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Assayag N, Bar-Shalita T, Rand D. The Functional-Cognitive and Sensory Treatment (F-CaST) to improve rehabilitation outcomes of individuals with substance use disorder: a study protocol for a mixed-method randomized controlled trial. Addict Sci Clin Pract 2024; 19:28. [PMID: 38594737 PMCID: PMC11003090 DOI: 10.1186/s13722-024-00449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Substance use disorder (SUD) is associated with executive function (EF) deficits and sensory modulation dysfunction (SMD). Yet, these deficits are not addressed therapeutically. This study aims to examine the effectiveness of the Functional-Cognitive and Sensory Treatment (F-CaST) compared to standard care to improve everyday performance and behavior and length of stay at the therapeutic community (TC) in individuals with SUD. In addition, to assess the improvement in EF, sensory modulation, participation, self-efficacy, life satisfaction, and use of strategies within and between groups. Satisfaction with F-CaST will also be assessed. METHODS Forty-eight participants from a community of men in a TC, aged 18-45 years will be randomly allocated to (i) F-CaST-(experimental group) providing sensory and EF strategies for improving daily function; (ii) standard care (control group) as provided in the TC. Assessments will be conducted by assessors blind to group allocation at 4 time points: T1- pre-intervention; T2- post-intervention; T3- 1-month follow-up; and T4- 3-month follow-up. Primary outcome measures will be everyday performance, assessed by the Canadian Occupational Performance Measure (COPM), behavior and length of stay in the TC; secondary outcome measures will assess EF, SMD. Semi-structured in-depth qualitative interviews will be conducted at T1, T2 and T4. DISCUSSION We hypothesize that F-CaST will lead to improved everyday performance and longer length of stay in the TC, compared to the control group. If F-CaST will prove to be effective, cognitive and sensory strategies may be incorporated as an adjunctive intervention in SUD rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov NCT05647863 Registered on 13 December 2022, https://classic. CLINICALTRIALS gov/ct2/show/NCT05647863 .
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Affiliation(s)
- Naama Assayag
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, 6997801, Tel Aviv, Israel.
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, 6997801, Tel Aviv, Israel
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Freund-Azaria A, Bart O, Regev R, Bar-Shalita T. Breastfeeding-related Pain, Sensory Over-responsiveness, and Exclusive Breastfeeding at 6 Months: A Prospective Cohort Study. Womens Health Issues 2024; 34:80-89. [PMID: 37940508 DOI: 10.1016/j.whi.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is recommended for the first 6 months of life, yet EBF rates at 6 months (T3) in most developed countries are low. Painful and nonpainful sensory stimuli processing is linked, and while pain has been suggested to restrict breastfeeding, its coupling with sensory over-responsiveness (SOR) in relation to breastfeeding has not yet been reported. OBJECTIVE We aimed to explore whether breastfeeding-related pain, SOR, and general pain sensitivity predict nonexclusive breastfeeding (NEBF) at T3. STUDY DESIGN In this prospective study, participants were recruited at 2 days postpartum (enrollment). For the assessment of breastfeeding-related pain, participants completed the visual analogue scale and the Short-Form McGill Pain Questionnaire at enrollment, and at 6 weeks after birth. At T3, they completed the Pain Sensitivity Questionnaire and the Sensory Responsiveness Questionnaire-Intensity Scale and then provided information about their breastfeeding status. Participants were divided into two groups accordingly: EBF and NEBF. RESULTS A total of 164 participants were reached at T3: EBF (n = 105) and NEBF (n = 59). The incidence of SOR was significantly higher among NEBF compared with EBF participants (25.4% vs. 11.4%; p = .020). Between enrollment and 6 weeks after birth, 72.3% of the EBF participants had reported a ≥30% pain reduction, compared with 44.8% of the NEBF participants (p = .001). Logistic regression modeling revealed that both breastfeeding-related pain reduction and SOR predicted NEBF at T3 (p < .001), indicating a 3.2 times (p = .001) and 2.5 times (p = .041) odds ratio for NEBF, respectively. CONCLUSIONS SOR and sustained breastfeeding-related pain predict NEBF at T3 and may emerge as substantial breastfeeding barriers.
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Affiliation(s)
- Adi Freund-Azaria
- Faculty of Medicine, Occupational Therapy Department, School of Health Professions, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel; Department of Neonatology, Meir Medical Center, Kfar-Saba, Israel
| | - Orit Bart
- Faculty of Medicine, Occupational Therapy Department, School of Health Professions, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Rivka Regev
- Clalit Health Organization and Neonatal Follow-up Clinic, Meir Medical Center, Kfar-Saba, Israel
| | - Tami Bar-Shalita
- Faculty of Medicine, Occupational Therapy Department, School of Health Professions, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel.
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Sensory Processing and Autistic Traits: Mediation Effect of Frontal Alpha Asymmetry. Occup Ther Int 2023; 2023:5065120. [PMID: 36721758 PMCID: PMC9884162 DOI: 10.1155/2023/5065120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
A sensory processing approach can be used to intervene with behaviours in individuals with autistic symptoms. However, neural mechanisms linking sensory processing patterns and autistic features are less understood. The purpose of this study was to investigate whether frontal alpha asymmetry could mediate the relationship between atypical sensory processing and autistic traits. Seventy-three neurotypical young adults were included in this study. Resting-state brain activity was recorded using electroencephalography. After the recording, participants completed the Adolescent/Adult Sensory Profile and the Autism-Spectrum Quotient. Frontal alpha asymmetry was calculated by subtracting left frontal alpha power from right frontal alpha power. Correlation analysis was performed to find which sensory processing patterns were related to frontal alpha asymmetry and autistic traits. Mediation analysis was then conducted with sensory avoiding patterns as an independent variable, autistic traits as a dependent variable, and frontal alpha asymmetry as a mediator. Interrelations between higher sensation avoiding patterns, greater right-sided cortical activity, and increased autistic traits were found. The sensation avoiding patterns affected autistic traits directly and indirectly through right-sided cortical activity. Findings of the current study demonstrate a mediating role of frontal alpha asymmetry in the relationship between sensation avoiding patterns and autistic traits in neurotypical adults. This study suggests that sensation avoiding patterns and withdrawal-related emotions, which are associated with right-sided cortical activity, need to be considered to improve autism symptoms.
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Efraim Kaufman A, Weissman-Fogel I, Rosenthal MZ, Kaplan Neeman R, Bar-Shalita T. Opening a window into the riddle of misophonia, sensory over-responsiveness, and pain. Front Neurosci 2022; 16:907585. [PMID: 35992931 PMCID: PMC9381840 DOI: 10.3389/fnins.2022.907585] [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: 03/29/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Misophonia and sensory over-responsiveness (SOR) share physiological and psychological symptoms. While individuals with SOR demonstrate pain perception alterations, these were not explored in misophonia. Methods This exploratory study comprised thirty healthy adults with (n = 15; based on the Misophonia Questionnaire) and without misophonia. The Sensory Responsiveness Questionnaire (SRQ) was used for evaluating sensory responsiveness. In addition, psychophysical tests were applied for quantification of: (i) stimulus-response function of painful stimuli, (ii) the individual perceived pain intensity, (iii) pain modulation efficiency, (iv) auditory intensity discrimination capability, and (v) painful and unpleasantness responses to six ecological daily sounds using the Battery of Aversiveness to Sounds (BAS). Results Individuals with misophonia reported higher scores in the SRQ-Aversive (p = 0.022) and SRQ-Hedonic (p = 0.029) scales as well as in auditory (p = 0.042) and smell (p = 0.006) sub-scales, indicating higher sensory responsiveness. Yet they were not identified with the SOR type of sensory modulation dysfunction. Groups did not differ in the pain psychophysical tests, and in auditory discrimination test scores (p > 0.05). However, in the misophonia group the BAS evoked higher pain intensity (p = 0.046) and unpleasantness (p <0.001) ratings in the apple biting sound, and higher unpleasantness rating in the scraping a dish sound (p = 0.007), compared to the comparison group. Conclusion Findings indicate increased sensory responsiveness in individuals with misophonia, yet not defined as SOR. Thus, this suggests that misophonia and SOR are two distinct conditions, differing in their behavioral responses to painful and non-painful stimuli.
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Affiliation(s)
- Adi Efraim Kaufman
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Weissman-Fogel
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - M. Zachary Rosenthal
- Department of Psychiatry and Behavioral Sciences, Center for Misophonia and Emotion Regulation, Duke University Medical Center, Durham, NC, United States
| | - Ricky Kaplan Neeman
- Department of Communication Disorders, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hamed R, Mizrachi L, Granovsky Y, Issachar G, Yuval-Greenberg S, Bar-Shalita T. Neurofeedback Therapy for Sensory Over-Responsiveness-A Feasibility Study. SENSORS 2022; 22:s22051845. [PMID: 35270991 PMCID: PMC8914621 DOI: 10.3390/s22051845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/22/2022]
Abstract
Background: Difficulty in modulating multisensory input, specifically the sensory over-responsive (SOR) type, is linked to pain hypersensitivity and anxiety, impacting daily function and quality of life in children and adults. Reduced cortical activity recorded under resting state has been reported, suggestive of neuromodulation as a potential therapeutic modality. This feasibility study aimed to explore neurofeedback intervention in SOR. Methods: Healthy women with SOR (n = 10) underwent an experimental feasibility study comprising four measurement time points (T1—baseline; T2—preintervention; T3—postintervention; T4—follow-up). Outcome measures included resting-state EEG recording, in addition to behavioral assessments of life satisfaction, attaining functional goals, pain sensitivity, and anxiety. Intervention targeted the upregulation of alpha oscillatory power over ten sessions. Results: No changes were detected in all measures between T1 and T2. Exploring the changes in brain activity between T2 and T4 revealed power enhancement in delta, theta, beta, and gamma oscillatory bands, detected in the frontal region (p = 0.03−<0.001; Cohen’s d = 0.637−1.126) but not in alpha oscillations. Furthermore, a large effect was found in enhancing life satisfaction and goal attainment (Cohen’s d = 1.18; 1.04, respectively), and reduced pain sensitivity and anxiety trait (Cohen’s d = 0.70). Conclusion: This is the first study demonstrating the feasibility of neurofeedback intervention in SOR.
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Affiliation(s)
- Ruba Hamed
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
| | - Limor Mizrachi
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
| | - Yelena Granovsky
- Laboratory of Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Rambam Health Care Campus, Technion, Haifa 3109601, Israel;
| | - Gil Issachar
- Biomedical Engineering Department, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Shlomit Yuval-Greenberg
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 6997801, Israel;
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-525437631
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Assayag N, Berger I, Parush S, Mell H, Bar-Shalita T. Attention-Deficit/Hyperactivity Disorder Symptoms, Sensation-Seeking, and Sensory Modulation Dysfunction in Substance Use Disorder: A Cross Sectional Two-Group Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052541. [PMID: 35270233 PMCID: PMC8909105 DOI: 10.3390/ijerph19052541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 12/23/2022]
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) and sensation-seeking, a trait characterized by risk-related behaviors, have been recognized as risk factors in substance use disorder (SUD). Though ADHD co-occurs with sensory modulation dysfunction (SMD), SMD has scarcely been explored in SUD. Thus, this study aimed to characterize ADHD symptomology, sensation-seeking, and SMD, as well as to explore their contribution to SUD likelihood. Methods: A cross sectional two-group comparative study including therapeutic community residents with SUD (n = 58; study group) and healthy individuals (n = 62; comparison group) applying the MOXO continuous performance test (MOXO-CPT) evaluating ADHD-related symptoms. In addition, participants completed the ADHD Self-Report Scale—Version 1.1 for ADHD screening; the Brief Sensation Seeking Scale quantifying risk-taking behaviors; and the Sensory Responsiveness Questionnaire-Intensity Scale for identifying SMD. Results: The study group demonstrated higher SMD incidence (53.57% vs. 14.52%) and lower performance in three MOXO-CPT indexes: Attention, Impulsivity, and Hyperactivity, but not in Timing, compared to the comparison group. Sensory over-responsiveness had the strongest relationship with SUD, indicating 27-times increased odds for SUD (95% CI = 5.965, 121.216; p ≤ 0.0001). A probability risk index is proposed. Conclusion: We found SMD with the strongest relation to SUD exceeding that of ADHD, thus contributing a new perspective for developing future therapeutic modalities. Our findings highlight the need to address SMD above and beyond ADHD symptomology throughout the SUD rehabilitation.
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Affiliation(s)
- Naama Assayag
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; (N.A.); (S.P.)
| | - Itai Berger
- Pediatric Neurology, Pediatric Division, Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva 8443944, Israel;
- School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Shula Parush
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; (N.A.); (S.P.)
| | - Haim Mell
- Department of Criminology, Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel;
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
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Personalized Biometrics of Physical Pain Agree with Psychophysics by Participants with Sensory over Responsivity. J Pers Med 2021; 11:jpm11020093. [PMID: 33540769 PMCID: PMC7913075 DOI: 10.3390/jpm11020093] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023] Open
Abstract
The study of pain requires a balance between subjective methods that rely on self-reports and complementary objective biometrics that ascertain physical signals associated with subjective accounts. There are at present no objective scales that enable the personalized assessment of pain, as most work involving electrophysiology rely on summary statistics from a priori theoretical population assumptions. Along these lines, recent work has provided evidence of differences in pain sensations between participants with Sensory Over Responsivity (SOR) and controls. While these analyses are useful to understand pain across groups, there remains a need to quantify individual differences more precisely in a personalized manner. Here we offer new methods to characterize pain using the moment-by-moment standardized fluctuations in EEG brain activity centrally reflecting the person’s experiencing temperature-based stimulation at the periphery. This type of gross data is often disregarded as noise, yet here we show its utility to characterize the lingering sensation of discomfort raising to the level of pain, individually, for each participant. We show fundamental differences between the SOR group in relation to controls and provide an objective account of pain congruent with the subjective self-reported data. This offers the potential to build a standardized scale useful to profile pain levels in a personalized manner across the general population.
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Assayag N, Bonneh Y, Parush S, Mell H, Kaplan Neeman R, Bar-Shalita T. Perceived Sensitivity to Pain and Responsiveness to Non-noxious Sensation in Substance Use Disorder. PAIN MEDICINE 2020; 21:1902-1912. [PMID: 31782772 DOI: 10.1093/pm/pnz292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This comparative cross-sectional study aimed to characterize individuals with substance use disorder (SUD) in self-perception of pain sensitivity, experimental auditory aversiveness, and non-noxious sensory responsiveness, as well as examine the associations with SUD. METHODS Therapeutic community (TC) individuals with SUD (N = 63, male 88.9%) and healthy controls (N = 60, male 86.7%) completed the Pain Sensitivity Questionnaire (PSQ) and the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS), followed by a psychophysical auditory battery, the Battery of Averseness to Sounds (BAS)-Revised. RESULTS The SUD group scored higher on the PSQ (P < 0.0001), BAS-R aversiveness (P < 0.0001), BAS-R-unpleasantness (P < 0.0001), and on the aftersensation of auditory aversiveness (P < 0.0001) and unpleasantness (P < 0.000). Fifty-four percent of the SUD group vs 11.7% of the control group were identified as having sensory modulation dysfunction (SMD; P < 0.0001). Logistic regression modeling revealed that the SRQ-IS-Aversive score had a stronger relationship, indicating a 12.6-times odds ratio for SUD (P = 0.0002). Finally, a risk score calculated from a linear combination of the logistic regression model parameters is presented based on the PSQ and SRQ. CONCLUSIONS This is the first study to explore sensory and aversive domains using experimental and self-reporting in situ, revealing pain perception alteration that co-occurs with high prevalence of SMD, specifically of the over-responsive type. Findings may be significant in clinical practice for treating pain, and for expanding therapeutic modalities as part of broader rehabilitation in TC and beyond, to better meet personalized therapy.
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Affiliation(s)
- Naama Assayag
- Faculty of Medicine, School of Occupational Therapy, Hadassah and Hebrew University, Jerusalem, Israel
| | - Yoram Bonneh
- School of Optometry and Vision Science, Mina & Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Shula Parush
- Faculty of Medicine, School of Occupational Therapy, Hadassah and Hebrew University, Jerusalem, Israel
| | - Haim Mell
- Yezreel Valley College, Afula, Israel
| | - Ricky Kaplan Neeman
- Department of Communication Disorders, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Bar-Shalita T, Granovsky Y, Parush S, Weissman-Fogel I. Sensory Modulation Disorder (SMD) and Pain: A New Perspective. Front Integr Neurosci 2019; 13:27. [PMID: 31379526 PMCID: PMC6659392 DOI: 10.3389/fnint.2019.00027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/01/2019] [Indexed: 01/17/2023] Open
Abstract
Sensory modulation disorder (SMD) affects sensory processing across single or multiple sensory systems. The sensory over-responsivity (SOR) subtype of SMD is manifested clinically as a condition in which non-painful stimuli are perceived as abnormally irritating, unpleasant, or even painful. Moreover, SOR interferes with participation in daily routines and activities (Dunn, 2007; Bar-Shalita et al., 2008; Chien et al., 2016), co-occurs with daily pain hyper-sensitivity, and reduces quality of life due to bodily pain. Laboratory behavioral studies have confirmed abnormal pain perception, as demonstrated by hyperalgesia and an enhanced lingering painful sensation, in children and adults with SMD. Advanced quantitative sensory testing (QST) has revealed the mechanisms of altered pain processing in SOR whereby despite the existence of normal peripheral sensory processing, there is enhanced facilitation of pain-transmitting pathways along with preserved but delayed inhibitory pain modulation. These findings point to central nervous system (CNS) involvement as the underlying mechanism of pain hypersensitivity in SOR. Based on the mutual central processing of both non-painful and painful sensory stimuli, we suggest shared mechanisms such as cortical hyper-excitation, an excitatory-inhibitory neuronal imbalance, and sensory modulation alterations. This is supported by novel findings indicating that SOR is a risk factor and comorbidity of chronic non-neuropathic pain disorders. This is the first review to summarize current empirical knowledge investigating SMD and pain, a sensory modality not yet part of the official SMD realm. We propose a neurophysiological mechanism-based model for the interrelation between pain and SMD. Embracing the pain domain could significantly contribute to the understanding of this condition’s pathogenesis and how it manifests in daily life, as well as suggesting the basis for future potential mechanism-based therapies.
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Affiliation(s)
- Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yelena Granovsky
- Laboratory of Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Technion-Israel Institute of Technology, Rambam Health Care Campus, Haifa, Israel
| | - Shula Parush
- School of Occupational Therapy, Faculty of Medicine of Hadassah, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Irit Weissman-Fogel
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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