontal and cingulate cortices, precuneus, nucleus accumbens, caudate nucleus, and dorsomedial hypothalamus, blood oxygen level dependent (BOLD) signal intensity increased in the increasing-MSNA group and remained at baseline or decreased in the decreasing-MSNA group. Similar responses occurred in the dorsolateral pons and in the region of the rostral ventrolateral medulla. By contrast, within the region of the dorsolateral periaqueductal gray (dlPAG) signal intensity initially increased in both groups but returned to baseline levels only in the increasing-MSNA group. These results suggest that the divergent sympathetic responses to muscle pain result from activation of a neural pathway that includes the dlPAG, an area thought to be responsible for the behavioral and cardiovascular responses to psychological rather than physical stressors. Hum Brain Mapp 38:869-881, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sophie Kobuch
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Azharuddin Fazalbhoy
- Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, RMIT University, Melbourne, VIC, Australia
| | - Rachael Brown
- School of Medicine, Western Sydney University, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Luke A Henderson
- Discipline of Anatomy and Histology, University of Sydney, Sydney, Australia
| | - Vaughan G Macefield
- School of Medicine, Western Sydney University, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
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