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Paparella G, Clemente L, Scannicchio S, Delussi M, De Tommaso M. Sex Differences in the Expression of Central Sensitization Symptoms in Migraine: An Observational Study. J Womens Health (Larchmt) 2024; 33:1656-1664. [PMID: 39034894 DOI: 10.1089/jwh.2024.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background: Migraine is the fourth most common cause of disability in women and the eighth most common cause in men. Central sensitization phenomena predispose to chronic migraine and are generally more pronounced in women. Objective: The aim of this retrospective observational study was to look for sex differences in a population of migraine subjects attending a tertiary headache center, focusing on symptoms of central sensitization such as allodynia and pericranial tenderness. Methods: This study is based on data collected at a tertiary headache center between January 1, 2018, and December 31, 2022. The clinical interview included the main features of migraine, allodynia, a disability questionnaire, the pericranial tenderness score, and anxiety and depression scales. Results: We selected a total of 1,087 migraine subjects (233 men). Osmophobia predominated in women, as did nausea. Disability scores, headache intensity, allodynia, anxiety, and depression predominated in women, without menopausal age playing a role. The frequency of symptomatic medication use was similar in both sexes. Allodynia score was the largest discriminating factor between women and men. Conclusions: Women with migraine are more likely than men to report acute allodynia, nausea, and osmophobia and are also more likely to be anxious, depressed, and disabled. These features appear to be independent of fertile age and are probably related to sex-specific genetic characteristics. These symptoms represent a tendency toward sensory hypersensitivity and central sensitization that should be carefully assessed in both women and men with migraine with a view to possibly predicting chronic development.
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Al-Khazali HM, Ashina H, Christensen RH, Wiggers A, Rose K, Iljazi A, Schytz HW, Amin FM, Ashina M. An exploratory analysis of clinical and sociodemographic factors in CGRP-induced migraine attacks: A REFORM study. Cephalalgia 2023; 43:3331024231206375. [PMID: 37815254 DOI: 10.1177/03331024231206375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate whether clinical and sociodemographic factors are associated with calcitonin gene-related peptide (CGRP) induced migraine attacks. METHODS A total of 139 participants with migraine received a 20-minute intravenous infusion of CGRP (1.5 µg/min) on a single experiment day. The incidence of CGRP-induced migraine attacks was recorded using a headache diary during the 12-hour observational period post-infusion. Univariable and multivariable regression analyses were conducted to examine potential predictors' relationship with CGRP-induced migraine attacks. RESULTS CGRP-induced migraine attacks were reported in 110 (79%) of 139 participants. Univariable analysis revealed that participants with cutaneous allodynia had higher odds of developing CGRP-induced migraine attacks, compared with those without allodynia (OR, 2.97, 95% CI, 1.28 to 7.43). The subsequent multivariable analysis confirmed this association (OR, 3.26, 95% CI, 1.32 to 8.69) and also found that participants with migraine with aura had lower odds of developing CGRP-induced migraine attacks (OR, 0.32, 95% CI, 0.12 to 0.84). CONCLUSION Our results suggest that cutaneous allodynia and aura play a role in CGRP-induced migraine attacks, while other clinical and sociodemographic factors do not seem to have any noticeable impact. This indicates that the CGRP provocation model is robust, as the CGRP hypersensitivity remained unaffected despite differences among a heterogeneous migraine population.Trial Registration: ClinicalTrials.gov Identifier: NCT04592952.
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Vitali-Silva A, Vuolo IG, Gonzalez LH, Galvão RF, Farges SG, Bello VA, Poli-Frederico RC. Oral combined hormonal contraceptive associated with protection against allodynia in migraine in a cross-sectional study. Ir J Med Sci 2023; 192:2203-2208. [PMID: 36720786 DOI: 10.1007/s11845-023-03293-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION For the most part, migraine afflicts young women who often need to use the hormonal contraceptive method. OBJECTIVE To evaluate the effects of using exogenous estrogen, present in combined hormonal contraceptives (CHC) and progestin-only methods on the prevalence of allodynia in women with migraine. METHODS Study comprising women diagnosed with migraine, with or without aura, who were not pregnant, breastfeeding, or menopausal. The study was conducted via the digital platform. Data were collected relating to demographics, contraceptive method, anthropometric information, smoking habits, and migraine-related symptoms. The participants then answered the following validated, self-administered questionnaires: Migraine Disability Assessment (MIDAS), Allodynia Symptom Checklist, Generalized Anxiety Disorder (GAD-7), and Beck's Depression Inventory (BDI). In order to determine the variables associated with allodynia, two binary logistic regression models were used. RESULTS Four hundred eighty-six women took part in the study. Of these, 205 used CHC, 89 used a progestin-only method, and 192 participants did not use any form of hormonal contraception. Allodynia was identified in 411 (84.6%) participants. Allodynia was linked to the presence of aura (OR = 2.76; CI 95% 1.55-4.91; p = 0.001), menstrually related migraine (OR = 2.14; CI 95% 1.28-3.57; p = 0.004), greater disability (MIDAS score 23 vs. 8; p < 0.001), depression (BDI score 14 vs. 10; p < 0.001), and anxiety (GAD-7 score 11 vs. 8; p < 0.001). In adjusted analysis, CHC was associated to protection against allodynia when jointly evaluated all CHC regimens (OR = 0.49 CI 95% 0.26-0.92; p = 0.028), as well as oral CHC individually (OR = 0.48 CI 95% 0.25-0.92; p = 0.027). CONCLUSION CHC reduced the chances of women with migraine getting allodynia.
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Rapisarda L, Trimboli M, Fortunato F, De Martino A, Marsico O, Demonte G, Augimeri A, Labate A, Gambardella A. Facemask headache: a new nosographic entity among healthcare providers in COVID-19 era. Neurol Sci 2021; 42:1267-1276. [PMID: 33502666 PMCID: PMC7838234 DOI: 10.1007/s10072-021-05075-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND SARS-CoV-2 is a novel infectious agent causing coronavirus disease 2019, which has been declared as pandemic in March 2020. Personal protective equipment has been mandatory for healthcare workers in order to contain the outbreak of pandemic disease. Mild neurological disturbances such as headache have been related to the extensive utilization of facemask. This study aims to examine headache variations related to the intensive utilization of facemask among a cohort of healthcare professionals in a setting of low-medium risk of exposure to SARS-CoV-2. METHODS This is a cross-sectional study among healthcare providers from different hospital and clinics in Italy. Each participant completed a specifically designed self-administered questionnaire. Headache features and outcome measures' change from baseline were evaluated over a 4-month period, in which wearing facemask has become mandatory for Italian healthcare workers. RESULTS A total of 400 healthcare providers completed the questionnaire, 383 of them met the inclusion criteria. The majority were doctors, with a mean age of 33.4 ± 9.2 years old. Among 166/383 subjects, who were headache free at baseline, 44 (26.5%) developed de novo headache. Furthermore, 217/383 reported a previous diagnosis of primary headache disorder: 137 were affected by migraine and 80 had tension-type headache. A proportion (31.3%) of these primary headache sufferers experienced worsening of their pre-existing headache disorder, mainly for migraine frequency and attack mean duration. CONCLUSIONS Our data showed the appearance of de novo associated facemask headache in previous headache-free subjects and an exacerbation of pre-existing primary headache disorders, mostly experienced by people with migraine disease.
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Dor A, Vatine JJ, Kalichman L. Proximal myofascial pain in patients with distal complex regional pain syndrome of the upper limb. J Bodyw Mov Ther 2019; 23:547-554. [PMID: 31563368 DOI: 10.1016/j.jbmt.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/17/2019] [Accepted: 02/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases. AIMS To evaluate the association of upper limb CRPS with myofascial pain in muscles that might influence arm or hand pain, and to evaluate whether the paraspinal skin and subcutaneous layers' tenderness and allodynia are associated with CRPS. METHODS A case-control study comprising 20 patients presenting with upper limb CRPS, and 20 healthy controls matched for sex and age, were evaluated in the thoracic paraspinal area and myofascial trigger points (MTrPs) (infraspinatus, rhomboids, subclavius, serratus posterior superior and pectoralis minor) via a skin rolling test. RESULTS The prevalence of MTrPs in the affected extremity of the subjects was significantly higher than in the right limb of the controls: 45% exhibited active and latent MTrPs in the infraspinatus muscle (χ2 = 11.613, p = 0.001); 60% in active and latent MTrPs in the subclavius muscle (χ2 = 17.143, p < 0.001); and in the pectoralis minor muscle (χ2 = 13.786, p < 0.001). In addition, 55% of the cases exhibited active and latent MTrPs in the serratus posterior superior muscle (χ2 = 15.172, p < 0.001). Significant differences between the groups in skin texture and pain levels (p = 0.01, p < 0.001, respectively) demonstrated that CRPS patients felt more pain, and their skin and subcutaneous layers were much tighter than in the healthy controls. CONCLUSION There is a high prevalence of MTrPs in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients.
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Brinck EC, Tiippana E, Heesen M, Bell RF, Straube S, Moore RA, Kontinen V. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev 2018; 12:CD012033. [PMID: 30570761 PMCID: PMC6360925 DOI: 10.1002/14651858.cd012033.pub4] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Inadequate pain management after surgery increases the risk of postoperative complications and may predispose for chronic postsurgical pain. Perioperative ketamine may enhance conventional analgesics in the acute postoperative setting. OBJECTIVES To evaluate the efficacy and safety of perioperative intravenous ketamine in adult patients when used for the treatment or prevention of acute pain following general anaesthesia. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase to July 2018 and three trials registers (metaRegister of controlled trials, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP)) together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We sought randomised, double-blind, controlled trials of adults undergoing surgery under general anaesthesia and being treated with perioperative intravenous ketamine. Studies compared ketamine with placebo, or compared ketamine plus a basic analgesic, such as morphine or non-steroidal anti-inflammatory drug (NSAID), with a basic analgesic alone. DATA COLLECTION AND ANALYSIS Two review authors searched for studies, extracted efficacy and adverse event data, examined issues of study quality and potential bias, and performed analyses. Primary outcomes were opioid consumption and pain intensity at rest and during movement at 24 and 48 hours postoperatively. Secondary outcomes were time to first analgesic request, assessment of postoperative hyperalgesia, central nervous system (CNS) adverse effects, and postoperative nausea and vomiting. We assessed the evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS We included 130 studies with 8341 participants. Ketamine was given to 4588 participants and 3753 participants served as controls. Types of surgery included ear, nose or throat surgery, wisdom tooth extraction, thoracotomy, lumbar fusion surgery, microdiscectomy, hip joint replacement surgery, knee joint replacement surgery, anterior cruciate ligament repair, knee arthroscopy, mastectomy, haemorrhoidectomy, abdominal surgery, radical prostatectomy, thyroid surgery, elective caesarean section, and laparoscopic surgery. Racemic ketamine bolus doses were predominantly 0.25 mg to 1 mg, and infusions 2 to 5 µg/kg/minute; 10 studies used only S-ketamine and one only R-ketamine. Risk of bias was generally low or uncertain, except for study size; most had fewer than 50 participants per treatment arm, resulting in high heterogeneity, as expected, for most analyses. We did not stratify the main analysis by type of surgery or any other factor, such as dose or timing of ketamine administration, and used a non-stratified analysis.Perioperative intravenous ketamine reduced postoperative opioid consumption over 24 hours by 8 mg morphine equivalents (95% CI 6 to 9; 19% from 42 mg consumed by participants given placebo, moderate-quality evidence; 65 studies, 4004 participants). Over 48 hours, opioid consumption was 13 mg lower (95% CI 10 to 15; 19% from 67 mg with placebo, moderate-quality evidence; 37 studies, 2449 participants).Perioperative intravenous ketamine reduced pain at rest at 24 hours by 5/100 mm on a visual analogue scale (95% CI 4 to 7; 19% lower from 26/100 mm with placebo, high-quality evidence; 82 studies, 5004 participants), and at 48 hours by 5/100 mm (95% CI 3 to 7; 22% lower from 23/100 mm, high-quality evidence; 49 studies, 2962 participants). Pain during movement was reduced at 24 hours (6/100 mm, 14% lower from 42/100 mm, moderate-quality evidence; 29 studies, 1806 participants), and 48 hours (6/100 mm, 16% lower from 37 mm, low-quality evidence; 23 studies, 1353 participants).Results for primary outcomes were consistent when analysed by pain at rest or on movement, operation type, and timing of administration, or sensitivity to study size and pain intensity. No analysis by dose was possible. There was no difference when nitrous oxide was used. We downgraded the quality of the evidence once if numbers of participants were large but small-study effects were present, or twice if numbers were small and small-study effects likely but testing not possible.Ketamine increased the time for the first postoperative analgesic request by 54 minutes (95% CI 37 to 71 minutes), from a mean of 39 minutes with placebo (moderate-quality evidence; 31 studies, 1678 participants). Ketamine reduced the area of postoperative hyperalgesia by 7 cm² (95% CI -11.9 to -2.2), compared with placebo (very low-quality evidence; 7 studies 333 participants). We downgraded the quality of evidence because of small-study effects or because the number of participants was below 400.CNS adverse events occurred in 52 studies, while 53 studies reported of absence of CNS adverse events. Overall, 187/3614 (5%) participants receiving ketamine and 122/2924 (4%) receiving control treatment experienced an adverse event (RR 1.2, 95% CI 0.95 to 1.4; high-quality evidence; 105 studies, 6538 participants). Ketamine reduced postoperative nausea and vomiting from 27% with placebo to 23% with ketamine (RR 0.88, 95% CI 0.81 to 0.96; the number needed to treat to prevent one episode of postoperative nausea and vomiting with perioperative intravenous ketamine administration was 24 (95% CI 16 to 54; high-quality evidence; 95 studies, 5965 participants). AUTHORS' CONCLUSIONS Perioperative intravenous ketamine probably reduces postoperative analgesic consumption and pain intensity. Results were consistent in different operation types or timing of ketamine administration, with larger and smaller studies, and by higher and lower pain intensity. CNS adverse events were little different with ketamine or control. Perioperative intravenous ketamine probably reduces postoperative nausea and vomiting by a small extent, of arguable clinical relevance.
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Bar-Shalita T, Livshitz A, Levin-Meltz Y, Rand D, Deutsch L, Vatine JJ. Sensory modulation dysfunction is associated with Complex Regional Pain Syndrome. PLoS One 2018; 13:e0201354. [PMID: 30091986 PMCID: PMC6084887 DOI: 10.1371/journal.pone.0201354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 07/14/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Complex Regional Pain Syndrome (CRPS), a chronic pain condition, develops mainly after limb trauma and severely inhibits function. While early diagnosis is essential, factors for CRPS onset are elusive. Therefore, identifying those at risk is crucial. Sensory modulation dysfunction (SMD), affects the capacity to regulate responses to sensory input in a graded and adaptive manner and was found associated with hyperalgesia in otherwise healthy individuals, suggestive of altered pain processing. AIM To test SMD as a potential risk factor for CRPS. METHODS In this cross-sectional study, forty-four individuals with CRPS (29.9±11 years, 27 men) and 204 healthy controls (27.4±3.7 years, 105 men) completed the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS). A physician conducted the CRPS Severity Score (CSS), testing individuals with CRPS. RESULTS Thirty-four percent of the individuals with CRPS and twelve percent of the healthy individuals were identified to have SMD (χ2 (1) = 11.95; p<0.001). Logistic regression modeling revealed that the risk of CRPS is 2.68 and 8.21 times higher in individuals with sensory over- and sensory under-responsiveness, respectively, compared to non-SMD individuals (p = 0.03 and p = 0.01, respectively). CONCLUSIONS SMD, particularly sensory under-responsiveness, might serve as a potential risk factor for CRPS and therefore screening for SMD is recommended. This study provides the risk index probability clinical tool a simple evaluation to be applied by clinicians in order to identify those at risk for CRPS immediately after injury. Further research is needed.
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De Groef A, Meeus M, De Vrieze T, Vos L, Van Kampen M, Geraerts I, Devoogdt N. Unraveling Self-Reported Signs of Central Sensitization in Breast Cancer Survivors with Upper Limb Pain: Prevalence Rate and Contributing Factors. Pain Physician 2018; 21:E247-E256. [PMID: 29871380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Hypersensitivity of the central nervous system to environmental and chemical stimuli is a clinical feature of central sensitization mechanisms that can be assessed with the central sensitization inventory (CSI). OBJECTIVE The aim was to determine prevalence rate of this feature and explore the treatment-, patient-, pain-, and psychosocial-related variables associated with the degree of self-reported signs of central sensitization, assessed with the CSI (0-100), in breast cancer survivors at long-term. STUDY DESIGN Cross-sectional study. SETTING University Hospitals, Leuven, Belgium. METHODS One hundred and forty-six women with persistent pain, more than one year after breast cancer surgery, were included. The following factors were analyzed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy, and trastuzumab); 2) patient's related variables (age and body mass index); 3) pain-related variables (pain intensity, pain quality, primary hyperalgesia, and index of widespread pain); and 4) psychosocial variables (the degree of pain catastrophizing and vigilance and awareness to pain). The dependent variable was degree of central sensitization measured with the CSI. Additionally, a stepwise regression was performed. RESULTS Fifty-five (38%) patients reported signs of central sensitization measured with the CSI (i.e., > 40/100). From multivariable analysis, it appears that more severe pain quality and higher levels of pain catastrophizing contribute to a higher degree of central sensitization. The stepwise regression revealed that up to 24% of variance of the CSI can be explained by these factors. LIMITATIONS A selection bias may be present since patients were all recruited from a larger cohort participating in clinical trials on the effectiveness of physical therapy after breast cancer treatment. CONCLUSION Signs of central sensitization cannot be neglected in breast cancer survivors at long term. More severe pain quality and pain catastrophizing contribute to higher levels of central sensitization in this population. KEY WORDS Breast neoplasm, pain, central sensitization mechanisms, central sensitization inventory.
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Kim SY, Park SP. Cutaneous Allodynia and Its Risk Factors in Korean Patients with Migraine: A Survey of Two Tertiary Care Hospitals. J Oral Facial Pain Headache 2017; 30:323-329. [PMID: 27792800 DOI: 10.11607/ofph.1687] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To measure the prevalence of cutaneous allodynia in Korean patients with migraine and to characterize the differential risks of migraine-associated factors and psychiatric disorders in its development. METHODS The study included consecutive patients with migraine who visited headache clinics at two tertiary care hospitals. Questionnaires including the 12-item Allodynia Symptom Checklist (ASC-12) and the Migraine Disability Assessment (MIDAS) were administered to the patients. The Mini International Neuropsychiatric Interview-Plus, Version 5.0.0 (MINI), was performed to diagnose current major depressive disorder (MDD) and current generalized anxiety disorder (GAD). To determine the predictive factors of cutaneous allodynia, a two-step logistic regression model was used. RESULTS A total of 332 patients were eligible for the study. Chronic migraine (CM) was present in 140 patients (42.2%). Current MDD and current GAD were identified in 73 (21.9%) and 59 patients (17.7%), respectively. Cutaneous allodynia was present in 48 patients (14.5%). Univariate analyses indicated that cutaneous allodynia was associated with female gender, CM, medication overuse headache, headache intensity, photophobia, phonophobia, MIDAS grade, current MDD, and current GAD. Multivariate analyses revealed that current MDD was the strongest risk factor for cutaneous allodynia (adjusted odds ratio [AOR] = 4.552; 95% confidence intervals [CI] = 2.300-9.007; P = .000), followed by CM (AOR = 3.666; 95% CI = 1.787-7.521; P = .000) and photophobia (AOR = 2.707; 95% CI = 1.340-5.469; P = .005). CONCLUSION Korean patients with migraine have a low prevalence of cutaneous allodynia. Both depression and migraine-associated features are important factors in the occurrence of cutaneous allodynia.
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Masgoret P, Gomar C, Tena B, Taurá P, Ríos J, Coca M. Incidence of persistent postoperative pain after hepatectomies with 2 regimes of perioperative analgesia containing ketamine. Medicine (Baltimore) 2017; 96:e6624. [PMID: 28403113 PMCID: PMC5403110 DOI: 10.1097/md.0000000000006624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 11/24/2022] Open
Abstract
Studies designed to assess persistent postoperative pain (PPP) incidence after hepatectomies are lacking. Our aim was to assess PPP incidence 6 months after hepatectomies with intravenous (IV) or epidural (EPI) analgesia containing ketamine.Prospective observational comparative study between 2 cohorts of patients submitted to hepatectomy. Patients received 1 of 2 analgesic regimes containing ketamine: EPI group or IV group. Visual analog scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), and quantitative sensorial testing (QST: to determine area of hyperalgesia/allodynia) were assessed preoperatively and postoperatively at 2 h, 24 h, 7 days, 1 month, and 6 months. VAS ≥ 1 at 1 and 6 months was considered indicative of PPP and VAS > 3 was considered as not controlled pain. Side effects and complications were registered.Forty-four patients were included: 23 in EPI group and 21 in IV group. Patients in IV group were older and had more comorbidities. No patient presented VAS > 3 at 1 or 6 months. VAS ≥ 1 at 1 and 6 months was 36.4% and 22.7%, respectively. No differences in VAS, NPSI, or PCS were found between groups. Allodynia/hyperalgesia area did not differ between groups and was infrequent and slight. Pain pressure threshold in the wound vertical component was significantly higher in EPI group after 7 days. IV group showed more cognitive side effects.Incidence of PPP at 6 months after open hepatectomies with EPI or IV analgesia containing ketamine was lower than previously reported for other abdominal surgeries.Ketamine influence on low PPP incidence and hyperalgesia cannot be discarded.
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Lopez-de-Uralde-Villanueva I, Beltran-Alacreu H, Fernandez-Carnero J, Kindelan-Calvo P, La Touche R. Widespread Pressure Pain Hyperalgesia in Chronic Nonspecific Neck Pain with Neuropathic Features: A Descriptive Cross-Sectional Study. Pain Physician 2016; 19:77-88. [PMID: 26815252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Neck pain has an elevated prevalence worldwide. Most people with neck pain are diagnosed as nonspecific neck pain patients. Poor recovery in neck disorders, as well as high levels of pain and disability, are associated with widespread sensory hypersensitivity. Nevertheless, there is controversy regarding the presence of widespread hyperalgesia in chronic nonspecific neck pain (CNSNP); this lack of agreement could be due to the presence of different pathophysiological mechanisms in CNSNP. OBJECTIVES To determinate differences in pressure pain thresholds (PPTs) over extracervical and cervical regions, and differences in cervical range of motion (ROM) between patients with CNSNP with and without neuropathic features (NF and No-NF, respectively). In addition, this study expected to observe correlations in these 2 types of CNSNP of psychosocial factors with PPTs and with cervical ROM separately. STUDY DESIGN Descriptive, cross-sectional study. SETTING A hospital physiotherapy outpatient department. METHODS This research involved 53 patients with CNSNP that had obtained a Self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) score = 12 (pain with NF, NF group); 54 that had obtained a S-LANSS score < 12 (pain with No-NF, No-NF group), and 53 healthy controls (control group, CG). Measures included: PPTs (suboccipital muscle, upper fibers trapezius muscle, lateral epicondyle, and anterior tibial muscle), cervical ROM (flexion, extension, rotation, and latero-flexion), pain intensity (Visual Analog Scale [VAS]), neck disability index (NDI), kinesiophobia (Tampa Scale of Kinesiophobia-11 [TSK-11]), and Pain Catastrophizing Scale (PCS). RESULTS A statistically significant effect was observed for the group factor in all assessed measures (P < 0.01). Both CNSNP groups showed statistically significant differences compared to the CG for PPTs in the cervical region (suboccipital and upper fibers trapezius muscles), but only the NF group demonstrated statistically significant differences for PPTs in the lateral epincondyle and anterior tibial muscle when compared to the CG or No-NF group. The largest statistically significant correlation found in the NF group was between PPT in the anterior tibial muscle and TSK-11 (r = -0.372; P < 0.01), while in the No-NF group it was between PPT in the suboccipital muscle and NDI (r = -0.288; P < 0.05). Statistically significant differences were found between the 2 CNSNP groups and CG in all cervical ROMs, but not between both CNSNP groups. The largest statistically significant correlation observed in the NF group was between cervical total rotation and TSK-11 (r = -0.473; P < 0.01), while in the No-NF group it was between cervical total latero-flexion and PCS (r = -0.532; P < 0.01). LIMITATIONS Although the S-LANSS scale has been validated as a screening tool for pain with NF, currently there is no "gold standard," so these findings should be interpreted with caution. CONCLUSIONS Widespread pressure pain hyperalgesia was detected in patients with CNSNP with NF, but not in patients with CNSNP with No-NF. Patients with CNSNP presented bilateral pressure pain hyperalgesia over the cervical region and a decreased cervical ROM compared to healthy controls. However, no differences were found between the 2 CNSNP groups. These findings suggest differences in the mechanism of pain processing between patients with CNSNP with NF and No-NF.
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Kee JR, Smith RG, Barnes CL. Recognizing and Reducing the Risk of Opioid Misuse in Orthopaedic Practice. J Surg Orthop Adv 2016; 25:238-243. [PMID: 28244866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Orthopaedic surgeons often treat patients with chronic musculoskeletal pain. This musculoskeletal pain is increasingly being treated with opioid medications, contributing to the growing opioid epidemic in the United States. Opioid use and abuse before orthopaedic surgery are associated with worse clinical outcomes. This article reviews the risk factors for opioid use, misuse, and other behaviors in chronic pain patients, discusses the screening tools for opioid misuse in chronic pain patients, and provides recommendations for the orthopaedic surgeon's role in managing these complicated patients.
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Rossi M, DeCarolis G, Liberatoscioli G, Iemma D, Nosella P, Nardi LF. A Novel Mini-invasive Approach to the Treatment of Neuropathic Pain: The PENS Study. Pain Physician 2016; 19:E121-E128. [PMID: 26752480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Peripheral neuromodulation is often used as chronic neuropathic pain treatment. Percutaneous electrical nerve stimulation (PENS) is generally utilized with several probes at the same time and repeated treatments. OBJECTIVES Evaluate the short- and long-term efficacy of a single probe and single shot PENS approach. STUDY DESIGN Multicenter, prospective, observational study. SETTING Four Italian pain therapy centers. METHODS Inclusion criteria were age = 18 and = 80 years, presence of severe peripheral neuropathic pain lasting more than 3 months, localized and refractory to pharmacological therapies. Patients with infection, coagulopathies, psychiatric disorders, pacemakers, or implantable cardiac defibrillators were excluded. PATIENTS Seventy-six patients (47 women, 29 men), mean age 62 ± 14 years, affected by neuralgia (21 herpes zoster infection, 31 causalgia, 24 postoperative pain) were enrolled in the study. INTERVENTION After localization of trigger point and/or allodynic/hyperalgesic area, PENS therapy was achieved with a single 21 gauge conductive probe tunneled percutaneously and a neurostimulator device. MEASUREMENT Numerical Rating Scale (NRS) and Neuropathic Pain Scale (NPS) were assessed at baseline, 60 minutes after PENS, at one week, after one, 3, and 6 months; perceived health outcome was measured with Euroqol-5 dimension (EQ-5D) questionnaire at baseline and at 6 months. Adverse events and patient satisfaction were reported. RESULTS NRS and NPS decreased significantly after 60 minutes and the reduction remained constant over time at follow-up. EQ-5D increased significantly with respect to the baseline. Two nonclinically significant adverse events (one contralateral dysestesia and one self-resolving hematoma) were observed. LIMITATIONS Small sample size and non-randomized observational study; high prevalence of post-herpetic and occipital neuralgias. CONCLUSION PENS therapy produced significant and long-lasting pain relief in chronic peripheral neuropathic pains of different etiology. The present study confirms the feasibility, safety, and repeatability of this minimally invasive technique.
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Gracely RH, Schweinhardt P. Key mechanisms mediating fibromyalgia. Clin Exp Rheumatol 2015; 33:S3-S6. [PMID: 25786039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 06/04/2023]
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de Tommaso M, Delussi M, Vecchio E, Sciruicchio V, Invitto S, Livrea P. Sleep features and central sensitization symptoms in primary headache patients. J Headache Pain 2014; 15:64. [PMID: 25260261 PMCID: PMC4189547 DOI: 10.1186/1129-2377-15-64] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/16/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Association between sleep disorders and headache is largely known. The aim of the present study was to evaluate sleep quality and quantity in a large cohort of primary headache patients, in order to correlate these scores with symptoms of central sensitization as allodynia, pericranial tenderness and comorbidity with diffuse muscle-skeletal pain. METHODS One thousand six hundreds and seventy primary headache out patients were submitted to the Medical Outcomes Study (MOS) within a clinical assessment, consisting of evaluation of frequency of headache, pericranial tenderness, allodynia and coexistence of fibromyalgia syndrome (FM). RESULTS Ten groups of primary headache patients were individuated, including patients with episodic and chronic migraine and tension type headache, mixed forms, cluster headache and other trigeminal autonomic cephalalgias. Duration but not sleep disturbances score was correlated with symptoms of central sensitization as allodynia and pericranial tenderness in primary headache patients. The association among allodynia, pericranial tenderness and short sleep characterized chronic migraine more than any other primary headache form. Patients presenting with FM comorbidity suffered from sleep disturbances in addition to reduction of sleep duration. CONCLUSION Self reported duration of sleep seems a useful index to be correlated with allodynia, pericranial tenderness and chronic headache as a therapeutic target to be assessed in forthcoming studies aiming to prevent central sensitization symptoms development.
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Lovati C, Mariotti C, Giani L, D'Amico D, Sinelli A, De Angeli F, Capiluppi E, Bussone G, Mariani C. Central sensitization in photophobic and non-photophobic migraineurs: possible role of retino nuclear way in the central sensitization process. Neurol Sci 2014; 34 Suppl 1:S133-5. [PMID: 23695062 DOI: 10.1007/s10072-013-1369-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of the present study was to investigate the possible relationships between the presence of headache-related photophobia and migraine-associated allodynia--a hallmark of central sensitization--among patients with different migraine types. A sample of 456 migraineurs was studied. Our results showed that photophobia was present in a high proportion of patients, with similar figures in patients with episodic migraine or CM, and confirmed that the prevalence of allodynia was higher among CM patients than in those with episodic migraine. We found a clear association between migraine-related allodynia and photophobia only in CM patients. Overall, these findings suggest that light stimulation may contribute to central sensitization of pain pathways in migraineurs, possibly contributing to progression into chronic forms. The possible connections underlying this type of sensitization is offered by the recently published data on a non-image-forming visual retino-thalamo-cortical pathway which may allow photic signals to converge on a thalamic region which is selectively activated during migraine headache.
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Dorsher PT. Invited commentary on central hypersensitivity in patients with subacromial impingement syndrome. Arch Phys Med Rehabil 2012; 94:209-10; disscussion 211-2. [PMID: 22878229 DOI: 10.1016/j.apmr.2012.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 07/21/2012] [Indexed: 11/18/2022]
Abstract
Pain pressure threshold (PPT) measurement by handheld algometer has been validated as a tool to identify and quantitate myofascial pain sites in an individual. The average of 3 readings at a given muscle site is used, so the standard error of measurement of these devices must be considered when determining whether PPT differences between muscle sites represent true changes. This commentary discusses this issue.
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Ortner CM, Granot M, Richebé P, Cardoso M, Bollag L, Landau R. Preoperative scar hyperalgesia is associated with post-operative pain in women undergoing a repeat Caesarean delivery. Eur J Pain 2012; 17:111-23. [PMID: 22689634 DOI: 10.1002/j.1532-2149.2012.00171.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND Over 1.4 million Caesarean deliveries are performed annually in the United States, out of which 30% are elective repeat procedures. Post-operative hyperalgesia is associated with an increased risk for persistent post-surgical pain; however, there are no data on whether residual scar hyperalgesia (SHA) from a previous Caesarean delivery (CD) persists until the next delivery. We hypothesized that residual SHA may be present in a substantial proportion of women and is associated with increased post-operative pain. METHODS One hundred and sixty-three women scheduled for a repeat CD under spinal anaesthesia were enrolled into the study. Mechanical temporal summation (mTS) and SHA index were measured preoperatively. SHA was considered present when the index was >0. Post-operative pain scores at 12, 24 and 48 h and wound hyperalgesia (WHA) at 48 h were recorded. RESULTS SHA was present in 67 women 41% with a median SHA index of 0.42 (Q (25) = 0.25; Q (75) = 1.1, range 0.03-4.25). Women with SHA had overall higher post-operative pain scores and SHA was correlated with preoperative mTS (r = 0.164, p < 0.05), post-operative pain severity (r = 0.25, p < 0.002) and WHA at 48 h (r = 0.608, p < 0.001). Severe pain (visual analogue pain scale-S48 ≥ 7, n = 20) was predicted with a sensitivity and specificity of 60% and 62%, respectively. Positive predictive value was 18% and negative predictive value was 92%. CONCLUSIONS Preoperative SHA is present in 41% of women scheduled for repeat CD and is associated with increased mTS and post-operative pain. Screening for preoperative SHA may predict women at risk for increased post-operative pain, and guide post-operative analgesia to include anti-hyperalgesic drugs.
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Sánchez del Río-González M. [Chronic migraine: pathophysiology]. Rev Neurol 2012; 54 Suppl 2:S13-S19. [PMID: 22532238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chronic migraine is considered a complication of episodic migraine. Several risk factors, which may be modifiable or non-modifiable, make varying contributions to the progression towards chronification. Every year 2.5% of patients with episodic migraine go on to suffer chronic migraine. Experimental studies point to a dysfunction in the descending pain modulatory system that would facilitate nociceptive afferents, in the absence of damage to tissues, and so chronic migraine would share a pathogenesis that is similar to that of fibromyalgia, irritable bowel syndrome or chronic tension-type headache (conditions that frequently coexist). This paper reviews the risk factors and the scientific evidence of the possible pathogenic mechanisms involved in the progression towards chronification.
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Ablin JN, Gurevitz I, Cohen H, Buskila D. Sexual dysfunction is correlated with tenderness in female fibromyalgia patients. Clin Exp Rheumatol 2011; 29:S44-S48. [PMID: 22132715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 03/10/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of the current study was to evaluate sexual dysfunction among female fibromyalgia syndrome (FMS) patients. METHODS Fifty female subjects were recruited and were asked to complete a questionnaire regarding sexual functioning. The control group included fifty-five healthy age-matched volunteers. The participants underwent a physical examination and tender point assessment was performed using manual palpation. All participants filled out the Arizona Sexual Experience Scale, which evaluates five areas of sexual functioning: sexual drive, sexual arousal, vaginal wetting, orgasm and sexual satisfaction. RESULTS FMS patients had significantly lower scores on all five aspects of sexual function assessed. A positive correlation was observed between the sexual drive score, signifying a decrease in sexual drive, and the number of tender points documented on examination. Similarly, a positive correlation was observed between the sexual satisfaction scale (indicating decreasing levels of sexual satisfaction) and the number of tender points documented. A positive correlation was demonstrated between the sexual arousal and orgasmatic scales and between the tender point counts, indicating a decrease in sexual arousal and in orgasmatic function in correlation with an increasing number of tender points. CONCLUSIONS The results of the current study indicate a multi-factorial sexual dysfunction among female FMS patients. All stages of sexual functioning, evaluated were significantly disturbed in comparison with the healthy controls. Physicians treating FMS patients should be aware of, and actively inquire about, sexual dysfunction as part of a multi-disciplinary evaluation of such patients.
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Kapoor SR, Hider SL, Brownfield A, Mattey DL, Packham JC. Fibromyalgia in patients with rheumatoid arthritis: driven by depression or joint damage? Clin Exp Rheumatol 2011; 29:S88-S91. [PMID: 22243554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 10/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Studies have shown an increased incidence of fibromyalgia (FMS) in RA patients. The aims of this study were to explore the effect of mood and disease damage on the prevalence of FMS. METHODS RA patients underwent a standardised clinical assessment, including disease activity (DAS-28), disease damage (mechanical joint score, MJS), fibromyalgia tender point assessment and the Hospital Anxiety and Depression Scale (HADS) and Health Assessment Questionnaire (HAQ). Patients were classified with FMS using two criteria a) tender-swollen joint count was ≥7 or b) tender point score of ≥11/18. RESULTS 44/285 (15%) patients were classified as having FMS using the joint count difference of ≥7, compared to 18/285 (6%) using the tender point score of >11. Using the joint count difference to classify patients as having FMS, those with FMS had higher HAQ scores than those without FMS (2.12 vs. 1.5, p<0.0001). Although the DAS-28 was higher in this group (5.4 vs. 3.82, p<0.0001), the MJS was similar (8 vs. 7, p=0.19), suggesting similar levels of joint damage. Those classified as having FMS were more likely to have HAD-D scores of >11 (25% vs. 6%, p=0.0001). CONCLUSIONS Coexistent FMS was common in our cohort, although using the tender point count to define FMS classified fewer patients with FMS. Within this group those with FMS had higher levels of depression but similar scores for joint damage indicating that in this cohort FMS and poorer physical functioning is mediated by low mood rather than joint damage.
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Zappaterra M, Guerzoni S, Cainazzo MM, Ferrari A, Pini LA. Basal cutaneous pain threshold in headache patients. J Headache Pain 2011; 12:303-10. [PMID: 21336562 PMCID: PMC3094665 DOI: 10.1007/s10194-011-0313-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 02/03/2011] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to analyze cutaneous pain threshold (CPT) during the interictal phase in headache patients, and the relationships between headache frequency and analgesic use. A consecutive series of 98 headache patients and 26 sex- and age-balanced controls were evaluated. Acute allodynia (AA) was assessed by Jakubowski questionnaire, and interictal allodynia (IA) by a skin test with calibrated monofilaments. AA is widely known as a symptom more present in migraine than in TTH spectrum: in our study this was confirmed only in cases of episodic attacks. When headache index rises towards chronicization, the prevalence of AA increases in both headache spectrums (χ (2) 13.55; p < 0.01). AA was associated with IA only in cases of chronic headache. When headache becomes chronic, mostly in presence of medication overuse, interictal CPT decreases and IA prevalence increases (χ (2) 20.44; p < 0.01), with closer association than AA. In MOH patients there were no significant differences depending on the diagnosis of starting headache (migraine or tension type headache) and, in both groups, we found the overuse of analgesics plays an important role: intake of more than one daily drug dramatically reduces the CPT (p < 0.05). Thus, when acute allodynia increases frequency, worsens or appears for the first time in patients with a long-standing history of chronic headache, it could reasonably suggest that the reduction of CPT had started, without using a specific practical skin test but simply by questioning clinical headache history. In conclusion, these results indicate that the role of medication overuse is more important than chronicization in lowering CPT, and suggest that prolonged periods of medication overuse can interfere with pain perception by a reduction of the pain threshold that facilitates the onset of every new attack leading to chronicization.
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Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician 2011; 14:145-161. [PMID: 21412369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Opioid-induced hyperalgesia (OIH) is defined as a state of nociceptive sensitization caused by exposure to opioids. The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli. The type of pain experienced might be the same as the underlying pain or might be different from the original underlying pain. OIH appears to be a distinct, definable, and characteristic phenomenon that could explain loss of opioid efficacy in some patients. Findings of the clinical prevalence of OIH are not available. However, several observational, cross-sectional, and prospective controlled trials have examined the expression and potential clinical significance of OIH in humans. Most studies have been conducted using several distinct cohorts and methodologies utilizing former opioid addicts on methadone maintenance therapy, perioperative exposure to opioids in patients undergoing surgery, and healthy human volunteers after acute opioid exposure using human experimental pain testing. The precise molecular mechanism of OIH, while not yet understood, varies substantially in the basic science literature, as well as clinical medicine. It is generally thought to result from neuroplastic changes in the peripheral and central nervous system (CNS) that lead to sensitization of pronociceptive pathways. While there are many proposed mechanisms for OIH, 5 mechanisms involving the central glutaminergic system, spinal dynorphins, descending facilitation, genetic mechanisms, and decreased reuptake and enhanced nociceptive response have been described as the important mechanisms. Of these, the central glutaminergic system is considered the most common possibility. Another is the hypothesis that N-methyl-D-aspartate (NMDA) receptors in OIH include activation, inhibition of the glutamate transporter system, facilitation of calcium regulated intracellular protein kinase C, and cross talk of neural mechanisms of pain and tolerance. Clinicians should suspect OIH when opioid treatment's effect seems to wane in the absence of disease progression, particularly if found in the context of unexplained pain reports or diffuse allodynia unassociated with the original pain, and increased levels of pain with increasing dosages. The treatment involves reducing the opioid dosage, tapering them off, or supplementation with NMDA receptor modulators. This comprehensive review addresses terminology and definition, prevalence, the evidence for mechanism and physiology with analysis of various factors leading to OIH, and effective strategies for preventing, reversing, or managing OIH.
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Staud R, Robinson ME, Weyl EE, Price DD. Pain variability in fibromyalgia is related to activity and rest: role of peripheral tissue impulse input. THE JOURNAL OF PAIN 2010; 11:1376-83. [PMID: 20451465 PMCID: PMC2932794 DOI: 10.1016/j.jpain.2010.03.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 03/03/2010] [Accepted: 03/16/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED Because fibromyalgia (FM) patients frequently report activity-dependent deep tissue pains, impulse input from painful body regions may be relevant for their musculoskeletal complaints. In addition, peripheral impulse input may induce and maintain thermal and mechanical hyperalgesia of FM patients. If so, activity and rest may alternately enhance and diminish intensity of FM pain. However, the effects of exercise on pain are ambiguous in studies of FM. Whereas exercise-only studies demonstrated increased pain and hyperalgesia during and after physical activity, some exercise studies that included rest periods resulted in decreased FM pain and increased function. To further clarify these effects, we examined the effects of alternating exercise with rest on clinical pain and thermal/mechanical hyperalgesia of 34 FM patients and 36 age-matched healthy controls (NC). Using an ergometer, all subjects performed arm exercise to exhaustion twice alternating with 15-minute rest periods. Although strenuous muscle activity was reported as painful by most FM subjects, overall clinical pain consistently decreased during the rest periods. Additionally, FM subjects' pain sensitivity to mechanical pressure decreased after each exercise and rest session. CONCLUSION Alternating strenuous exercise with brief rest periods not only decreased overall clinical pain of FM subjects but also their mechanical hyperalgesia. No prolonged worsening of overall FM pain and hyperalgesia occurred despite vigorous muscle activity. Our findings contribute further evidence that FM pain and hyperalgesia are at least partially maintained by muscle impulse input, and that some types of exercises may be beneficial for FM. PERSPECTIVE FM is a pain-amplification syndrome that depends at least in part on peripheral tissue impulse input. Whereas muscle activity increased overall pain, short rest periods produced analgesic effects.
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Marmura MJ, Abbas M, Ashkenazi A. Dynamic mechanical (brush) allodynia in cluster headache: a prevalence study in a tertiary headache clinic. J Headache Pain 2009; 10:255-8. [PMID: 19421708 PMCID: PMC3451753 DOI: 10.1007/s10194-009-0124-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 04/18/2009] [Indexed: 11/09/2022] Open
Abstract
Cutaneous allodynia (CA) has been described in migraine and has been related to treatment failure. There are little data about the incidence of CA in other primary headache syndromes such as cluster headache (CH). The objectives of this study are to evaluate the prevalence of dynamic mechanical (brush) allodynia (BA) in CH patients attending a tertiary headache clinic, and to assess its relation to disease characteristics. Adult patients with episodic or chronic CH were recruited. We obtained demographic data and data on disease characteristics through a structured questionnaire, and tested the patients for brush allodynia BA by applying a 4 x 4 gauze pad over the V1, C2/C3 and C8 skin areas bilaterally. The prevalence of allodynia in the entire study population and in the different sub-groups was calculated. We also examined the association between CA and demographic parameters, and its association with disease characteristics. Forty-one patients were recruited (22 men, 19 women; mean age 44.9 years). Twenty-two had chronic CH (CCH) and 19 had episodic CH (ECH). Mean disease duration was 14.1 years (12.3 the CCH group and 15.7 in the ECH group). Overall, 20 (49%) patients were allodynic. There was no statistically significant association between the presence of allodynia and age, gender, diagnosis (episodic vs. chronic CH), disease duration or disease severity. In conclusion, BA was common in this CH patient sample. The therapeutic implications of the presence of BA in CH need to be further studied.
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