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da Cunha PHM, de Andrade DC. THE DEEP AND THE DEEPER: SPINAL CORD AND DEEP BRAIN STIMULATION FOR NEUROPATHIC PAIN. Presse Med 2024:104231. [PMID: 38636785 DOI: 10.1016/j.lpm.2024.104231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
Neuropathic pain occurs in people experiencing lesion or disease affecting the somatosensorial system. It is present in 7% of the general population and may not fully respond to first- and second-line treatments in up to 40% of cases. Neuromodulation approaches are often proposed for those not tolerating or not responding to usual pharmacological management. These approaches can be delivered surgically (invasively) or non-invasively. Invasive neuromodulation techniques were the first to be employed in neuropathic pain. Among them is spinal cord stimulation (SCS), which consists of the implantation of epidural electrodes over the spinal cord. It is recommended in some guidelines for peripheral neuropathic pain. While recent studies have called into question its efficacy, others have provided promising data, driven by advances in techniques, battery capabilities, programming algorithms and software developments. Deep brain stimulation (DBS) is another well-stablished neuromodulation therapy routinely used for movement disorders; however, its role in pain management remains limited to specific research centers. This is not only due to variable results in the literature contesting its efficacy, but also because several different brain targets have been explored in small trials, compromising comparisons between these studies. Structures such as the periaqueductal grey, posterior thalamus, anterior cingulate cortex, ventral striatum/anterior limb of the internal capsule and the insula are the main targets described to date in literature. SCS and DBS present diverse rationales for use, mechanistic backgrounds, and varying levels of support from experimental studies. The present review aims to present their methodological details, main mechanisms of action for analgesia and their place in the current body of evidence in the management of patients with neuropathic pain, as well their particularities, effectiveness, safety and limitations.
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Affiliation(s)
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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De Martino E, Casali A, Casarotto S, Hassan G, Couto BA, Rosanova M, Graven‐Nielsen T, de Andrade DC. Evoked oscillatory cortical activity during acute pain: Probing brain in pain by transcranial magnetic stimulation combined with electroencephalogram. Hum Brain Mapp 2024; 45:e26679. [PMID: 38647038 PMCID: PMC11034005 DOI: 10.1002/hbm.26679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Temporal dynamics of local cortical rhythms during acute pain remain largely unknown. The current study used a novel approach based on transcranial magnetic stimulation combined with electroencephalogram (TMS-EEG) to investigate evoked-oscillatory cortical activity during acute pain. Motor (M1) and dorsolateral prefrontal cortex (DLPFC) were probed by TMS, respectively, to record oscillatory power (event-related spectral perturbation and relative spectral power) and phase synchronization (inter-trial coherence) by 63 EEG channels during experimentally induced acute heat pain in 24 healthy participants. TMS-EEG was recorded before, during, and after noxious heat (acute pain condition) and non-noxious warm (Control condition), delivered in a randomized sequence. The main frequency bands (α, β1, and β2) of TMS-evoked potentials after M1 and DLPFC stimulation were recorded close to the TMS coil and remotely. Cold and heat pain thresholds were measured before TMS-EEG. Over M1, acute pain decreased α-band oscillatory power locally and α-band phase synchronization remotely in parietal-occipital clusters compared with non-noxious warm (all p < .05). The remote (parietal-occipital) decrease in α-band phase synchronization during acute pain correlated with the cold (p = .001) and heat pain thresholds (p = .023) and to local (M1) α-band oscillatory power decrease (p = .024). Over DLPFC, acute pain only decreased β1-band power locally compared with non-noxious warm (p = .015). Thus, evoked-oscillatory cortical activity to M1 stimulation is reduced by acute pain in central and parietal-occipital regions and correlated with pain sensitivity, in contrast to DLPFC, which had only local effects. This finding expands the significance of α and β band oscillations and may have relevance for pain therapies.
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Affiliation(s)
- Enrico De Martino
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of MedicineAalborg UniversityAalborgDenmark
| | - Adenauer Casali
- Institute of Science and TechnologyFederal University of São PauloSão PauloBrazil
| | - Silvia Casarotto
- Department of Biomedical and Clinical SciencesUniversity of MilanMilanItaly
- IRCCS Fondazione Don Carlo GnocchiMilanItaly
| | - Gabriel Hassan
- Department of Biomedical and Clinical SciencesUniversity of MilanMilanItaly
| | - Bruno Andry Couto
- Institute of Science and TechnologyFederal University of São PauloSão PauloBrazil
| | - Mario Rosanova
- Department of Biomedical and Clinical SciencesUniversity of MilanMilanItaly
| | - Thomas Graven‐Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of MedicineAalborg UniversityAalborgDenmark
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of MedicineAalborg UniversityAalborgDenmark
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Bernardes LS, Fernandes AM, de Carvalho MA, Ottolia J, Hamani M, Oliveira I, Kubota GT, Aparecida da Silva V, Veloso A, Burlachini de Cavalho MH, de Amorin Filho AG, Arenholt LTS, Leutscher PC, de Andrade DC. ASSESSMENT OF HUMAN FETUSES UNDERGOING ACUTE PAIN: VALIDATION OF THE FETAL-7 SCALE. J Pain 2024:104527. [PMID: 38599264 DOI: 10.1016/j.jpain.2024.104527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
Improvements in fetal ultrasound have allowed for the diagnosis and treatment of fetal diseases in the uterus, often though surgery. However, little attention has been drawn to the assessment of fetal pain. To address this gap, a fetal pain scoring system, known as the Fetal-7 scale, was developed. The present study is a full validation of the Fetal-7 scale. The validation involved two steps: i. four fetuses with indication of surgery were evaluated in three conditions perioperatively: acute pain, rest, and under loud sound stimulation. Facial expressions were assessed by 30 raters using screenshots from 4D high-definition ultrasound films; ii., assessment of sensitivity and specificity of the Fetal-7 scale in 54 healthy fetuses and two fetuses undergoing acute pain after preoperative anesthetic intramuscular injection. There was high internal consistency with Cronbach's alpha (α) of 0.99. Intra-rater reliability of the Fetal-7 scale (test-retest) calculated by intraclass correlation coefficient (ICC) was 0.95, and inter-rater reliability was 0.99. The scale accurately differentiated between healthy fetuses at rest and those experiencing acute pain (sensitivity of 100% and specificity of 94.4%). The Fetal-7 scale is a valid tool for assessing acute pain-related behavior in third trimester fetuses and may be of value in guiding analgesic procedures efficacy in these patients. Further research is warranted to explore the presence of post-operative pain in fetuses and its effects afterbirth. PERSPECTIVE: Recordings with three-dimension ultrasound of human fetuses undergoing pre-operative anesthetic injections revealed complex facial expressions during acute pain, similar to those collected in newborns. This study presented the validation process and cut-off value of the Fetal-7 scale, paving the way for the study of pain before birth in humans.
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Affiliation(s)
- Lisandra Stein Bernardes
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Gynecology and Obstetrics Department, University of Sao Paulo, Brazil; SEPACO Maternity Hospital, São Paulo, Brazil; Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Hjoerring, Denmark.
| | - Ana Mércia Fernandes
- Pain Center, Department of Neurology, University of Sao Paulo, Brazil; Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Mariana Azevedo de Carvalho
- Gynecology and Obstetrics Department, University of Sao Paulo, Brazil; SEPACO Maternity Hospital, São Paulo, Brazil
| | - Juliana Ottolia
- Gynecology and Obstetrics Department, University of Sao Paulo, Brazil; SEPACO Maternity Hospital, São Paulo, Brazil
| | - Michele Hamani
- Pain Center, Department of Neurology, University of Sao Paulo, Brazil
| | - Inaeh Oliveira
- Pain Center, Department of Neurology, University of Sao Paulo, Brazil
| | | | | | - Adriano Veloso
- Computational Science Department, Universidade Federal de Minas Gerais, Brazil
| | | | | | - Louise Thomsen Schmidt Arenholt
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Christian Leutscher
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain, Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Pain Center, Department of Neurology, University of Sao Paulo, Brazil
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4
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Menezes JR, Nunes GA, Carra RB, da Silva Simões J, Solla DJF, Oliveira JR, Teixeira MJ, Marcolin MA, Barbosa ER, Tanaka C, de Andrade DC, Cury RG. Trans-Spinal Theta Burst Magnetic Stimulation in Parkinson's Disease and Gait Disorders. Mov Disord 2024. [PMID: 38477413 DOI: 10.1002/mds.29776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Gait disorders in patients with Parkinson's disease (PD) can become disabling with disease progression without effective treatment. OBJECTIVES To investigate the efficacy of intermittent θ burst trans-spinal magnetic stimulation (TsMS) in PD patients with gait and balance disorders. METHODS This was a randomized, parallel, double-blind, controlled trial. Active or sham TsMS was applied at third thoracic vertebra with 100% of the trans-spinal motor threshold, during 5 consecutive days. Participants were evaluated at baseline, immediately after last session, 1 and 4 weeks after last session. Primary outcome was Total Timed Up and Go (TUG) values comparing active versus sham phases 1 week after intervention. The secondary outcome measurements consisted of motor, gait and balance scales, and questionnaires for quality of life and cognition. RESULTS Thirty-three patients were included, average age 68.5 (6.4) years in active group and 70.3 (6.3) years in sham group. In active group, Total TUG mean baseline was 107.18 (95% CI, 52.1-116.1), and 1 week after stimulation was 93.0 (95% CI, 50.7-135.3); sham group, Total TUG mean baseline was 101.2 (95% CI, 47.1-155.3) and 1 week after stimulation 75.2 (95% CI 34.0-116.4), P = 0.54. Similarly, intervention had no significant effects on secondary outcome measurements. During stimulation period, five patients presented with mild side effects (three in active group and two in sham group). DISCUSSION TsMS did not significantly improve gait or balance analysis in patients with PD and gait disorders. The protocol was safe and well tolerated. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Janaína Reis Menezes
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Glaucia Aline Nunes
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael Bernhart Carra
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Juliana da Silva Simões
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Davi Jorge Fontoura Solla
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jussan Rodrigues Oliveira
- Department of Phytotherapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Antônio Marcolin
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Clarice Tanaka
- Department of Phytotherapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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5
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Mylius V, Baars JH, Witt K, Benninger D, de Andrade DC, Kägi G, Bally JF, Brugger F. Deep Brain Stimulation Improves Parkinson's Disease-Associated Pain by Decreasing Spinal Nociception. Mov Disord 2024; 39:447-449. [PMID: 38071401 DOI: 10.1002/mds.29666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 02/29/2024] Open
Abstract
Dopamine exerts antinociceptive effects on pain in PD at cortical and spinal levels, whereas only cortical effects have been described for DBS, so far. By assessing the nociceptive flexion reflex (NFR) threshold at medication on, and DBS ON and OFF in two patients, we showed that DBS additionally decreases spinal nociception.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
| | - Jan Harald Baars
- Department of Anesthesia, Klinikum Neubrandenburg, Neubrandenburg, Germany
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
- Department of Neurology, Evangelic Hospital Oldenburg, Oldenburg, Germany
| | - David Benninger
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julien F Bally
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Florian Brugger
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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6
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Wangnamthip S, Zinboonyahgoon N, Rushatamukayanunt P, Papaisarn P, Pajina B, Jitsinthunun T, Promsin P, Sirijatuphat R, Fernández-de-las-Peñas C, Arendt-Nielsen L, de Andrade DC. The incidence, characteristics, impact and risk factors of post-COVID chronic pain in Thailand: A single-center cross-sectional study. PLoS One 2024; 19:e0296700. [PMID: 38215071 PMCID: PMC10786369 DOI: 10.1371/journal.pone.0296700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024] Open
Abstract
The COVID-19 pandemic has affected millions of individuals worldwide. Pain has emerged as a significant post-COVID-19 symptom. This study investigated the incidence, characteristics, and risk factors of post-COVID chronic pain (PCCP) in Thailand. A cross-sectional study was conducted in participants who had been infected, including those hospitalized and monitored at home by SARS-CoV-2 from August to September 2021. Data were collected for screening from medical records, and phone interviews were done between 3 to 6 months post-infection. Participants were classified into 1) no-pain, 2) PCCP, 3) chronic pain that has been aggravated by COVID-19, or 4) chronic pain that has not been aggravated by COVID-19. Pain interference and quality of life were evaluated with the Brief Pain Inventory and EuroQol Five Dimensions Five Levels Questionnaire. From 1,019 participants, 90% of the participants had mild infection, assessed by WHO progression scale. The overall incidence of PCCP was 3.2% (95% CI 2.3-4.5), with 2.8% (95% CI 2.0-4.1) in mild infection, 5.2% (95% CI 1.2-14.1) in moderate infection and 8.5% (95% CI 3.4-19.9) in severe infection. Most participants (83.3%) reported pain in the back and lower extremities and were classified as musculoskeletal pain and headache (8.3%). Risk factors associated with PCCP, included female sex (relative risk [RR] 2.2, 95% CI 1.0-4.9) and greater COVID-19 severity (RR 3.5, 95% CI 1.1-11.7). Participants with COVID-19-related exacerbated chronic pain displayed higher pain interferences and lower utility scores than other groups. In conclusion, this study highlights the incidence, features, and risk factors of post-COVID chronic pain (PCCP) in Thailand. It emphasizes the need to monitor and address PCCP, especially in severe cases, among females, and individuals with a history of chronic pain to improve their quality of life in the context of the ongoing COVID-19 pandemic.
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Affiliation(s)
- Suratsawadee Wangnamthip
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Nantthasorn Zinboonyahgoon
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Pranee Rushatamukayanunt
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Patcha Papaisarn
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Burapa Pajina
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Thanawut Jitsinthunun
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Panuwat Promsin
- Faculty of Medicine Siriraj Hospital, Department of Medicine, Mahidol University, Bangkok, Thailand
| | - Rujipas Sirijatuphat
- Faculty of Medicine Siriraj Hospital, Department of Medicine, Mahidol University, Bangkok, Thailand
| | - César Fernández-de-las-Peñas
- Faculty of Medicine, Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lars Arendt-Nielsen
- Faculty of Medicine, Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Daniel Ciampi de Andrade
- Faculty of Medicine, Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
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7
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Mylius V, Moisset X, Rukavina K, Rosner J, Korwisi B, Marques A, Lloret SP, Kägi G, Bohlhalter S, Bannister K, Chaudhuri KR, Barke A, Tinazzi M, Brefel-Courbon C, Treede RD, de Andrade DC. New ICD-11 diagnostic criteria for chronic secondary musculoskeletal pain associated with Parkinson disease. Pain 2024:00006396-990000000-00497. [PMID: 38227568 DOI: 10.1097/j.pain.0000000000003138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/10/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Katarina Rukavina
- Division of Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson Foundation Centre of Excellence in Care and Research, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jan Rosner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Beatrice Korwisi
- Division of Clinical Psychology and Psychological Interventions, Institute of Psychology, University Duisburg-Essen, Essen, Germany
| | - Ana Marques
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Santiago Perez Lloret
- Facultad de Medicina, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Observatorio de Salud Pública, Universidad Católica Argentina, Consejo de Investigaciones Científicas y Técnicas (UCA-CONICET), Buenos Aires, Argentina
| | - Georg Kägi
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Kirsty Bannister
- Division of Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Kallol Ray Chaudhuri
- Division of Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson Foundation Centre of Excellence in Care and Research, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Antonia Barke
- Division of Clinical Psychology and Psychological Interventions, Institute of Psychology, University Duisburg-Essen, Essen, Germany
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Christine Brefel-Courbon
- Department of Clinical Pharmacology and Neurosciences, University Hospital of Toulouse, Inserm, Toulouse, France
| | - Rolf Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, and Department of Psychiatry and Psychotherapy, Central Institute for Mental Health, Heidelberg University, Mannheim, Germany
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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8
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Barboza VR, Kubota GT, da Silva VA, Barbosa LM, Arnaut D, Rodrigues ALDL, Galhardoni R, Cury RG, Barbosa ER, Brunoni AR, Teixeira MJ, de Andrade DC. Parkinson's Disease-related Pains are Not Equal: Clinical, Somatosensory and Cortical Excitability Findings in Individuals With Nociceptive Pain. J Pain 2023; 24:2186-2198. [PMID: 37442404 DOI: 10.1016/j.jpain.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
Chronic pain is a frequent and burdensome nonmotor symptom of Parkinson's disease (PD). PD-related chronic pain can be classified as nociceptive, neuropathic, or nociplastic, the former being the most frequent subtype. However, differences in neurophysiologic profiles between these pain subtypes, and their potential prognostic and therapeutic implications have not been explored yet. This is a cross-sectional study on patients with PD (PwP)-related chronic pain (ie, started with or was aggravated by PD). Subjects were assessed for clinical and pain characteristics through questionnaires and underwent quantitative sensory tests and motor corticospinal excitability (CE) evaluations. Data were then compared between individuals with nociceptive and non-nociceptive (ie, neuropathic or nociplastic) pains. Thirty-five patients were included (51.4% male, 55.7 ± 11.0 years old), 20 of which had nociceptive pain. Patients with nociceptive PD-related pain had lower warm detection threshold (WDT, 33.34 ± 1.39 vs 34.34 ± 1.72, P = .019) and mechanical detection threshold (MDT, 2.55 ± 1.54 vs 3.86 ± .97, P = .007) compared to those with non-nociceptive pains. They also presented a higher proportion of low rest motor threshold values than the non-nociceptive pain ones (64.7% vs 26.6%, P = .048). In non-nociceptive pain patients, there was a negative correlation between WDT and non-motor symptoms scores (r = -.612, P = .045) and a positive correlation between MDT and average pain intensity (r = .629, P = .038), along with neuropathic pain symptom scores (r = .604, P = .049). It is possible to conclude that PD-related chronic pain subtypes have distinctive somatosensory and CE profiles. These preliminary data may help better frame previous contradictory findings in PwP and may have implications for future trial designs aiming at developing individually-tailored therapies. PERSPECTIVE: This work showed that PwP-related nociceptive chronic pain may have distinctive somatosensory and CE profiles than those with non-nociceptive pain subtypes. These data may help shed light on previous contradictory findings in PwP and guide future trials aiming at developing individually-tailored management strategies.
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Affiliation(s)
| | | | | | | | - Debora Arnaut
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Ricardo Galhardoni
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Andre Russowsky Brunoni
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil; Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg E, Denmark
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de Andrade DC, Mylius V, Perez-Lloret S, Cury RG, Bannister K, Moisset X, Taricani Kubota G, Finnerup NB, Bouhassira D, Chaudhuri KR, Graven-Nielsen T, Treede RD. Pain in Parkinson disease: mechanistic substrates, main classification systems, and how to make sense out of them. Pain 2023; 164:2425-2434. [PMID: 37318012 DOI: 10.1097/j.pain.0000000000002968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 06/16/2023]
Abstract
ABSTRACT Parkinson disease (PD) affects up to 2% of the general population older than 65 years and is a major cause of functional loss. Chronic pain is a common nonmotor symptom that affects up to 80% of patients with (Pw) PD both in prodromal phases and during the subsequent stages of the disease, negatively affecting patient's quality of life and function. Pain in PwPD is rather heterogeneous and may occur because of different mechanisms. Targeting motor symptoms by dopamine replacement or with neuromodulatory approaches may only partially control PD-related pain. Pain in general has been classified in PwPD according to the motor signs, pain dimensions, or pain subtypes. Recently, a new classification framework focusing on chronic pain was introduced to group different types of PD pains according to mechanistic descriptors: nociceptive, neuropathic, or neither nociceptive nor neuropathic. This is also in line with the International Classification of Disease-11 , which acknowledges the possibility of chronic secondary musculoskeletal or nociceptive pain due to disease of the CNS. In this narrative review and opinion article, a group of basic and clinical scientists revise the mechanism of pain in PD and the challenges faced when classifying it as a stepping stone to discuss an integrative view of the current classification approaches and how clinical practice can be influenced by them. Knowledge gaps to be tackled by coming classification and therapeutic efforts are presented, as well as a potential framework to address them in a patient-oriented manner.
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Affiliation(s)
- Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Veit Mylius
- Department of Neurology, Centre for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
- Department of Neurology, Kantonsspital, St. Gallen, Switzerland
| | - Santiago Perez-Lloret
- Observatorio de Salud Pública, Universidad Católica Argentina, Consejo de Investigaciones Científicas y Técnicas (UCA-CONICET), Buenos Aires, Argentina
- Facultad de Medicina, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Rubens G Cury
- Movement Disorders Center, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Gabriel Taricani Kubota
- Department of Neurology, Centre for Neurorehabilitation, Valens, Switzerland
- Pain Center, University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
- Center for Pain Treatment, Institute of Cancer of the State of Sao Paulo, University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Kallol Ray Chaudhuri
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence in Care and Research, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
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10
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Ciampi de Andrade D, García-Larrea L. Beyond trial-and-error: Individualizing therapeutic transcranial neuromodulation for chronic pain. Eur J Pain 2023; 27:1065-1083. [PMID: 37596980 DOI: 10.1002/ejp.2164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) applied to the motor cortex provides supplementary relief for some individuals with chronic pain who are refractory to pharmacological treatment. As rTMS slowly enters treatment guidelines for pain relief, its starts to be confronted with challenges long known to pharmacological approaches: efficacy at the group-level does not grant pain relief for a particular patient. In this review, we present and discuss a series of ongoing attempts to overcome this therapeutic challenge in a personalized medicine framework. DATABASES AND DATA TREATMENT Relevant scientific publications published in main databases such as PubMed and EMBASE from inception until March 2023 were systematically assessed, as well as a wide number of studies dedicated to the exploration of the mechanistic grounds of rTMS analgesic effects in humans, primates and rodents. RESULTS The main strategies reported to personalize cortical neuromodulation are: (i) the use of rTMS to predict individual response to implanted motor cortex stimulation; (ii) modifications of motor cortex stimulation patterns; (iii) stimulation of extra-motor targets; (iv) assessment of individual cortical networks and rhythms to personalize treatment; (v) deep sensory phenotyping; (vi) personalization of location, precision and intensity of motor rTMS. All approaches except (i) have so far low or moderate levels of evidence. CONCLUSIONS Although current evidence for most strategies under study remains at best moderate, the multiple mechanisms set up by cortical stimulation are an advantage over single-target 'clean' drugs, as they can influence multiple pathophysiologic paths and offer multiple possibilities of individualization. SIGNIFICANCE Non-invasive neuromodulation is on the verge of personalised medicine. Strategies ranging from integration of detailed clinical phenotyping into treatment design to advanced patient neurophysiological characterisation are being actively explored and creating a framework for actual individualisation of care.
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Affiliation(s)
- Daniel Ciampi de Andrade
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
| | - Luís García-Larrea
- University Hospital Pain Center (CETD), Neurological Hospital P. Wertheimer, Hospices Civils de Lyon, Lyon, France
- NeuroPain Lab, INSERM U1028, UMR5292, Lyon Neuroscience Research Center, CNRS, University Claude Bernard Lyon 1, Lyon, France
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11
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De Martino E, Casali A, Casarotto S, Hassan G, Rosanova M, Graven-Nielsen T, Ciampi de Andrade D. Acute pain drives different effects on local and global cortical excitability in motor and prefrontal areas: insights into interregional and interpersonal differences in pain processing. Cereb Cortex 2023; 33:9986-9996. [PMID: 37522261 DOI: 10.1093/cercor/bhad259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Pain-related depression of corticomotor excitability has been explored using transcranial magnetic stimulation-elicited motor-evoked potentials. Transcranial magnetic stimulation-electroencephalography now enables non-motor area cortical excitability assessments, offering novel insights into cortical excitability changes during pain states. Here, pain-related cortical excitability changes were explored in the dorsolateral prefrontal cortex and primary motor cortex (M1). Cortical excitability was recorded in 24 healthy participants before (Baseline), during painful heat (Acute Pain), and non-noxious warm (Warm) stimulation at the right forearm in a randomized sequence, followed by a pain-free stimulation measurement. Local cortical excitability was assessed as the peak-to-peak amplitude of early transcranial magnetic stimulation evoked potential, whereas global-mean field power measured the global excitability. Relative to the Baseline, Acute Pain decreased the peak-to-peak amplitude in M1 and dorsolateral prefrontal cortex compared with Warm (both P < 0.05). A reduced global-mean field power was only found in M1 during Acute Pain compared with Warm (P = 0.003). Participants with the largest reduction in local cortical excitability under Acute Pain showed a negative correlation between dorsolateral prefrontal cortex and M1 local cortical excitability (P = 0.006). Acute experimental pain drove differential pain-related effects on local and global cortical excitability changes in motor and non-motor areas at a group level while also revealing different interindividual patterns of cortical excitability changes, which can be explored when designing personalized treatment plans.
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Affiliation(s)
- Enrico De Martino
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg 9220, Denmark
| | - Adenauer Casali
- Institute of Science and Technology, Federal University of São Paulo, São Paulo 04021-001, Brazil
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan 50143, Italy
| | - Gabriel Hassan
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg 9220, Denmark
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg 9220, Denmark
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Carvalho EDA, Terra RM, Pinheiro Campos AC, Martinez RCR, Pagano RL, Amano MT, Real JM, de Andrade DC, Pêgo Fernandes PM. Vagal electrostimulation in postoperative thoracic surgery reduces the systemic inflammatory response and cardiopulmonary complications: an experimental study in pigs. Ann Transl Med 2023; 11:347. [PMID: 37675307 PMCID: PMC10477644 DOI: 10.21037/atm-22-2919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/08/2023] [Indexed: 09/08/2023]
Abstract
Background Conventional thoracotomy (CT) often leads to systemic inflammatory response syndrome (SIRS), which induces several clinical complications. CT remains widely used in low-income institutions. Although minimally invasive surgical procedures, such as robotic surgery (RS), have been used to prevent many of the complications inherit from the surgical procedure. Here, we investigated the protective effect of vagus nerve stimulation (VNS) in a pre-clinical model during CT or RS and postoperative period (POP) relative to clinical complications and inflammatory control. The objective was to compare hemodynamic features and cytokine levels in the blood, lung, and bronchoalveolar lavage (BAL) fluids of animals subjected to CT or RS with or without VNS. Methods Twenty-four minipigs were subjected to 12 animals CT and 12 animals RS, with or without VNS, and accompanied 24 h later by pulmonary lobectomy. Blood samples for evaluating the hemodynamic parameters were collected before the surgical preparation, immediately after the beginning of VNS, and every 4 h until 24 h after the lobectomy. BAL fluid and lung tissue were collected at the end of the experiment. Cytokine levels were evaluated in the blood, BAL fluid, and lung tissues. Results VNS maintained a more stable heart rate during POP and decreased the incidence of overall cardiac complications while preventing increase in IL-6 levels 12 h after lobectomy, compared to sham animals. No differences were found in cytokine expression in the BAL fluid and lung tissue in any of the studied groups. Conclusions Taken together, our data suggested that VNS should be considered a non-pharmacological tool in the prevention of the exacerbated inflammatory response responsible for severe clinical complications, especially in more aggressive surgical procedures.
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Affiliation(s)
- Erlon de Avila Carvalho
- Instituto do Coração, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - Ricardo Mingarini Terra
- Instituto do Coração, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | - Raquel Chacon Ruiz Martinez
- Hospital Sírio-Libanês, Sao Paulo, Brazil
- LIM/23, Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | - Daniel Ciampi de Andrade
- Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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da Silva ML, Fernandes AM, Silva VA, Galhardoni R, Felau V, de Araujo JO, Rosi J, Brock RS, Kubota GT, Teixeira MJ, Yeng LT, de Andrade DC. Motor corticospinal excitability abnormalities differ between distinct chronic low back pain syndromes. Neurophysiol Clin 2023; 53:102853. [PMID: 37018953 DOI: 10.1016/j.neucli.2023.102853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/26/2023] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVES It is not known whether cortical plastic changes reported in low-back pain (LBP) are present in all etiologies of LBP. Here we report on the assessment of patients with three LBP conditions: non-specific-LBP (ns-LBP), failed back surgery syndrome (FBSS), and sciatica (Sc). METHODS Patients underwent a standardized assessment of clinical pain, conditioned pain modulation (CPM), and measures of motor evoked potential (MEPs)-based motor corticospinal excitability (CE) by transcranial magnetic stimulation, including short interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Comparisons were also made with normative data from sex- and age-matched healthy volunteers. RESULTS 60 patients (42 women, 55.1±9.1 years old) with LBP were included (20 in each group). Pain intensity was higher in patients with neuropathic pain [FBSS (6.8±1.3), and Sc (6.4±1.4)] than in those with ns-LBP (4.7±1.0, P<0.001). The same was shown for pain interference (5.9±2.0, 5.9±1.8, 3.2±1.9, P<0.001), disability (16.4±3.3, 16.3±4.3, 10.4±4.3, P<0.001), and catastrophism (31.1±12.3, 33.0±10.4, 17.4±10.7, P<0.001) scores for FBSS, Sc, and ns-LBP groups, respectively. Patients with neuropathic pain (FBSS, Sc) had lower CPM (-14.8±1.9, -14.1±16.7, respectively) compared to ns-LBP (-25.4±16.6; P<0.02). 80.0% of the FBSS group had defective ICF compared to the other two groups (52.5% for ns-LBP, P=0.025 and 52.5% for Sc, P=0.046). MEPs (140%-rest motor threshold) were low in 50.0% of patients in the FBSS group compared to 20.0% of ns-LBP (P=0.018) and 15.0% of Sc (P=0.001) groups. Higher MEPs were correlated with mood scores (r=0.489), and with lower neuropathic pain symptom scores(r=-0.415) in FBSS. CONCLUSIONS Different types of LBP were associated with different clinical, CPM and CE profiles, which were not uniquely related to the presence of neuropathic pain. These results highlight the need to further characterize patients with LBP in psychophysics and cortical neurophysiology studies.
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Affiliation(s)
- Marcelo Luiz da Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ana Mércia Fernandes
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Valquíria A Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- School of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Valter Felau
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Joaci O de Araujo
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Jefferson Rosi
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Roger S Brock
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Gabriel T Kubota
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Lin T Yeng
- Pain Center, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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Barbosa LM, Valerio F, da Silva VA, Rodrigues ALDL, Galhardoni R, Yeng LT, Junior JR, Conforto AB, Lucato LT, Teixeira MJ, de Andrade DC. Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients. Neurophysiol Clin 2023; 53:102845. [PMID: 36822032 DOI: 10.1016/j.neucli.2023.102845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES Central neuropathic pain (CNP) is associated with altered corticomotor excitability (CE), which can potentially provide insights into its mechanisms. The objective of this study is to describe the CE changes that are specifically related to CNP. METHODS We evaluated CNP associated with brain injury after stroke or spinal cord injury (SCI) due to neuromyelitis optica through a battery of CE measurements and comprehensive pain, neurological, functional, and quality of life assessments. CNP was compared to two groups of patients with the same disease: i. with non-neuropathic pain and ii. without chronic pain, matched by sex and lesion location. RESULTS We included 163 patients (stroke=93; SCI=70: 74 had CNP, 43 had non-neuropathic pain, and 46 were pain-free). Stroke patients with CNP had lower motor evoked potential (MEP) in both affected and unaffected hemispheres compared to non- neuropathic pain and no-pain patients. Patients with CNP had lower amplitudes of MEPs (366 μV ±464 μV) than non-neuropathic (478 ±489) and no-pain (765 μV ± 880 μV) patients, p < 0.001. Short-interval intracortical inhibition (SICI) was defective (less inhibited) in patients with CNP (2.6±11.6) compared to no-pain (0.8±0.7), p = 0.021. MEPs negatively correlated with mechanical and cold-induced allodynia. Furthermore, classifying patients' results according to normative data revealed that at least 75% of patients had abnormalities in some CE parameters and confirmed MEP findings based on group analyses. DISCUSSION CNP is associated with decreased MEPs and SICI compared to non-neuropathic pain and no-pain patients. Corticomotor excitability changes may be helpful as neurophysiological markers of the development and persistence of pain after CNS injury, as they are likely to provide insights into global CE plasticity changes occurring after CNS lesions associated with CNP.
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Affiliation(s)
- Luciana Mendonça Barbosa
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil; Department of Neurology, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Fernanda Valerio
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Jefferson Rosi Junior
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil; Department of Neurology, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Department of Neurology, University of São Paulo, 05403-900, São Paulo, Brazil; Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark.
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Barbosa LM, Valerio F, Pereira SLA, da Silva VA, de Lima Rodrigues AL, Galhardoni R, Yeng LT, Rosi J, Conforto AB, Lucato LT, Lemos MD, Teixeira MJ, de Andrade DC. Site matters: Central neuropathic pain characteristics and somatosensory findings after brain and spinal cord lesions. Eur J Neurol 2023; 30:1443-1452. [PMID: 36773324 DOI: 10.1111/ene.15744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND It is unknown if different etiologies or lesion topographies influence central neuropathic pain (CNP) clinical manifestation. METHODS We explored the symptom-somatosensory profile relationships in CNP patients with different types of lesions to the central nervous system to gain insight into CNP mechanisms. We compared the CNP profile through pain descriptors, standardized bedside examination, and quantitative sensory test in two different etiologies with segregated lesion locations: the brain, central poststroke pain (CPSP, n = 39), and the spinal cord central pain due to spinal cord injury (CPSCI, n = 40) in neuromyelitis optica. RESULTS Results are expressed as median (25th to 75th percentiles). CPSP presented higher evoked and paroxysmal pain scores compared to CPSCI (p < 0.001), and lower cold thermal limen (5.6°C [0.0-12.9]) compared to CPSCI (20.0°C [4.2-22.9]; p = 0.004). CPSCI also had higher mechanical pain thresholds (784.5 mN [255.0-1078.0]) compared to CPSP (235.2 mN [81.4-1078.0], p = 0.006) and higher mechanical detection threshold compared to control areas (2.7 [1.5-6.2] vs. 1.0 [1.0-3.3], p = 0.007). Evoked pain scores negatively correlated with mechanical pain thresholds (r = -0.38, p < 0.001) and wind-up ratio (r = -0.57, p < 0.001). CONCLUSIONS CNP of different etiologies may present different pain descriptors and somatosensory profiles, which is likely due to injury site differences within the neuroaxis. This information may help better design phenotype mechanism correlations and impact trial designs for the main etiologies of CNP, namely stroke and spinal cord lesions. This study provides evidence that topography may influence pain symptoms and sensory profile. The findings suggest that CNP mechanisms might vary according to pain etiology or lesion topography, impacting future mechanism-based treatment choices.
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Affiliation(s)
- Luciana Mendonça Barbosa
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil.,Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Fernanda Valerio
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | - Jefferson Rosi
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, São Paulo, Brazil.,Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Department of Neurology, University of São Paulo, São Paulo, Brazil.,Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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De Martino E, Green DA, Ciampi de Andrade D, Weber T, Herssens N. Human movement in simulated hypogravity-Bridging the gap between space research and terrestrial rehabilitation. Front Neurol 2023; 14:1062349. [PMID: 36815001 PMCID: PMC9939477 DOI: 10.3389/fneur.2023.1062349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/18/2023] [Indexed: 02/09/2023] Open
Abstract
Human movement is optimized to Earth's gravity and based on highly complex interactions between sensory and neuro-muscular systems. Yet, humans are able to adapt-at least partially-to extreme environments upon and beyond Earth's surface. With upcoming Lunar Gateway and Artemis missions, it is crucial to increase our understanding of the impact of hypogravity-i.e., reduced vertical loading-on physiological and sensory-motor performances to improve countermeasure programs, and define crewmember's readiness to perform mission critical tasks. Several methodologies designed to reduce vertical loading are used to simulate hypogravity on Earth, including body weight support (BWS) devices. Countering gravity and offloading the human body is also used in various rehabilitation scenarios to improve motor recovery in neurological and orthopedic impairments. Thus, BWS-devices have the potential of advancing theory and practice of both space exploration and terrestrial rehabilitation by improving our understanding of physiological and sensory-motor adaptations to reduced vertical loading and sensory input. However, lack of standardization of BWS-related research protocols and reporting hinders the exchange of key findings and new advancements in both areas. The aim of this introduction paper is to review the role of BWS in understanding human movement in simulated hypogravity and the use of BWS in terrestrial rehabilitation, and to identify relevant research areas contributing to the optimization of human spaceflight and terrestrial rehabilitation. One of the main aims of this research topic is to facilitate standardization of hypogravity-related research protocols and outcome reporting, aimed at optimizing knowledge transfer between space research and BWS-related rehabilitation sciences.
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Affiliation(s)
- Enrico De Martino
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - David A. Green
- Space Medicine Team, European Astronaut Centre, Cologne, Germany,KBR GmbH, Cologne, Germany,Centre of Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Daniel Ciampi de Andrade
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, Cologne, Germany,KBR GmbH, Cologne, Germany
| | - Nolan Herssens
- Space Medicine Team, European Astronaut Centre, Cologne, Germany,*Correspondence: Nolan Herssens ✉
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Moisset X, Attal N, Ciampi de Andrade D. An Emoji-Based Visual Analog Scale Compared With a Numeric Rating Scale for Pain Assessment. JAMA 2022; 328:1980. [PMID: 36378212 DOI: 10.1001/jama.2022.16940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Xavier Moisset
- CHU de Clermont-Ferrand, Université Clermont Auvergne, Clermont Ferrand, France
| | - Nadine Attal
- CHU Ambroise Paré, Paris-Saclay University, Boulogne-Billancourt, France
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Lapa JDDS, da Cunha PHM, Teixeira MJ, Brito Medeiros VM, Fernandes AM, Silva de Morais AD, Graven-Nielsen T, Cury RG, Ciampi de Andrade D. Burst Transspinal Magnetic Stimulation Alleviates Nociceptive Pain in Parkinson Disease—A Pilot Phase II Double-Blind, Randomized Study. Neuromodulation 2022:S1094-7159(22)01331-9. [DOI: 10.1016/j.neurom.2022.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022]
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19
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da Cunha PHM, Tanaka H, Lapa JDDS, Dongyang L, Boa Sorte AA, Pereira TMR, Soares FHC, Fernandes AM, Aparecida da Silva V, Graven-Nielsen T, Teixeira MJ, de Andrade DC. The fast-posterior superior insula (Fast-PSI): A neuronavigation-free targeting method for non-invasive neuromodulation. Brain Stimul 2022; 15:1178-1180. [PMID: 35987328 DOI: 10.1016/j.brs.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Harki Tanaka
- Center of Engineering Modeling and Applied Social Science (CECS), Federal University of ABC (UFABC), Alameda da Universidade s/n, CEP 09606-045, São Bernardo do Campo, SP, Brazil
| | | | - Liu Dongyang
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Ana Mércia Fernandes
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Daniel Ciampi de Andrade
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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20
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Barbosa LM, da Silva VA, de Lima Rodrigues AL, Mendes Fernandes DTR, de Oliveira RAA, Galhardoni R, Yeng LT, Junior JR, Conforto AB, Lucato LT, Lemos MD, Peyron R, Garcia-Larrea L, Teixeira MJ, de Andrade DC. Dissecting central post-stroke pain: a controlled symptom-psychophysical characterization. Brain Commun 2022; 4:fcac090. [PMID: 35528229 PMCID: PMC9070496 DOI: 10.1093/braincomms/fcac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Central post-stroke pain affects up to 12% of stroke survivors and is notoriously refractory to treatment. However, stroke patients often suffer from other types of pain of non- neuropathic nature (musculoskeletal, inflammatory, complex regional) and no head-to-head comparison of their respective clinical and somatosensory profiles has been performed so far.
We compared 39 patients with definite central neuropathic post-stroke pain with two matched- control groups: 32 patients with exclusively non-neuropathic pain developed after stroke and 31 stroke patients not complaining of pain. Patients underwent deep phenotyping via a comprehensive assessment including clinical exam, questionnaires and quantitative sensory testing to dissect central post-stroke pain from chronic pain in general and stroke.
While central post-stroke pain was mostly located in the face and limbs, non-neuropathic pain was predominantly axial and located in neck, shoulders and knees (p<0.05). Neuropathic Pain Symptom Inventory clusters burning (82.1%, n=32, p<0.001), tingling (66.7%, n= 26, p<0.001) and evoked by cold (64.1%, n=25, p<0.001) occurred more frequently in central post-stroke pain. Hyperpathia, thermal and mechanical allodynia also occurred more commonly in this group (p<0.001), which also presented higher levels of deafferentation (p<0.012) with more asymmetric cold and warm detection thresholds compared to controls. In particular, cold hypoesthesia (considered when the threshold of the affected side was less than 41% of the contralateral threshold) odds ratio was 12 (95%CI: 3.8-41.6) for neuropathic pain. Additionally, cold detection threshold/ warm detection threshold ratio correlated with the presence of neuropathic pain (ρ=-0.4, p< 0.001). Correlations were found between specific neuropathic pain symptom clusters and quantitative sensory testing: paroxysmal pain with cold (ρ=-0.4; p=0.008) and heat pain thresholds (ρ=0.5; p=0.003), burning pain with mechanical detection (ρ= -0.4; p=0.015) and mechanical pain thresholds (ρ=-0.4, p<0.013), evoked pain with mechanical pain threshold (ρ= -0.3; p=0.047). Logistic regression showed that the combination of cold hypoesthesia on quantitative sensory testing, the Neuropathic Pain Symptom Inventory, and the allodynia intensity on bedside examination explained 77% of the occurrence of neuropathic pain.
These findings provide insights into the clinical-psychophysics relationships in central post-stroke pain and may assist more precise distinction of neuropathic from non-neuropathic post-stroke pain in clinical practice and in future trials.
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Affiliation(s)
| | | | | | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Jefferson Rosi Junior
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Marcelo Delboni Lemos
- Department of Radiology, LIM-44, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Roland Peyron
- NeuroPain team, Lyon Neuroscience Research Center (CRNL), Inserm U1028, CNRS UMR5292, UCBL1, UJM, F-6900, Lyon, France
| | - Luis Garcia-Larrea
- NeuroPain team, Lyon Neuroscience Research Center (CRNL), Inserm U1028, CNRS UMR5292, UCBL1, UJM, F-6900, Lyon, France
| | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Department of Neurology, LIM-62, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark
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21
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da Cunha PHM, Dongyang L, Fernandes AM, Thibes RB, Sato J, Tanaka H, Dale C, Lapa JDDS, de Morais ADS, Soares FHC, da Silva VA, Graven-Nielsen T, Teixeira MJ, de Andrade DC. Non-invasive insular stimulation for peripheral neuropathic pain: Influence of target or symptom? Neurophysiol Clin 2022; 52:109-116. [DOI: 10.1016/j.neucli.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022] Open
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22
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de Andrade DC, Saaibi D, Sarría N, Vainstein N, Ruiz LC, Espinosa R. Assessing the burden of osteoarthritis in Latin America: a rapid evidence assessment. Clin Rheumatol 2022; 41:1285-1292. [PMID: 35094195 PMCID: PMC9056472 DOI: 10.1007/s10067-022-06063-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/14/2021] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
Abstract
Abstract
This rapid evidence assessment (REA) was conducted to explore the burden of weight-bearing joint osteoarthritis in the developing countries of Latin America. REA methodology used a standardized search strategy to identify observational studies published from 2010 to 23 April 2020 that reported outcomes pertaining to the epidemiology and humanistic or economic burden of weight-bearing osteoarthritis. Relevant data from each included study were used to populate bespoke data extraction tables and qualitatively analyzed. Thirteen publications were identified that reported on knee and hip osteoarthritis in the Latin American region. Overall prevalence of physician-diagnosed symptomatic knee osteoarthritis in adults ranged from 1.55% in Peru to 7.4% in Ecuador. Total prevalence of grade ≥ 2 radiographic knee osteoarthritis was 22% among those ≥ 39 years of age in Brazil and 25.5% among those ≥ 40 years of age in Mexico. The prevalence of symptomatic/radiographic knee osteoarthritis was 7.1% in people ≥ 18 years of age in Mexico and 17.6% among those ≥ 40 years of age. Prevalence of hip osteoarthritis was similar to or slightly lower than knee osteoarthritis. The limited data available indicates weight-bearing osteoarthritis negatively affects quality of life and that the economic burden may vary between countries with different healthcare systems. The limited evidence found in the published literature suggests the burden of osteoarthritis in Latin America is substantial. Our analysis identified several evidence gaps, particularly for health-related quality of life and socioeconomic outcomes. Further research is of particular importance in areas where government-subsidized healthcare and resources are scarce.
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Sá KN, Venas G, Souza MPD, Andrade DCD, Baptista AF. Brazilian research on noninvasive brain stimulation applied to health conditions. Arq Neuropsiquiatr 2021; 79:974-981. [PMID: 34816989 DOI: 10.1590/0004-282x-anp-2020-0480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/23/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Brazil has a top position regarding scientific production on noninvasive neuromodulation worldwide. Knowledge of scientometric phenomena involving Brazilian researchers who produce science on this theme may aid confidence in Brazilian clinical and research professionals. OBJECTIVE To investigate the scenario of research on the theme of noninvasive neuromodulation in Brazil. METHODS This was a scientometric study for mapping scientific production on this subject involving network phenomena, the professions of researchers, institutional affiliation, main research unit, total number of scientific articles on noninvasive neuromodulation published in journals, research sub-area and year of obtaining the PhD title. Public data from Lattes Platform curricula vitae and from VOSViewer© were used. RESULTS A total of 54 Brazilian researchers were identified, of whom 16 are research productivity fellows. Most of them are linked to institutions in southeastern Brazil, involving the professions of biology, biochemistry, physical education, physiotherapy, speech therapy, gerontology, medicine and psychology, with 1175 articles published in journals. These studies involve experimental animal and human models to account for mechanisms, observational studies, case reports, randomized clinical trials, systematic reviews, meta-analyses, product and process development, computer modeling and guidelines. CONCLUSIONS Brazil occupies a prominent place in the world scenario of research on noninvasive neuromodulation, which is used by different professions for treatment of brain dysfunctions, with a trend towards expansion to other fields.
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Affiliation(s)
- Katia Nunes Sá
- Escola Bahiana de Medicina e Saúde Pública, Programa de Pós Graduação, Salvador BA, Brazil
| | - Gabriel Venas
- Universidade de São Paulo, Ciências da Reabilitação, São Paulo SP, Brazil
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24
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de Oliveira RAA, Pinto BD, Rebouças BH, Ciampi de Andrade D, de Vasconcellos ACS, Basta PC. Neurological Impacts of Chronic Methylmercury Exposure in Munduruku Indigenous Adults: Somatosensory, Motor, and Cognitive Abnormalities. Int J Environ Res Public Health 2021; 18:ijerph181910270. [PMID: 34639574 PMCID: PMC8507861 DOI: 10.3390/ijerph181910270] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
There has been increasing evidence about mercury (Hg) contamination in traditional populations from the Amazon Basin due to illegal gold mining. The most concerning health impact is neurotoxicity caused by Hg in its organic form: methylmercury (MeHg). However, the severity and extent of the neurotoxic effects resulting from chronic environmental exposure to MeHg are still unclear. We conducted a clinical-epidemiological study to evaluate the neurological impacts of chronic MeHg exposure in Munduruku indigenous people, focusing on somatosensory, motor, and cognitive abnormalities. All participants were subjected to a systemized neurological exam protocol, including Brief Cognitive Screening Battery (BCSB), verbal fluency test, and Stick Design Test. After the examination, hair samples were collected to determine MeHg levels. Data collection took place between 29 October and 9 November 2019, in three villages (Sawré Muybu, Poxo Muybu, and Sawré Aboy) from Sawré Muybu Indigenous Land, Southwest of Pará state. One hundred and ten individuals >12 years old were included, 58 of which were men (52.7%), with an average age of 27.6 years (range from 12 to 72). Participants’ median MeHg level was 7.4 µg/g (average: 8.7; S.D: 4.5; range: 2.0–22.8). In Sawré Aboy village, the median MeHg level was higher (12.5 µg/g) than in the others, showing a significant statistical exposure gradient (Kruskal–Wallis test with p-value < 0.001). Cerebellar ataxia was observed in two participants with MeHg levels of 11.68 and 15.68 µg/g. Individuals with MeHg exposure level ≥10 µg/g presented around two-fold higher chances of cognitive deficits (RP: 2.2; CI 95%: 1.13–4.26) in BCSB, and in the verbal fluency test (RP: 2.0; CI 95%: 1.18–3.35). Furthermore, adolescents of 12 to 19 years presented three-fold higher chances of verbal development deficits, according to the fluency test (RP: 3.2; CI 95%: 1.06–9.42), than individuals of 20 to 24 years. The worsened motor and cognitive functions are suggestive of neurotoxicity due to chronic MeHg exposure. In conclusion, we believe monitoring and follow-up measures are necessary for chronic mercury exposed vulnerable people, and a basic care protocol should be established for contaminated people in the Brazilian Unified Health System.
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Affiliation(s)
- Rogério Adas Ayres de Oliveira
- Centro de Dor, Departamento de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 05403-000, Brazil; (R.A.A.d.O.); (B.D.P.); (B.H.R.); (D.C.d.A.)
| | - Bruna Duarte Pinto
- Centro de Dor, Departamento de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 05403-000, Brazil; (R.A.A.d.O.); (B.D.P.); (B.H.R.); (D.C.d.A.)
| | - Bruno Hojo Rebouças
- Centro de Dor, Departamento de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 05403-000, Brazil; (R.A.A.d.O.); (B.D.P.); (B.H.R.); (D.C.d.A.)
| | - Daniel Ciampi de Andrade
- Centro de Dor, Departamento de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 05403-000, Brazil; (R.A.A.d.O.); (B.D.P.); (B.H.R.); (D.C.d.A.)
| | - Ana Claudia Santiago de Vasconcellos
- Laboratório de Educação Profissional em Vigilância em Saúde, Escola Politécnica de Saúde Joaquim Venâncio, Fundação Oswaldo Cruz (EPSJV/Fiocruz), Rio de Janeiro 21040-900, Brazil;
| | - Paulo Cesar Basta
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rio de Janeiro 21041-210, Brazil
- Correspondence: ; Tel.: +55-21-2598-2503
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25
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Diniz JM, Cury RG, Iglesio RF, Lepski GA, França CC, Barbosa ER, de Andrade DC, Teixeira MJ, Duarte KP. Dentate nucleus deep brain stimulation: Technical note of a novel methodology assisted by tractography. Surg Neurol Int 2021; 12:400. [PMID: 34513166 PMCID: PMC8422468 DOI: 10.25259/sni_338_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background The cerebellum has emerged as an attractive and promising target for neuromodulation in movement disorders due to its vast connection with important cortical and subcortical areas. Here, we describe a novel technique of deep brain stimulation (DBS) of the dentate nucleus (DN) aided by tractography. Methods Since 2015, patients with movement disorders including dystonia, ataxia, and tremor have been treated with DN DBS. The cerebellar target was initially localized using coordinates measured from the fastigial point. The target was adjusted with direct visualization of the DN in the susceptibility-weighted imaging and T2 sequences of the MRI and finally refined based on the reconstruction of the dentatorubrothalamic tract (DRTT). Results Three patients were treated with this technique. The final target was located in the anterior portion of DN in close proximity to the DRTT, with the tip of the lead on the white matter and the remaining contacts on the DN. Clinical outcomes were variable and overall positive, with no major side effect. Conclusion Targeting the DN based on tractography of the DRTT seems to be feasible and safe. Larger studies will be necessary to support our preliminary findings.
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Affiliation(s)
- Juliete Melo Diniz
- Department of Neurology, Functional Neurosurgery Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Ferrareto Iglesio
- Department of Neurology, Functional Neurosurgery Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Guilherme Alves Lepski
- Department of Neurology, Functional Neurosurgery Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carina Cura França
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Manoel Jacobsen Teixeira
- Department of Neurology, Functional Neurosurgery Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Kleber Paiva Duarte
- Department of Neurology, Functional Neurosurgery Division, School of Medicine, University of São Paulo, São Paulo, Brazil
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26
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Basta PC, Viana PVDS, de Vasconcellos ACS, Périssé ARS, Hofer CB, Paiva NS, Kempton JW, Ciampi de Andrade D, de Oliveira RAA, Achatz RW, Perini JA, Meneses HDNDM, Hallwass G, Lima MDO, de Jesus IM, dos Santos CCR, Hacon SDS. Mercury Exposure in Munduruku Indigenous Communities from Brazilian Amazon: Methodological Background and an Overview of the Principal Results. Int J Environ Res Public Health 2021; 18:9222. [PMID: 34501811 PMCID: PMC8430525 DOI: 10.3390/ijerph18179222] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/20/2022]
Abstract
The Amazonian indigenous peoples depend on natural resources to live, but human activities' growing impacts threaten their health and livelihoods. Our objectives were to present the principal results of an integrated and multidisciplinary analysis of the health parameters and assess the mercury (Hg) exposure levels in indigenous populations in the Brazilian Amazon. We carried out a cross-sectional study based on a census of three Munduruku indigenous villages (Sawré Muybu, Poxo Muybu, and Sawré Aboy), located in the Sawré Muybu Indigenous Land, between 29 October and 9 November 2019. The investigation included: (i) sociodemographic characterization of the participants; (ii) health assessment; (iii) genetic polymorphism analysis; (iv) hair mercury determination; and (v) fish mercury determination. We used the logistic regression model with conditional Prevalence Ratio (PR), with the respective 95% confidence intervals (CI95%) to explore factors associated with mercury exposure levels ≥6.0 µg/g. A total of 200 participants were interviewed. Mercury levels (197 hair samples) ranged from 1.4 to 23.9 μg/g, with significant differences between the villages (Kruskal-Wallis test: 19.9; p-value < 0.001). On average, the general prevalence of Hg exposure ≥ 6.0 µg/g was 57.9%. For participants ≥12 years old, the Hg exposure ≥6.0 µg/g showed associated with no regular income (PR: 1.3; CI95%: 1.0-1.8), high blood pressure (PR: 1.6; CI95%: 1.3-2.1) and was more prominent in Sawré Aboy village (PR: 1.8; CI95%: 1.3-2.3). For women of childbearing age, the Hg exposure ≥6.0 µg/g was associated with high blood pressure (PR: 1.9; CI95%: 1.2-2.3), with pregnancy (PR: 1.5; CI95%: 1.0-2.1) and was more prominent among residents in Poxo Muybu (PR: 1.9; CI95%: 1.0-3.4) and Sawré Aboy (PR: 2.5; CI95%: 1.4-4.4) villages. Our findings suggest that chronic mercury exposure causes harmful effects to the studied indigenous communities, especially considering vulnerable groups of the population, such as women of childbearing age. Lastly, we propose to stop the illegal mining in these areas and develop a risk management plan that aims to ensure the health, livelihoods, and human rights of the indigenous people from Amazon Basin.
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Affiliation(s)
- Paulo Cesar Basta
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480-Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Paulo Victor de Sousa Viana
- Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (CRPHF/ENSP/Fiocruz), Estrada de Curicica, 2000-Curicica, Rio de Janeiro 22780-195, Brazil;
| | - Ana Claudia Santiago de Vasconcellos
- Laboratório de Educação Profissional em Vigilância em Saúde, Escola Politécnica de Saúde Joaquim Venâncio, Fundação Oswaldo Cruz (EPSJV/Fiocruz), Av. Brazil, 4365-Manguinhos, Rio de Janeiro 21040-900, Brazil;
| | - André Reynaldo Santos Périssé
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480-Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Cristina Barroso Hofer
- Instituto de Pediatria e Puericultura Martagão Gesteira, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50-Cidade Universitária, Rio de Janeiro 21941-912, Brazil;
| | - Natalia Santana Paiva
- Instituto de Estudos em Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo, s/n, Ilha do Fundão-Cidade Universitária, Rio de Janeiro 21941-598, Brazil;
| | - Joseph William Kempton
- Faculty of Medicine, Imperial College London, Medical School Building, St Mary’s Hospital, Norfolk Place, London W2 1PG, UK;
| | - Daniel Ciampi de Andrade
- Centro de Dor, Departamento de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo 05403-000, Brazil; (D.C.d.A.); (R.A.A.d.O.)
| | - Rogério Adas Ayres de Oliveira
- Centro de Dor, Departamento de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo 05403-000, Brazil; (D.C.d.A.); (R.A.A.d.O.)
| | - Rafaela Waddington Achatz
- Programa de Pós-Graduação em Psicologia Clínica do Instituto de Psicologia da Universidade de São Paulo (USP), Av. Professor Mello Moraes, 1721-Butantã, São Paulo 05508-030, Brazil;
| | - Jamila Alessandra Perini
- Laboratório de Pesquisa de Ciências Farmacêuticas (LAPESF), Centro Universitário Estadual da Zona Oeste (UEZO), Av. Manuel Caldeira de Alvarenga, 1.203, Rio de Janeiro 23070-200, Brazil;
| | - Heloísa do Nascimento de Moura Meneses
- Programa de Pós-Graduação em Ciências da Saúde (PPGCSA), Universidade Federal do Oeste do Pará, Rua Vera Paz Av. Vera Paz, s/n, Bairro Salé, 1° Pavimento, Bloco Modular Tapajós, Unidade Tapajós, Santarém, Pará 68035-110, Brazil;
| | - Gustavo Hallwass
- Programa de Pós-Graduação em Biociências (PPGBio), Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, Bairro Salé, Santarém 68035-110, Brazil;
| | - Marcelo de Oliveira Lima
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7, s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Iracina Maura de Jesus
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7, s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Cleidiane Carvalho Ribeiro dos Santos
- Distrito Sanitário Especial Indígena Rio Tapajós (DSEI), Secretaria Especial de Saúde Indígena Tapajós (Sesai), Av. Santa Catarina, 10° Rua, nº 96, Bairro Bela Vista, Itaituba 68180-210, Brazil;
| | - Sandra de Souza Hacon
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480-Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
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27
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Hamani C, Fonoff ET, Parravano DC, Silva VA, Galhardoni R, Monaco B, Navarro J, Yeng LT, Teixeira MJ, Ciampi de Andrade D. Motor cortex stimulation for chronic neuropathic pain: results of a double-blind randomized study. Brain 2021; 144:2994-3004. [PMID: 34373901 DOI: 10.1093/brain/awab189] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/04/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Motor cortex stimulation (MCS) via surgically implanted electrodes has been used as an off-label treatment for chronic neuropathic pain (cNeP) but its efficacy has not been fully established. We aimed to objectively study the efficacy of MCS and characterize potential predictors of response. In this randomised, double-blind, sham-controlled, single centre trial, we recruited 18 cNeP patients who did not adequately respond to conventional treatment and had a numerical rating pain scale (NRS) score ≥ 6. Patients were initially assigned to receive three months of active ("on") or sham ("off") stimulation in a double-blind cross-over phase. This was followed by a 3-month single-blind phase, and 6 months of open-label follow-up. A meaningful response in our trial was defined as a ≥ 30% or 2-point reduction in NRS scores during active stimulation. Using Bayesian statistics, we found a 41.4% probability of response towards "on" vs. "off" MCS. The probability of improvement during active stimulation (double-blind, single-blind and open label phases) compared to baseline was of 47.2-68.5%. 39% of patients were long-term responders, 71.4% of whom had facial pain, phantom limb pain, or complex regional pain syndrome. In contrast, 72.7% of non-responders had either post-stroke pain or pain associated with brachial plexus avulsion. 39% of patients had a substantial post-operative analgesic effect after electrode insertion in the absence of stimulation. Individuals with diagnoses associated with a good postoperative outcome or those who developed an insertional effect had a near 100% probability of response to MCS. In summary, we found that approximately 40% of patients responded to MCS, particularly those who developed an insertional effect or had specific clinical conditions that seemed to predict an appropriate postoperative response.
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Affiliation(s)
- Clement Hamani
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Harquail Centre for Neuromodulation, Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Erich T Fonoff
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniella C Parravano
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Valquiria A Silva
- Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bernardo Monaco
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jessie Navarro
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Lin T Yeng
- Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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28
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Mylius V, Möller JC, Bohlhalter S, Ciampi de Andrade D, Perez Lloret S. Diagnosis and Management of Pain in Parkinson's Disease: A New Approach. Drugs Aging 2021; 38:559-577. [PMID: 34224103 DOI: 10.1007/s40266-021-00867-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/27/2022]
Abstract
Pain is a frequent and disabling non-motor feature of Parkinson's disease (PD). The recently proposed PD Pain Classification System (PD-PCS) allows for an association of pain with PD to be determined before being allocated to the main pain mechanism (i.e. nociceptive, neuropathic, and nociplastic). In this article, previous studies on treatments for pain in PD are summarized according to the pain mechanisms. A mechanistic approach to treatment is discussed. We suggest that the first step should be optimizing dopaminergic therapy before other therapy is started. When these treatments remain unsuccessful, further causes of pain must be considered. The role of drugs, invasive treatments, and physiotherapeutic interventions are discussed with a focus on older PD patients and considering polypharmacy, altered pharmacokinetics, and comorbidities.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, 7317, Valens, Switzerland. .,Department of Neurology, Philipps University, Marburg, Germany. .,Department of Neurology, Kantonsspital, St. Gallen, Switzerland.
| | - Jens Carsten Möller
- Department of Neurology, Philipps University, Marburg, Germany.,Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Daniel Ciampi de Andrade
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, Brazil.,Instituto do Cancer de Sao Paulo, Octavio Frias de Oliveira, Sao Paulo, Brazil.,Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Santiago Perez Lloret
- LIM 62, Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), Buenos Aires, Argentina.,Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina.,Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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29
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Brucki SMD, Adoni T, Almeida CMO, Andrade DCD, Anghinah R, Barbosa LM, Bazan R, Carvalho AADS, Carvalho W, Christo PP, Coletta MD, Conforto AB, Correa-Neto Y, Engelhardt E, França Junior MC, Franco C, VON Glehn F, Gomes HR, Houly CGDB, Kaup AO, Kowacs F, Kanashiro A, Lopes VG, Maia D, Manreza M, Martinez ARM, Martinez SCG, Nader SN, Neves LDO, Okamoto IH, Oliveira RAAD, Peixoto FDM, Pereira CB, Saba RA, Sampaio LPDB, Schilling LP, Silva MTT, Silva ER, Smid J, Soares CN, Sobreira-Neto M, Sousa NADC, Souza LCD, Teive HAG, Terra VC, Vale M, Vieira VMG, Zanoteli E, Prado G. Cannabinoids in Neurology - Position paper from Scientific Departments from Brazilian Academy of Neurology. Arq Neuropsiquiatr 2021; 79:354-369. [PMID: 34133518 DOI: 10.1590/0004-282x-anp-2020-0432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 01/02/2023]
Abstract
Cannabinoids comprehend endocannabinoids, phytocannabinoids, and synthetic cannabinoids, with actions both in the central and peripherical nervous systems. A considerable amount of publications have been made in recent years, although cannabis has been known for over a thousand years. Scientific Departments from the Brazilian Academy of Neurology described evidence for medical use in their areas. Literature is constantly changing, and possible new evidence can emerge in the next days or months. Prescription of these substances must be discussed with patients and their families, with knowledge about adverse events and their efficacy.
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Affiliation(s)
- Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.,Hospital Santa Marcelina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Tarso Adoni
- Hospital Sírio-Libanês, Núcleo de Neurociências, São Paulo SP, Brazil.,Hospital Heliópolis, Departamento de Neurologia, São Paulo SP, Brazil
| | - Carlos Mauricio Oliveira Almeida
- Universidade Estadual do Amazonas, Departamento de Neurologia, Manaus AM, Brazil.,Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Daniel Ciampi de Andrade
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Renato Anghinah
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Luciana Mendonça Barbosa
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências Médicas e Biológicas de Botucatu, Hospital das Clínicas, Departamento de Neurologia, Psicologia e Psiquiatria, Botucatu SP, Brazil
| | | | - William Carvalho
- Hospital Geral de Goiânia Dr Alberto Rassi, Departamento de Neurologia, Goiânia GO, Brazil
| | - Paulo Pereira Christo
- Santa Casa de Belo Horizonte, Departamento de Neurologia, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Hospital das Clínicas, Departamento de Neurologia, Belo Horizonte MG, Brazil
| | - Marcus Della Coletta
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus AM, Brazil
| | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Eliasz Engelhardt
- Universidade Federal do Rio de Janeiro, Instituto de Neurologia Deolindo Couto, Departamento de Neurologia, Rio de Janeiro RJ, Brazil
| | | | | | - Felipe VON Glehn
- Universidade Estadual de Campinas, Instituto de Biologia, Genética, Imunologia e Bioagentes, Campinas SP, Brazil
| | - Helio Rodrigues Gomes
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | | | - Fernando Kowacs
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Clínica Médica, Porto Alegre RS, Brazil.,Hospital Moinhos de Vento, Serviço de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil
| | | | - Victor Gonçalves Lopes
- Hospital Federal dos Servidores do Estado, Departamento de Neurologia, São Paulo SP, Brazil
| | - Débora Maia
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Departamento de Neurologia, Belo Horizonte MG, Brazil
| | - Maria Manreza
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | | | - Saulo Nardy Nader
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | | | - Rogério Adas Ayres de Oliveira
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Fabiano de Melo Peixoto
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Cristiana Borges Pereira
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Roberta Arb Saba
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.,Hospital do Servidor Público Estadual, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Lucas Porcello Schilling
- Pontifícia Universidade Católica do Rio Grande do Sul, São Lucas Hospital, Instituto do Cérebro, Porto Alegre RS, Brazil
| | | | - Emanuelle Roberta Silva
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.,Hospital Sírio-Libanês, Núcleo de Neurociências, São Paulo SP, Brazil
| | - Jerusa Smid
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Manoel Sobreira-Neto
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Fortaleza CE, Brazil
| | | | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | | | | | - Matheus Vale
- Faculdade de Medicina do ABC, Departamento de Neurologia, Santo André SP, Brazil
| | | | - Edmar Zanoteli
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Gilmar Prado
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
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30
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Dongyang L, Fernandes AM, da Cunha PHM, Tibes R, Sato J, Listik C, Dale C, Kubota GT, Galhardoni R, Teixeira MJ, Aparecida da Silva V, Rosi J, Ciampi de Andrade D. Posterior-superior insular deep transcranial magnetic stimulation alleviates peripheral neuropathic pain - A pilot double-blind, randomized cross-over study. Neurophysiol Clin 2021; 51:291-302. [PMID: 34175192 DOI: 10.1016/j.neucli.2021.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Peripheral neuropathic pain (pNeP) is prevalent, and current treatments, including drugs and motor cortex repetitive transcranial magnetic stimulation (rTMS) leave a substantial proportion of patients with suboptimal pain relief. METHODS We explored the intensity and short-term duration of the analgesic effects produced in pNeP patients by 5 days of neuronavigated deep rTMS targeting the posterior superior insula (PSI) with a double-cone coil in a sham-controlled randomized cross-over trial. RESULTS Thirty-one pNeP patients received induction series of five active or sham consecutive sessions of daily deep-rTMS to the PSI in a randomized sequence, with a washout period of at least 21 days between series. The primary outcome [number of responders (>50% pain intensity reduction from baseline in a numerical rating scale ranging from 0 to 10)] was significantly higher after real (58.1%) compared to sham (19.4%) stimulation (p = 0.002). The number needed to treat was 2.6, and the effect size was 0.97 [95% CI (0.6; 1.3)]. One week after the 5th stimulation day, pain scores were no longer different between groups, and no difference in neuropathic pain characteristics and interference with daily living were present. No major side effects occurred, and milder adverse events (i.e., short-lived headaches after stimulation) were reported in both groups. Blinding was effective, and analgesic effects were not affected by sequence of the stimulation series (active-first or sham-first), age, sex or pain duration of participants. DISCUSSION PSI deep-rTMS was safe in refractory pNeP and was able to provide significant pain intensity reduction after a five-day induction series of treatments. Post-hoc assessment of neuronavigation targeting confirmed deep-rTMS was delivered within the boundaries of the PSI in all participants. CONCLUSION PSI deep-rTMS provided significant pain relief during 5-day induction sessions compared to sham stimulation.
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Affiliation(s)
- Liu Dongyang
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Ana Mércia Fernandes
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Pedro Henrique Martins da Cunha
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Raissa Tibes
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - João Sato
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Clarice Listik
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Camila Dale
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Gabriel Taricani Kubota
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Ricardo Galhardoni
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Manoel Jacobsen Teixeira
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Valquíria Aparecida da Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Jefferson Rosi
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil
| | - Daniel Ciampi de Andrade
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, P.O. Box: 05403-900, São Paulo, SP, Brazil; Pain Center Instituto do Câncer Octavio Frias de Oliveira, University of São Paulo, Avenida Dr. Arnaldo 251, P.O. Box: 01246-000, São Paulo, SP, Brazil.
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31
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Pimentel GA, Coutinho AM, de Souza Godoy LF, de Lima LGCA, de Andrade DC. Intense Hypermetabolic Tumefactive Demyelination on 18F-FDG PET and MRI Related to Multiple Sclerosis Relapse After Fingolimod Suspension. Clin Nucl Med 2021; 46:e198-e199. [PMID: 33323727 DOI: 10.1097/rlu.0000000000003419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
ABSTRACT A 57-year-old woman with a history of multiple sclerosis presented with a 5-day history of progressive headache and confusion, followed by left hemiparesis. The patient had stopped her previous fingolimod usage during the last 8 weeks. Brain MRI and 18F-FDG PET showed a subcortical tumefactive lesion with an intense peripheric rim of hypermetabolism and central hypometabolism, with central hyperintensity, thin isointense rim, and peripheral finger-like "tentacles" of edema with an irregular and thick border enhancement on postcontrast T2-weighted MRI. Brain biopsy showed features suggestive of relapsing MS. The patient improved after methylprednisone and plasma exchange.
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32
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Bouhassira D, Branders S, Attal N, Fernandes AM, Demolle D, Barbour J, Ciampi de Andrade D, Pereira A. Stratification of patients based on the Neuropathic Pain Symptom Inventory: development and validation of a new algorithm. Pain 2021; 162:1038-1046. [PMID: 33136982 DOI: 10.1097/j.pain.0000000000002130] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022]
Abstract
ABSTRACT The personalization of neuropathic pain treatment could be improved by identifying specific sensory phenotypes (ie, specific combinations of symptoms and signs) predictive of the response to different classes of drugs. A simple and reliable phenotyping method is required for such a strategy. We investigated the utility of an algorithm for stratifying patients into clusters corresponding to specific combinations of neuropathic symptoms assessed with the Neuropathic Pain Symptom Inventory (NPSI). Consistent with previous results, we first confirmed, in a cohort of 628 patients, the existence of a structure consisting of 3 clusters of patients characterized by higher NPSI scores for: pinpointed pain (cluster 1), evoked pain (cluster 2), or deep pain (cluster 3). From these analyses, we derived a specific algorithm for assigning each patient to one of these 3 clusters. We then assessed the clinical relevance of this algorithm for predicting treatment response, through post hoc analyses of 2 previous controlled trials of the effects of subcutaneous injections of botulinum toxin A. Each of the 97 patients with neuropathic pain included in these studies was individually allocated to one cluster, by applying the algorithm to their baseline NPSI responses. We found significant effects of botulinum toxin A relative to placebo in clusters 2 and 3, but not in cluster 1, suggesting that this approach was, indeed, relevant. Finally, we developed and performed a preliminary validation of a web-based version of the NPSI and algorithm for the stratification of patients in both research and daily practice.
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Affiliation(s)
- Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, CHU Ambroise Pare, Boulogne-Billancourt, France
| | | | - Nadine Attal
- Inserm U987, APHP, UVSQ, Paris-Saclay University, CHU Ambroise Pare, Boulogne-Billancourt, France
| | - Ana Mercia Fernandes
- LIM-62, Hospital Das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Julio Barbour
- LIM-62, Hospital Das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- LIM-62, Hospital Das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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33
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Mylius V, Perez Lloret S, Cury RG, Teixeira MJ, Barbosa VR, Barbosa ER, Moreira LI, Listik C, Fernandes AM, de Lacerda Veiga D, Barbour J, Hollenstein N, Oechsner M, Walch J, Brugger F, Hägele-Link S, Beer S, Rizos A, Chaudhuri KR, Bouhassira D, Lefaucheur JP, Timmermann L, Gonzenbach R, Kägi G, Möller JC, Ciampi de Andrade D. The Parkinson disease pain classification system: results from an international mechanism-based classification approach. Pain 2021; 162:1201-1210. [PMID: 33044395 PMCID: PMC7977616 DOI: 10.1097/j.pain.0000000000002107] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT Pain is a common nonmotor symptom in patients with Parkinson disease (PD) but the correct diagnosis of the respective cause remains difficult because suitable tools are lacking, so far. We developed a framework to differentiate PD- from non-PD-related pain and classify PD-related pain into 3 groups based on validated mechanistic pain descriptors (nociceptive, neuropathic, or nociplastic), which encompass all the previously described PD pain types. Severity of PD-related pain syndromes was scored by ratings of intensity, frequency, and interference with daily living activities. The PD-Pain Classification System (PD-PCS) was compared with classic pain measures (ie, brief pain inventory and McGill pain questionnaire [MPQ], PDQ-8 quality of life score, MDS-UPDRS scores, and nonmotor symptoms). 159 nondemented PD patients (disease duration 10.2 ± 7.6 years) and 37 healthy controls were recruited in 4 centers. PD-related pain was present in 122 patients (77%), with 24 (15%) suffering one or more syndromes at the same time. PD-related nociceptive, neuropathic, or nociplastic pain was diagnosed in 87 (55%), 25 (16%), or 35 (22%), respectively. Pain unrelated to PD was present in 35 (22%) patients. Overall, PD-PCS severity score significantly correlated with pain's Brief Pain Inventory and MPQ ratings, presence of dyskinesia and motor fluctuations, PDQ-8 scores, depression, and anxiety measures. Moderate intrarater and interrater reliability was observed. The PD-PCS is a valid and reliable tool for differentiating PD-related pain from PD-unrelated pain. It detects and scores mechanistic pain subtypes in a pragmatic and treatment-oriented approach, unifying previous classifications of PD-pain.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
| | - Santiago Perez Lloret
- Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), and Faculty of Medicine, Pontifical Catholic University of Argentina, Buenos Aires, Argentina
| | - Rubens G. Cury
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Manoel J. Teixeira
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Victor R. Barbosa
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Egberto R. Barbosa
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Larissa I. Moreira
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Clarice Listik
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Ana M. Fernandes
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Diogo de Lacerda Veiga
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Julio Barbour
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | | | - Matthias Oechsner
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Julia Walch
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
| | - Florian Brugger
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
| | | | - Serafin Beer
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Alexandra Rizos
- King's College Hospital, Parkinson Foundation Centre of Excellence, London, United Kingdom
| | - Kallol Ray Chaudhuri
- King's College Hospital, Parkinson Foundation Centre of Excellence, London, United Kingdom
- King's College London, Department Basic and Clinical Neuroscience, London, United Kingdom
- The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom
| | - Didier Bouhassira
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Assistance Publique—Hôpitaux de Paris, Boulogne-Billancourt and Université Versailles-Saint-Quentin, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine de Créteil, Université Paris-Est-Créteil, France
| | - Lars Timmermann
- Department of Neurology, Philipps University, Marburg, Germany
| | - Roman Gonzenbach
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Georg Kägi
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
| | - Jens Carsten Möller
- Department of Neurology, Philipps University, Marburg, Germany
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Daniel Ciampi de Andrade
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
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Listik C, Cury RG, da Silva VA, Casagrande SCB, Listik E, Link N, Galhardoni R, Barbosa ER, Teixeira MJ, Ciampi de Andrade D. Abnormal sensory thresholds of dystonic patients are not affected by deep brain stimulation. Eur J Pain 2021; 25:1355-1366. [PMID: 33740316 DOI: 10.1002/ejp.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Unlike motor symptoms, the effects of deep brain stimulation (DBS) on non-motor symptoms associated with dystonia remain unknown. METHODS The objective of this study was to assess the effects of DBS on evoked experimental pain and cutaneous sensory thresholds in a crossover, double-blind on/off study and compare these results with those of healthy volunteers (HV). RESULTS Sixteen patients with idiopathic dystonia (39.9 ± 13 years old, n = 14 generalized) with DBS of the globus pallidus internus underwent a battery of quantitative sensory testing and assessment using a pain top-down modulation system (conditioned pain modulation, CPM). Results for the more and less dystonic body regions were compared in on and off stimulation. The patients' results were compared to age- and sex-matched HV. Descending pain modulation CPM responses in dystonic patients (on-DBS, 11.8 ± 40.7; off-DBS, 1.8 ± 22.1) was abnormally low (defective) compared to HV (-15.6 ± 23.5, respectively p = .006 and p = .042). Cold pain threshold and cold hyperalgesia were 54.8% and 95.7% higher in dystonic patients compared to HV. On-DBS CPM correlated with higher Burke-Fahn-Marsden disability score (r = 0.598; p = .014). While sensory and pain thresholds were not affected by DBS on/off condition, pain modulation was abnormal in dystonic patients and tended to be aggravated by DBS. CONCLUSION The analgesic effects after DBS do not seem to depend on short-duration changes in cutaneous sensory thresholds in dystonic patients and may be related to changes in the central processing of nociceptive inputs.
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Affiliation(s)
- Clarice Listik
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Valquiria Aparecida da Silva
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Eduardo Listik
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Naira Link
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ricardo Galhardoni
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.,Federal University of ABC, São Bernardo do Campo, SP, Brazil.,School of Medicine, Santo André, SP, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Manoel Jacobsen Teixeira
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Daniel Ciampi de Andrade
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.,Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.,Pain Center, Instituto do Cancer do Estado de São Paulo, São Paulo, SP, Brazil
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Gomes Dos Santos A, Hayashi CY, de Almeida CC, Paiva WS, de Andrade DC, Galhardoni R, Brunoni AR, Teixeira MJ, Neville IS. Letter: Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading. Neurosurgery 2021; 88:E302-E303. [PMID: 33370792 DOI: 10.1093/neuros/nyaa512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexandra Gomes Dos Santos
- LIM-62 / Division of Neurosurgery Department of Neurology Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Cintya Yukie Hayashi
- Service of Interdisciplinary Neuromodulation (SIN) Laboratory of Neuroscience (LIM 27) and National Institute of Biomarkers in Neuropsychiatry (INBioN) Instituto de Psiquiatria Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Cesar Cimonari de Almeida
- LIM-62 / Division of Neurosurgery Department of Neurology Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Wellingson Silva Paiva
- LIM-62 / Division of Neurosurgery Department of Neurology Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN) Laboratory of Neuroscience (LIM 27) and National Institute of Biomarkers in Neuropsychiatry (INBioN) Instituto de Psiquiatria Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- LIM-62 / Division of Neurosurgery Department of Neurology Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN) Laboratory of Neuroscience (LIM 27) and National Institute of Biomarkers in Neuropsychiatry (INBioN) Instituto de Psiquiatria Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil.,Instituto do Cancer do Estado de Sao Paulo Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Ricardo Galhardoni
- LIM-62 / Division of Neurosurgery Department of Neurology Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN) Laboratory of Neuroscience (LIM 27) and National Institute of Biomarkers in Neuropsychiatry (INBioN) Instituto de Psiquiatria Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil.,Universidade Cidade de Sao Paulo Faculdade de Medicina São Paulo, Brazil
| | - Andre Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation (SIN) Laboratory of Neuroscience (LIM 27) and National Institute of Biomarkers in Neuropsychiatry (INBioN) Instituto de Psiquiatria Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- LIM-62 / Division of Neurosurgery Department of Neurology Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Iuri Santana Neville
- LIM-62 / Division of Neurosurgery Department of Neurology Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil.,Instituto do Cancer do Estado de Sao Paulo Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
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Soares FHC, Kubota GT, Fernandes AM, Hojo B, Couras C, Costa BV, Lapa JDDS, Braga LM, Almeida MMD, Cunha PHMD, Pereira VHH, Morais ADSD, Teixeira MJ, Ciampi de Andrade D. Prevalence and characteristics of new-onset pain in COVID-19 survivours, a controlled study. Eur J Pain 2021; 25:1342-1354. [PMID: 33619793 PMCID: PMC8013219 DOI: 10.1002/ejp.1755] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/21/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND We assessed whether COVID-19 is associated with de novo pain and de novo chronic pain (CP). METHODS This controlled cross-sectional study was based on phone interviews of patients discharged from hospital after COVID-19 compared to the control group composed of individuals hospitalized during the same period due to non-COVID-19 causes. Patients were classified as having previous CP based on the ICD-11/IASP criteria, de novo pain (i.e. any new type of pain, irrespective of the pain status before hospital stay), and de novo CP (i.e. persistent or recurring de novo pain, lasting more than 3 months) after COVID-19. We assessed pain prevalence and its characteristics, including headache profile, pain location, intensity, interference, and its relationship with fatigue, and persistent anosmia. Forty-six COVID-19 and 73 control patients were included. Both groups had similar sociodemographic characteristics and past medical history. RESULTS Length of in-hospital-stay and ICU admission rates were significantly higher amongst COVID-19 survivours, while mechanical ventilation requirement was similar between groups. Pre-hospitalisation pain was lower in COVID-19 compared to control group (10.9% vs. 42.5%; p = 0.001). However, the COVID-19 group had a significantly higher prevalence of de novo pain (65.2% vs. 11.0%, p = 0.001), as well as more de novo headache (39.1%) compared to controls (2.7%, p = 0.001). New-onset CP was 19.6% in COVID-19 patients and 1.4% (p = 0.002) in controls. These differences remained significant (p = 0.001) even after analysing exclusively (COVID: n = 40; controls: n = 34) patients who did not report previous pain before the hospital stay. No statistically significant differences were found for mean new-onset pain intensity and interference with daily activities between both groups. COVID-19 pain was more frequently located in the head/neck and lower limbs (p < 0.05). New-onset fatigue was more common in COVID-19 survivours necessitating inpatient hospital care (66.8%) compared to controls (2.5%, p = 0.001). COVID-19 patients who reported anosmia had more new-onset pain (83.3%) compared to those who did not (48.0%, p = 0.024). CONCLUSION COVID-19 was associated with a significantly higher prevalence of de novo CP, chronic daily headache, and new-onset pain in general, which was associated with persistent anosmia. SIGNIFICANCE There exists de novo pain in a substantial number of COVID-19 survivours, and some develop chronic pain. New-onset pain after the infection was more common in patients who reported anosmia after hospital discharge.
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Affiliation(s)
| | | | - Ana Mércia Fernandes
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Bruno Hojo
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Catarina Couras
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | | | - Luíza Mansur Braga
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.,Pain Center, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, University of São Paulo, São Paulo, Brazil
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Neville IS, Gomes Dos Santos A, Almeida CC, Hayashi CY, Solla DJF, Galhardoni R, de Andrade DC, Brunoni AR, Teixeira MJ, Paiva WS. Evaluation of Changes in Preoperative Cortical Excitability by Navigated Transcranial Magnetic Stimulation in Patients With Brain Tumor. Front Neurol 2021; 11:582262. [PMID: 33551949 PMCID: PMC7863982 DOI: 10.3389/fneur.2020.582262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/14/2020] [Indexed: 01/09/2023] Open
Abstract
Background: This prospective study aimed to evaluate the cortical excitability (CE) of patients with brain tumors surrounding or directly involving the corticospinal tract (CST) using navigated transcranial magnetic stimulation (nTMS). Methods: We recruited 40 patients with a single brain tumor surrounding or directly involving the CST as well as 82 age- and sex-matched healthy controls. The patients underwent standard nTMS and CE evaluations. Single and paired pulses were applied to the primary motor area (M1) of both affected and unaffected cerebral hemispheres 1 week before surgery. The CE parameters included resting motor threshold (RMT), motor evoked potential (MEP) ratio for 140 and 120% stimulus (MEP 140/120 ratio), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Motor outcome was evaluated on hospital discharge and on 30-day and 90-day postoperative follow-up. Results: In the affected hemispheres of patients, SICI and ICF were significantly higher than in the unaffected hemispheres (p=0.002 and p=0.009, respectively). The 140/120 MEP ratio of patients' unaffected hemispheres was lower than that in controls (p=0.001). Patients with glioblastomas (GBM) had a higher interhemispheric RMT ratio than patients with grade II and III gliomas (p = 0.018). A weak correlation was observed among the RMT ratio and the preoperative motor score (R2 = 0.118, p = 0.017) and the 90-day follow-up (R2 = 0.227, p = 0.016). Conclusion: Using preoperative nTMS, we found that brain hemispheres affected by tumors had abnormal CE and that patients with GBM had a distinct pattern of CE. These findings suggest that tumor biological behavior might play a role in CE changes.
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Affiliation(s)
- Iuri Santana Neville
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexandra Gomes Dos Santos
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cesar Cimonari Almeida
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cintya Yukie Hayashi
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Davi Jorge Fontoura Solla
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,School of Medicine - Universidade da Cidade de São Paulo UNICID, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Andre Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Wellingson Silva Paiva
- LIM-62/Division of Neurosurgery, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Listik C, Listik E, Cury RG, Barbosa ER, Teixeira MJ, Andrade DCD. Deep brain stimulation treatment in dystonia: a bibliometric analysis. Arq Neuropsiquiatr 2020; 78:586-592. [PMID: 33053012 DOI: 10.1590/0004-282x20200016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/27/2020] [Indexed: 08/11/2023]
Abstract
BACKGROUND Dystonia is a heterogeneous disorder that, when refractory to medical treatment, may have a favorable response to deep brain stimulation (DBS). A practical way to have an overview of a research domain is through a bibliometric analysis, as it makes it more accessible for researchers and others outside the field to have an idea of its directions and needs. OBJECTIVE To analyze the 100 most cited articles in the use of DBS for dystonia treatment in the last 30 years. METHODS The research protocol was performed in June 2019 in Elsevier's Scopus database, by retrieving the most cited articles regarding DBS in dystonia. We analyzed authors, year of publication, country, affiliation, and targets of DBS. RESULTS Articles are mainly published in Movement Disorders (19%), Journal of Neurosurgery (9%), and Neurology (9%). European countries offer significant contributions (57% of our sample). France (192.5 citations/paper) and Germany (144.1 citations/paper) have the highest citation rates of all countries. The United States contributes with 31% of the articles, with 129.8 citations/paper. The publications are focused on General outcomes (46%), followed by Long-term outcomes (12.5%), and Complications (11%), and the leading type of dystonia researched is idiopathic or inherited, isolated, segmental or generalized dystonia, with 27% of articles and 204.3 citations/paper. CONCLUSIONS DBS in dystonia research is mainly published in a handful of scientific journals and focused on the outcomes of the surgery in idiopathic or inherited, isolated, segmental or generalized dystonia, and with globus pallidus internus as the main DBS target.
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Affiliation(s)
- Clarice Listik
- Universidade de São Paulo, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
| | - Eduardo Listik
- Universidade Federal de São Paulo, Departamento de Bioquímica, São Paulo SP, Brazil
| | - Rubens Gisbert Cury
- Universidade de São Paulo, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
| | | | - Daniel Ciampi de Andrade
- Universidade de São Paulo, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.,Instituto do Câncer do Estado de São Paulo, Centro de Dor, São Paulo SP, Brazil
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Paraguay IB, França C, Duarte KP, Diniz JM, Galhardoni R, Silva V, Iglesio R, Bissoli AB, Menezes JR, Carra RB, Lepski G, Barbosa ER, Ciampi de Andrade D, Teixeira MJ, Cury RG. Dentate nucleus stimulation for essential tremor. Parkinsonism Relat Disord 2020; 82:121-122. [PMID: 33307418 DOI: 10.1016/j.parkreldis.2020.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Isabela Bruzzi Paraguay
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carina França
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Kleber Paiva Duarte
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Juliete Melo Diniz
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Valquiria Silva
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Ricardo Iglesio
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - André Bortolon Bissoli
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Janaína Reis Menezes
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael Bernhart Carra
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Guilherme Lepski
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Department of Neurosurgery, Eberhard Karls University in Tuebingen, Germany
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
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Moisset X, Pereira B, Ciampi de Andrade D, Fontaine D, Lantéri-Minet M, Mawet J. Neuromodulation techniques for acute and preventive migraine treatment: a systematic review and meta-analysis of randomized controlled trials. J Headache Pain 2020; 21:142. [PMID: 33302882 PMCID: PMC7726868 DOI: 10.1186/s10194-020-01204-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/18/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Several neuromodulation methods exists for migraine treatment. The aim of the present study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) focusing on migraine treatment using neurostimulation methods. METHODS We searched Medline and Embase up to July 1, 2020 for RCTs reporting acute or preventive treatment of migraine with either non-invasive or invasive neurostimulation methods. Two researchers independently assessed the eligibility of the retrieved studies and extracted data. Outcomes for the quantitative synthesis were 2 h pain free for acute treatment and headache days per month for preventive treatment. We performed subgroup analyses by treatment (stimulation method and site of application). Estimates were pooled using random-effects meta-analysis. RESULTS Thirty-eight articles were included in the qualitative analysis (7 acute, 31 preventive) and 34 in the quantitative evaluation (6 acute, 28 preventive). Remote electrical neuromodulation (REN) was effective for acute treatment. Data were insufficient to draw conclusions for any other techniques (single studies). Invasive occipital nerve stimulation (ONS) was effective for migraine prevention, with a large effect size but considerable heterogeneity, whereas supra-orbital transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS), and high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) were effective, with small to medium effect sizes. Vagus-nerve stimulation, left prefrontal cortex rTMS, and cathodal transcranial direct current stimulation (tDCS) over the M1 had no significant effect and heterogeneity was high. CONCLUSION Several neuromodulation methods are of potential interest for migraine management, but the quality of the evidence is very poor. Future large and well-conducted studies are needed and could improve on the present results.
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Affiliation(s)
- Xavier Moisset
- Service de Neurologie, Biostatistics unit (DRCI), Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, 58 rue Montalembert, F-63000, Clermont-Ferrand, France.
| | - Bruno Pereira
- Service de Neurologie, Biostatistics unit (DRCI), Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, 58 rue Montalembert, F-63000, Clermont-Ferrand, France
| | | | - Denys Fontaine
- Department of Neurosurgery, Université Côte Azur, FHU InovPain, CHU Nice, Nice, France
| | - Michel Lantéri-Minet
- Pain Department, Université Côte Azur, FHU InovPain, CHU Nice, Nice, France- Université Clermont-Auvergne, INSERM, Neuro-Dol, Nice, France
| | - Jérôme Mawet
- Emergency Headache Center (Centre d'Urgences Céphalées), Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
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Baptista AF, Baltar A, Okano AH, Moreira A, Campos ACP, Fernandes AM, Brunoni AR, Badran BW, Tanaka C, de Andrade DC, da Silva Machado DG, Morya E, Trujillo E, Swami JK, Camprodon JA, Monte-Silva K, Sá KN, Nunes I, Goulardins JB, Bikson M, Sudbrack-Oliveira P, de Carvalho P, Duarte-Moreira RJ, Pagano RL, Shinjo SK, Zana Y. Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19. Front Neurol 2020; 11:573718. [PMID: 33324324 PMCID: PMC7724108 DOI: 10.3389/fneur.2020.573718] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.
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Affiliation(s)
- Abrahão Fontes Baptista
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Brazilian Institute of Neuroscience and Neurotechnology Centros de Pesquisa, Investigação e Difusão - Fundação de Amparo à Pesquisa do Estado de São Paulo (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
| | - Adriana Baltar
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Specialized Neuromodulation Center—Neuromod, Recife, Brazil
| | - Alexandre Hideki Okano
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Brazilian Institute of Neuroscience and Neurotechnology Centros de Pesquisa, Investigação e Difusão - Fundação de Amparo à Pesquisa do Estado de São Paulo (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, Brazil
- Graduate Program in Physical Education, State University of Londrina, Londrina, Brazil
| | - Alexandre Moreira
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Ana Mércia Fernandes
- Centro de Dor, LIM-62, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - André Russowsky Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria, São Paulo, Brazil
- Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Clarice Tanaka
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
- Instituto Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Centro de Dor, LIM-62, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Edgard Morya
- Edmond and Lily Safra International Neuroscience Institute, Santos Dumont Institute, Macaiba, Brazil
| | - Eduardo Trujillo
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
| | - Jaiti K. Swami
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, United States
| | - Joan A. Camprodon
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Katia Monte-Silva
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil
| | - Katia Nunes Sá
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Isadora Nunes
- Department of Physiotherapy, Pontifícia Universidade Católica de Minas Gerais, Betim, Brazil
| | - Juliana Barbosa Goulardins
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- Universidade Cruzeiro do Sul (UNICSUL), São Paulo, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, United States
| | | | - Priscila de Carvalho
- Instituto Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Jardim Duarte-Moreira
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
| | | | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Yossi Zana
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
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Reis Menezes J, Bernhart Carra R, Aline Nunes G, da Silva Simões J, Jacobsen Teixeira M, Paiva Duarte K, Ciampi de Andrade D, Barbosa ER, Antônio Marcolin M, Cury RG. Transcutaneous magnetic spinal cord stimulation for freezing of gait in Parkinson's disease. J Clin Neurosci 2020; 81:306-309. [PMID: 33222935 DOI: 10.1016/j.jocn.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/18/2022]
Abstract
Dopaminergic drugs partially alleviate gait problems in Parkinson's disease, but the effects are not sustained in the long-term. Particularly, the freezing of gait directly impacts patients' quality of life. Experimental epidural spinal cord stimulation (SCS) studies have suggested positive effects on locomotion among PD patients, but the effects of non-invasive stimulation have never been explored. Here, we investigated in a prospective, open-label, pilot study the efficacy and safety of non-invasive magnetic stimulation of the spinal cord in five patients with PD who experienced gait problems, including freezing of gait. A trial of transcutaneous magnetic SCS was performed at the level of the fifth thoracic vertebra. The primary outcome was the change in freezing of gait 7 days after stimulation. Secondary outcome measures included changes in gait speed and UPDRS part III. After non-invasive spinal cord stimulation, patients experienced a 22% improvement in freezing of gait (p = 0.040) and 17.4% improvement in the UPDRS part III (p = 0.042). Timed up and go times improved by 48.2%, although this did not reach statistical significance (p = 0.06). Patients' global impression of change was 'much improved' for four patients. Improvement in gait after stimulation was reversible, since it returned to baseline scores 4 weeks after stimulation. No severe side effects were recorded. This pilot study suggests that transcutaneous magnetic spinal cord stimulation is feasible and can potentially improve gait problems in PD, without severe adverse effects. Large scale phase II trials are needed to test this hypothesis.
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Affiliation(s)
- Janaína Reis Menezes
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael Bernhart Carra
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Glaucia Aline Nunes
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Juliana da Silva Simões
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Kleber Paiva Duarte
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Antônio Marcolin
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
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Oliveira RAAD, Baptista AF, Sá KN, Barbosa LM, Nascimento OJMD, Listik C, Moisset X, Teixeira MJ, Andrade DCD. Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology. Arq Neuro-Psiquiatr 2020; 78:741-752. [DOI: 10.1590/0004-282x20200166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022]
Abstract
ABSTRACT Background: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions. Objective: To develop recommendations for the treatment of CNP in Brazil. Methods: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health. Results: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol. Conclusions: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Daniel Ciampi de Andrade
- Universidade de São Paulo, Brazil; Academia Brasileira de Neurologia, Brazil; Universidade de São Paulo, Brazil
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Moisset X, Giraud P, Meunier E, Condé S, Périé M, Picard P, Pereira B, Ciampi de Andrade D, Clavelou P, Dallel R. Ketamine-Magnesium for Refractory Chronic Cluster Headache: A Case Series. Headache 2020; 60:2537-2543. [PMID: 33128280 DOI: 10.1111/head.14005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of ketamine-magnesium combination to reduce attacks in a series of patients with refractory chronic cluster headache (rCCH). BACKGROUND Refractory chronic cluster headache (CCH) is a rare but highly debilitating condition that needs new treatment options. A previous publication reported that a single infusion of ketamine-magnesium combination was effective in 2 patients with rCCH. METHODS The treatment was proposed to consecutive patients with rCCH seen in 2 French hospitals between November 2015 and February 2020 and who were resistant to at least 3 preventive treatments. They received a single ketamine infusion (0.5 mg/kg over 2 hours) combined with magnesium sulfate (3000 mg). The main outcome was a comparison of the number of daily attacks 2 weeks prior to the ketamine-magnesium infusion and 1 week after (on days 7 and 8). The second outcome was the percentage of responders (patients with ≥50% reduction in the frequency of daily attacks). Safety was assessed by the recording of adverse events during infusion. Descriptive statistics are presented as mean ± standard deviation. RESULTS Seventeen patients (14 men), with an age of 35.2 ± 8.1 years, were included. They presented with CCH for 6.6 ± 4.3 years. The number of daily attacks decreased from 4.3 ± 2.4 before treatment to 1.3 ± 1.0 after treatment (difference: -3.1 (95% CI: -4.5 to -1.6), P < .001). Seventy six percent (13/17) were responders. Transient and mild sedation was reported by 7/17 patients (41.2%). CONCLUSIONS The ketamine-magnesium combination seems an effective and well-tolerated therapy for rCCH. Placebo-controlled studies should be conducted to further confirm these findings.
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Affiliation(s)
- Xavier Moisset
- Service de Neurologie, Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Clermont-Ferrand, France
| | - Pierric Giraud
- Department of Neurology, Annecy Genevois Hospital, Annecy, France
| | - Estelle Meunier
- Service de Neurologie, Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Clermont-Ferrand, France
| | - Sakahlé Condé
- Service de Neurologie, Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Clermont-Ferrand, France
| | - Maud Périé
- Service de Neurologie, Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Clermont-Ferrand, France
| | - Pascale Picard
- Service de Neurologie, Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Pierre Clavelou
- Service de Neurologie, Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Clermont-Ferrand, France
| | - Radhouane Dallel
- Service de Neurologie, Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Clermont-Ferrand, France
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Fernandes AM, Ciampi de Andrade D, Lopez LCS, Gawryszewski LDG, Torro N. Como mulheres avaliam expressões faciais de alegria e dor? Psipesq 2020. [DOI: 10.34019/1982-1247.2020.v14.30256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A expressão facial de dor pode provocar diferentes reações comportamentais. Todavia, ainda não está claro se a face de dor evoca respostas motoras mais lentas ou mais rápidas, quando comparada à expressão com valência positiva, e sua interação com o sexo da pessoa que demonstra a expressão facial. O objetivo desse trabalho foi avaliar o padrão de resposta motora de mulheres em uma tarefa de reconhecimento de expressões faciais de alegria e dor em faces femininas e masculinas. Na tarefa experimental, 32 estudantes classificaram emoções faciais dinâmicas de homens e mulheres entre as opções de alegria e dor, sendo registradas as respostas de tempo de reação manual (TRM). A ANOVA indicou uma diferença entre faces masculinas e femininas apenas para a identificação da dor (p = 0,001), mas não da alegria (p = 0,064). Neste caso, a dor foi reconhecida mais rapidamente na face masculina (TRM = 625,1 ms) que na face feminina (TRM = 668,0 ms). Considera-se que este padrão de resposta motora pode estar relacionado à detecção de situações potencialmente ameaçadoras no ambiente, com possibilidade de ser estudado em pessoas com dor crônica.
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Ciampi de Andrade D, Galhardoni R, da Silva VA, García-Larrea L, Dale C, Baptista AF, Barbosa LM, Bahia Menezes LM, de Siqueira SRDT, Valério F, Rosi J, Lilian de Lima Rodrigues A, Toledo Reis Mendes Fernandes D, Selingardi PML, Marcolin MA, Luís de Souza Duran F, Ono CR, Lucato LT, Fernandes AMBL, da Silva FEF, Yeng LT, Brunoni AR, Buchpiguel CA, Teixeira MJ. Author response: Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain. Neurology 2020; 94:721-722. [PMID: 32312880 DOI: 10.1212/wnl.0000000000009304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Kaziyama H, Barbour J, Galhardoni R, da Silva V, Tesseroli de Siqueira S, Listik C, dos Santos GJ, Yeng LT, Marcolin MA, Raicher I, Teixeira MJ, Ciampi de Andrade D. Sifting the wheat from the chaff? Evidence for the existence of an asymmetric fibromyalgia phenotype. Eur J Pain 2020; 24:1635-1647. [DOI: 10.1002/ejp.1620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Helena Kaziyama
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Instituto de Ortopedia e TraumatologiaDivision of Physical Medicine and RehabilitationUniversity of São Paulo São Paulo Brazil
| | - Julio Barbour
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | - Ricardo Galhardoni
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- School of MedicineUniversity of City of São Paulo (UNICID) São Paulo Brazil
| | - Valquíria da Silva
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | | | - Clarice Listik
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | | | - Lin T. Yeng
- Instituto de Ortopedia e TraumatologiaDivision of Physical Medicine and RehabilitationUniversity of São Paulo São Paulo Brazil
| | | | - Irina Raicher
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
| | - Manoel J. Teixeira
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
| | - Daniel Ciampi de Andrade
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
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Kwiatkowska KM, Bacalini MG, Sala C, Kaziyama H, de Andrade DC, Terlizzi R, Giannini G, Cevoli S, Pierangeli G, Cortelli P, Garagnani P, Pirazzini C. Analysis of Epigenetic Age Predictors in Pain-Related Conditions. Front Public Health 2020; 8:172. [PMID: 32582603 PMCID: PMC7296181 DOI: 10.3389/fpubh.2020.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/20/2020] [Indexed: 01/31/2023] Open
Abstract
Chronic pain prevalence is high worldwide and increases at older ages. Signs of premature aging have been associated with chronic pain, but few studies have investigated aging biomarkers in pain-related conditions. A set of DNA methylation (DNAm)-based estimates of age, called “epigenetic clocks,” has been proposed as biological measures of age-related adverse processes, morbidity, and mortality. The aim of this study is to assess if different pain-related phenotypes show alterations in DNAm age. In our analysis, we considered three cohorts for which whole-blood DNAm data were available: heat pain sensitivity (HPS), including 20 monozygotic twin pairs discordant for heat pain temperature threshold; fibromyalgia (FM), including 24 cases and 20 controls; and headache, including 22 chronic migraine and medication overuse headache patients (MOH), 18 episodic migraineurs (EM), and 13 healthy subjects. We used the Horvath's epigenetic age calculator to obtain DNAm-based estimates of epigenetic age, telomere length, levels of 7 proteins in plasma, number of smoked packs of cigarettes per year, and blood cell counts. We did not find differences in epigenetic age acceleration, calculated using five different epigenetic clocks, between subjects discordant for pain-related phenotypes. Twins with high HPS had increased CD8+ T cell counts (nominal p = 0.028). HPS thresholds were negatively associated with estimated levels of GDF15 (nominal p = 0.008). FM patients showed decreased naive CD4+ T cell counts compared with controls (nominal p = 0.015). The severity of FM manifestations expressed through various evaluation tests was associated with decreased levels of leptin, shorter length of telomeres, and reduced CD8+ T and natural killer cell counts (nominal p < 0.05), while the duration of painful symptoms was positively associated with telomere length (nominal p = 0.034). No differences in DNAm-based estimates were detected for MOH or EM compared with controls. In summary, our study suggests that HPS, FM, and MOH/EM do not show signs of epigenetic age acceleration in whole blood, while HPS and FM are associated with DNAm-based estimates of immunological parameters, plasma proteins, and telomere length. Future studies should extend these observations in larger cohorts.
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Affiliation(s)
| | | | - Claudia Sala
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Helena Kaziyama
- Department of Neurology, Pain Center, LIM 62, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Department of Neurology, Pain Center, LIM 62, University of São Paulo, São Paulo, Brazil.,Pain Center, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | - Giulia Giannini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Pierangeli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Garagnani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,Department of Laboratory Medicine, Clinical Chemistry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Applied Biomedical Research Center (CRBA), Policlinico S.Orsola-Malpighi Polyclinic, Bologna, Italy.,Unit of Bologna, CNR Institute of Molecular Genetics Luigi Luca Cavalli-Sforza, Bologna, Italy
| | - Chiara Pirazzini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Valerio F, Apostolos-Pereira SL, Sato DK, Callegaro D, Lucato LT, Barboza VR, Silva VA, Galhardoni R, Rodrigues ALDL, Jacobsen Teixeira M, Ciampi de Andrade D. Characterization of pain syndromes in patients with neuromyelitis optica. Eur J Pain 2020; 24:1548-1568. [PMID: 32488917 DOI: 10.1002/ejp.1608] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pain is common and refractory in spinal cord injury (SCI). Currently, most studies evaluated pain in male-predominant traumatic-SCI. Also, concomitant secondary pain syndromes and its temporal evolution were seldom reported. METHODS We aimed to prospectively describe the main and secondary pain and its associated factors in inflammatory-SCI evaluating neuromyelitis optica (NMO) patients. In-remission NMO patients underwent neurological, imaging and autoantibody evaluations. Questionnaires detailing main and secondary pains, functional state, mood, catastrophizing, quality of life (QoL) and "non-motor symptoms" were used at two time points. RESULTS Pain was present in 53 (73.6%) of the 72 patients included. At-level neuropathic pain was the most common main pain syndrome, affecting 32 subjects (60.4% of those with pain). Over 70% (n = 38) of this cohort reported two pain syndromes. Those without pain were significantly younger (26.1 ± 12.7 y.o. in those without pain and 40.1 ± 12.5, 37.2 ± 11.4 y.o. in those whose main pain was neuropathic and non-neuropathic, respectively, p = .001), and no differences in the inflammatory status were observed between groups. On follow-up, one-fifth (n = 11) had a different main pain syndrome from the first visit. Pain impacted QoL as much as disability and motor strength. CONCLUSION Pain is a prevalent and disabling non-motor symptom in NMO-SCI. Most patients experience more than one pain syndrome which can change in time even in the absence of clinical relapse. Age of the inflammatory-SCI was a major determinant of pain. Acknowledging temporal changes and multiplicity of pain syndromes in NMO-SCI may give insights into more precise designs of clinical trials and general management of pain in SCI. SIGNIFICANCE In this longitudinal study with NMO-related SCI, pain affected almost three-quarters of patients with NMO. Over 70% have more than one pain syndrome and at-level neuropathic pain is the most common type of pain syndrome. Patients without pain were significantly younger but had the same burden of inflammatory lesions than those with pain. During follow-up, up to one fifth of patients presented with changes in the main pain syndromes, which can occur even in the absence of clinical activity of the inflammatory disease. In this cohort, Pain affected quality of life as much as disability or motor strength.
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Affiliation(s)
- Fernanda Valerio
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Samira L Apostolos-Pereira
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Douglas Kazutoshi Sato
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto do Cérebro do Rio Grande do Sul (InsCer), Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Dagoberto Callegaro
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Leandro Tavares Lucato
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Victor Rosseto Barboza
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Valquiria A Silva
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antonia L de Lima Rodrigues
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Lim-62, Centro de Dor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Cury RG, Teixeira MJ, Galhardoni R, Silva V, Iglesio R, França C, Arnaut D, Fonoff ET, Barbosa ER, Ciampi de Andrade D. Connectivity Patterns of Subthalamic Stimulation Influence Pain Outcomes in Parkinson's Disease. Front Neurol 2020; 11:9. [PMID: 32116998 PMCID: PMC7028764 DOI: 10.3389/fneur.2020.00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Pain is highly prevalent in Parkinson's disease and is associated with significant reduction in health-related quality of life. Subthalamic deep brain stimulation can produce significant pain relief in a subset of patients after surgery. However, the mechanism by which deep brain stimulation modulates sensory function in Parkinson's disease remains uncertain. Objective: To describe the motor and pain outcomes of deep brain stimulation applied to a series of patients with Parkinson's disease and to determine whether the structural connectivity between the volume of tissue activated and different regions of the brain was associated with the changes of these outcomes after surgery. Methods: Data from a long-term prospective cohort of 32 Parkinson's disease patients with subthalamic stimulation were combined with available human connectome to identify connections consistently associated with clinical improvement (Unified Parkinson Disease Rating Scale), pain intensity, and experimental cold pain threshold after surgery. Results: The connectivity between the volume of tissue activated and a distributed network of sensory brain regions (prefrontal, insular and cingulate cortex, and postcentral gyrus) was inversely correlated with pain intensity improvement and reduced sensitivity to cold pain after surgery (p < 0.01). The connectivity strength with the supplementary motor area positively correlated with motor and pain threshold improvement (p < 0.05). Conclusions: These data suggest that the pattern of the connectivity between the region stimulated and specific brain cortical area might be responsible, in part, for the successful control of motor and pain symptoms by subthalamic deep brain stimulation in Parkinson's disease.
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Affiliation(s)
- Rubens Gisbert Cury
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil
| | - Valquiria Silva
- Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil.,Department of Neurology, Pain Center, LIM 62, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Iglesio
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carina França
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Débora Arnaut
- Department of Neurology, Pain Center, LIM 62, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Erich Talamoni Fonoff
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Department of Neurology, Pain Center, LIM 62, School of Medicine, University of São Paulo, São Paulo, Brazil.,Pain Center, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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