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POS0018 REDUCTION OF DIFFUSE NOXIOUS INHIBITORY CONTROL IN ACTIVE INFLAMMATORY RHEUMATISM: A DEMONSTRATION OF CENTRAL SENSITISATION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn rheumatoid arthritis (RA) and spondyloarthritis (Spa), persistent pain remains challenging. It is thought to result from central pain sensitisation, which can be measured by quantitative sensory testing (QST) and conditioned pain modulation (CPM).ObjectivesThe main objective of the RAPID (Rheumatism Pain Inhibitory Descending pathways) study, was to assess descending pain modulation (through CPM paradigms) in patients with RA or Spa, comparing these patients with healthy sex- and age-matched controls. The secondary objectives were the measurement pain thresholds (heat and cold) in a non-articular, non-painful area in patients and controls as a means of detecting possible widespread hyperalgesia as another index of central sensitisation in our patients.MethodsWe included 50 RA and 50 Spa patients and 100 age- and sex-matched controls. We assessed clinical disease variables for patients, together with responses to various psychological questionnaires. All participants underwent QST with the determination of heat and cold pain thresholds (HPT-CPT) and CPM. In CPM, a conditioning stimulus was applied to a foot and the non-dominant hand in a randomised sequence. Descending pain control was assessed as the change in HPT (in °C) following a conditioning stimulus: the higher the CPM effect, the more efficient the inhibitory control.ResultsHPT and CPT were similar in patients and controls. Mean CPM effect was significantly weaker in patients than controls: 0.25°C (±2.57) and 2.79°C (±2.31) for patients and controls, respectively (p<0.0001) for conditioning on the foot; 0.57°C (±2.74) and 2.68°C (±2.12) (p<0.0001), respectively, for conditioning on the hand. The heat pain threshold was 42.35°C (± 3.68°C) for patients and 41.54°C (± 3.34°C) for healthy controls; this difference was not statistically significant. The cold pain threshold was 13.11°C (± 10.04°C) for patients and 13.28°C (± 9.34°C) for healthy controls; this difference was not significant. The weaker CPM effect in patients was associated with higher pain intensity. In all participants, a weak CPM effect was associated with high Central Sensitisation Inventory score, anxiety, depression, sleep disturbance and pain catastrophising.ConclusionDiffuse noxious inhibitory control is weaker in patients with active chronic inflammatory rheumatism than in healthy subjects, supporting the hypothesis of central sensitisation.Figure 1.Disclosure of InterestsNone declared
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French guidelines for neuropathic pain: An update and commentary. Rev Neurol (Paris) 2021; 177:834-837. [PMID: 34332778 DOI: 10.1016/j.neurol.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/08/2021] [Indexed: 12/01/2022]
Abstract
Neuropathic pain remains a significant unmet need. French recommendations were updated in 2020. The goal of this minireview is to provide an update on these published guidelines. Despite newer relevant studies, our proposed algorithm remains relevant. First-line treatments include serotonin-noradrenaline reuptake inhibitors (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants, topical lidocaine and transcutaneous electrical nerve stimulation being specifically proposed for focal peripheral neuropathic pain. Second-line treatments include pregabalin (such position being confirmed by newer studies), tramadol, combinations and psychotherapy as add on, high-concentration capsaicin patches and botulinum toxin A being proposed specifically for focal peripheral neuropathic pain. Third-line treatments include high-frequency repetitive transcranial magnetic stimulation of the motor cortex, spinal cord stimulation and strong opioids (in the lack of alternative). Disseminating these recommendations and ensuring that they are well accepted by French practitioners will be necessary to optimize neuropathic pain management in real life.
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Traitements pharmacologiques et non pharmacologiques de la douleur neuropathique : une synthèse des recommandations françaises. ACTA ACUST UNITED AC 2020. [DOI: 10.3166/dea-2020-0113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Les douleurs neuropathiques (DN) restent très difficiles à soulager. Plusieurs recommandations ont été proposées au cours de ces dernières années, mais aucune n’a pris en compte à ce jour l’ensemble des approches thérapeutiques disponibles. Nous avons réalisé une revue systématique portant sur toutes les études concernant le traitement des DN périphériques et centrales de l’adulte et de l’enfant, publiées jusqu’en janvier 2018 et avons évalué la qualité des études et le niveau de preuve des traitements au moyen du système GRADE. Les principaux critères d’inclusion étaient l’existence d’une DN chronique (≥ 3 mois), une méthodologie contrôlée et randomisée, un suivi supérieur ou égal à trois semaines, un nombre de patients supérieur ou égal à dix par groupe et une évaluation en double insu pour les traitements pharmacologiques. Sur la base du GRADE, nous recommandons en première intention les antidépresseurs inhibiteurs mixtes de recapture des monoamines (duloxétine et venlafaxine), les antidépresseurs tricycliques, la gabapentine pour toute DN, et les emplâtres de lidocaïne 5 % et la stimulation électrique transcutanée pour les DN périphériques localisées. Nous recommandons en deuxième intention la prégabaline, le tramadol (avec les précautions d’emploi afférentes aux opioïdes) et certaines associations pharmacologiques (antidépresseurs et gabapentine ou prégabaline) pour toute DN, et les patchs de haute concentration de capsaïcine (8 %) et la toxine botulique de type A (en milieu spécialisé) pour les DN périphériques localisées. Nous recommandons en troisième intention la stimulation magnétique transcrânienne répétitive à haute fréquence du cortex moteur (en milieu spécialisé) et les opioïdes forts (en l’absence d’alternative et en respectant les précautions d’emploi afférentes aux opioïdes) pour toute douleur neuropathique, et la stimulation médullaire pour les douleurs radiculaires chroniques postchirurgicales et la polyneuropathie diabétique douloureuse. La psychothérapie (thérapie cognitivocomportementale et thérapie de pleine conscience) peut être recommandée en deuxième intention en association avec les traitements précédents.
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Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Rev Neurol (Paris) 2020; 176:325-352. [PMID: 32276788 DOI: 10.1016/j.neurol.2020.01.361] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed.
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Réponse des auteurs. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain 2018; 22:216-241. [DOI: 10.1002/ejp.1140] [Citation(s) in RCA: 360] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
AbstractDifferent neuroplastic processes can occur along the nociceptive pathways and may be important in the transition from acute to chronic pain and for diagnosis and development of optimal management strategies. The neuroplastic processes may result in gain (sensitisation) or loss (desensitisation) of function in relation to the incoming nociceptive signals. Such processes play important roles in chronic pain, and although the clinical manifestations differ across condition processes, they share some common mechanistic features. The fundamental understanding and quantitative assessment of particularly some of the central sensitisation mechanisms can be translated from preclinical studies into the clinic. The clinical perspectives are implementation of such novel information into diagnostics, mechanistic phenotyping, prevention, personalised treatment, and drug development. The aims of this paper are to introduce and discuss (1) some common fundamental central pain mechanisms, (2) how they may translate into the clinical signs and symptoms across different chronic pain conditions, (3) how to evaluate gain and loss of function using quantitative pain assessment tools, and (4) the implications for optimising prevention and management of pain. The chronic pain conditions selected for the paper are neuropathic pain in general, musculoskeletal pain (chronic low back pain and osteoarthritic pain in particular), and visceral pain (irritable bowel syndrome in particular). The translational mechanisms addressed are local and widespread sensitisation, central summation, and descending pain modulation.SignificanceCentral sensitisation is an important manifestation involved in many different chronic pain conditions. Central sensitisation can be different to assess and evaluate as the manifestations vary from pain condition to pain condition. Understanding central sensitisation may promote better profiling and diagnosis of pain patients and development of new regimes for mechanism based therapy. Some of the mechanisms underlying central sensitisation can be translated from animals to humans providing new options in development of therapies and profiling drugs under development.
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Neuropathic pain in cancer: systematic review, performance of screening tools and analysis of symptom profiles. Br J Anaesth 2017; 119:765-774. [DOI: 10.1093/bja/aex175] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
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Flight Lieutenant Peach's observations on Burning Feet Syndrome in Far Eastern Prisoners of War 1942-45. QJM 2017; 110:131-139. [PMID: 28069916 DOI: 10.1093/qjmed/hcw195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION 'Burning Feet Syndrome' affected up to one third of Far Eastern Prisoners of War in World War 2. Recently discovered medical records, produced by RAF Medical Officer Nowell Peach whilst in captivity, are the first to detail neurological examinations of patients with this condition. METHODS The 54 sets of case notes produced at the time were analysed using modern diagnostic criteria to determine if the syndrome can be retrospectively classed as neuropathic pain. RESULTS With a history of severe malnutrition raising the possibility of a peripheral polyneuropathy, and a neuroanatomically plausible pain distribution, this analysis showed that Burning Feet Syndrome can now be described as a 'possible' neuropathic pain syndrome. CONCLUSION After 70 years, the data painstakingly gathered under the worst of circumstances have proved to be of interest and value in modern diagnostics of neuropathic pain.
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[Misuse and dependence on prescription opioids: Prevention, identification and treatment]. Rev Med Interne 2017; 38:539-546. [PMID: 28214183 DOI: 10.1016/j.revmed.2016.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/23/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022]
Abstract
Since the 1990s, the use of prescription opioids has largely spread, which has brought a real progress in the treatment of pain. The long-term use of prescription opioid is sometimes required, and may lead to pharmacological tolerance and withdrawal symptoms, i.e. pharmacological dependence on prescription opioids. Occasionally, this may also lead to misuse of prescription opioids (MPO). MPO preferentially occurs in vulnerable individuals, i.e., those with a young age, history of other addictive or psychiatric disorders, especially anxious and depressive disorders. MPO is associated with numerous complications, including an increased risk of fatal overdose. Prevention of MPO begins before the opioid prescription, with the identification of potential vulnerability factors. A planned and personalized monitoring should be systematically implemented. In vulnerable patients, contractualizing the prescription is warranted. During follow-up, the relevance of the prescription should be regularly reconsidered, according to the benefit observed on pain and the potential underlying signs of MPO. Patients with suspected MPO should be referred early to pain or addiction centers. The treatment of MPO should be based on multidisciplinary strategies, involving both the addiction and pain aspects: progressive opioid withdrawal, non-pharmacological measures against pain, or switching to medication-assisted treatment of addiction (i.e., buprenorphine or methadone).
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Translational neuropathic pain research: A clinical perspective. Neuroscience 2016; 338:27-35. [DOI: 10.1016/j.neuroscience.2016.03.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 12/31/2022]
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Patch de capsaicine 8 % (Qutenza®) en pratique courante : résultats de l’étude post-inscription QAPSA demandée par la Haute Autorité de santé. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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From pulses to pain relief: an update on the mechanisms of rTMS-induced analgesic effects. Eur J Pain 2015; 20:689-700. [DOI: 10.1002/ejp.811] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/12/2022]
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Are there different predictors of analgesic response between antidepressants and anticonvulsants in painful diabetic neuropathy? Eur J Pain 2015; 20:472-82. [PMID: 26311228 DOI: 10.1002/ejp.763] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND To investigate baseline demographics and disease characteristics as predictors of the analgesic effect of duloxetine and pregabalin on diabetic peripheral neuropathic pain (DPNP). METHODS Based on data from the COMBO-DN study, a multinational clinical trial in DPNP, the potential impact of baseline characteristics on pain relief after 8-week monotherapy with 60 mg/day duloxetine or 300 mg/day pregabalin was assessed using analyses of covariance. Subgroups of interest were characterized regarding their baseline characteristics and efficacy outcomes. RESULTS A total of 804 patients were evaluated at baseline. A significant interaction with treatment was observed in the mood symptom subgroups with a larger pain reduction in duloxetine-treated patients having no mood symptoms [Hospital Anxiety and Depression Scale (HADS) depression or anxiety subscale score <11; -2.33 (duloxetine); -1.52 (pregabalin); p = 0.024]. There were no significant interactions between treatment for subgroups by age (<65 or ≥65 years), gender, baseline pain severity [Brief Pain Inventory Modified Short Form (BPI-MSF) average pain <6 or ≥6], diabetic neuropathy duration (≤2 or >2 years), baseline haemoglobin A1c (HbA1c) (<8% or ≥8%), presence of comorbidities and concomitant medication use. CONCLUSIONS Our analyses suggest that the efficacy of duloxetine and pregabalin for initial 8-week treatment in DPNP was consistent across examined subgroups based on demographics and disease characteristics at baseline except for the presence of mood symptoms. Duloxetine treatment appeared to be particularly beneficial in DPNP patients having no mood symptoms.
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How many dimensions are needed to describe pain properly? Eur J Pain 2015; 19:879-80. [PMID: 26173568 DOI: 10.1002/ejp.706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2015] [Indexed: 11/11/2022]
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Prolonged continuous theta-burst stimulation is more analgesic than ‘classical’ high frequency repetitive transcranial magnetic stimulation. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Failures of translational pain research: Can they be due to misinterpretation of pain-related nomenclature? Eur J Pain 2015; 19:147-9. [DOI: 10.1002/ejp.643] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2011] [Indexed: 11/10/2022]
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Recommendations on practice of conditioned pain modulation (CPM) testing. Eur J Pain 2014; 19:805-6. [DOI: 10.1002/ejp.605] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 11/10/2022]
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The analgesic efficiency of combined pregabalin and ketamine for total hip arthroplasty: a randomised, double-blind, controlled study. Anaesthesia 2013; 69:46-52. [DOI: 10.1111/anae.12495] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 10/25/2022]
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Early antiviral treatment fails to completely prevent herpes-related pain. Med Mal Infect 2013; 43:461-6. [DOI: 10.1016/j.medmal.2013.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 07/17/2013] [Accepted: 07/25/2013] [Indexed: 11/16/2022]
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Changes in the modulation of spinal pain processing are related to severity in irritable bowel syndrome. Neurogastroenterol Motil 2013; 25:623-e468. [PMID: 23551988 DOI: 10.1111/nmo.12123] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 03/04/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND In irritable bowel syndrome (IBS) patients can be divided in two groups according to inhibition or facilitation of the RIII nociceptive spinal reflex induced by rectal distension. We further investigated the differences in pain processes in these two groups and their relationship to clinical symptoms. METHODS This study included 10 female IBS-C patients with facilitation (Group F) and 10 patients with inhibition (Group I) of the RIII reflex recorded on the left lower limb during slow-ramp rectal distension, and 11 healthy female volunteers. Diffuse noxious inhibitory control (DNIC)-induced inhibition was assessed by measuring the effects of noxious cold stimulation of the right hand on the RIII reflex and the concomitant sensation of pain. Functional magnetic resonance imaging (fMRI) was performed to compare the changes in brain activity induced by painful and non painful rectal distension. Irritable bowel syndrome symptom severity, mood, anxiety, and catastrophizing were also systematically assessed. KEY RESULTS Unlike the patients of Group I and healthy volunteers, Group F patients displayed no inhibition of the RIII reflex or of concomitant pain sensation during immersion of the hand in ice-cold water. The reduction of the inhibition induced by heterotopic noxious stimuli was directly correlated with the severity of IBS symptoms, but not with psychological symptoms. The fMRI study showed that non-painful and painful rectal distension induced similar changes in brain activity in the two groups of patients. CONCLUSION & INFERENCES Alterations of the modulation of spinal pain processing in IBS correlates with symptom severity but not with psychological factors or brain activity.
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Abstract
BACKGROUND Schizophrenia patients display impaired recognition of their own emotions and those of others and deficits in several domains of empathy. The first-person experience of pain and observing others in pain normally trigger strong emotional mechanisms. We therefore hypothesized that schizophrenia patients would display impaired recognition and categorization of both their own pain and the pain of others. METHODS We studied 29 patients (18 men/11 women; 36 ± 13 years old) with paranoid schizophrenia-spectrum disorder and 27 healthy volunteers (20 men/7 women; 31 ± 9 years old) matched for age, gender, IQ and socio-cultural level. We assessed symptom severity and theory of mind. The participants' ability to detect and categorize pain in others was assessed with the sensitivity to expressions of pain (STEP) test, which is based on facial expressions, and another dynamic test involving a series of video sequences showing various pain-inducing events. The ability of patients to evaluate their own pain was assessed with the situational pain questionnaire (SPQ), which includes a series of questions assessing how one would expect to feel in different imaginary situations. Empathic tendencies were assessed with the interpersonal reactivity index. RESULTS Patients and controls differed significantly in STEP, pain video and SPQ scores. By contrast with control subjects, the patients' pain judgements were not correlated with their affective or cognitive empathic capacities. CONCLUSIONS Schizophrenic patients have a deficit of the identification and categorization of pain both in themselves and in others.
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Increase in fecal primary bile acids and dysbiosis in patients with diarrhea-predominant irritable bowel syndrome. Neurogastroenterol Motil 2012; 24:513-20, e246-7. [PMID: 22356587 DOI: 10.1111/j.1365-2982.2012.01893.x] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a multifactorial disease for which a dysbiosis of the gut microbiota has been described. Bile acids (BA) could play a role as they are endogenous laxatives and are metabolized by gut microbiota. We compared fecal BA profiles and microbiota in healthy subjects (HS) and patients with diarrhea-predominant IBS (IBS-D), and we searched for an association with symptoms. METHODS Clinical features and stool samples were collected in IBS-D patients and HS. Fecal BA profiles were generated using HPLC coupled to tandem mass spectrometry. The fecal microbiota composition was assessed by q-PCR targeting dominant bacterial groups and species implicated in BA transformation. KEY RESULTS Fourteen IBS-D patients and 18 HS were included. The two groups were comparable in terms of age and sex. The percentage of fecal primary BA was significantly higher in IBS-D patients than in HS, and it was significantly correlated with stool consistency and frequency. Fecal counts of all bacteria, lactobacillus, coccoides, leptum and Faecalibacterium prausnitzii were similar. There was a significant increase of Escherichia coli and a significant decrease of leptum and bifidobacterium in IBS-D patients. CONCLUSIONS & INFERENCES We report an increase of primary BA in the feces of IBS-D patients compared to HS, correlated with stool consistency and frequency. A dysbiosis of different bacterial groups was detected, some of them involved in BA transformation. As the gut microbiota is the exclusive pathway to transform primary into secondary BA, this suggests a functional consequence of dysbiosis, leading to lower BA transformation.
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F509 PREVALENCE OF NEUROPATHIC PAIN IN DIABETIC PATIENTS: A FRENCH CROSS-SECTIONAL STUDY. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1754-3207(11)70554-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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260 PREVALENCE OF POLYNEUROPATHY WITH OR WITHOUT NEUROPATHIC PAIN IN TYPE 1 AND 2 DIABETIC PATIENTS. Eur J Pain 2012. [DOI: 10.1016/j.ejpain.2007.03.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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920 VALIDITY, INTER-RATTER AGREEMENT AND TEST-RETEST RELIABILITY OF THE SPANISH VERSION OF DN4 SCALE FOR DIFFERENTIAL DIAGNOSIS OF NEUROPATHIC PAIN. Eur J Pain 2012. [DOI: 10.1016/s1090-3801(06)60923-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Linguistic validation of the DN4 for use in international studies. Eur J Pain 2012; 14:58-63. [DOI: 10.1016/j.ejpain.2009.01.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 11/28/2008] [Accepted: 01/27/2009] [Indexed: 10/21/2022]
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Are oral cannabinoids safe and effective in refractory neuropathic pain? Eur J Pain 2012; 8:173-7. [PMID: 14987627 DOI: 10.1016/s1090-3801(03)00084-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2003] [Accepted: 06/24/2003] [Indexed: 11/15/2022]
Abstract
Although cannabinoids have anti-hyperalgesic effects in animal models of nerve injury, there are currently very few prospective trials of the efficacy of cannabinoids in neuropathic pain in humans. This open label prospective study investigated the safety, tolerability and analgesic benefit of oral Delta-9-tetrahydrocannabinol (THC) titrated to a maximal dosage of 25 mg/day in 8 consecutive patients with chronic refractory neuropathic pain. Spontaneous ongoing and paroxysmal pain, allodynia and paresthesias were assessed. The sensory and affective components of pain using the McGill pain questionnaire, quality of life, mood, anxiety and functionality were also evaluated. Seven patients suffered from side effects necessitating premature arrest of the drug in 5 of them. THC (mean dosage: 16.6+/-6.5 mg/day) did not induce any significant effects on ongoing and paroxysmal pain, allodynia, quality of life, anxiety/depression scores and functional impact of pain. These results do not support an overall benefit of THC in pain and quality of life in patients with refractory neuropathic pain.
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[French guidelines on the use of repetitive transcranial magnetic stimulation (rTMS): safety and therapeutic indications]. Neurophysiol Clin 2011; 41:221-95. [PMID: 22153574 DOI: 10.1016/j.neucli.2011.10.062] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 12/31/2022] Open
Abstract
During the past decade, a large amount of work on transcranial magnetic stimulation (TMS) has been performed, including the development of new paradigms of stimulation, the integration of imaging data, and the coupling of TMS techniques with electroencephalography or neuroimaging. These accumulating data being difficult to synthesize, several French scientific societies commissioned a group of experts to conduct a comprehensive review of the literature on TMS. This text contains all the consensual findings of the expert group on the mechanisms of action, safety rules and indications of TMS, including repetitive TMS (rTMS). TMS sessions have been conducted in thousands of healthy subjects or patients with various neurological or psychiatric diseases, allowing a better assessment of risks associated with this technique. The number of reported side effects is extremely low, the most serious complication being the occurrence of seizures. In most reported seizures, the stimulation parameters did not follow the previously published recommendations (Wassermann, 1998) [430] and rTMS was associated to medication that could lower the seizure threshold. Recommendations on the safe use of TMS / rTMS were recently updated (Rossi et al., 2009) [348], establishing new limits for stimulation parameters and fixing the contraindications. The recommendations we propose regarding safety are largely based on this previous report with some modifications. By contrast, the issue of therapeutic indications of rTMS has never been addressed before, the present work being the first attempt of a synthesis and expert consensus on this topic. The use of TMS/rTMS is discussed in the context of chronic pain, movement disorders, stroke, epilepsy, tinnitus and psychiatric disorders. There is already a sufficient level of evidence of published data to retain a therapeutic indication of rTMS in clinical practice (grade A) in chronic neuropathic pain, major depressive episodes, and auditory hallucinations. The number of therapeutic indications of rTMS is expected to increase in coming years, in parallel with the optimisation of stimulation parameters.
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Painful diabetic neuropathy: Diagnosis and management. DIABETES & METABOLISM 2011; 37:377-88. [DOI: 10.1016/j.diabet.2011.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 06/13/2011] [Indexed: 01/01/2023]
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Identification of sensory symptom clusters in patients with neuropathic pain based on the neuropathic pain symptom inventory questionnaire. THE JOURNAL OF PAIN 2011. [DOI: 10.1016/j.jpain.2011.02.194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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S25-7 Use of botulinum toxin for the treatment of pain. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)60167-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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P11-26 Long term analgesic efficacy of transcranial magnetic stimulation of the motor cortex in patients with fibromyalgia. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)60703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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P20-26 Neuropharmacological basis of repetitive transcranial magnetic stimulation (rTMS) induced analgesia: the role of endogenous opioids. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)60923-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clinical, functional and structural determinants of central pain in syringomyelia. Brain 2010; 133:3409-22. [DOI: 10.1093/brain/awq244] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Assessment of spinal somatosensory systems with diffusion tensor imaging in syringomyelia. J Neurol Neurosurg Psychiatry 2009; 80:1350-6. [PMID: 19535353 DOI: 10.1136/jnnp.2008.167858] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The use of diffusion tensor imaging with three-dimensional fibre tracking (DTI-FT) was tested for the assessment of spinal sensory tract lesions. The relationships between tract lesions quantified with DTI-FT were systematically examined, and somatosensory dysfunction was assessed with quantitative sensory testing (QST) and laser-evoked potentials (LEP), in patients with syringomyelia. METHODS 28 patients with cervical syringomyelia and thermosensory impairment of the hands, and 19 healthy volunteers, were studied. A DTI-FT of the spinal cord was performed, focusing on the upper segment (C3-C4) of the syrinx. Three-dimensional DTI-FT parameters (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) of the full, anterior and posterior spinal cord were individually compared with QST (thermal detection thresholds) and LEP (amplitude, latency and spinothalamic tract (STT) conduction time) of the hands. RESULTS Patients had a significantly lower FA, but not ADC, than healthy subjects. The mean FA of the full section of the spinal cord was correlated both to sensory deficits (ie, increase in warm (rho = -0.63, p<0.010) and cold thresholds (rho = -0.72; p<0.001 of the hands)) and to changes in LEP parameters, in particular STT conduction time (rho = -0.75; p<0.010). Correlations between FA and the clinical and electrophysiological measures were higher in the anterior area (where the spinothalamic tracts are located) than in the posterior area of the spinal cord. CONCLUSIONS The data indicate that diffusion tensor imaging with 3D-fibre tracking is a new imaging method suitable for the objective and quantitative anatomical assessment of spinal somatosensory system dysfunction.
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556 THERMAL SENSORY TESTING PREDICTS NEUROPATHIC PAIN IN GUILLAIN BARRE SYNDROME. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60559-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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799 THE DN4 TEST TO ASSESS THE PREVALENCE OF NEUROPATHY IN TYPE 2 DIABETES PATIENTS AT THE GENERAL PRACTITIONER. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60802-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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572 PAINFUL DIABETIC POLYNEUROPATHY AND ITS PREDISPOSING FACTORS. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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512 ALTERATION OF CORTICAL EXCITABILITY IN PATIENTS OF FIBROMYALGIA. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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948 INTERACTION BETWEEN APATHY AND MENTAL FLEXIBILITY ON PAIN COPING STRATEGIES IN FIBROMYALGIA (FM). Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60951-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Thermal hyperalgesia as a marker of oxaliplatin neurotoxicity: A prospective quantified sensory assessment study. Pain 2009; 144:245-252. [DOI: 10.1016/j.pain.2009.03.024] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 03/04/2009] [Accepted: 03/23/2009] [Indexed: 02/07/2023]
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Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. DIABETES & METABOLISM 2009; 35:206-13. [PMID: 19297223 DOI: 10.1016/j.diabet.2008.11.004] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Revised: 11/22/2008] [Accepted: 11/28/2008] [Indexed: 10/21/2022]
Abstract
AIMS Diabetic polyneuropathy (DPN) without or with neuropathic pain (DPN-P) is one of the most frequent complications of diabetes. To better delineate their respective prevalences, we conducted a cross-sectional study that included 1111 patients (767 type 2 and 344 type 1 diabetic patients) followed up in diabetic outpatients clinics. The association of DPN and DPN-P with other diabetic complications, the impact on quality of life (QoL) and pain management were also investigated. METHODS Two validated tools (Neuropen) and the DN4 questionnaire) were used to diagnose the two conditions. Pain intensity was measured using a visual analogue scale, and participants completed the 12-item Short-Form Health Survey to evaluate the physical and mental components of QoL. Univariate and multivariate models were used for the statistical analyses. RESULTS The prevalence of DPN was 43% (95% CI 40.1-45.9), and was higher in type 2 (50.8%) than in type 1 (25.6%) diabetic patients. The prevalence of DPN-P was 14% (95% CI 12.1-16.2) which, again, was higher in type 2 (17.9%) than in type 1 (5.8%) patients. These prevalences both increased with age and diabetes duration. Nephropathy, obesity, low HDL cholesterol and high triglyceride levels were independently associated with DPN and/or DPN-P. Physical and mental components of QoL were significantly altered by DPN-P, but not DPN. Only half of the DPN-P patients were using analgesic treatment, while 28% were using anticonvulsants or antidepressants. CONCLUSION DPN and DPN-P are frequent complications of diabetes, especially in type 2, and can be identified with inexpensive and easy-to-use screening tools. Despite its profound impact on QoL, DPN-P remains undertreated.
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Beyond neuropathy in hereditary sensory and autonomic neuropathy type V: cognitive evaluation. Eur J Neurol 2008; 15:712-9. [DOI: 10.1111/j.1468-1331.2008.02172.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Toxine botulique : effets antalgiques à long terme sur la douleur neuropathique. Rev Neurol (Paris) 2008. [DOI: 10.1016/s0035-3787(08)70046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Effects of unilateral repetitive transcranial magnetic stimulation of the motor cortex on chronic widespread pain in fibromyalgia. Brain 2007; 130:2661-70. [PMID: 17872930 DOI: 10.1093/brain/awm189] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Non-invasive unilateral repetitive transcranial magnetic stimulation (rTMS) of the motor cortex induces analgesic effects in focal chronic pain syndromes, probably by modifying central pain modulatory systems. Neuroimaging studies have shown bilateral activation of a large number of structures, including some of those involved in pain processing, suggesting that such stimulation may induce generalized analgesic effects. The goal of this study was to assess the effects of unilateral rTMS of the motor cortex on chronic widespread pain in patients with fibromyalgia. Thirty patients with fibromyalgia syndrome (age: 52.6 +/- 7.9) were randomly assigned, in a double-blind fashion, to two groups, one receiving active rTMS (n = 15) and the other sham stimulation (n = 15), applied to the left primary motor cortex in 10 daily sessions. The primary outcome measure was self-reported average pain intensity over the last 24 h, measured at baseline, daily during the stimulation period and then 15, 30 and 60 days after the first stimulation. Other outcome measures included: sensory and affective pain scores for the McGill pain Questionnaire, quality of life (assessed with the pain interference items of the Brief Pain Inventory and the Fibromyalgia Impact Questionnaire), mood and anxiety (assessed with the Hamilton Depression Rating Scale, the Beck Depression Inventory and the Hospital Anxiety and Depression Scale). We also assessed the effects of rTMS on the pressure pain threshold at tender points ipsi- and contralateral to stimulation. Follow-up data were obtained for all the patients on days 15 and 30 and for 26 patients (13 in each treatment group) on day 60. Active rTMS significantly reduced pain and improved several aspects of quality of life (including fatigue, morning tiredness, general activity, walking and sleep) for up to 2 weeks after treatment had ended. The analgesic effects were observed from the fifth stimulation onwards and were not related to changes in mood or anxiety. The effects of rTMS were more long-lasting for affective than for sensory pain, suggesting differential effects on brain structures involved in pain perception. Only few minor and transient side effects were reported during the stimulation period. Our data indicate that unilateral rTMS of the motor cortex induces a long-lasting decrease in chronic widespread pain and may therefore constitute an effective alternative analgesic treatment for fibromyalgia.
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17 NEUROPATHIC PAIN QUESTIONNAIRES: COULD THEY BE USED IN CLINICAL RESEARCH? Eur J Pain 2007. [DOI: 10.1016/j.ejpain.2007.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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257 A PROSPECTIVE PSYCHOPHYSICAL STUDY OF OXALIPLATIN AND CISPLATIN INDUCED NEUROTOXICITY IN HUMANS. Eur J Pain 2007. [DOI: 10.1016/j.ejpain.2007.03.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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921 VALIDITY OF THE DN4 SCALE FOR DIFFERENTIAL DIAGNOSIS OF PATIENT WITH PERIPHERAL, CENTRAL NEUROPATHIC OR MIXED PAIN. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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261 CONSTITUTIVE CYCLO-OXGENASE-2 IS INVOLVED IN CENTRAL NOCICEPTIVE PROCESS IN HUMANS. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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440 CHARACTERIZATION OF THE PERIPHERAL NEUROPATHY INDUCED BY ADMINISTRATION OF CISPLATIN AND OXALIPLATIN: A PROSPECTIVE PSYCHOPHYSICAL STUDY. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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