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Aghazadeh Mohandesi N, Puiu T, Mittal S, Hall MR, Sokumbi O, Mangold AR, Colgan MB, Tollefson MM, Sartori-Valinotti JC. Teledermatology in practice: Report of Mayo Clinic experience. Digit Health 2024; 10:20552076241234581. [PMID: 38410791 PMCID: PMC10896044 DOI: 10.1177/20552076241234581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Background Delivery of dermatologic care through telemedicine was accelerated by the COVID-19 pandemic. We sought to analyze the teledermatology experience across Mayo Clinic's health care system to identify strengths and limitations of teledermatology. Methods Electronic health records of dermatology televisits were reviewed from multiple U.S. Mayo Clinic sites from January 2020 through January 2021. Results A total of 13,181 dermatology televisits were conducted in 6468 unique patients. Patients were primarily female (60.2%), and mean age of all patients was 34.1 years. Synchronous / live video conferencing visits were the most common (40.0%) telecare modality. Synchronous / live audio conferencing and asynchronous / store-and-forward visits comprised 33.0% and 27.0% of appointments. In total, 3944 televisits (29.9%) were successfully concluded via a single appointment. An in-person appointment was needed for 1693 patients (26.2%) after their initial televisit. For patients with a single televisit, synchronous / live video conferencing was the most common virtual modality (58.0% vs 32.2% of patients with multiple visits, p < 0.001). Patients needing in-person follow-up visits were slightly older than those who did not (mean [SD], 38.8 [22.3] vs 35.0 [23.6] years; p < 0.001) but without any sex-based difference. Around one-third of patients needed an in-person follow-up visit after their initial asynchronous / store-and-forward visit which was higher when compared with synchronous / live audio and video conferencing. Conclusion Single dermatology televisits effectively managed nearly one-third of patients who did not require in-person follow-up. An initial synchronous / live video conferencing was more likely to yield a single clinical encounter, whereas asynchronous / store-and-forward visits required more in-person follow-up. Future studies are required that focus on dermatology-specific cost, diagnoses, access, quality of care, and outcomes.
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Affiliation(s)
| | - Tudor Puiu
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | - Setu Mittal
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Matthew R Hall
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Michael B Colgan
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Dermatology, Mayo Clinic Health System, Eau Claire, WI, USA
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Boyle MM, Ashi S, Puiu T, Reimer D, Sokumbi O, Soltani K, Onajin O. Lichen Planus Pemphigoides Associated With PD-1 and PD-L1 Inhibitors: A Case Series and Review of the Literature. Am J Dermatopathol 2022; 44:360-367. [PMID: 35120032 DOI: 10.1097/dad.0000000000002139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Immune checkpoint inhibitors are increasingly being used in the treatment of various solid organ and hematologic malignancies. Dermatologic toxicities associated with programmed cell death protein-1 (PD-1) and programmed death ligand-1 (PD-L1) therapy have been widely reported in the literature. It is important for clinicians to be aware of these toxicities to ensure prompt recognition and treatment. Herein, we present the clinical, histopathologic, and immunofluorescence findings of 3 patients diagnosed with lichen planus pemphigoides (LPP) after treatment with anti-PD-1 inhibitors. We also reviewed the literature and summarize 7 previously reported cases of LPP associated with anti-PD-1 and anti-PD-L1 inhibitors. LPP was diagnosed at a median time of 24.4 weeks (range: 4-78 weeks) after initiation of immunotherapy. Clinical findings included papules, plaques, erosions, vesicles, and bullae on the trunk and extremities. Oral involvement was present in half the cases. Histopathologic features of immunotherapy-induced LPP included lichenoid or vacuolar interface dermatitis, the presence of eosinophils, and subepidermal bullae. Direct immunofluorescence demonstrated linear deposition of immunoglobulin G (IgG) or C3. Indirect immunofluorescence demonstrated linear IgG along basement membrane zone on monkey esophagus in 2 cases and linear IgG on the epidermal side of salt split skin in 3 cases. Serum anti-BP180 was elevated in all cases in which enzyme-linked immunosorbent assay was performed.
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Affiliation(s)
- Margaret M Boyle
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago IL; and
| | - Shaymaa Ashi
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago IL; and
| | - Tudor Puiu
- Department of Dermatology, Mayo Clinic, Jacksonville, FL
| | | | | | - Keyoumars Soltani
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago IL; and
| | - Oluwakemi Onajin
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago IL; and
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Majeed U, Puiu T, Sluzevich J, Reynolds G, Acampora M, Moreno-Aspitia A, Bodiford KJ, Advani P. Case Report: Alpelisib-Induced Drug Reaction With Eosinophilia and Systemic Symptoms: A Rare Manifestation of a Common Side Effect. Front Oncol 2021; 11:726785. [PMID: 34504802 PMCID: PMC8421674 DOI: 10.3389/fonc.2021.726785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/04/2021] [Indexed: 12/19/2022] Open
Abstract
Alpelisib is a PIK3a inhibitor approved for the treatment of metastatic ER+ breast cancer in combination with fulvestrant. Although rash is a common side effect of this medication, we present the first case of drug reaction with eosinophilia and systemic symptoms (DRESS) upon initial exposure to alpelisib. Here we describe the clinical-pathological findings and management of our patient with alpelisib-induced life-threatening DRESS syndrome. The goal of this case report is to highlight association of alpelisib with DRESS syndrome, in clinical practice, so that alpelisib can be immediately stopped and treatment for this serious condition promptly initiated.
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Affiliation(s)
- Umair Majeed
- Division of Hematology Oncology, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Tudor Puiu
- Division of Dermatology, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Jason Sluzevich
- Division of Dermatology, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Gina Reynolds
- Division of Hematology Oncology, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Marites Acampora
- Division of Hematology Oncology, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Alvaro Moreno-Aspitia
- Division of Hematology Oncology, Mayo Clinic Florida, Jacksonville, FL, United States
| | | | - Pooja Advani
- Division of Hematology Oncology, Mayo Clinic Florida, Jacksonville, FL, United States
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Puiu T, Veenstra J, Antonyan AS, Tisack A, Chaffins M. Recurrent Painful Nodules Following Synthol Injection to Enhance Bicep Volume. Cutis 2021; 107:E24-E26. [PMID: 33891850 DOI: 10.12788/cutis.0189] [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] [Indexed: 11/20/2022]
Affiliation(s)
- Tudor Puiu
- Dr. Puiu is from the University of Michigan Medical School, Ann Arbor. Drs. Veenstra, Antonyan, Tisack, and Chaffins are from the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Jesse Veenstra
- Dr. Puiu is from the University of Michigan Medical School, Ann Arbor. Drs. Veenstra, Antonyan, Tisack, and Chaffins are from the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Albert S Antonyan
- Dr. Puiu is from the University of Michigan Medical School, Ann Arbor. Drs. Veenstra, Antonyan, Tisack, and Chaffins are from the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Alison Tisack
- Dr. Puiu is from the University of Michigan Medical School, Ann Arbor. Drs. Veenstra, Antonyan, Tisack, and Chaffins are from the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Marsha Chaffins
- Dr. Puiu is from the University of Michigan Medical School, Ann Arbor. Drs. Veenstra, Antonyan, Tisack, and Chaffins are from the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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Puiu T, Mohammad TF, Ozog DM, Rambhatla PV. A Comparative Analysis of Electric and Radiofrequency Microneedling Devices on the Market. J Drugs Dermatol 2018; 17:1010-1013. [PMID: 30235390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Microneedling was first described in 1995 by Orentreich and Orentreich for the treatment of atrophic scars and wrinkles.1 The local injury induced by dermal penetration of microneedling causes release of growth factors such as transforming growth factor (TGF)-α, TGF-β, and platelet-derived growth factor (PDGF). This stimulates collagen and elastin fiber production as well as capillary formation, ultimately leading to tissue remodeling.2.
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Harper DE, Ichesco E, Schrepf A, Halvorson M, Puiu T, Clauw DJ, Harris RE, Harte SE. Relationships between brain metabolite levels, functional connectivity, and negative mood in urologic chronic pelvic pain syndrome patients compared to controls: A MAPP research network study. Neuroimage Clin 2017; 17:570-578. [PMID: 29201643 PMCID: PMC5702874 DOI: 10.1016/j.nicl.2017.11.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/06/2017] [Accepted: 11/14/2017] [Indexed: 02/01/2023]
Abstract
Until recently, the predominant pathology of chronic pelvic pain conditions was thought to reside in the peripheral tissues. However, mounting evidence from neuroimaging studies suggests an important role of the central nervous system in the pathogenesis of these conditions. In the present cross-sectional study, proton magnetic resonance spectroscopy (1H-MRS) of the brain was conducted in female patients with urologic chronic pelvic pain syndrome (UCPPS) to determine if they exhibit abnormal concentrations of brain metabolites (e.g. those indicative of heightened excitatory tone) in regions involved in the processing and modulation of pain, including the anterior cingulate cortex (ACC) and the anterior and posterior insular cortices. Compared to a group of age-matched healthy subjects, there were significantly higher levels of choline (p = 0.006, uncorrected) in the ACC of UCPPS patients. ACC choline levels were therefore compared with the region's resting functional connectivity to the rest of the brain. Higher choline was associated with greater ACC-to-limbic system connectivity in UCPPS patients, contrasted with lower connectivity in controls (i.e. an interaction). In patients, ACC choline levels were also positively correlated with negative mood. ACC γ-aminobutyric acid (GABA) levels were lower in UCPPS patients compared with controls (p = 0.02, uncorrected), but this did not meet statistical correction for the 4 separate regional comparisons of metabolites. These results are the first to uncover abnormal GABA and choline levels in the brain of UCPPS patients compared to controls. Low GABA levels have been identified in other pain syndromes and might contribute to CNS hyper-excitability in these conditions. The relationships between increased ACC choline levels, ACC-to-limbic connectivity, and negative mood in UCPPS patients suggest that this metabolite could be related to the affective symptomatology of this syndrome.
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Affiliation(s)
- Daniel E Harper
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
| | - Eric Ichesco
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Megan Halvorson
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Tudor Puiu
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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Puiu T, Kairys AE, Pauer L, Schmidt-Wilcke T, Ichesco E, Hampson JP, Napadow V, Clauw DJ, Harris RE. Association of Alterations in Gray Matter Volume With Reduced Evoked-Pain Connectivity Following Short-Term Administration of Pregabalin in Patients With Fibromyalgia. Arthritis Rheumatol 2017; 68:1511-21. [PMID: 26816332 DOI: 10.1002/art.39600] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/14/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Pregabalin (PGB) is an α2 δ calcium-channel subunit ligand that has previously been shown to reduce chronic pain in multiple conditions. Preclinical studies indicate that PGB may down-regulate brain glutamate release while also inhibiting astrocyte induction of glutamatergic synapse formation, and recent clinical findings support the notion that PGB modulates glutamatergic activity and functional brain connectivity in order to produce analgesia. The present study was undertaken to examine concurrent changes in brain gray matter volume (GMV) or evoked-pain connectivity in humans receiving PGB. METHODS Sixteen female fibromyalgia patients participated in a randomized double-blind 2-period crossover study of PGB versus placebo. Before and after each period, patients underwent high-resolution structural and evoked pressure-pain functional brain imaging. GMV was analyzed using voxel-based morphometry, and functional connectivity during evoked pressure-pain was assessed. RESULTS PGB administration significantly reduced GMV within the posterior insula bilaterally, whereas there were no significant changes in insular GMV following placebo treatment. GMV reductions in the medial frontal gyrus were also observed when comparing PGB versus placebo treatment, and were associated with reduced clinical pain. These reductions in insular GMV were associated with concomitant reductions in connectivity to the default mode network, which was also associated with reduced clinical pain. CONCLUSION Short-term PGB treatment altered brain structure and evoked-pain connectivity, and these decreases were associated with reduced clinical pain. We speculate that these fairly rapid changes in GMV may be related to brain neuroplasticity. It is unknown whether these effects are generalizable to other chronic pain states.
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Affiliation(s)
| | - Anson E Kairys
- University of Michigan, Ann Arbor, and University of Colorado Denver
| | - Lynne Pauer
- Pfizer Global Research and Development, Groton, Connecticut
| | | | | | | | - Vitaly Napadow
- Massachusetts General Hospital and Harvard Medical School, Boston
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Puiu T, Porto DA, Siddiqui F, Lim HW. Tumour-stage mycosis fungoides regressing with milia and pustules after total skin electron beam therapy. J Eur Acad Dermatol Venereol 2017; 31:e440. [PMID: 28557155 DOI: 10.1111/jdv.14372] [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] [Indexed: 11/29/2022]
Affiliation(s)
- T Puiu
- University of Michigan Medical School, Ann Arbor, 48103, MI, USA
| | - D A Porto
- Department of Dermatology, Henry Ford Hospital, Detroit, 48202, MI, USA.,Harvard University Health Policy and Management, Boston, 02115, MA, USA
| | - F Siddiqui
- Department of Dermatology, Henry Ford Hospital, Detroit, 48202, MI, USA
| | - H W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, 48202, MI, USA
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Ichesco E, Puiu T, Hampson JP, Kairys AE, Clauw DJ, Harte SE, Peltier SJ, Harris RE, Schmidt-Wilcke T. Altered fMRI resting-state connectivity in individuals with fibromyalgia on acute pain stimulation. Eur J Pain 2016; 20:1079-89. [PMID: 26773435 DOI: 10.1002/ejp.832] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Fibromyalgia is a chronic widespread pain condition, with patients commonly reporting other symptoms such as sleep difficulties, memory complaints and fatigue. The use of magnetic resonance imaging (MRI) in fibromyalgia has allowed for the detection of neural abnormalities, with alterations in brain activation elicited by experimental pain and alterations in resting state connectivity related to clinical pain. METHODS In this study, we sought to monitor state changes in resting brain connectivity following experimental pressure pain in fibromyalgia patients and healthy controls. Twelve fibromyalgia patients and 15 healthy controls were studied by applying discrete pressure stimuli to the thumbnail bed during MRI. Resting-state functional MRI scanning was performed before and immediately following experimental pressure pain. We investigated changes in functional connectivity to the thalamus and the insular cortex. RESULTS Acute pressure pain increased insula connectivity to the anterior cingulate and the hippocampus. Additionally, we observed increased thalamic connectivity to the precuneus/posterior cingulate cortex, a known part of the default mode network, in patients but not in controls. This connectivity was correlated with changes in clinical pain. CONCLUSIONS These data reporting changes in resting-state brain activity following a noxious stimulus suggest that the acute painful stimuli may contribute to the alteration of the neural signature of chronic pain. WHAT DOES THIS STUDY/ADD?: In this study acute pain application shows an echo in functional connectivity and clinical pain changes in chronic pain.
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Affiliation(s)
- E Ichesco
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - T Puiu
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - J P Hampson
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - A E Kairys
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
- Department of Psychology, University of Colorado Denver, USA
| | - D J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - S E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - S J Peltier
- Functional MRI Laboratory, University of Michigan, Ann Arbor, USA
| | - R E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - T Schmidt-Wilcke
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
- Department of Neurology, BG Universitätsklinik Bergmannsheil, Ruhr University Bochum, Germany
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Kairys AE, Schmidt-Wilcke T, Puiu T, Ichesco E, Labus JS, Martucci K, Farmer MA, Ness TJ, Deutsch G, Mayer EA, Mackey S, Apkarian AV, Maravilla K, Clauw DJ, Harris RE. Increased brain gray matter in the primary somatosensory cortex is associated with increased pain and mood disturbance in patients with interstitial cystitis/painful bladder syndrome. J Urol 2014; 193:131-7. [PMID: 25132239 DOI: 10.1016/j.juro.2014.08.042] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Interstitial cystitis is a highly prevalent pain condition estimated to affect 3% to 6% of women in the United States. Emerging data suggest there are central neurobiological components to the etiology of this disease. We report the first brain structural imaging findings from the MAPP network with data on more than 300 participants. MATERIALS AND METHODS We used voxel based morphometry to determine whether human patients with chronic interstitial cystitis display changes in brain morphology compared to healthy controls. A total of 33 female patients with interstitial cystitis without comorbidities and 33 age and gender matched controls taken from the larger sample underwent structural magnetic resonance imaging at 5 MAPP sites across the United States. RESULTS Compared to controls, females with interstitial cystitis displayed significant increased gray matter volume in several regions of the brain including the right primary somatosensory cortex, the superior parietal lobule bilaterally and the right supplementary motor area. Gray matter volume in the right primary somatosensory cortex was associated with greater pain, mood (anxiety) and urological symptoms. We explored these correlations in a linear regression model, and found independent effects of these 3 measures on primary somatosensory cortex gray matter volume, namely clinical pain (McGill pain sensory total), a measure of urgency and anxiety (HADS). CONCLUSIONS These data support the notion that changes in somatosensory gray matter may have an important role in pain sensitivity as well as affective and sensory aspects of interstitial cystitis. Further studies are needed to confirm the generalizability of these findings to other pain conditions.
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Affiliation(s)
- Anson E Kairys
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | | | - Tudor Puiu
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Eric Ichesco
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan.
| | - Jennifer S Labus
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Katherine Martucci
- Department of Anesthesiology, Division of Pain Medicine, Stanford University Medical Center, Stanford, California
| | - Melissa A Farmer
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Timothy J Ness
- Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, Alabama
| | - Georg Deutsch
- Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, Alabama
| | - Emeran A Mayer
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sean Mackey
- Department of Anesthesiology, Division of Pain Medicine, Stanford University Medical Center, Stanford, California
| | - A Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Kenneth Maravilla
- Department of Radiology, University of Washington, Seattle, Washington
| | - Daniel J Clauw
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Richard E Harris
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
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