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Failla MD, Beach PA, Atalla S, Dietrich MS, Bruehl S, Cowan RL, Monroe TB. Gender Differences in Pain Threshold, Unpleasantness, and Descending Pain Modulatory Activation Across the Adult Life Span: A Cross Sectional Study. J Pain 2024; 25:1059-1069. [PMID: 37956742 PMCID: PMC10960699 DOI: 10.1016/j.jpain.2023.10.027] [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] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/04/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
The neurobiological underpinnings of gender differences in pain perception, and how these differences may be modified by age, are incompletely understood, placing patients at risk of suboptimal pain management. Using functional magnetic resonance imaging, we examined brain responses in the descending pain modulatory system (DPMS, specifically, dorsolateral prefrontal cortex, anterior cingulate cortex, insula, hypothalamus, amygdala, and periaqueductal gray, during an evoked pain task. We investigated the interaction of age and gender in our sample of healthy adults (27 females, 32 males, 30-86 years) on DPMS response. In a perceptually matched thermal pain paradigm, we investigated pain unpleasantness and neural responses for 3 heat pain percepts: just noticeable pain, weak pain, and moderate pain (MP). Females reported just noticeable pain at a lower temperature, but reported less unpleasantness at weak pain and MP percepts, compared to males. There was a significant age-by-gender interaction during moderate pain in the right anterior cingulate cortex and bilateral insula, such that, males had a stronger positive relationship between DPMS response and age compared to females in these regions. Our results indicate that differences in DPMS responses may explain some gender differences in pain perception and that this effect may change across the adult lifespan. PERSPECTIVE: Gender differences in pain have been well-documented but the brain mechanisms for these differences are still unclear. This article describes potential differences in brain functioning during different levels of pain that could explain differences in pain responses between men and women across the adult lifespan.
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Affiliation(s)
- Michelle D. Failla
- College of Nursing, The Ohio State University, Columbus, OH
- Nisonger Center, The Ohio State University, Columbus, OH
| | - Paul A. Beach
- Department of Neurology, Emory University, Atlanta, GA
| | | | | | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Ronald L. Cowan
- Departments of Psychiatry and Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN
| | - Todd B. Monroe
- College of Nursing, The Ohio State University, Columbus, OH
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Jesus CHA, Ferreira MV, Gasparin AT, Rosa ES, Genaro K, Crippa JADS, Chichorro JG, Cunha JMD. Cannabidiol enhances the antinociceptive effects of morphine and attenuates opioid-induced tolerance in the chronic constriction injury model. Behav Brain Res 2022; 435:114076. [PMID: 36028000 DOI: 10.1016/j.bbr.2022.114076] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 06/29/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022]
Abstract
Neuropathic pain (NP) is a complex health problem that includes sensorial manifestations such as evoked and ongoing pain. Cannabidiol (CBD) has shown potential in the treatment of NP and the combination between opioids and cannabinoids has provided promising results on pain relief. Thus, our study aimed to investigate the effect of treatment combination between CBD and morphine on evoked and ongoing pain, and the effect of CBD on morphine-induced tolerance in the model of chronic constriction injury (CCI) of the sciatic nerve in rats. Mechanical thresholds (i.e., evoked pain) were evaluated before and 7 days after surgery. We also employed a 4-day conditioned place preference (CPP) protocol, to evaluate relief of ongoing pain (6-9 days after surgery). Treatment with morphine (2 and 4 mg/kg) or CBD (30 mg/kg) induced a significant antinociceptive effect on evoked pain. The combination of CBD (30 mg/kg) and morphine (1 mg/kg) produced an enhanced antinociceptive effect, when compared to morphine alone (1 mg/Kg). Treatment with morphine (1 and 2 mg/kg) or CBD (30 mg/kg) alone failed to induce significant scores in the CPP test. However, combined treatment of CBD (30 mg/kg) and morphine (1 mg/kg) provided significant positive scores, increased the number of entrances in the drug-paired chamber in the CPP test and did not alter locomotor activity in rats. Lastly, treatment with CBD partially attenuated morphine-induced tolerance. In summary, our results support the indication of CBD as an adjuvant to opioid therapy for the attenuation of NP and opioid-induced analgesic tolerance.
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Affiliation(s)
- Carlos Henrique Alves Jesus
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Curitiba, Paraná, Brazil.
| | - Matheus Vinicius Ferreira
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Aléxia Thamara Gasparin
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Evelize Stacoviaki Rosa
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Karina Genaro
- Department of Anesthesiology, University of California, Irvine, CA, USA; Institute of Neurosciences and Behavior (INeC), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José Alexandre de Souza Crippa
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; National Institute of Science and Technology for Translational Medicine (INCT-TM, CNPq), Ribeirão Preto, São Paulo, Brazil
| | - Juliana Geremias Chichorro
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Joice Maria da Cunha
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Curitiba, Paraná, Brazil; Institute of Neurosciences and Behavior (INeC), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Han X, Ashar YK, Kragel P, Petre B, Schelkun V, Atlas LY, Chang LJ, Jepma M, Koban L, Losin EAR, Roy M, Woo CW, Wager TD. Effect sizes and test-retest reliability of the fMRI-based neurologic pain signature. Neuroimage 2022; 247:118844. [PMID: 34942367 PMCID: PMC8792330 DOI: 10.1016/j.neuroimage.2021.118844] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 07/12/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 01/28/2023] Open
Abstract
Identifying biomarkers that predict mental states with large effect sizes and high test-retest reliability is a growing priority for fMRI research. We examined a well-established multivariate brain measure that tracks pain induced by nociceptive input, the Neurologic Pain Signature (NPS). In N = 295 participants across eight studies, NPS responses showed a very large effect size in predicting within-person single-trial pain reports (d = 1.45) and medium effect size in predicting individual differences in pain reports (d = 0.49). The NPS showed excellent short-term (within-day) test-retest reliability (ICC = 0.84, with average 69.5 trials/person). Reliability scaled with the number of trials within-person, with ≥60 trials required for excellent test-retest reliability. Reliability was tested in two additional studies across 5-day (N = 29, ICC = 0.74, 30 trials/person) and 1-month (N = 40, ICC = 0.46, 5 trials/person) test-retest intervals. The combination of strong within-person correlations and only modest between-person correlations between the NPS and pain reports indicate that the two measures have different sources of between-person variance. The NPS is not a surrogate for individual differences in pain reports but can serve as a reliable measure of pain-related physiology and mechanistic target for interventions.
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Affiliation(s)
- Xiaochun Han
- Faculty of Psychology, Beijing Normal University, Beijing, China; Dartmouth College, Hanover, NH, United States
| | - Yoni K Ashar
- Weill Cornell Medical College, New York, NY, United States
| | | | | | | | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, United States; National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States; National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | | | | | | | | | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Gyeonggi-do, South Korea
| | - Tor D Wager
- Dartmouth College, Hanover, NH, United States.
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Farzad M, MacDermid JC, Mehta S, Grewal R, Shafiee E. Early post-immobilization pain at rest, movement evoked pain, and their ratio as potential predictors of pain and disability at six- and 12-months after distal radius fracture. Arch Physiother 2021; 11:6. [PMID: 33641681 PMCID: PMC7919326 DOI: 10.1186/s40945-021-00101-6] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
Background Removal of immobilization is a critical phase of distal radius fracture (DRF) rehabilitation, typically occurring by 2 months post injury. This study examined the extent to which pain at rest (PAR), movement evoked pain (MEP), or the ratio between those (MEPR) assessed at 2-months after DRF predicts the occurrence of chronic pain or disability at 6- and 12-months after the injury. Methods This secondary analysis of a prospective cohort study was done at the Hand and Upper Limb Centre (HULC), London, Ontario, Canada. A total of 229 patients with DRF (159 (69.4%) women) were included. Scores for the pain and function subscales of the Patient-Rated Wrist Evaluation (PRWE) were extracted for 2, 6 and 12 months after DRF. Logistic as well as nonlinear quartile regression examined whether PAR and MEP predicted the severity of chronic pain and disability at 6- and 12-months after DRF. Receiver Operating Characteristics Curve were plotted, where area under the curve (AUC) examined the accuracy of the PAR and MEP scores in classifying those who experienced chronic pain and disability. Results Scores of ≥3 (AUC of 0.77) for PAR or ≥ 6 (AUC of 0.78) for MEP at 2 months after DRF predicted moderate to severe wrist pain at 6-months, whereas scores of ≥7 (AUC of 0.79) for MEP at 2-months predicted ongoing wrist disability at 6-months after the injury. The MEPR of 2 ≤ or ≥ 8 at 2-months was associated with adverse pain at 6-months and functional outcomes at 6- and 12-months (R-square = 0.7 and 0.04 respectively), but prediction accuracy was very poor (AUC ≤ 0.50). Conclusion Chronic wrist-related pain at 6-months can be predicted by either elevated PAR ≥ 3/10) or MEP (≥ 6/10) reported at 2-months after the injury, while disability experienced at 6-months after DRF is best predicted by MEP (≥7/10) reported at 2-months. The ratio of these two pain indicators increases assessment complexity and reduces classification accuracy.
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Affiliation(s)
- Maryam Farzad
- Department of Health and Rehabilitation Sciences, Roth McFarlane Hand and Upper Limb Centre, University of Western Ontario, School of Physical Therapy, St. Joseph's Hospital, London, Ontario, Canada. .,Department of Occupational therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada.,Co-director Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.,Rehabilitation Science McMaster University, Hamilton, ON, Canada
| | - Saurabh Mehta
- School of Physical Therapy, Marshall University, Huntington, WV, USA.,Department of Orthopedic Surgery, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Ruby Grewal
- Roth
- McFarlane Hand and Upper Limb Center, Department of Surgery, Western University, London, ON, Canada
| | - Erfan Shafiee
- Department of Health and Rehabilitation Sciences, School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Molstad DHH, Bradley EW. Pain and Activity Measurements. Methods Mol Biol 2021; 2221:291-9. [PMID: 32979210 DOI: 10.1007/978-1-0716-0989-7_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Musculoskeletal pain contributes significantly to chronic pain experienced by adults and to health care use. This chapter details several methods to evaluate pain and physical activity in mice that can be applied to preclinical orthopedic models. These methods include the von Frey filament assay that measures mechanical allodynia, open-field activity assays for evaluation of ambulation, and incapacitance measurements to determine static weight bearing.
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Strachan E, Poeschla B, Dansie E, Succop A, Chopko L, Afari N. Clinical and evoked pain, personality traits, and emotional states: can familial confounding explain the associations? J Psychosom Res 2015; 78:58-63. [PMID: 25311873 PMCID: PMC4272603 DOI: 10.1016/j.jpsychores.2014.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 09/08/2014] [Accepted: 09/24/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Pain is a complex phenomenon influenced by context and person-specific factors. Affective dimensions of pain involve both enduring personality traits and fleeting emotional states. We examined how personality traits and emotional states are linked with clinical and evoked pain in a twin sample. METHODS 99 female twin pairs were evaluated for clinical and evoked pain using the McGill Pain Questionnaire (MPQ) and dolorimetry, and completed the 120-item International Personality Item Pool (IPIP), the Positive and Negative Affect Scale (PANAS), and ratings of stress and mood. Using a co-twin control design we examined a) the relationship of personality traits and emotional states with clinical and evoked pain and b) whether genetics and common environment (i.e. familial factors) may account for the associations. RESULTS Neuroticism was associated with the sensory component of the MPQ; this relationship was not confounded by familial factors. None of the emotional state measures was associated with the MPQ. PANAS negative affect was associated with lower evoked pressure pain threshold and tolerance; these associations were confounded by familial factors. There were no associations between IPIP traits and evoked pain. CONCLUSIONS A relationship exists between neuroticism and clinical pain that is not confounded by familial factors. There is no similar relationship between negative emotional states and clinical pain. In contrast, the relationship between negative emotional states and evoked pain is strong while the relationship with enduring personality traits is weak. The relationship between negative emotional states and evoked pain appears to be non-causal and due to familial factors.
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Affiliation(s)
- Eric Strachan
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
- University of Washington Twin Registry, University of Washington, Seattle, WA
| | - Brian Poeschla
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Elizabeth Dansie
- Department of Anesthesiology, University of Washington, Seattle, WA
| | - Annemarie Succop
- University of Washington Twin Registry, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Laura Chopko
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
- University of Washington Twin Registry, University of Washington, Seattle, WA
| | - Niloofar Afari
- University of Washington Twin Registry, University of Washington, Seattle, WA
- VA Center of Excellence for Stress and Mental Health, VA San Diego He althcare System, and Department of Psychiatry, University of California, San Diego, CA
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Duez L, Qerama E, Jensen TS, Fuglsang-Frederiksen A. Modulation of the muscle and nerve compound muscle action potential by evoked pain. Scand J Pain 2015; 6:55-60. [PMID: 29911580 DOI: 10.1016/j.sjpain.2014.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
Background and aims To our knowledge there are no studies that have examined the effects of the experimental pain on muscle fibre excitability as measured by the amplitudes of the potentials evoked by direct muscle stimulation (DMS) in a muscle at rest. We hypothesized that evoked pain can modulate the muscle compound action potential (CMAP) obtained by DMS possibly due to changes in muscle fibre excitability. Methods Pain was evoked by intramuscular infusion of hypertonic saline in 50 men. Ten control subjects were infused with isotonic saline. The infusions were given distal to the motor end plate region of the dominant brachial biceps muscle (BBM) in a double-blind manner. The nerve CMAP was obtained by stimulating the musculocutaneous nerve and recording from the BBM using surface-electrodes. Muscle CMAPs were obtained by direct muscle stimulation with subdermal electrodes placed subcutaneously in the distal third of the muscle. A stimuli-response curve of the amplitudes from muscle CMAP was obtained by stimulating from 10 to 90 mA. Results There was a decrease of the nerve CMAP amplitudes after infusion of isotonic saline (from 13.78mV to 12.16 mV), p-value 0.0007 and of hypertonic saline (from 13.35 mV to 10.85 mV), p-value 0.0000. The percent decrease from before to after infusion was larger in the hypertonic saline group (19.37%) compared to the isotonic saline group (12.18%), p-value 0.025. There was a decrease of the amplitudes of the muscle CMAP after infusion of both isotonic (at 90 mA from 13.84mV to 10.32 mV, p value 0.001) and of hypertonic saline (at 90 mA from 14.01 mV to 8.19 mV, p value 0.000). The percent decrease was larger in the hypertonic saline group compared to the isotonic saline group for all the stimulations intensities. At 90 mA we saw a 42% decrease in the hypertonic saline group and 24.5% in the isotonic saline group, p value 0.005. There were no changes in conduction velocity. Conclusion We found a larger amplitude decrease of the muscle and nerve potentials following hypertonic saline infusion compared with that of isotonic saline. We suggest that this deferential outcome of hypertonic saline on muscle CMAP may be linked to the nociceptive effect on muscle fibre membrane excitability. Implications The study supplies with some evidence of the peripheral effect of muscle pain. However, further trials with other nociceptive substances such as capsaicin should be performed.
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Affiliation(s)
- L Duez
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.,Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - E Qerama
- Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - T S Jensen
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
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Freeman R, Baron R, Bouhassira D, Cabrera J, Emir B. Sensory profiles of patients with neuropathic pain based on the neuropathic pain symptoms and signs. Pain 2013; 155:367-376. [PMID: 24472518 DOI: 10.1016/j.pain.2013.10.023] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/21/2013] [Indexed: 11/20/2022]
Abstract
This manuscript aimed to characterize the clinical profile of various neuropathic pain (NeP) disorders and to identify whether patterns of sensory symptoms/signs exist, based on baseline responses on the Neuropathic Pain Symptom Inventory (NPSI) questionnaire and the quantitative sensory testing (QST). These post hoc analyses were based on data from 4 randomized, double-blind, placebo-controlled clinical studies of pregabalin (150-600mg/day) in patients with NeP syndromes: central poststroke pain, posttraumatic peripheral pain, painful HIV neuropathy, and painful diabetic peripheral neuropathy. The NPSI questionnaire includes 10 different pain symptom descriptors. QST was used to detect sensory thresholds of accurately calibrated sensory stimuli and to quantify the intensity of evoked sensation. To identify symptoms/signs clusters and select the number of clusters, a principal component analysis (PCA) and hierarchical clustering methods with clinical input were used. Analysis of the NPSI pain qualities and individual QST measures at baseline indicated no clear association between particular symptoms/signs profiles and etiologies. Based on NPSI symptoms, PCA identified 3 pain dimensions: provoked, deep, and pinpoint. A hierarchical cluster analysis identified 3 clusters with distinct pain characteristics profiles independent of NeP syndrome. Based on QST signs, PCA identified 2 pain dimensions: evoked by cold and evoked by touch. A hierarchical cluster analysis identified 4 clusters with distinct pain characteristics profiles. These "trans-etiological" profiles may reflect distinct pathophysiological mechanisms and therefore, potential differential responses to treatment.
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Affiliation(s)
- Roy Freeman
- Autonomic and Peripheral Nerve Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts University, Kiel, Germany INSERM U987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Boulogne-Billancourt F-92100, France Université Versailles-Saint-Quentin, Versailles F-78035, France Department of Statistics and Biostatistics, Rutgers University, New Brunswick, NJ, USA Pfizer Inc, New York, NY, USA
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