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Mueller C, Fang YHD, Jones C, McConathy JE, Raman F, Lapi SE, Younger JW. Evidence of neuroinflammation in fibromyalgia syndrome: a [ 18 F]DPA-714 positron emission tomography study. Pain 2023; 164:2285-2295. [PMID: 37326674 PMCID: PMC10502894 DOI: 10.1097/j.pain.0000000000002927] [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: 09/26/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 06/17/2023]
Abstract
ABSTRACT This observational study aimed to determine whether individuals with fibromyalgia (FM) exhibit higher levels of neuroinflammation than healthy controls (HCs), as measured with positron emission tomography using [ 18 F]DPA-714, a second-generation radioligand for the translocator protein (TSPO). Fifteen women with FM and 10 HCs underwent neuroimaging. Distribution volume (V T ) was calculated for in 28 regions of interest (ROIs) using Logan graphical analysis and compared between groups using multiple linear regressions. Group (FM vs HC) was the main predictor of interest and TSPO binding status (high- vs mixed-affinity) was added as a covariate. The FM group had higher V T in the right postcentral gyrus ( b = 0.477, P = 0.033), right occipital gray matter (GM; b = 0.438, P = 0.039), and the right temporal GM ( b = 0.466, P = 0.042). The FM group also had lower V T than HCs in the left isthmus of the cingulate gyrus ( b = -0.553, P = 0.014). In the subgroup of high-affinity binders, the FM group had higher V T in the bilateral precuneus, postcentral gyrus, parietal GM, occipital GM, and supramarginal gyrus. Group differences in the right parietal GM were associated with decreased quality of life, higher pain severity and interference, and cognitive problems. In support of our hypothesis, we found increased radioligand binding (V T ) in the FM group compared with HCs in several brain regions regardless of participants' TSPO binding status. The ROIs overlapped with prior reports of increased TSPO binding in FM. Overall, increasing evidence supports the hypothesis that FM involves microglia-mediated neuroinflammation in the brain.
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Affiliation(s)
| | - Yu-Hua D. Fang
- Radiology and Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Chloe Jones
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jonathan E. McConathy
- Department of Radiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Fabio Raman
- Department of Radiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Suzanne E. Lapi
- Department of Radiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jarred W. Younger
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
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Mueller C, Jordan I, Jones C, Lawson P, Younger JW. Abnormal immune system response in the brain of women with Fibromyalgia after experimental endotoxin challenge. Brain Behav Immun Health 2023; 30:100624. [PMID: 37114015 PMCID: PMC10126845 DOI: 10.1016/j.bbih.2023.100624] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/13/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Background The pathophysiology of fibromyalgia (FM) is thought to include an overactive immune system, leading to central nervous system sensitization, allodynia, and hyperalgesia. We aimed to test this theory using an experimental immune system activation procedure and neuroimaging with magnetic resonance spectroscopic imaging (MRSI). Methods Twelve women with FM and 13 healthy women (healthy controls; HC) received 0.3 or 0.4 ng/kg endotoxin and underwent MRSI before and after the infusion. Changes in brain levels of choline (CHO), myo-inositol (MI), N-Acetylaspartate (NAA), and MRSI-derived brain temperature were compared between groups and dosage levels using mixed analyses of variance. Results Significant group-by-time interactions in brain temperature were found in the right thalamus. Post-hoc testing revealed that brain temperature increased by 0.55 °C in the right thalamus in FM (t(10) = -3.483, p = 0.006), but not in HCs (p > 0.05). Dose-by-time interactions revealed brain temperature increases in the right insula after 0.4 ng/kg (t(12) = -4.074, p = 0.002), but not after 0.3 ng/kg (p > 0.05). Dose-by-time interactions revealed decreased CHO in the right Rolandic operculum after 0.4 ng/kg endotoxin (t(13) = 3.242, p = 0.006) but not 0.3 ng/kg. In the left paracentral lobule, CHO decreased after 0.3 ng/kg (t(9) = 2.574, p = 0.030) but not 0.4 ng/kg. Dose-by-time interactions affected MI in several brain regions. MI increased after 0.3 ng/kg in the right Rolandic operculum (t(10) = -2.374, p = 0.039), left supplementary motor area (t(9) = -2.303, p = 0.047), and left occipital lobe (t(10) = -3.757, p = 0.004), with no changes after 0.4 ng/kg (p > 0.05). Group-by time interactions revealed decreased NAA in the left Rolandic operculum in FM (t(13) = 2.664, p = 0.019), but not in HCs (p > 0.05). A dose-by-time interaction showed decreased NAA in the left paracentral lobule after 0.3 ng/kg (t(9) = 3.071, p = 0.013) but not after 0.4 ng/kg (p > 0.05). In the combined sample, there was a main effect of time whereby NAA decreased in the left anterior cingulate (F[1,21] = 4.458, p = 0.047) and right parietal lobe (F[1,21] = 5.457, p = 0.029). Conclusion We found temperature increases and NAA decreases in FM that were not seen in HCs, suggesting that FM patients may have abnormal immune responses in the brain. The 0.3 and 0.4 ng/kg had differential effects on brain temperature and metabolites, with neither dose effecting a stronger response overall. There is insufficient evidence provided by the study to determine whether FM involves abnormal central responses to low-level immune challenges.
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Affiliation(s)
- Christina Mueller
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Corresponding author. CIRC 312, 1719 6th Ave S, Birmingham, AL, 35233, USA.
| | - Indonesia Jordan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chloe Jones
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Prentiss Lawson
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jarred W. Younger
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Colomer-Carbonell A, Sanabria-Mazo JP, Hernández-Negrín H, Borràs X, Suso-Ribera C, García-Palacios A, Muchart J, Munuera J, D'Amico F, Maes M, Younger JW, Feliu-Soler A, Rozadilla-Sacanell A, Luciano JV. Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost-utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study). BMJ Open 2022; 12:e055351. [PMID: 34992118 PMCID: PMC8739052 DOI: 10.1136/bmjopen-2021-055351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION There is evidence that low-dose naltrexone (LDN; <5.0 mg/day) reduces pain and improves the quality of life of people with fibromyalgia syndrome (FMS). However, no randomised controlled trials with long-term follow-ups have been carried out. The INNOVA study will evaluate the add-on efficacy, safety, cost-utility and neurobiological effects of LDN for reducing pain in patients with FMS, with a 1-year follow-up. METHODS AND ANALYSIS A single-site, prospective, randomised, double-blinded, placebo-controlled, parallel design phase III trial will be performed. Eligibility criteria include being adult, having a diagnosis of FMS and experiencing pain of 4 or higher on a 10-point numerical rating scale. Participants will be randomised to a LDN intervention group (4.5 mg/day) or to a placebo control group. Clinical assessments will be performed at baseline (T0), 3 months (T1), 6 months (T2) and 12 months (T3). The primary endpoint will be pain intensity. A sample size of 60 patients per study arm (120 in total), as calculated prior to recruitment for sufficient power, will be monitored between January 2022 and August 2024. Assessment will also include daily ecological momentary evaluations of FMS-related symptoms (eg, pain intensity, fatigue and sleep disturbance), and side effects via ecological momentary assessment through the Pain Monitor app during the first 3 months. Costs and quality-adjusted life years will be also calculated. Half of the participants in each arm will be scanned with MRI at T0 and T1 for changes in brain metabolites related to neuroinflammation and central sensitisation. Inflammatory biomarkers in serum will also be measured. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and community engagement activities. TRIAL REGISTRATION NUMBER NCT04739995.
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Affiliation(s)
- Ariadna Colomer-Carbonell
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Halbert Hernández-Negrín
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Universidad de Ciencias Médicas de Villa Clara, Santa Clara, Cuba
| | - Xavier Borràs
- Department of Basics, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
- Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain
| | - Jordi Muchart
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Josep Munuera
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Francesco D'Amico
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | | | - Albert Feliu-Soler
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | | | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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Sharma AA, Nenert R, Mueller C, Maudsley AA, Younger JW, Szaflarski JP. Corrigendum: Repeatability and Reproducibility of in-vivo Brain Temperature Measurements. Front Hum Neurosci 2021; 15:780797. [PMID: 34899222 PMCID: PMC8663824 DOI: 10.3389/fnhum.2021.780797] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/04/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Ayushe A Sharma
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States.,Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States.,University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, United States
| | - Rodolphe Nenert
- University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, United States.,Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Christina Mueller
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jarred W Younger
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Jerzy P Szaflarski
- Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States.,University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, United States.,Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States.,Department of Neurosurgery, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
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Massicano AVF, Bartels JL, Jeffers CD, Crenshaw BK, Houson H, Mueller C, Younger JW, Knapp P, McConathy JE, Lapi SE. Production of [ 89 Zr]Oxinate 4 and cell radiolabeling for human use. J Labelled Comp Radiopharm 2021; 64:209-216. [PMID: 33326139 DOI: 10.1002/jlcr.3901] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/11/2023]
Abstract
[89 Zr]Oxinate4 is a Positron Emission Tomography (PET) tracer for cell radiolabeling that can enable imaging techniques to help better understand cell trafficking in various diseases. Although several groups have synthetized this compound for use in preclinical studies, there is no available data regarding the production of [89 Zr]Oxinate4 for human use. In this report, we describe the detailed production of [89 Zr]Oxinate4 under USP <823> and autologous leukocyte radiolabeling under USP <797>. The final product presented high radiochemical purity and stability at 24 h post synthesis (>99%) and passed in all quality control assays required for clinical use. [89 Zr]Oxinate4 did not compromise the white blood cells viability and did not show considerable cellular efflux up to 3 h post labeling. The translation of this technique into human use can provide insight into several disease mechanisms since [89 Zr]Oxinate4 has the potential to label any cell subset of interest.
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Affiliation(s)
- Adriana V F Massicano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer L Bartels
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charlotte D Jeffers
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bryant K Crenshaw
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hailey Houson
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina Mueller
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jarred W Younger
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Knapp
- Nuclear and Precision Health Solutions, Cardinal Health, Dublin, Ohio, USA
| | - Jonathan E McConathy
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne E Lapi
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lin JC, Mueller C, Campbell KA, Thannickal HH, Daredia AF, Sheriff S, Maudsley AA, Brunner RC, Younger JW. Investigating whole-brain metabolite abnormalities in the chronic stages of moderate or severe traumatic brain injury. PM R 2021; 14:472-485. [PMID: 33930238 DOI: 10.1002/pmrj.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence suggests that neurometabolic abnormalities can persist after traumatic brain injury (TBI) and drive clinical symptoms such as fatigue and cognitive disruption. Magnetic resonance spectroscopy has been used to investigate metabolite abnormalities following TBI, but few studies have obtained data beyond the subacute stage or over large brain regions. OBJECTIVE To measure whole-brain metabolites in chronic stages of TBI. DESIGN Observational study. SETTING University. PARTICIPANTS Eleven men with a moderate or severe TBI more than 12 months prior and 10 age-matched healthy controls completed whole-brain spectroscopic imaging. MAIN MEASURES Ratios of N-acetylaspartate (NAA), choline (CHO), and myo-inositol (MI) to creatine (CR) were measured in whole-brain gray and white matter as well as 64 brain regions of interest. Arterial spin labeling (ASL) data were also collected to investigate whether metabolite abnormalities were accompanied by differences in cerebral perfusion. RESULTS There were no differences in metabolite ratios within whole-brain gray and white matter regions of interest (ROIs). Linear regression showed lower NAA/CR in the white matter of the left occipital lobe but higher NAA/CR in the gray matter of the left parietal lobe. Metabolite abnormalities were observed in several brain regions in the TBI group including the corpus callosum, putamen, and posterior cingulate. However, none of the findings survived correction for multiple comparison. There were no differences in cerebral blood flow between patients and controls. CONCLUSION Higher MI/CR may indicate ongoing gliosis, and it has been suggested that low CHO/CR at chronic time points may indicate cell death or lack of healthy turnover and repair. However, with the small sample size of this study, we caution against the overinterpretation of our results. None of the findings within ROIs survived correction for multiple comparison. Thus, they may be considered possible avenues for future research in this area.
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Affiliation(s)
- Joanne C Lin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina Mueller
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelsey A Campbell
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Altamish F Daredia
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sulaiman Sheriff
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jarred W Younger
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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7
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Donovan EK, Kekes-Szabo S, Lin JC, Massey RL, Cobb JD, Hodgin KS, Ness TJ, Hangee-Bauer C, Younger JW. A Placebo-Controlled, Pseudo-Randomized, Crossover Trial of Botanical Agents for Gulf War Illness: Curcumin ( Curcuma longa), Boswellia ( Boswellia serrata), and French Maritime Pine Bark ( Pinus pinaster). Int J Environ Res Public Health 2021; 18:ijerph18052468. [PMID: 33802272 PMCID: PMC7967595 DOI: 10.3390/ijerph18052468] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
This report is part of a larger study designed to rapidly and efficiently screen potential treatments for Gulf War Illness (GWI) by testing nine different botanicals. In this placebo-controlled, pseudo-randomized, crossover clinical trial of 20 men with GWI, we tested three botanical agents with putative peripheral and central anti-inflammatory actions: curcumin (Curcuma longa), boswellia (Boswellia serrata), and French maritime pine bark extract (Pinus pinaster). Participants completed 30 +/− 3 days of baseline symptom reports, followed by 30 +/− 3 days of placebo, 30 +/− 3 days of lower-dose botanical, and 30 +/− 3 days of higher-dose botanical. Participants then repeated the process with a new botanical until completing up to three botanical cycles. Data were analyzed using linear mixed models. Curcumin reduced GWI symptom severity significantly more than placebo at both the lower (p < 0.0001) and higher (p = 0.0003) dosages. Boswellia was not more effective than placebo at reducing GWI symptoms at either the lower (p = 0.726) or higher (p = 0.869) dosages. Maritime pine was not more effective than placebo at the lower dosage (p = 0.954) but was more effective than placebo at the higher dosage (p = 0.006). This study provides preliminary evidence that curcumin and maritime pine may help alleviate symptoms of GWI. As a screening study, a final determination of the efficacy of these compounds for all individuals with GWI cannot be made, and further studies will need to be conducted to determine strength and durability of effects, as well as optimal dosage. These results suggest that GWI may, at least in part, involve systemic inflammatory processes. This trial was registered on ClinicalTrials.gov (NCT02909686) on 13 September 2016.
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Affiliation(s)
- Emily K. Donovan
- Department of Psychology, Virginia Commonwealth University, White House, 806 West Franklin Street, Richmond, VA 23284, USA;
| | - Sophia Kekes-Szabo
- Department of Psychology, Vanderbilt University, PMB 407817, 2301 Vanderbilt Place, Nashville, TN 37240, USA;
| | - Joanne C. Lin
- School of Pharmacy, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand;
| | - Rebecca L. Massey
- UAB School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL 35223, USA;
| | - James D. Cobb
- Department of Psychology, University of Alabama at Birmingham, CH 233, 1300 University Blvd, Birmingham, AL 35233, USA; (J.D.C.); (K.S.H.)
| | - Kathleen S. Hodgin
- Department of Psychology, University of Alabama at Birmingham, CH 233, 1300 University Blvd, Birmingham, AL 35233, USA; (J.D.C.); (K.S.H.)
| | - Timothy J. Ness
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, BMR2-208, 901 19th St. S, Birmingham, AL 35205, USA;
| | - Carl Hangee-Bauer
- San Francisco Natural Medicine, 1615 20th Street, San Francisco, CA 94107, USA;
| | - Jarred W. Younger
- Department of Psychology, University of Alabama at Birmingham, CH 233, 1300 University Blvd, Birmingham, AL 35233, USA; (J.D.C.); (K.S.H.)
- Correspondence: ; Tel.: +1-(205)-975-5907
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Mueller C, Ness TJ, Younger JW. Low-Dose Dextromethorphan for the Treatment of Fibromyalgia Pain: Results from a Longitudinal, Single-Blind, Placebo-Controlled Pilot Trial. J Pain Res 2021; 14:189-200. [PMID: 33542651 PMCID: PMC7851375 DOI: 10.2147/jpr.s285609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/08/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022] Open
Abstract
Objective Fibromyalgia (FM) is a debilitating chronic pain condition with few treatment options. Central sensitization and neuroinflammation have been forwarded as models of FM pathophysiology, both of which indicate dextromethorphan (DXM) as a potential treatment. DXM is an NMDA-receptor antagonist and microglial modulator with anti-neuroinflammatory properties at low doses. It is available for clinical use but has not been tested as a treatment for FM at low dosages. This study evaluated the effectiveness of DXM in treating FM-associated symptoms. Methods In a single-blind, placebo-controlled trial, 14 women meeting the 2010 American College of Rheumatology criteria for FM received a placebo for five weeks, followed by 20 mg DXM for ten weeks, while providing daily symptom reports on a 0–100 scale. Pain and physical activity were the primary and secondary outcomes, respectively. Daily symptom ratings during the last four weeks of placebo were contrasted with ratings during the last four weeks of the active treatment using generalized estimating equations (GEE). Results DXM was well tolerated, and treatment adherence was high. Baseline pain was reduced by at least 20% in six participants. Self-reported daily pain and physical activity in the entire cohort were not significantly different between the placebo and DXM conditions, and the primary hypotheses were not supported. Exploratory analyses using the entire placebo and DXM data showed that pain was significantly lower in the DXM condition than in the placebo condition (b=−9.933, p=0.013). Discussion A strong clinical effect of DXM was not observed at the 20mg/day dosage.
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Affiliation(s)
- Christina Mueller
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy J Ness
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jarred W Younger
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Mueller C, Lin JC, Sheriff S, Maudsley AA, Younger JW. Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy. Brain Imaging Behav 2021; 14:562-572. [PMID: 30617782 DOI: 10.1007/s11682-018-0029-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Previous neuroimaging studies have detected markers of neuroinflammation in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Magnetic Resonance Spectroscopy (MRS) is suitable for measuring brain metabolites linked to inflammation, but has only been applied to discrete regions of interest in ME/CFS. We extended the MRS analysis of ME/CFS by capturing multi-voxel information across the entire brain. Additionally, we tested whether MRS-derived brain temperature is elevated in ME/CFS patients. Fifteen women with ME/CFS and 15 age- and gender-matched healthy controls completed fatigue and mood symptom questionnaires and whole-brain echo-planar spectroscopic imaging (EPSI). Choline (CHO), myo-inositol (MI), lactate (LAC), and N-acetylaspartate (NAA) were quantified in 47 regions, expressed as ratios over creatine (CR), and compared between ME/CFS patients and controls using independent-samples t-tests. Brain temperature was similarly tested between groups. Significant between-group differences were detected in several regions, most notably elevated CHO/CR in the left anterior cingulate (p < 0.001). Metabolite ratios in seven regions were correlated with fatigue (p < 0.05). ME/CFS patients had increased temperature in the right insula, putamen, frontal cortex, thalamus, and the cerebellum (all p < 0.05), which was not attributable to increased body temperature or differences in cerebral perfusion. Brain temperature increases converged with elevated LAC/CR in the right insula, right thalamus, and cerebellum (all p < 0.05). We report metabolite and temperature abnormalities in ME/CFS patients in widely distributed regions. Our findings may indicate that ME/CFS involves neuroinflammation.
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Affiliation(s)
- Christina Mueller
- Department of Psychology, The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294, USA
| | - Joanne C Lin
- Department of Psychology, The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294, USA
| | - Sulaiman Sheriff
- Department of Radiology, Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Jarred W Younger
- Department of Psychology, The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294, USA.
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Sharma AA, Nenert R, Mueller C, Maudsley AA, Younger JW, Szaflarski JP. Repeatability and Reproducibility of in-vivo Brain Temperature Measurements. Front Hum Neurosci 2020; 14:598435. [PMID: 33424566 PMCID: PMC7785722 DOI: 10.3389/fnhum.2020.598435] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/24/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Magnetic resonance spectroscopic imaging (MRSI) is a neuroimaging technique that may be useful for non-invasive mapping of brain temperature (i.e., thermometry) over a large brain volume. To date, intra-subject reproducibility of MRSI-based brain temperature (MRSI-t) has not been investigated. The objective of this repeated measures MRSI-t study was to establish intra-subject reproducibility and repeatability of brain temperature, as well as typical brain temperature range. Methods: Healthy participants aged 23-46 years (N = 18; 7 females) were scanned at two time points ~12-weeks apart. Volumetric MRSI data were processed by reconstructing metabolite and water images using parametric spectral analysis. Brain temperature was derived using the frequency difference between water and creatine (TCRE) for 47 regions of interest (ROIs) delineated by the modified Automated Anatomical Labeling (AAL) atlas. Reproducibility was measured using the coefficient of variation for repeated measures (COVrep), and repeatability was determined using the standard error of measurement (SEM). For each region, the upper and lower bounds of Minimal Detectable Change (MDC) were established to characterize the typical range of TCRE values. Results: The mean global brain temperature over all subjects was 37.2°C with spatial variations across ROIs. There was a significant main effect for time [F (1, 1,591) = 37.0, p < 0.0001] and for brain region [F (46, 1,591) = 2.66, p < 0.0001]. The time*brain region interaction was not significant [F (46, 1,591) = 0.80, p = 0.83]. Participants' TCRE was stable for each ROI across both time points, with ROIs' COVrep ranging from 0.81 to 3.08% (mean COVrep = 1.92%); majority of ROIs had a COVrep <2.0%. Conclusions: Brain temperature measurements were highly consistent between both time points, indicating high reproducibility and repeatability of MRSI-t. MRSI-t may be a promising diagnostic, prognostic, and therapeutic tool for non-invasively monitoring brain temperature changes in health and disease. However, further studies of healthy participants with larger sample size(s) and numerous repeated acquisitions are imperative for establishing a reference range of typical brain TCRE, as well as the threshold above which TCRE is likely pathological.
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Affiliation(s)
- Ayushe A. Sharma
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, United States
| | - Rodolphe Nenert
- University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, United States
- Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Christina Mueller
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Andrew A. Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jarred W. Younger
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Jerzy P. Szaflarski
- Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, United States
- Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Department of Neurosurgery, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
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Abstract
STUDY DESIGN An experimental study. OBJECTIVE This study aimed to investigate task-dependent changes in fractional anisotropy (FA) within the spinal cord during painful stimulation. SUMMARY OF BACKGROUND DATA Earlier experiments by Mandl et al (2008, 2013) used non-invasive functional diffusion tensor imaging (fDTI) to detect white matter fibers that were active during functional tasks. In two studies, it was observed that FA of involved white matter tracts exhibited repeatable task-related increases. In this study, we attempted to extend the fDTI work in the spinal cord. METHODS Twenty-three healthy, right-handed men (mean age 22 yrs, standard deviation [SD] = 4) were invited to participate in this study. Diffusion-weighted images were collected over spinal levels C2 to T4 during a painful thermal stimulus applied to the left thenar eminence. In order to investigate task-related activity, FA values within the contralateral (right) spinothalamic tract were analyzed using a generalized estimating equations (GEE) procedure. As a control, we also examined activity in the ipsilateral and contralateral corticospinal tracts, which are not considered to be involved in nociception. RESULTS Significant task-related decreases in FA were observed in the right spinothalamic tract at vertebral levels C2-C5 (Wald X(1) = 17.754, P < 0.001). There was no change in control regions at levels C7-T2 of the same tract, which are located below the level of input from dermatome C6, Wald X(1) = 0.185, P = 0.667. Results in all other regions assessed, that is, the left spinothalamic tract and bilateral corticospinal tract, were also not significant (P > 0.05). CONCLUSION The current findings suggest that task-related changes in FA associated with the transmission of pain signals along the spinal cord can be detected using fDTI. We observed decreased FA values in the contralateral (right) spinothalamic tract following painful stimulation, while no such activity was apparent in control regions. LEVEL OF EVIDENCE 5.
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12
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Affiliation(s)
- Christina Mueller
- Graduate Student, Department of Psychology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Larry F Chu
- Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Joanne C Lin
- Postdoctoral Research Fellow, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Fernando Ovalle
- Associate Professor, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jarred W Younger
- Associate Professor, Department of Psychology, The University of Alabama at Birmingham, Birmingham, Alabama
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Weinstock LB, Myers TL, Walters AS, Schwartz OA, Younger JW, Chopra PJ, Guarino AH. Identification and Treatment of New Inflammatory Triggers for Complex Regional Pain Syndrome: Small Intestinal Bacterial Overgrowth and Obstructive Sleep Apnea. ACTA ACUST UNITED AC 2017; 6:272-6. [PMID: 26867023 DOI: 10.1213/xaa.0000000000000292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Complex regional pain syndrome (CRPS) is evoked by conditions that may be associated with local and/or systemic inflammation. We present a case of long-standing CRPS in a patient with Ehlers-Danlos syndrome in which prolonged remission was attained by directing therapy toward concomitant small intestinal bacterial overgrowth, obstructive sleep apnea, and potential increased microglia activity. We theorize that cytokine production produced by small intestinal bacterial overgrowth and obstructive sleep apnea may act as stimuli for ongoing CRPS symptoms. CRPS may also benefit from the properties of low-dose naltrexone that blocks microglia Toll-like receptors and induces production of endorphins that regulate and reduce inflammation.
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Affiliation(s)
- Leonard B Weinstock
- From the Departments of *Anesthesia and †Internal Medicine, Washington University School of Medicine, St. Louis, Missouri; ‡Specialists in Gastroenterology, LLC, St. Louis, Missouri; §Department of Neurology, Vanderbilt University, Nashville, Tennessee; ‖Sleep and EEG Laboratory, Barnes Jewish West County, BJC Medical Group Center for Sleep Medicine, St. Louis, Missouri; Departments of ¶Psychology, #Anesthesiology, and **Rheumatology, Neuroinflammation, Pain and Fatigue Lab, University of Alabama, Birmingham, Alabama; ††Pain Management Center, Department of Anesthesia, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and ‡‡Department of Anesthesia, Washington University School of Medicine, St. Louis, Missouri
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Lin JC, Chu LF, Stringer EA, Baker KS, Sayyid ZN, Sun J, Campbell KA, Younger JW. One Month of Oral Morphine Decreases Gray Matter Volume in the Right Amygdala of Individuals with Low Back Pain: Confirmation of Previously Reported Magnetic Resonance Imaging Results. Pain Med 2015; 17:1497-504. [PMID: 26814280 PMCID: PMC4921346 DOI: 10.1093/pm/pnv047] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/09/2015] [Indexed: 02/06/2023]
Abstract
Objective. Prolonged exposure to opioids is known to produce neuroplastic changes in animals; however, few studies have investigated the effects of short-term prescription opioid use in humans. A previous study from our laboratory demonstrated a dosage-correlated volumetric decrease in the right amygdala of participants administered oral morphine daily for 1 month. The purpose of this current study was to replicate and extend the initial findings. Methods. Twenty-one participants with chronic low back pain were enrolled in this double-blind, placebo-controlled study. Participants were randomized to receive daily morphine (n = 11) or a matched placebo (n = 10) for 1 month. High-resolution anatomical images were acquired immediately before and after the treatment administration period. Morphological gray matter changes were investigated using tensor-based morphometry, and significant regions were subsequently tested for correlation with morphine dosage. Results. Decreased gray matter volume was observed in several reward- and pain-related regions in the morphine group, including the bilateral amygdala, left inferior orbitofrontal cortex, and bilateral pre-supplementary motor areas. Morphine administration was also associated with significant gray matter increases in cingulate regions, including the mid cingulate, dorsal anterior cingulate, and ventral posterior cingulate. Conclusions. Many of the volumetric increases and decreases overlapped spatially with the previously reported changes. Individuals taking placebo for 1 month showed neither gray matter increases nor decreases. The results corroborate previous reports that rapid alterations occur in reward-related networks following short-term prescription opioid use.
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Affiliation(s)
- Joanne C Lin
- *Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA;
| | - Larry F Chu
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California, USA
| | - Elizabeth Ann Stringer
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California, USA
| | - Katharine S Baker
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Zahra N Sayyid
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California, USA
| | - John Sun
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California, USA
| | - Kelsey A Campbell
- *Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jarred W Younger
- *Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Chu LF, Lin JC, Clemenson A, Encisco E, Sun J, Hoang D, Alva H, Erlendson M, Clark JD, Younger JW. Acute opioid withdrawal is associated with increased neural activity in reward-processing centers in healthy men: A functional magnetic resonance imaging study. Drug Alcohol Depend 2015; 153:314-22. [PMID: 26059463 DOI: 10.1016/j.drugalcdep.2015.04.019] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Opioid analgesics are frequently prescribed for chronic pain. One expected consequence of long-term opioid use is the development of physical dependence. Although previous resting state functional magnetic resonance imaging (fMRI) studies have demonstrated signal changes in reward-associated areas following morphine administration, the effects of acute withdrawal on the human brain have been less well-investigated. In an earlier study by our laboratory, ondansetron was shown to be effective in preventing symptoms associated with opioid withdrawal. The purpose of this current study was to characterize neural activity associated with acute opioid withdrawal and examine whether these changes are modified by ondansetron. METHODS Ten participants were enrolled in this placebo-controlled, randomized, double-blind, crossover study and attended three acute opioid withdrawal sessions. Participants received either placebo or ondansetron (8Ymg IV) before morphine administration (10Ymg/70Ykg IV). Participants then underwent acute naloxone-precipitated withdrawal during a resting state fMRI scan. Objective and subjective opioid withdrawal symptoms were assessed. RESULTS Imaging results showed that naloxone-precipitated opioid withdrawal was associated with increased neural activity in several reward processing regions, including the right pregenual cingulate, putamen, and bilateral caudate, and decreased neural activity in networks involved in sensorimotor integration. Ondansetron pretreatment did not have a significant effect on the imaging correlates of opioid withdrawal. CONCLUSIONS This study presents a preliminary investigation of the regional changes in neural activity during acute opioid withdrawal. The fMRI acute opioid withdrawal model may serve as a tool for studying opioid dependence and withdrawal in human participants.
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Affiliation(s)
- Larry F Chu
- Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building Room S268C, Stanford, CA 94305, United States.
| | - Joanne C Lin
- Department of Psychology, University of Alabama at Birmingham, 233 Campbell Hall, 1300 University Boulevard, Birmingham, AL 35294, United States
| | - Anna Clemenson
- Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building Room S268C, Stanford, CA 94305, United States
| | - Ellen Encisco
- Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building Room S268C, Stanford, CA 94305, United States
| | - John Sun
- Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building Room S268C, Stanford, CA 94305, United States
| | - Dan Hoang
- Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building Room S268C, Stanford, CA 94305, United States
| | - Heather Alva
- Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building Room S268C, Stanford, CA 94305, United States
| | - Matthew Erlendson
- Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building Room S268C, Stanford, CA 94305, United States
| | - J David Clark
- Veterans Affairs Palo Alto Healthcare System, 3801 Miranda Avenue, Palo Alto, CA 94304, United States
| | - Jarred W Younger
- Department of Psychology, University of Alabama at Birmingham, 233 Campbell Hall, 1300 University Boulevard, Birmingham, AL 35294, United States
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Carroll IR, Hah JM, Barelka PL, Wang CKM, Wang BM, Gillespie MJ, McCue R, Younger JW, Trafton J, Humphreys K, Goodman SB, Dirbas FM, Mackey SC. Pain Duration and Resolution following Surgery: An Inception Cohort Study. Pain Med 2015; 16:2386-96. [PMID: 26179223 DOI: 10.1111/pme.12842] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Preoperative determinants of pain duration following surgery are poorly understood. We identified preoperative predictors of prolonged pain after surgery in a mixed surgical cohort. METHODS We conducted a prospective longitudinal study of patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. We measured preoperative psychological distress and substance use, and then measured pain and opioid use after surgery until patients reported the cessation of both opioid consumption and pain. The primary endpoint was time to opioid cessation, and those results have been previously reported. Here, we report preoperative determinants of time to pain resolution following surgery in Cox proportional hazards regression. RESULTS Between January 2007 and April 2009, we enrolled 107 of 134 consecutively approached patients undergoing the aforementioned surgical procedures. In the final multivariate model, preoperative self-perceived risk of addiction predicted more prolonged pain. Unexpectedly, anxiety sensitivity predicted more rapid pain resolution after surgery. Each one-point increase (on a four point scale) of self-perceived risk of addiction was associated with a 38% (95% CI 3-61) reduction in the rate of pain resolution (P = 0.04). Furthermore, higher anxiety sensitivity was associated with an 89% (95% CI 23-190) increased rate of pain resolution (P = 0.004). CONCLUSIONS Greater preoperative self-perceived risk of addiction, and lower anxiety sensitivity predicted a slower rate of pain resolution following surgery. Each of these factors was a better predictor of pain duration than preoperative depressive symptoms, post-traumatic stress disorder symptoms, past substance use, fear of pain, gender, age, preoperative pain, or preoperative opioid use.
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Affiliation(s)
- Ian R Carroll
- Departments of Anesthesiology, Perioperative, and Pain Medicine, Division of Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Jennifer M Hah
- Departments of Anesthesiology, Perioperative, and Pain Medicine, Division of Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Peter L Barelka
- Departments of Anesthesiology, Perioperative, and Pain Medicine, Division of Pain Medicine, Stanford University, Palo Alto, California, USA.,Anesthesiology Service Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Charlie K M Wang
- Stanford Systems Neuroscience and Pain Lab (SNAPL), Stanford School of Medicine, Palo Alto, California, USA
| | - Bing M Wang
- Stanford Systems Neuroscience and Pain Lab (SNAPL), Stanford School of Medicine, Palo Alto, California, USA
| | - Matthew J Gillespie
- Stanford Systems Neuroscience and Pain Lab (SNAPL), Stanford School of Medicine, Palo Alto, California, USA
| | - Rebecca McCue
- Stanford Systems Neuroscience and Pain Lab (SNAPL), Stanford School of Medicine, Palo Alto, California, USA
| | - Jarred W Younger
- Departments of Anesthesiology, Perioperative, and Pain Medicine, Division of Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Jodie Trafton
- Departments of Psychiatry & Behavioral Sciences, Veterans Affairs and Stanford University, Palo Alto, California, USA
| | - Keith Humphreys
- Departments of Psychiatry & Behavioral Sciences, Veterans Affairs and Stanford University, Palo Alto, California, USA
| | - Stuart B Goodman
- Orthopaedic Surgery, Stanford University, Palo Alto, California, USA
| | | | - Sean C Mackey
- Departments of Anesthesiology, Perioperative, and Pain Medicine, Division of Pain Medicine, Stanford University, Palo Alto, California, USA
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Younger JW. Being female is a risk factor for chronic pain. Are inflammatory processes to blame? Brain Behav Immun 2015; 46:33-4. [PMID: 25596175 DOI: 10.1016/j.bbi.2015.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jarred W Younger
- The University of Alabama at Birmingham, Department of Psychology, United States; The University of Alabama at Birmingham, Department of Anesthesiology, United States; The University of Alabama at Birmingham, Department of Rheumatology, United States
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Robbins JA, Qi L, Garcia L, Younger JW, Seldin MF. Relationship of pain and ancestry in African American women. Eur J Pain 2015; 19:601-10. [PMID: 25752262 DOI: 10.1002/ejp.680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND African Americans are reported to be more sensitive to pain than European Americans. Pain sensitivity has been shown to be genetically linked in animal models and is likely to be in humans. METHODS Exactly, 11,239 self-identified African American post-menopausal women enrolled in the Women's Health Initiative had percentage African ancestry determined by ancestry informative markers, "Pain Construct" measurements and covariate information. They answered five questions about specific types and location of pain, such as joint, neck, low back, headache and urinary. They also answered two questions which were used to derive a "Pain Construct", a measure of general pain scored on a scale of 1-100. Associations were tested in linear regression models adjusting for age, self-reported medical conditions, neighbourhood socio-economic status, education and depression. RESULTS In the unadjusted model of the five specific types of pain measures, greater pain perception was associated with a higher proportion of African ancestry. However, some of the specific types of pain measures were no longer associated with African ancestry after adjustment for other study covariates. The Pain Construct was statistically significantly associated with African ancestry in both the unadjusted [β = -0.132, 95% confidence interval (CI) = -099 to -0.164; r = -0.075, 95% CI -0.056 to -0.093] and the adjusted models (β = -0.069 95% CI = -0.04 to -0.10). CONCLUSIONS Greater African ancestry was associated with higher levels of self-reported pain, although this accounted for only a minor fraction of the overall variation in the Pain Construct.
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Affiliation(s)
- J A Robbins
- Department of Internal Medicine, School of Medicine, University of California, Davis
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Deshpande S, Rivera DE, Younger JW, Nandola NN. Erratum to: "A control systems engineering approach for adaptive behavioral interventions: illustration with a fibromyalgia intervention" [Translational Behavioral Medicine, Volume 4, Issue 3, pp 275-289]. Transl Behav Med 2015; 4:439. [PMID: 25585247 DOI: 10.1007/s13142-014-0294-8] [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: 10/24/2022] Open
Abstract
[This corrects the article DOI: 10.1007/s13142-014-0282-z.].
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Affiliation(s)
- Sunil Deshpande
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287-6106 USA
| | - Daniel E Rivera
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287-6106 USA
| | - Jarred W Younger
- Neuroinflammation, Pain and Fatigue Laboratory, Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Naresh N Nandola
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287-6106 USA ; ABB Corporate Research Center, Bangalore, India
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Hah JM, Mackey S, Barelka PL, Wang CKM, Wang BM, Gillespie MJ, McCue R, Younger JW, Trafton J, Humphreys K, Goodman SB, Dirbas FM, Schmidt PC, Carroll IR. Self-loathing aspects of depression reduce postoperative opioid cessation rate. Pain Med 2015; 15:954-64. [PMID: 24964916 DOI: 10.1111/pme.12439] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%-64%) reduction in the rate of opioid cessation following surgery. We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs somatic) associated with a decreased rate of opioid cessation after surgery. METHODS We conducted a secondary analysis of the data from a previously reported prospective, longitudinal, observational study of opioid use after five distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression. RESULTS The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75-0.99, P value 0.037). CONCLUSIONS Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.
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Affiliation(s)
- Jennifer M Hah
- Division of Pain Medicine, Stanford University, Palo Alto, California, USA
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Deshpande S, Nandola NN, Rivera DE, Younger JW. Optimized Treatment of Fibromyalgia Using System Identification and Hybrid Model Predictive Control. Control Eng Pract 2014; 33:161-173. [PMID: 25506132 PMCID: PMC4261765 DOI: 10.1016/j.conengprac.2014.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The term adaptive intervention is used in behavioral health to describe individually-tailored strategies for preventing and treating chronic, relapsing disorders. This paper describes a system identification approach for developing dynamical models from clinical data, and subsequently, a hybrid model predictive control scheme for assigning dosages of naltrexone as treatment for fibromyalgia, a chronic pain condition. A simulation study that includes conditions of significant plant-model mismatch demonstrates the benefits of hybrid predictive control as a decision framework for optimized adaptive interventions. This work provides insights on the design of novel personalized interventions for chronic pain and related conditions in behavioral health.
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Affiliation(s)
- Sunil Deshpande
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287 USA
| | - Naresh N. Nandola
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287 USA
| | - Daniel E. Rivera
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287 USA
| | - Jarred W. Younger
- Department of Psychology, Departments of Anesthesiology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35233 USA
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Deshpande S, Rivera DE, Younger JW, Nandola NN. A control systems engineering approach for adaptive behavioral interventions: illustration with a fibromyalgia intervention. Transl Behav Med 2014; 4:275-89. [PMID: 25264467 DOI: 10.1007/s13142-014-0282-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The term adaptive intervention has been used in behavioral medicine to describe operationalized and individually tailored strategies for prevention and treatment of chronic, relapsing disorders. Control systems engineering offers an attractive means for designing and implementing adaptive behavioral interventions that feature intensive measurement and frequent decision-making over time. This is illustrated in this paper for the case of a low-dose naltrexone treatment intervention for fibromyalgia. System identification methods from engineering are used to estimate dynamical models from daily diary reports completed by participants. These dynamical models then form part of a model predictive control algorithm which systematically decides on treatment dosages based on measurements obtained under real-life conditions involving noise, disturbances, and uncertainty. The effectiveness and implications of this approach for behavioral interventions (in general) and pain treatment (in particular) are demonstrated using informative simulations.
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Affiliation(s)
- Sunil Deshpande
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287 USA
| | - Daniel E Rivera
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287 USA
| | - Jarred W Younger
- Neuroinflammation, Pain and Fatigue Laboratory, Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Naresh N Nandola
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287 USA ; ABB Corporate Research Center, Bangalore, India
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Stringer EA, Baker KS, Carroll IR, Montoya JG, Chu L, Maecker HT, Younger JW. Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology. J Transl Med 2013; 11:93. [PMID: 23570606 PMCID: PMC3637529 DOI: 10.1186/1479-5876-11-93] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [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: 01/11/2013] [Accepted: 03/20/2013] [Indexed: 12/31/2022] Open
Abstract
Background Chronic fatigue syndrome (CFS) is a debilitating disorder characterized by persistent fatigue that is not alleviated by rest. The lack of a clearly identified underlying mechanism has hindered the development of effective treatments. Studies have demonstrated elevated levels of inflammatory factors in patients with CFS, but findings are contradictory across studies and no biomarkers have been consistently supported. Single time-point approaches potentially overlook important features of CFS, such as fluctuations in fatigue severity. We have observed that individuals with CFS demonstrate significant day-to-day variability in their fatigue severity. Methods Therefore, to complement previous studies, we implemented a novel longitudinal study design to investigate the role of cytokines in CFS pathophysiology. Ten women meeting the Fukuda diagnostic criteria for CFS and ten healthy age- and body mass index (BMI)-matched women underwent 25 consecutive days of blood draws and self-reporting of symptom severity. A 51-plex cytokine panel via Luminex was performed for each of the 500 serum samples collected. Our primary hypothesis was that daily fatigue severity would be significantly correlated with the inflammatory adipokine leptin, in the women with CFS and not in the healthy control women. As a post-hoc analysis, a machine learning algorithm using all 51 cytokines was implemented to determine whether immune factors could distinguish high from low fatigue days. Results Self-reported fatigue severity was significantly correlated with leptin levels in six of the participants with CFS and one healthy control, supporting our primary hypothesis. The machine learning algorithm distinguished high from low fatigue days in the CFS group with 78.3% accuracy. Conclusions Our results support the role of cytokines in the pathophysiology of CFS.
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Affiliation(s)
- Elizabeth Ann Stringer
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 94304, USA
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Carroll I, Barelka P, Wang CKM, Wang BM, Gillespie MJ, McCue R, Younger JW, Trafton J, Humphreys K, Goodman SB, Dirbas F, Whyte RI, Donington JS, Cannon WB, Mackey SC. A pilot cohort study of the determinants of longitudinal opioid use after surgery. Anesth Analg 2012; 115:694-702. [PMID: 22729963 DOI: 10.1213/ane.0b013e31825c049f] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Determinants of the duration of opioid use after surgery have not been reported. We hypothesized that both preoperative psychological distress and substance abuse would predict more prolonged opioid use after surgery. METHODS Between January 2007 and April 2009, a prospective, longitudinal inception cohort study enrolled 109 of 134 consecutively approached patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. We measured preoperative psychological distress and substance use, and then measured the daily use of opioids until patients reported the cessation of both opioid consumption and pain. The primary end point was time to opioid cessation. All analyses were controlled for the type of surgery done. RESULTS Overall, 6% of patients continued on new opioids 150 days after surgery. Preoperative prescribed opioid use, depressive symptoms, and increased self-perceived risk of addiction were each independently associated with more prolonged opioid use. Preoperative prescribed opioid use was associated with a 73% (95% confidence interval [CI] 0.51%-87%) reduction in the rate of opioid cessation after surgery (P = 0.0009). Additionally, each 1-point increase (on a 4-point scale) of self-perceived risk of addiction was associated with a 53% (95% CI 23%-71%) reduction in the rate of opioid cessation (P = 0.003). Independent of preoperative opioid use and self-perceived risk of addiction, each 10-point increase on a preoperative Beck Depression Inventory II was associated with a 42% (95% CI 18%-58%) reduction in the rate of opioid cessation (P = 0.002). The variance in the duration of postoperative opioid use was better predicted by preoperative prescribed opioid use, self-perceived risk of addiction, and depressive symptoms than postoperative pain duration or severity. CONCLUSIONS Preoperative factors, including legitimate prescribed opioid use, self-perceived risk of addiction, and depressive symptoms each independently predicted more prolonged opioid use after surgery. Each of these factors was a better predictor of prolonged opioid use than postoperative pain duration or severity.
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Affiliation(s)
- Ian Carroll
- Department of Anesthesia, Division of Pain Management, Stanford University, Palo Alto, CA 94035, USA.
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Lawler-Row KA, Younger JW, Piferi RL, Jones WH. The Role of Adult Attachment Style in Forgiveness Following an Interpersonal Offense. Journal of Counseling & Development 2011. [DOI: 10.1002/j.1556-6678.2006.tb00434.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Younger JW, Chu LF, D'Arcy NT, Trott KE, Jastrzab LE, Mackey SC. Prescription opioid analgesics rapidly change the human brain. Pain 2011; 152:1803-1810. [PMID: 21531077 DOI: 10.1016/j.pain.2011.03.028] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 03/21/2011] [Accepted: 03/23/2011] [Indexed: 11/16/2022]
Abstract
Chronic opioid exposure is known to produce neuroplastic changes in animals; however, it is not known if opioids used over short periods of time and at analgesic dosages can similarly change brain structure in humans. In this longitudinal, magnetic resonance imaging study, 10 individuals with chronic low back pain were administered oral morphine daily for 1 month. High-resolution anatomical images of the brain were acquired immediately before and after the morphine administration period. Regional changes in gray matter volume were assessed on the whole brain using tensor-based morphometry, and those significant regional changes were then independently tested for correlation with morphine dosage. Thirteen regions evidenced significant volumetric change, and degree of change in several of the regions was correlated with morphine dosage. Dosage-correlated volumetric decrease was observed primarily in the right amygdala. Dosage-correlated volumetric increase was seen in the right hypothalamus, left inferior frontal gyrus, right ventral posterior cingulate, and right caudal pons. Follow-up scans that were conducted an average of 4.7 months after cessation of opioids demonstrated many of the morphine-induced changes to be persistent. In a separate study, 9 individuals consuming blinded placebo capsules for 6 weeks evidenced no significant morphologic changes over time. The results add to a growing body of literature showing that opioid exposure causes structural and functional changes in reward- and affect-processing circuitry. Morphologic changes occur rapidly in humans during new exposure to prescription opioid analgesics. Further research is needed to determine the clinical impact of those opioid-induced gray matter changes.
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Affiliation(s)
- Jarred W Younger
- Department of Anesthesia, School of Medicine, Stanford University, Palo Alto, CA, USA Department of Human Biology, School of Arts & Sciences, Stanford University, Palo Alto, CA, USA
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Abstract
The relationship between hypnotizability and somatic illness was measured in 45 college students. Several weeks after completing the Waterloo-Stanford Group C Scale (WSGC), participants filled out a somatic-complaint checklist and measures of psychopathology. Results indicated a positive correlation between hypnotizability and somatic illness, and the relationship was stronger for female participants. In contrast to the quadratic model proposed by Wickramasekera, the current data demonstrated a linear relationship between hypnotizability and somatic complaint. Further analyses showed that somatic complaints were associated with hallucination and imagery items, corresponding to the perceptual-cognitive factor identified in Woody, Barnier, and McConkey's (2005) factor analysis of the Stanford Hypnotic Susceptibility Scale, Form C. The results call into question some claims that high hypnotizability is an adaptive and healthy trait.
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Affiliation(s)
- Jarred W Younger
- Stanford University School of Medicine, Department of Anesthesea, Stanford, California 94304-1573, USA.
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Younger JW, Lawler-Row KA, Moe KA, Kratz AL, Keenum AJ. Effects of naltrexone on repressive coping and disclosure of emotional material: a test of the opioid-peptide hypothesis of repression and hypertension. Psychosom Med 2006; 68:734-41. [PMID: 17012527 DOI: 10.1097/01.psy.0000234029.38245.c9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present study was designed to assess the role of endogenous opioids in the relationship of hypertension to repressive coping. METHODS Ten hypertensive and 8 normotensive males were given either the opioid antagonist naltrexone or placebo in a randomized, double-blind fashion over the course of four laboratory sessions. Measures of repression and disclosure were completed and blood pressure was assessed during a laboratory stressor protocol. RESULTS Opioid antagonism reduced repression and increased disclosure only in the hypertensive group. Also, opioid antagonism increased stress-related systolic blood pressure only in the hypertensive group. CONCLUSION The results support the hypothesis that endogenous opioid dysregulation underlies both hypertension and repressive phenomena.
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Affiliation(s)
- Jarred W Younger
- Stanford University School of Medicine, Department of Anesthesia, Pain Research, MC 5747, 780 Welch Rd., Suite 208, Palo Alto, CA 94304, USA.
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Winkel JD, Younger JW, Tomcik N, Borckardt JJ, Nash MR. Anatomy of a hypnotic response: Self-report estimates, actual behavior, and physiological response to the hypnotic suggestion for arm rigidity. Int J Clin Exp Hypn 2006; 54:186-205. [PMID: 16581690 DOI: 10.1080/00207140500528430] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study closely examines subject response to the arm-rigidity item of the HGSHS:A. Subject behavior, subject self-report, and surface EMG of the biceps and triceps muscles were monitored. Two distinct ways of passing the item were observed and verified by EMG recordings: some subjects (tremblers) exerted muscular effort to bend the arm and kept it rigidly straight. Others (nontremblers) passively kept the arm straight without exerting muscular effort to bend, even though they reported exerting effort to bend their arm. These two behaviorally and physiologically different methods of passing the item support the idea of individual differences in hypnotic responding and suggest that subjects may be using different mental processes to pass the item.
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Affiliation(s)
- Justin D Winkel
- Department of Psychology, University of Tennessee, Knoxville, Tennessee 37996, USA.
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Abstract
The relationship of forgiveness, both state and trait, to health was assessed. Eighty-one community adults completed a packet of questionnaires and participated in a laboratory interview about a time of hurt or betrayal. Heart rate and blood pressure were recorded during a 10 min baseline, the interview and during a recovery period; interviews were structured around a framework of questions and videotaped. Four measures of forgiveness were all statistically associated with five measures of health (physical symptoms, medications used, sleep quality, fatigue, and somatic complaints). Trait forgiveness was associated with decreased reactivity (rate-pressure product) to the interview, but sympathetic reactivity did not account for the trait forgiveness-health association. Four mechanisms or pathways by which forgiveness could lead to fewer physical symptoms were examined: spirituality, social skills, reduction in negative affect, and reduction in stress. All factors either partially or fully mediated the effect of forgiveness on health; however, the strongest mediator for both state and trait forgiveness was reduction in negative affect. For state forgiveness, the second strongest mediator was reduction in stress; for trait forgiveness, both conflict management and reduction in stress were strong contributors.
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Affiliation(s)
- Kathleen A Lawler
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
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Lawler KA, Younger JW, Piferi RL, Billington E, Jobe R, Edmondson K, Jones WH. A change of heart: cardiovascular correlates of forgiveness in response to interpersonal conflict. J Behav Med 2004; 26:373-93. [PMID: 14593849 DOI: 10.1023/a:1025771716686] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [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: 11/12/2022]
Abstract
This study sought to examine the psychophysiological correlates of forgiveness in response to interpersonal conflict. One hundred eight college students (44 males and 64 females) participated in two interviews about times of interpersonal betrayal, one about a parent and one about a friend/partner. Measures of forgiving personality and state forgiveness were collected, as well as stress, hostility, empathy, and self-reported illness symptoms. During baseline, interviews and recovery periods, repeated measures were taken of blood pressure, heart rate, frontalis EMG, and skin conductance. Trait forgiveness was associated with lower levels of blood pressure. State forgiveness was associated with lower blood pressure levels, heart rate, and rate pressure product. Acute, stress-induced reactivity was also linked to forgiveness: state forgiveness was associated with diastolic and mean arterial pressure and rate pressure product reactivity during the parent interview. Increased blood pressure recovery after stress was also linked to trait forgiveness. Forgiveness may produce beneficial effects directly by reducing allostatic load associated with betrayal and conflict, and indirectly through reductions in perceived stress.
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Affiliation(s)
- Kathleen A Lawler
- Department of Psychology, University of Tennessee, Knoxville, Tennessee 37996-0900, USA.
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FitzGerald MG, MacDonald DJ, Krainer M, Hoover I, O'Neil E, Unsal H, Silva-Arrieto S, Finkelstein DM, Beer-Romero P, Englert C, Sgroi DC, Smith BL, Younger JW, Garber JE, Duda RB, Mayzel KA, Isselbacher KJ, Friend SH, Haber DA. Germ-line BRCA1 mutations in Jewish and non-Jewish women with early-onset breast cancer. N Engl J Med 1996; 334:143-9. [PMID: 8531968 DOI: 10.1056/nejm199601183340302] [Citation(s) in RCA: 291] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mutations in a germ-line allele of the BRCA1 gene contribute to the familial breast cancer syndrome. However, the prevalence of these mutations is unknown in women with breast cancer who do not have the features of this familial syndrome. We sought BRCA1 mutations in women who were given a diagnosis of breast cancer at an early age, because early onset is characteristic of a genetic predisposition to cancer. METHODS Clinical information and peripheral-blood mononuclear cells were obtained from 418 women from the Boston metropolitan area in whom breast cancer was diagnosed at or before the age of 40. A comprehensive BRCA1 mutational analysis, involving automated nucleotide sequencing and a protein-truncation assay, was undertaken in 30 of these women, who had breast cancer before the age of 30. In addition, the BRCA1 mutation 185delAG, which is prevalent in the Ashkenazi Jewish population, was sought with an allele-specific polymerase-chain-reaction assay in 39 Jewish women among the 418 women who had breast cancer at or before the age of 40. RESULTS Among 30 women with breast cancer before the age of 30, 4 (13 percent) had definite, chain-terminating mutations and 1 had a missense mutation. Two of the four Jewish women in this cohort had the 185delAG mutation. Among the 39 Jewish women with breast cancer at or before the age of 40, 8 (21 percent) carried the 185delAG mutation (95 percent confidence interval, 9 to 36 percent). CONCLUSIONS Germ-line BRCA1 mutations can be present in young women with breast cancer who do not belong to families with multiple affected members. The specific BRCA1 mutation known as 185delAG is strongly associated with the onset of breast cancer in Jewish women before the age of 40.
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