Chronic pain in osteoarthritis of the hip is associated with selective cognitive impairment

Chronic Pain-Related Cognitive Deficits: Preclinical Insights into Molecular, Cellular, and Circuit Mechanisms

Cognitive impairment is a common comorbidity of chronic pain, significantly disrupting patients' quality of life. Despite this comorbidity being clinically recognized, the underlying neuropathological mechanisms remain unclear. Recent preclinical studies have focused on the fundamental mechanisms underlying the coexistence of chronic pain and cognitive decline. Pain chronification is accompanied by structural and functional changes in the neural substrate of cognition. Based on the developments in electrophysiology and optogenetics/chemogenetics, we summarized the relevant neural circuits involved in pain-induced cognitive impairment, as well as changes in connectivity and function in brain regions. We then present the cellular and molecular alternations related to pain-induced cognitive impairment in preclinical studies, mainly including modifications in neuronal excitability and structure, synaptic plasticity, glial cells and cytokines, neurotransmitters and other neurochemicals, and the gut-brain axis. Finally, we also discussed the potential treatment strategies and future research directions.

Prevalence of psychiatric morbidity and cognitive impairment among non-communicable disease patients in Southern Chennai, Tamil Nadu

Introduction

According to the WHO, non-communicable diseases cause 71% of all deaths globally. Despite many studies showing a significant association between non-communicable diseases (NCDs) and cognitive decline, it is not researched in Tamil Nadu. Hence, this study was conducted to screen for psychiatric morbidity and cognitive impairment (CI) among NCD patients in Southern Chennai.

Aims

The aim of this study was to estimate the prevalence of psychiatric morbidity and CI and their associated factors among NCD patients attending NCD clinics of tertiary care hospitals.

Methods and Material

A cross-sectional study was carried out in NCD patients (n = 343) attending an NCD clinic in a tertiary care hospital. Basic sociodemographic and clinical details were obtained by a semi-structured questionnaire. Cognition function and psychiatric morbidity were assessed using mini-mental state examination, patient health questionnaire 9 and generalised anxiety disorder 7 tools, respectively.

Results

The mean age of the study participants was 58 years. Of 343 participants, 19.2% had severe CI, 26.8% had severe depression, and 29.7% had severe anxiety. Among 180 participants aged 59-86 years, 25.5% participants had osteoarthritis; of these, 41.3% had severe CI (P < 0.0001), 82.6% had severe depression (P < 0.0001) and 63% had severe anxiety (P < 0.027), and their association was statistically significant.

Conclusions

This study concludes that about one-fourth of the NCD patients suffered from CI and psychiatric morbidity, which are of rising concern. Musculoskeletal diseases are neglected to be assessed under NCDs, and in this study, osteoarthritis was found to be significantly associated with depression, anxiety and CI.

Body movement as a biomarker for use in chronic pain rehabilitation: An embedded analysis of an RCT of a virtual reality solution for adults with chronic pain

Introduction

Chronic low back pain (CLBP) is a major public health problem. Reliably measuring the effects of chronic pain on movement and activity, and any changes due to treatment, is a healthcare challenge. A recently published paper demonstrated that a novel digital therapeutic (DTxP) was efficacious in reducing fear of movement and increasing the quality of life of adult patients with moderate to severe CLBP. In this paper, we report a study of how data from wearable devices collected in this study could be used as a digital measure for use in studies of chronic low back pain.

Methods

Movement, electrodermal recording, general activity and clinical assessment data were collected in a clinical trial of a novel digital therapeutic intervention (DTxP) by using the sensors in commercial Garmin Vivosmart 4, Empatica Embrace2 and Oculus Quest wearables. Wearable data were collected during and between the study interventions (frequent treatment sessions of DTxP). Data were analyzed using exploratory statistical analysis.

Results

A pattern of increased longitudinal velocity in the movement data collected with right-hand, left-hand, and head sensors was observed in the study population. Correlations were observed with the changes in clinical scales (Tampa Scale of Kinesiophobia, EQ5D Overall health VAS, and EQ5D QoL score). The strongest correlation was observed with the increased velocity of head and right-hand sensors (Spearman correlation with increasing head sensor velocity and Tampa Scale of Kinesiophobia -0.45, Overall health VAS +0.67 and EQ5D QoL score -0.66). The sample size limited interpretation of electrodermal and general activity data.

Discussion/Conclusion

We found a novel digital signal for use in monitoring the efficacy of a digital therapeutics (DTxP) in adults with CLBP. We discuss the potential use of such movement based digital markers as surrogate or additional endpoints in studies of chronic musculoskeletal pain.

Clinical Trial Registration

https://clinicaltrials.gov/ct2/show/NCT04225884?cond=NCT04225884&draw=2&rank=1, identifier: NCT04225884.

Knockdown of DAPK1 attenuates IL-1β-induced extracellular matrix degradation and inflammatory response in osteoarthritis chondrocytes via regulating the p38 MAPK-signaling pathway

OBJECTIVE

To reveal the possible effects of death-associated protein kinase 1 (DAPK1) on the progression of osteoarthritis (OA) and the potential underlying mechanism.

METHODS

: The expression of DAPK1 in OA and normal samples and interleukin (IL)-1β-stimulated chondrocytes was analyzed by quantitative real-time polymerase chain reaction and Immunoblot assay. Cell viability, proliferation, and apoptosis in DAPK1-knockdown cells stimulated with IL-1β were detected by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) solution, 5-ethynyl-2β-deoxyuridine staining and flow cytometry. The chondrocyte degradation and inflammatory response in IL-1β-induced chondrocytes were investigated by Immunoblot analysis and enzyme-linked-immunosorbent serologic assay. In addition, the effect of DAPK1 on p38 mitogen-activated protein kinase (MAPK) activation was analyzed by immunoblot assay.

RESULTS

: This study revealed that DAPK1 was highly expressed in OA patients and IL-1β-induced chondrocytes. Down-regulation of DAPK1 enhanced IL-1β-induced chondrocyte proliferation. DAPK1 knockdown inhibited IL-1β-induced chondrocyte degradation. In addition, DAPK1 depletion inhibited IL-1β-induced chondrocyte inflammation. Mechanically, it was revealed that down--regulation of DAPK1 could inhibit the p38 MAPK pathway, and therefore affected progression of OA.

CONCLUSION

: DAPK1 knockdown attenuates IL-1β-induced extracellular matrix degradation and inflammatory response in OA chondrocytes by regulating the p38 MAPK pathway.