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de-la-Hoz-López D, Cuadrado ML, López-Valdés E, García-Ramos R, Alonso-Frech F, Fernández-Revuelta A, Fernández-de-las-Peñas C, Gómez-Mayordomo V. Sensitization-Associated Symptoms and Neuropathic-like Features in Patients with Cervical Dystonia and Pain. J Clin Med 2024; 13:2134. [PMID: 38610899 PMCID: PMC11012442 DOI: 10.3390/jcm13072134] [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: 03/14/2024] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This exploratory study evaluated the presence of sensitization-associated and neuropathic-like symptoms and identified their association with pressure sensitivity, pain, and disability in patients with cervical dystonia (CD). Methods: Thirty-one patients with CD (74.2% women, age: 61.2 years, SD 10.1) participated. Data collected included clinical variables, the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), the Central Sensitization Inventory (CSI), the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI), as well as widespread pressure pain thresholds (PPTs). Results: Patients with CD with pain (n = 20, 64.5%) showed higher scores on the TWSTRS disability subscale and the CSI (p < 0.001), and lower PPTs (p < 0.05). Fifteen patients (15/31, 48%) showed sensitization-associated symptoms (CSI ≥ 40), whereas five of the patients with pain (5/20, 25%) exhibited neuropathic-like symptoms (S-LANSS ≥ 12). The CSI and S-LANSS were positively associated with the TWSTRS, HADS-A and HADS-D, and negatively associated with PPTs. HADS-D and S-LANSS explained 72.5% of the variance of the CSI (r2: 0.725), whereas CSI explained 42.3% of the variance of the S-LANSS (r2: 0.423). Conclusions: Pain is an important source of disability in CD, and may be a consequence of different mechanisms, including sensitization.
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Affiliation(s)
- Diego de-la-Hoz-López
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - María L. Cuadrado
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Eva López-Valdés
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Rocío García-Ramos
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Fernando Alonso-Frech
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Ana Fernández-Revuelta
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Víctor Gómez-Mayordomo
- Synaptia Institute of Neurosciencies, Hospital Universitario Vithas Madrid La Milagrosa, 28010 Madrid, Spain;
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Gómez-Mayordomo V, Kojović M, López-Valdés E, Alonso-Frech F, Horga A, Fernández-Rodríguez R, Pareés I. Functional neurological symptoms as initial presentation of Creutzfeldt-Jakob disease: case series. J Neurol 2023; 270:1141-1146. [PMID: 36175672 DOI: 10.1007/s00415-022-11376-5] [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: 08/07/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional Neurological Disorders (FND) are common in clinical practice. It is recognized that FND may present at onset or during the course of other neurological diseases (functional comorbidity). CASES We report a clinical series of three patients who initially presented positive signs of a functional movement disorder (FMD) and were later diagnosed with a Creutzfeldt-Jakob disease (CJD). All patients presented with unilateral functional tremor, two patients also had functional limb weakness. All patients progressed to an asymmetric corticobasal syndrome, fulfilling clinical criteria of CJD. They had a rapid progression and died within 2-3 months. CONCLUSIONS FND may be the initial clinical presentation of neurodegenerative diseases reflecting a dysfunction across brain circuits that are involved in the pathophysiology of FND. A positive diagnosis of FND is essential as it is an adequate examination and a close follow-up of these patients in neurology clinics.
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Affiliation(s)
- Víctor Gómez-Mayordomo
- Neurology Department, Hospital Universitario Infanta Elena. Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (iiSFJD). Universidad Complutense de Madrid, Madrid, Spain.
| | - Maja Kojović
- Neurology Department, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Eva López-Valdés
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Alejandro Horga
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Isabel Pareés
- Neurology Department, Hospital Ruber Internacional, Madrid, Spain
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Fernández-García C, Monje MH, Gómez-Mayordomo V, Foffani G, Herranz R, Catalán MJ, González-Hidalgo M, Matias-Guiu J, Alonso-Frech F. Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming. Brain Stimul 2022; 15:727-736. [DOI: 10.1016/j.brs.2022.04.015] [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: 03/08/2021] [Revised: 01/16/2022] [Accepted: 04/20/2022] [Indexed: 11/02/2022] Open
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López-Ariztegui N, Mata-Alvarez Santullano M, Tegel I, Almeida F, Sarasa P, Rojo R, Rico-Villademoros F, Abril-Jaramillo J, Bermejo P, Borrue C, Caballol N, Campins-Romeu M, Clavero P, García-Caldentey J, Gómez-Mayordomo V, Labandeira C, Martí-Andrés G, Martínez-Castrillo JC, Martinez-Poles J, Muñoz T, Salom JM, Valderrama-Martín C, Vinagre-Aragón A. [Opicapone for the treatment of Parkinson's disease: real-life data in Spain]. Rev Neurol 2021; 73:S01-S14. [PMID: 34897643 DOI: 10.33588/rn.73s02.2021461] [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: 11/24/2022]
Abstract
Opicapone is a catechol-O-methyl-transferase (iCOMT) inhibitor authorized in Europe in 2016 and indicated as adjunctive therapy to preparations of levodopa/ DOPA decarboxylase inhibitors in adult patients with Parkinson's disease and end-of-dose motor fluctuations who cannot be stabilised on those combinations. The efficacy of opicapone in these patients has been demonstrated in two pivotal randomized clinical trials, BIPARK I and BIPARK II, in which it has demonstrated its superiority versus placebo and non-inferiority versus entacapone. Although they constitute the gold standard for the evaluation of interventions, randomized clinical trials present limitations of external validity due to the use of strict eligibility criteria. Therefore, it is considered necessary to have a more comprehensive evaluation of the efficacy of the drug, complementing the information obtained from randomized clinical trials with that of "real world or real clinical practice" studies. The objective of this review has been to collect and put into perspective the information available on opicapone coming from real clinical practice studies in Spain. The data from Spain with opicapone in 18 series with more than 1,000 patients in total, confirm the safety and efficacy previously reported with this iCOMT. Furthermore, they show that opicapone is especially useful in patients with a less advanced stage of the disease and mild motor fluctuations, which would suggest that the earlier its introduction in the therapeutic scheme for the management of motor fluctuations, the better is the benefit-risk ratio for the drug.
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Affiliation(s)
| | | | - I Tegel
- Laboratorios Bial, S.A., Madrid, España
| | - F Almeida
- Laboratorios Bial, S.A., Madrid, España
| | - P Sarasa
- Laboratorios Bial, S.A., Madrid, España
| | - R Rojo
- Universidad Alfonso X El Sabio, Villanueva de la Cañada, España
| | | | | | - P Bermejo
- Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, España
| | - C Borrue
- Hospital Universitario Infanta Sofía, Madrid, España
| | - N Caballol
- Hospital de San Juan Despí Moisès Broggi, Sant Joan Despí, España
| | | | - P Clavero
- Complejo Hospitalario de Navarra, Pamplona, Pamplona, España
| | | | | | | | | | | | | | - T Muñoz
- Hospital Universitario Regional de Málaga, Málaga, España
| | - J M Salom
- Hospital Clínico Universitario de Valencia, 46010 Valencia, España
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5
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Fernández-de-Las-Peñas C, Gómez-Mayordomo V, de-la-Llave-Rincón AI, Palacios-Ceña M, Rodríguez-Jiménez J, Florencio LL, Velasco-Arribas M, Fuensalida-Novo S, Cigarán-Méndez M, Ambite-Quesada S, Guijarro C, Cuadrado ML, Arias-Navalón JA, Ortega-Santiago R, Elvira-Martínez CM, Molina-Trigueros LJ, Torres-Macho J, Sebastián-Viana T, Canto-Diez MG, Hernández-Barrera V, Palacios-Ceña D. Anxiety, depression and poor sleep quality as long-term post-COVID sequelae in previously hospitalized patients: A multicenter study. J Infect 2021; 83:496-522. [PMID: 34192525 PMCID: PMC8236125 DOI: 10.1016/j.jinf.2021.06.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 12/21/2022]
Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain.
| | - Víctor Gómez-Mayordomo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
| | | | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
| | - María Velasco-Arribas
- Department of Internal Medicine-Infectious Department, Research Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain; Department of Medicine, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Stella Fuensalida-Novo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
| | | | - Silvia Ambite-Quesada
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
| | - Carlos Guijarro
- Department of Internal Medicine-Infectious Department, Research Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain; Department of Medicine, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - María L Cuadrado
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
| | | | - Luis J Molina-Trigueros
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain; Department of Physical Therapy, Hospital Universitario Fuenlabrada, Madrid, Spain
| | - Juan Torres-Macho
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Internal Medicine, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid Spain
| | | | - Mª Gabriela Canto-Diez
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Internal Medicine, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid Spain
| | | | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
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6
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Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Florencio LL, Cuadrado ML, Plaza-Manzano G, Navarro-Santana M. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. Eur J Intern Med 2021; 92:55-70. [PMID: 34167876 PMCID: PMC8206636 DOI: 10.1016/j.ejim.2021.06.009] [Citation(s) in RCA: 264] [Impact Index Per Article: 88.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/21/2021] [Accepted: 06/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Single studies support the presence of several post-COVID-19 symptoms; however, no meta-analysis differentiating hospitalized and non-hospitalized patients has been published to date. This meta-analysis analyses the prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized patients recovered from COVID-19 . METHODS MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers were searched up to March 15, 2021. Peer-reviewed studies or preprints reporting data on post-COVID-19 symptoms collected by personal, telephonic or electronic interview were included. Methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. We used a random-effects models for meta-analytical pooled prevalence of each post-COVID-19 symptom, and I² statistics for heterogeneity. Data synthesis was categorized at 30, 60, and ≥90 days after . RESULTS From 15,577 studies identified, 29 peer-reviewed studies and 4 preprints met inclusion criteria. The sample included 15,244 hospitalized and 9011 non-hospitalized patients. The methodological quality of most studies was fair. The results showed that 63.2, 71.9 and 45.9% of the sample exhibited ≥one post-COVID-19 symptom at 30, 60, or ≥90days after onset/hospitalization. Fatigue and dyspnea were the most prevalent symptoms with a pooled prevalence ranging from 35 to 60% depending on the follow-up. Other post-COVID-19 symptoms included cough (20-25%), anosmia (10-20%), ageusia (15-20%) or joint pain (15-20%). Time trend analysis revealed a decreased prevalence 30days after with an increase after 60days . CONCLUSION This meta-analysis shows that post-COVID-19 symptoms are present in more than 60% of patients infected by SARS-CoV‑2. Fatigue and dyspnea were the most prevalent post-COVID-19 symptoms, particularly 60 and ≥90 days after.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Avenida de Atenas s/n, Madrid, Alcorcón 28922 Spain.
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Avenida de Atenas s/n, Madrid, Alcorcón 28922 Spain
| | | | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Avenida de Atenas s/n, Madrid, Alcorcón 28922 Spain
| | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Marcos Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
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7
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Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Palacios-Ceña M, Rodríguez-Jiménez J, de-la-Llave-Rincón AI, Velasco-Arribas M, Fuensalida-Novo S, Ambite-Quesada S, Guijarro C, Cuadrado ML, Florencio LL, Arias-Navalón JA, Ortega-Santiago R, Elvira-Martínez CM, Molina-Trigueros LJ, Torres-Macho J, Sebastián-Viana T, Canto-Diez MG, Cigarán-Méndez M, Hernández-Barrera V, Arendt-Nielsen L. Fatigue and Dyspnoea as Main Persistent Post-COVID-19 Symptoms in Previously Hospitalized Patients: Related Functional Limitations and Disability. Respiration 2021; 101:132-141. [PMID: 34569550 PMCID: PMC8678253 DOI: 10.1159/000518854] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 03/12/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
Background Multicentre studies focussing on specific long-term post-COVID-19 symptoms are scarce. Objective The aim of this study was to determine the levels of fatigue and dyspnoea, repercussions on daily life activities, and risk factors associated with fatigue or dyspnoea in COVID-19 survivors at long term after hospital discharge. Methods Age, gender, height, weight, symptoms at hospitalization, pre-existing medical comorbidity, intensive care unit admission, and the presence of cardio-respiratory symptoms developed after severe acute respiratory syndrome coronavirus 2 infection were collected from patients who recovered from COVID-19 at 4 hospitals in Madrid (Spain) from March 1 to May 31, 2020 (first COVID-19 wave). The Functional Impairment Checklist was used for evaluating fatigue/dyspnoea levels and functional limitations. Results A total of 1,142 patients (48% women, age: 61, standard deviation [SD]: 17 years) were assessed 7.0 months (SD 0.6) after hospitalization. Fatigue was present in 61% patients, dyspnoea with activity in 55%, and dyspnoea at rest in 23.5%. Only 355 (31.1%) patients did not exhibit fatigue and/or dyspnoea 7 months after hospitalization. Forty-five per cent reported functional limitations with daily living activities. Risk factors associated with fatigue and dyspnoea included female gender, number of pre-existing comorbidities, and number of symptoms at hospitalization. The number of days at hospital was a risk factor just for dyspnoea. Conclusions Fatigue and/or dyspnoea were present in 70% of hospitalized COVID-19 survivors 7 months after discharge. In addition, 45% patients exhibited limitations on daily living activities. Being female, higher number of pre-existing medical comorbidities and number of symptoms at hospitalization were risk factors associated to fatigue/dyspnoea in COVID-19 survivors 7 months after hospitalization.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Ana I de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - María Velasco-Arribas
- Department of Internal Medicine-Infectious, Research Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain.,Department of Medicine, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Stella Fuensalida-Novo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Silvia Ambite-Quesada
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Carlos Guijarro
- Department of Internal Medicine-Infectious, Research Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain.,Department of Medicine, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - María L Cuadrado
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - Luis J Molina-Trigueros
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain.,Department of Physical Therapy, Hospital Universitario Fuenlabrada, Madrid, Spain
| | - Juan Torres-Macho
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Department of Internal Medicine, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
| | | | - María Gabriela Canto-Diez
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Department of Internal Medicine, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
| | | | | | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, CNAP, Center for Sensory-Motor Interaction (SMI), Aalborg, Denmark
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8
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Palacios-Ceña D, Talavera B, Gómez-Mayordomo V, Garcia-Azorin D, Gallego-Gallego M, Cuadrado ML, Guerrero-Peral ÁL. Understanding the diagnoses and medical care experience of patients with new daily persistent headache: a qualitative study in Spain. BMJ Open 2021; 11:e048552. [PMID: 34404708 PMCID: PMC8372810 DOI: 10.1136/bmjopen-2020-048552] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To explore the experiences of patients suffering from new daily persistent headache (NDPH) regarding the diagnostic process, treatment and medical care. DESIGN A qualitative phenomenological study was conducted. SETTING A specialised headache unit at two university hospitals in Spain between February 2017 and December 2018. PARTICIPANTS Patients diagnosed with NDPH according to the International Classification of Headache disorders (third beta edition). METHODS Purposeful sampling was performed. Data were collected using unstructured and semistructured interviews, researchers' field notes and patients' drawings. An inductive thematic analysis was used to identify significant emerging themes from interviews, field notes and descriptions of patients' drawings. Also, Guillemin's proposal was used to analyse the contents of drawings. RESULTS Nineteen patients with a mean age of 45.3 were recruited. Four main themes emerged: (1) Seeking a diagnosis, patients visit many doctors without receiving a clear answer and their diagnosis is delayed; (2) Self-medication-minimising pill intake, medication is ineffective, and therefore, some patients discontinue treatment, or are flexible with how they take medication; (3) Trying other non-pharmacological options, many patients turn to other therapies and complementary and/or alternative therapies as a second option, however these are ineffective and (4) Medical care, with two subthemes, referrals and lacking continuity of care, and building the doctor-patient relationship. Patients describe how the referral breaks the continuity of care, and how they identify the traits of a doctor who is approachable and which behaviours the doctor should avoid when caring for patients. CONCLUSIONS An in-depth knowledge of the beliefs and expectations of patients with NDPH will allow the professional to establish a relationship of trust, which will improve the patients' knowledge of which therapies are the most appropriate, and to establish expectations based on the relationship with the doctor, and not only on patients' beliefs.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón/Madrid, Spain
- Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Alcorcón/ Madrid, Spain
| | - Blanca Talavera
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Víctor Gómez-Mayordomo
- Department of Neurology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - David Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María Luz Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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9
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Fernández-de-Las-Peñas C, Navarro-Santana M, Gómez-Mayordomo V, Cuadrado ML, García-Azorín D, Arendt-Nielsen L, Plaza-Manzano G. Headache as an acute and post-COVID-19 symptom in COVID-19 survivors: A meta-analysis of the current literature. Eur J Neurol 2021; 28:3820-3825. [PMID: 34327787 PMCID: PMC8444899 DOI: 10.1111/ene.15040] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [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: 07/11/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
Background Headache is identified as a common post‐COVID sequela experienced by COVID‐19 survivors. The aim of this pooled analysis was to synthesize the prevalence of post‐COVID headache in hospitalized and non‐hospitalized patients recovering from SARS‐CoV‐2 infection. Methods MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers, were searched up to 31 May 2021. Studies or preprints providing data on post‐COVID headache were included. The methodological quality of the studies was assessed using the Newcastle‐Ottawa Scale. Random effects models were used for meta‐analytical pooled prevalence of post‐COVID headache. Data synthesis was categorized at hospital admission/symptoms' onset, and at 30, 60, 90, and ≥180 days afterwards. Results From 9573 studies identified, 28 peer‐reviewed studies and 7 preprints were included. The sample was 28,438 COVID‐19 survivors (12,307 females; mean age: 46.6, SD: 17.45 years). The methodological quality was high in 45% of the studies. The overall prevalence of post‐COVID headache was 47.1% (95% CI 35.8–58.6) at onset or hospital admission, 10.2% (95% CI 5.4–18.5) at 30 days, 16.5% (95% CI 5.6–39.7) at 60 days, 10.6% (95% CI 4.7–22.3) at 90 days, and 8.4% (95% CI 4.6–14.8) at ≥180 days after onset/hospital discharge. Headache as a symptom at the acute phase was more prevalent in non‐hospitalized (57.97%) than in hospitalized (31.11%) patients. Time trend analysis showed a decreased prevalence from the acute symptoms’ onset to all post‐COVID follow‐up periods which was maintained afterwards. Conclusion This meta‐analysis found that the prevalence of post‐COVID headache ranged from 8% to 15% during the first 6 months after SARS‐CoV‐2 infection.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain.,Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Marcos Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | | | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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10
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Fernández-de-Las-Peñas C, Florencio LL, Gómez-Mayordomo V, Cuadrado ML, Palacios-Ceña D, Raveendran AV. Proposed integrative model for post-COVID symptoms. Diabetes Metab Syndr 2021; 15:102159. [PMID: 34186367 PMCID: PMC8168334 DOI: 10.1016/j.dsx.2021.05.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS To propose an integrative model for post-COVID symptoms by considering the absence/presence of previous symptomatology. METHODS We searched different databases for original articles and reviews on post-COVID symptoms. RESULTS The first consideration is to define which symptoms are of "new-onset" (symptoms never experienced by a patient before COVID-19 and experienced the first time after) and which symptoms are "exacerbated" (symptoms experienced by a patient prior to COVID-19 but aggravated later) after infection. The second consideration includes defining "persistent" (symptoms experienced at the acute phase and continuing after without remission period) and "delayed-onset" (symptoms not experienced at the acute phase of the infection but appearing after a "latency period"). This model integrates predisposing individual factors, biological factors associated to the severity of disease, hospitalization/treatment factors, and outbreak surrounding factors which may promote post-COVID. CONCLUSION Since current literature on post-COVID is heterogeneous, this integrative model could help to a better characterization of long-COVID.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain.
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
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11
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Fernández-de-las-Peñas C, Gómez-Mayordomo V, García-Azorín D, Palacios-Ceña D, Florencio LL, Guerrero AL, Hernández-Barrera V, Cuadrado ML. Previous History of Migraine Is Associated With Fatigue, but Not Headache, as Long-Term Post-COVID Symptom After Severe Acute Respiratory SARS-CoV-2 Infection: A Case-Control Study. Front Hum Neurosci 2021; 15:678472. [PMID: 34295230 PMCID: PMC8290894 DOI: 10.3389/fnhum.2021.678472] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/09/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the association of pre-existing migraine in patients hospitalised and who recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with the presence of post-coronavirus disease (COVID) symptoms. BACKGROUND No study has investigated the role of migraine as a risk factor for development of post-COVID symptoms. METHODS A case-control study including individuals hospitalised during the first wave of the pandemic (from February 20 to May 31, 2020) was conducted. Patients with confirmed previous diagnosis of migraine were considered cases. Two age- and sex-matched individuals without a history of headache per case were also recruited as controls. Hospitalisation/clinical data were collected from hospital medical records. Patients were scheduled for a telephone interview. A list of post-COVID symptoms was systematically evaluated, but participants were invited to freely report any symptom. The Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index were used to assess anxiety/depressive symptoms and sleep quality. Multivariable conditional logistic regression models were constructed. RESULTS Overall, 57 patients with confirmed diagnosis of migraine and 144 non-migraine controls who had recovered from COVID-19 were assessed at 7.3 months (SD 0.6) after hospital discharge. The number of post-COVID symptoms in the migraine group was significantly greater (OR 1.70, 95% CI 1.29-2.25, P < 0.001) than in the non-migraine group. Fatigue was significantly more prevalent (OR 2.89, 95% CI 1.32-6.32, P = 0.008) in the migraine group. However, no between-groups difference in the prevalence of headache as a post-COVID symptom was detected. CONCLUSION Patients with a history of migraine who recovered from COVID-19 exhibited more long-term fatigue as post-COVID sequelae than those without migraine. Some of the pathophysiological changes associated with migraine could predispose to the occurrence of post-COVID symptoms.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Angel L. Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | | | - María L. Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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12
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Fernández-de-Las-Peñas C, Gómez-Mayordomo V, Cuadrado ML, Palacios-Ceña D, Florencio LL, Guerrero AL, García-Azorín D, Hernández-Barrera V, Arendt-Nielsen L. The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: A case-control study. Cephalalgia 2021; 41:1332-1341. [PMID: 34134526 PMCID: PMC8212025 DOI: 10.1177/03331024211020404] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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] [Indexed: 12/12/2022]
Abstract
Objective To investigate the association of headache during the acute phase of SARS-CoV-2 infection with long-term post-COVID headache and other post-COVID symptoms in hospitalised survivors. Methods A case-control study including patients hospitalised during the first wave of the pandemic in Spain was conducted. Patients reporting headache as a symptom during the acute phase and age- and sex-matched patients without headache during the acute phase participated. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview 7 months after hospital discharge. Participants were asked about a list of post-COVID symptoms and were also invited to report any additional symptom they might have. Anxiety/depressive symptoms and sleep quality were assessed with the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Results Overall, 205 patients reporting headache and 410 patients without headache at hospitalisation were assessed 7.3 months (Standard Deviation 0.6) after hospital discharge. Patients with headache at onset presented a higher number of post-COVID symptoms (Incident Rate Ratio: 1.16, 95% CI: 1.03–1.30). Headache at onset was associated with a previous history of migraine (Odd Ratio: 2.90, 95% Confidence Interval: 1.41–5.98) and with the development of persistent tension-type like headache as a new post-COVID symptom (Odd Ratio: 2.65, 95% CI: 1.66–4.24). Fatigue as a long-term symptom was also more prevalent in patients with headache at onset (Odd Ratio: 1.55, 95% CI: 1.07–2.24). No between-group differences in the prevalence of anxiety/depressive symptoms or sleep quality were seen. Conclusion Headache in the acute phase of SARS-CoV-2 infection was associated with higher prevalence of headache and fatigue as long-term post-COVID symptoms. Monitoring headache during the acute phase could help to identify patients at risk of developing long-term post-COVID symptoms, including post-COVID headache.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | | | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | - Angel L Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | | | - Lars Arendt-Nielsen
- CNAP, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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13
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Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Rodríuez-Jiménez J, Palacios-Ceña M, Velasco-Arribas M, Guijarro C, de-la-Llave-Rincón AI, Fuensalida-Novo S, Elvira-Martínez CM, Cuadrado ML, Arias-Navalón JA, Florencio LL, Ortega-Santiago R, Molina-Trigueros LJ, Sebastián-Viana T, Torres-Macho J, Canto-Diez G, Plaza-Canteli S, Cigarán-Méndez M, Ambite-Quesada S, Hernández-Barrera V, Arias-Buría JL, Arendt-Nielsen L. Long-term post-COVID symptoms and associated risk factors in previously hospitalized patients: A multicenter study. J Infect 2021; 83:237-279. [PMID: 33984399 PMCID: PMC8110627 DOI: 10.1016/j.jinf.2021.04.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022]
Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - Jorge Rodríuez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - María Velasco-Arribas
- Department of Internal Medicine-Infectious Department, Research Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain; Department of Medicine, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Carlos Guijarro
- Department of Internal Medicine-Infectious Department, Research Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain; Department of Medicine, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Ana I de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Stella Fuensalida-Novo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos. Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Luis J Molina-Trigueros
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain; Department of Physical Therapy, Hospital Universitario Fuenlabrada, Madrid, Spain
| | | | - Juan Torres-Macho
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Internal Medicine, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
| | - Gabriela Canto-Diez
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Allergy, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
| | - Susana Plaza-Canteli
- School of Health Sciences, Universidad Alfonso X el Sabio, Madrid, Spain; Department of Internal Medicine, Hospital Universitario Severo Ochoa, Madrid, Spain
| | | | - Silvia Ambite-Quesada
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Lars Arendt-Nielsen
- CNAP, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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14
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Guerrero-Peral Á, Gómez-Mayordomo V, García-Azorín D, González-García N, Fernández-de-Las-Peñas C, Arendt-Nielsen L, Cuadrado ML. Association of dynamic and widespread mechanical sensitivity in cluster headache. Acta Neurol Belg 2020; 120:1265-1270. [PMID: 32710285 DOI: 10.1007/s13760-020-01450-y] [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: 11/11/2019] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
We investigated if dynamic pressure pain sensitivity in the symptomatic area is associated with pressure sensitivity in local and distant pain-free areas in cluster headache (CH). A pressure algometry set consisting of 8 rollers with fixed pressure levels ranging from 500 to 5300 g was used to assess dynamic pressure pain sensitivity in men with episodic CH. Each roller was moved from an anterior-to-posterior direction over the temporalis muscle. The load level of the first painful roller was considered the dynamic pain threshold (DPT). Further, pain elicited during DPT (roller evoked pain) was also assessed. We used a pressure algometer to determine pressure pain thresholds (PPTs) over the temporalis muscle, C5/C6 joint, second metacarpal, and tibialis anterior. Patients were assessed in an asymptomatic (remission) phase, at least 6 months after their last cluster period and without taking pharmacological treatment. Forty men with episodic CH (mean age 42 years) were included. Both outcomes, DPTs (r = 0.781, P < 0.001) and roller-evoked pain (r = 0.586; P < 0.001) were bilaterally correlated. Further, DPT, but not roller-evoked pain, was moderately associated with PPTs measured at the symptomatic (temporalis: r = 0.665, P < 0.001) and distant pain-free (C5-C6 joint: r = 0.389, P = 0.013; second metacarpal: r = 0.551, P < 0.001; and, tibialis anterior: r = 0.308, P = 0.035) points. Dynamic pressure sensitivity in the trigeminal area was correlated to pressure pain sensitivity at both symptomatic and distant pain-free areas in men with CH supporting the use of roller pressure algometry. Dynamic pressure algometry may be a new tool for assessing the status of sensitization in primary headaches.
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Affiliation(s)
- Ángel Guerrero-Peral
- Neurology Department, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | | | - David García-Azorín
- Neurology Department, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | | | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
- Department of Health Science and Technology, Faculty of Medicine, CNAP, Sensory-Motor Interaction (SMI) Center, Aalborg University, Aalborg, Denmark.
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, CNAP, Sensory-Motor Interaction (SMI) Center, Aalborg University, Aalborg, Denmark
| | - María L Cuadrado
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
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15
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Gómez-Mayordomo V, Palacios-Ceña M, Guerrero-Peral Á, Fuensalida-Novo S, Fernández-de-Las-Peñas C, Cuadrado ML. Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety. Pain Pract 2019; 20:147-153. [PMID: 31538698 DOI: 10.1111/papr.12839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/07/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diminished pressure pain thresholds (PPTs) have been found in patients with cluster headache (CH), suggesting the presence of central sensitization. However, it is not known whether sensitization persists over time during the asymptomatic periods. OBJECTIVE To investigate if men with episodic CH in a long-lasting remission phase exhibit widespread pressure pain hypersensitivity. METHODS Forty men with episodic CH and 40 matched controls were enrolled. PPTs were assessed bilaterally over 1 trigeminal (temporalis muscle) and 3 extra-trigeminal points (C5/C6 zygapophyseal joint, second metacarpal, tibialis anterior muscle) by a blinded assessor. Patients were assessed in a prolonged remission phase, at least 6 months after their last CH attack and without taking any medication. Depression and anxiety levels were assessed with the Hospital Anxiety and Depression Scale (HADS). For each point, differences in PPTs were evaluated with a multivariate mixed-model analysis of covariance test, with side and group as main factors and depression and anxiety levels as covariates. RESULTS PPTs were significantly decreased bilaterally over the temporalis muscle (mean difference: 85 to 100 kPa), C5/C6 zygapophyseal joint (mean difference: 65 to 80 kPa), second metacarpal (mean difference: 65 to 90 kPa), and tibialis anterior muscle (mean difference: 135 to 155 kPa) in patients with CH when compared to headache-free subjects (all, P < 0.001). No effect of anxiety or depression levels was found. CONCLUSIONS Patients with CH exhibited bilateral widespread hypersensitivity to pressure pain during long-lasting remission periods, which was not associated with depression or anxiety. These results support the persistence of central sensitization in episodic CH, even in remote asymptomatic phases.
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Affiliation(s)
| | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Ángel Guerrero-Peral
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Stella Fuensalida-Novo
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - María L Cuadrado
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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16
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García-Sáez R, Gutiérrez-Viedma Á, González-García N, Gómez-Mayordomo V, Porta-Etessam J, Cuadrado ML. OnabotulinumtoxinA injections for atypical odontalgia: an open-label study on nine patients. J Pain Res 2018; 11:1583-1588. [PMID: 30197533 PMCID: PMC6112804 DOI: 10.2147/jpr.s169701] [Citation(s) in RCA: 6] [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] [Indexed: 12/03/2022] Open
Abstract
Background Atypical odontalgia (AO) manifests as continuous pain in the region of one or several teeth, in the absence of signs of dental pathology. Currently, there is insufficient evidence to establish treatment guidelines for AO. The aim of this study was to describe the effectiveness and safety of treatment with OnabotulinumtoxinA (OnabotA) on a series of patients with AO. Methods Nine patients with AO (four males and five females, aged between 31 and 77 years) received injections of OnabotA in the region of pain. The dosage used in each procedure ranged between 10 and 30 U, spread between 4 and 12 injection sites along the gums (n=9), the lips (n=3), and the hard palate (n=1). The median follow-up time was 27 months (interquartile range, IQR 20–40) and the median number of injection sessions per patient was seven (IQR 4.5–9). The assessment variables included the change in the maximal intensity of pain on a 0–10 numerical rating scale (NRS), the response latency, and the duration of the effect. Results All patients experienced a significant improvement, with ≥50% of reduction in the intensity of the maximal pain. The median of reduction of maximal pain after treatment was six points on the NRS (IQR 5–8.5). The response latency was 2–15 days and the duration of the effect was 2–6 months. No significant adverse reactions were registered. Conclusion OnabotA may be a safe and effective option for the treatment of AO.
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Affiliation(s)
- Rafael García-Sáez
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain,
| | - Álvaro Gutiérrez-Viedma
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain, .,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,
| | - Nuria González-García
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain,
| | - Víctor Gómez-Mayordomo
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain,
| | - Jesús Porta-Etessam
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain, .,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,
| | - María-Luz Cuadrado
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain, .,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,
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17
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Gómez-Mayordomo V, Gutiérrez-Viedma Á, Porta-Etessam J, Rubio-Rodríguez C, Cuadrado ML. Zygomaticofacial Neuralgia: A New Cause of Facial Pain. Headache 2018; 58:455-457. [DOI: 10.1111/head.13270] [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: 11/15/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Víctor Gómez-Mayordomo
- Department of Neurology, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Madrid Spain
- Department of Medicine, School of Medicine; Universidad Complutense de Madrid (UCM); Madrid Spain
| | - Álvaro Gutiérrez-Viedma
- Department of Neurology, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Madrid Spain
- Department of Medicine, School of Medicine; Universidad Complutense de Madrid (UCM); Madrid Spain
| | - Jesús Porta-Etessam
- Department of Neurology, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Madrid Spain
- Department of Medicine, School of Medicine; Universidad Complutense de Madrid (UCM); Madrid Spain
| | - Carmen Rubio-Rodríguez
- Department of Radiation Oncology; Hospital Universitario HM Sanchinarro; Madrid Spain
- Department of Clinical Medical Sciences, School of Medicine; Universidad San Pablo CEU; Madrid Spain
| | - María-Luz Cuadrado
- Department of Neurology, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Madrid Spain
- Department of Medicine, School of Medicine; Universidad Complutense de Madrid (UCM); Madrid Spain
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