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Schrepf A, Kaplan C, Harris RE, Williams DA, Clauw DJ, As-Sanie S, Till S, Clemens JQ, Rodriguez LV, Van Bokhoven A, Landis R, Gallop R, Bradley C, Naliboff B, Pontari M, O’Donnell M, Luo Y, Kreder K, Lutgendorf SK, Harte SE. Stimulated whole-blood cytokine/chemokine responses are associated with interstitial cystitis/bladder pain syndrome phenotypes and features of nociplastic pain: a multidisciplinary approach to the study of chronic pelvic pain research network study. Pain 2023; 164:1148-1157. [PMID: 36279178 PMCID: PMC10106356 DOI: 10.1097/j.pain.0000000000002813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
ABSTRACT Interstitial cystitis/bladder pain syndrome (IC/BPS) is a common and debilitating disease with poor treatment outcomes. Studies from the multidisciplinary approach to the study of chronic pelvic pain research network established that IC/BPS patients with chronic overlapping pain conditions (COPCs) experience poorer quality of life and more severe symptoms, yet the neurobiological correlates of this subtype are largely unknown. We previously showed that ex vivo toll-like receptor 4 (TLR4) cytokine/chemokine release is associated with the presence of COPCs, as well as widespread pain and experimental pain sensitivity women with IC/BPS. Here, we attempt to confirm these findings in the multisite multidisciplinary approach to the study of chronic pelvic pain Symptom Patterns Study using TLR4-stimulated whole blood (female IC/BPS patients with COPC n = 99; without n = 36). Samples were collected in tubes preloaded with TLR4 agonist, incubated for 24 hours, and resulting supernatant assayed for 7 cytokines/chemokines. These were subject to a principal components analysis and the resulting components used as dependent variables in general linear models. Controlling for patient age, body mass index, and site of collection, we found that greater ex vivo TLR4-stimulated cytokine/chemokine release was associated with the presence of COPCs ( P < 0.01), extent of widespread pain ( P < 0.05), but not experimental pain sensitivity ( P > 0.05). However, a second component of anti-inflammatory, regulatory, and chemotactic activity was associated with reduced pain sensitivity ( P < 0.01). These results confirm that the IC/BPS + COPCs subtype show higher levels of ex vivo TLR4 cytokine/chemokine release and support a link between immune priming and nociplastic pain in IC/BPS.
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Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Chelsea Kaplan
- 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
| | - David A. Williams
- 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
| | - Sawsan As-Sanie
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Sara Till
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | | | - Larissa V. Rodriguez
- Departments of Urology and Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
| | - Adrie Van Bokhoven
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard Landis
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - Catherine Bradley
- Departments of Urology and Obstetrics & Gynecology, University of Iowa, Iowa City, IA, USA
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles CA, USA
| | - Mike Pontari
- Department of Urology, Temple University, Philadelphia, PA, USA
| | | | - Yi Luo
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Karl Kreder
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Susan K Lutgendorf
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, Urology, University of Iowa, Iowa City, IA, USA
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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Yang M, Baser RE, Li SQ, Hou YN, Chong K, Zhang YL, Hoque I, Bao T, Mao JJ. Tibetan Herbal Pain-Relieving Plaster for Chronic Musculoskeletal Pain Among Cancer Survivors: Study Protocol of a Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol 2022; 13:878371. [PMID: 35600872 PMCID: PMC9114465 DOI: 10.3389/fphar.2022.878371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic pain is common and debilitating in cancer survivors. Tibetan herbal pain-relieving plaster is used as an external analgesic to treat musculoskeletal pain in China; however, its safety and efficacy have not been evaluated via clinical trials in cancer survivors. We designed this Phase II randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT04916249) to assess the efficacy and safety of the pain-relieving plaster for temporary pain relief among cancer survivors with chronic musculoskeletal pain. Under ethical approval from the Institutional Review Board at the Memorial Sloan Kettering Cancer Center, we will enroll eligible cancer survivors who have a clinical diagnosis of moderate to severe chronic musculoskeletal pain in this study. We use a central randomization system to allocate the eligible participants to either the treatment or the control group in a 1:1 ratio, with stratification by baseline opioid use. We will instruct the participants to apply the herbal patch (Tibetree Pain-Relieving Plaster, Tibet Cheezheng Tibetan Medicine Co. Ltd., Tibet, China) or placebo patch daily at the focal area with worst pain for 14 consecutive days. Study physician, participant, outcome assessor, and biostatistician are blinded to the group allocation. The primary outcome is pain severity measured by the Brief Pain Inventory on Days 2–7. Secondary outcomes include changes in insomnia, anxiety, depression, fatigue, pressure pain threshold, pain medication use, and global impression of change. We will also monitor the adverse events throughout the study period. Statistical analysis will follow the intention-to-treat principle and linear mixed modeling will be used. With rigorous design and implementation, this randomized, placebo-controlled trial will provide the initial evidence on the efficacy and safety of the pain-relieving plaster for pain relief among cancer survivors with chronic musculoskeletal pain.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY, United States
| | - Susan Q. Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yen-Nien Hou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Kamyar Chong
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yi Lily Zhang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Irfan Hoque
- Investigational Drug Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
- *Correspondence: Jun J. Mao,
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Pierce J, Hassett AL, Brummett CM, McAfee J, Sieberg C, Schrepf A, Harte SE. Characterizing Pain and Generalized Sensory Sensitivity According to Trauma History Among Patients With Knee Osteoarthritis. Ann Behav Med 2021; 55:853-869. [PMID: 33377478 PMCID: PMC8382144 DOI: 10.1093/abm/kaaa105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood trauma and adversity have been linked to chronic pain and pain sensitivity, particularly centralized pain. Yet, there remain numerous gaps in our understanding of this link. PURPOSE We explored the association between nonviolent and violent childhood trauma and a component of centralized pain (i.e., generalized sensory sensitivity) and pain sensitivity using self-report measures of centralized pain and quantitative sensory testing (QST). METHODS Patients scheduled for a total knee arthroplasty (n = 129) completed questionnaires and QST prior to surgery. RESULTS We found that self-report measures of centralized pain (i.e., widespread pain, somatic awareness, and sensory sensitivity) displayed a graded relationship across trauma groups, with patients with a history of violent trauma reporting the highest scores. Univariable multinomial logistic regression analyses showed that higher sensory sensitivity was associated with increased risk of being in the nonviolent trauma group compared to the no trauma group. Furthermore, higher widespread pain, higher somatic awareness, and higher sensory sensitivity distinguished the violent trauma group from the no trauma group. In multivariable analyses, sensory sensitivity is uniquely distinguished between the violent trauma group and the no trauma group. QST did not distinguish between groups. CONCLUSIONS The findings highlight the need for future research and interventions that reduce sensory sensitivity for chronic pain patients with a history of violent childhood trauma.
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Affiliation(s)
- Jennifer Pierce
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Christine Sieberg
- Center for Pain and the Brain, Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
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4
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Sankarasubramanian V, Chiravuri S, Mirzakhalili E, Anaya CJ, Scott JR, Brummett CM, Clauw DJ, Patil PG, Harte SE, Lempka SF. Quantitative Sensory Testing of Spinal Cord and Dorsal Root Ganglion Stimulation in Chronic Pain Patients. Neuromodulation 2021; 24:672-684. [PMID: 33471409 DOI: 10.1111/ner.13329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/17/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES The physiological mechanisms underlying the pain-modulatory effects of clinical neurostimulation therapies, such as spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRGS), are only partially understood. In this pilot prospective study, we used patient-reported outcomes (PROs) and quantitative sensory testing (QST) to investigate the physiological effects and possible mechanisms of action of SCS and DRGS therapies. MATERIALS AND METHODS We tested 16 chronic pain patients selected for SCS and DRGS therapy, before and after treatment. PROs included pain intensity, pain-related symptoms (e.g., pain interference, pain coping, sleep interference) and disability, and general health status. QST included assessments of vibration detection theshold (VDT), pressure pain threshold (PPT) and tolerance (PPToL), temporal summation (TS), and conditioned pain modulation (CPM), at the most painful site. RESULTS Following treatment, all participants reported significant improvements in PROs (e.g., reduced pain intensity [p < 0.001], pain-related functional impairment [or pain interference] and disability [p = 0.001 for both]; better pain coping [p = 0.03], sleep [p = 0.002]), and overall health [p = 0.005]). QST showed a significant treatment-induced increase in PPT (p = 0.002) and PPToL (p = 0.011), and a significant reduction in TS (p = 0.033) at the most painful site, but showed no effects on VDT and CPM. We detected possible associations between a few QST measures and a few PROs. Notably, higher TS was associated with increased pain interference scores at pre-treatment (r = 0.772, p = 0.009), and a reduction in TS was associated with the reduction in pain interference (r = 0.669, p = 0.034) and pain disability (r = 0.690, p = 0.027) scores with treatment. CONCLUSIONS Our preliminary findings suggest significant clinical and therapeutic benefits associated with SCS and DRGS therapies, and the possible ability of these therapies to modulate pain processing within the central nervous system. Replication of our pilot findings in future, larger studies is necessary to characterize the physiological mechanisms of SCS and DRGS therapies.
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Affiliation(s)
- Vishwanath Sankarasubramanian
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Srinivas Chiravuri
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Ehsan Mirzakhalili
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Carlos J Anaya
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - John Ryan Scott
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Parag G Patil
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Neurological Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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5
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Clemens JQ, Kutch JJ, Mayer EA, Naliboff BD, Rodriguez LV, Klumpp DJ, Schaeffer AJ, Kreder KJ, Clauw DJ, Harte SE, Schrepf AD, Williams DA, Andriole GL, Lai HH, Buchwald D, Lucia MS, van Bokhoven A, Mackey S, Moldwin RM, Pontari MA, Stephens-Shields AJ, Mullins C, Landis JR. The Multidisciplinary Approach to The Study of Chronic Pelvic Pain (MAPP) Research Network*: Design and implementation of the Symptom Patterns Study (SPS). Neurourol Urodyn 2020; 39:1803-1814. [PMID: 32578257 DOI: 10.1002/nau.24423] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/29/2020] [Indexed: 11/07/2022]
Abstract
AIMS The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network initiated a second observational cohort study-the Symptom Patterns Study (SPS)-to further investigate the underlying pathophysiology of Urologic Chronic Pelvic Pain Syndrome (UCPPS) and to discover factors associated with longitudinal symptom changes and responses to treatments. METHODS This multisite cohort study of males and females with UCPPS features a run-in period of four weekly web-based symptom assessments before a baseline visit, followed by quarterly assessments up to 36 months. Controls were also recruited and assessed at baseline and 6 months. Extensive clinical data assessing urological symptoms, nonurological pain, chronic overlapping pain syndromes, and psychosocial factors were collected. Diverse biospecimens for biomarker and microbiome studies, quantitative sensory testing (QST) data under multiple stimuli, and structural and functional neuroimaging scans were obtained under a standardized protocol. RESULTS Recruitment was initiated (July 2015) and completed (February 2019) at six discovery sites. A total of 620 males and females with UCPPS and 73 Controls were enrolled, including 83 UCPPS participants who re-enrolled from the first MAPP Network cohort study (2009-2012). Baseline neuroimaging scans, QST measures, and biospecimens were obtained on 578 UCPPS participants. The longitudinal follow-up of the cohort is ongoing. CONCLUSIONS This comprehensive characterization of a large UCPPS cohort with extended follow-up greatly expands upon earlier MAPP Network studies and provides unprecedented opportunities to increase our understanding of UCPPS pathophysiology, factors associated with symptom change, clinically relevant patient phenotypes, and novel targets for future interventions.
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Affiliation(s)
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Emeran A Mayer
- Department of Medicine, David Geffen School of Medicine at The University of California, Los Angeles, California
| | - Bruce D Naliboff
- Department of Medicine, David Geffen School of Medicine at The University of California, Los Angeles, California
| | - Larissa V Rodriguez
- Departments of Urology & Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - David J Klumpp
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anthony J Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karl J Kreder
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Andrew D Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Gerald L Andriole
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - H Henry Lai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Dedra Buchwald
- Department of Epidemiology and Medicine, Washington State University Institute for Research and Education to Advance Community Health, Seattle, Washington
| | - M Scott Lucia
- Department of Pathology, University of Colorado Denver, Aurora, Colorado
| | - Adrie van Bokhoven
- Department of Pathology, University of Colorado Denver, Aurora, Colorado
| | - Sean Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pain Medicines, Stanford University School of Medicine, Stanford, California
| | - Robert M Moldwin
- Department of Urology, Hofstra University School of Medicine, The Arthur Smith Institute for Urology, New Hyde Park, New York
| | - Michel A Pontari
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Alisa J Stephens-Shields
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Mullins
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - J Richard Landis
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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6
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Quantitative assessment of nonpelvic pressure pain sensitivity in urologic chronic pelvic pain syndrome: a MAPP Research Network study. Pain 2020; 160:1270-1280. [PMID: 31050659 DOI: 10.1097/j.pain.0000000000001505] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Experimental pain sensitivity was assessed in individuals with urologic chronic pelvic pain syndrome (UCPPS) as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. A series of computer-controlled pressure stimuli were delivered to the thumbnail bed, an asymptomatic site distant from the area of UCPPS pain that is considered to be indicative of overall body pain threshold. Stimuli were rated according to a standardized magnitude estimation protocol. Pain sensitivity in participants with UCPPS was compared with healthy controls and a mixed pain group composed of individuals with other chronic overlapping pain conditions, including fibromyalgia, chronic fatigue, and irritable bowel syndromes. Data from 6 participating MAPP testing sites were pooled for analysis. Participants with UCPPS (n = 153) exhibited an intermediate pain sensitivity phenotype: they were less sensitive relative to the mixed pain group (n = 35) but significantly more sensitive than healthy controls (n = 100). Increased pain sensitivity in patients with UCPPS was associated with both higher levels of clinical pain severity and more painful body areas outside the pelvic region. Exploratory analyses in participants with UCPPS revealed that pain sensitivity increased during periods of urologic symptom flare and that less pressure pain sensitivity at baseline was associated with a greater likelihood of subsequent genitourinary pain improvement 1 year later. The finding that individuals with UCPPS demonstrate nonpelvic pain hypersensitivity that is related to clinical symptoms suggests that central nervous system mechanisms of pain amplification contribute to UCPPS.
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7
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Pressure Pain Tolerance Predicts the Success of Emotional Awareness and Expression Therapy in Patients With Fibromyalgia. Clin J Pain 2020; 36:562-566. [PMID: 32271184 DOI: 10.1097/ajp.0000000000000829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Quantitative sensory testing may help predict treatment responses in individuals with chronic pain. Our objective was to determine whether evoked pain sensitivity at baseline predicted preferential treatment responses to either emotional awareness and expression therapy (EAET) or cognitive behavioral therapy (CBT) in individuals with fibromyalgia (FM). METHODS This was a secondary analysis of a previous randomized clinical trial, in which individuals with FM were randomized to EAET, CBT, or Education as a control intervention. Only females who completed baseline and post-treatment assessments were analyzed (n=196). The primary outcome was change in overall clinical pain severity from pretreatment to posttreatment, and the primary predictor of interest was pressure pain tolerance at baseline. RESULTS Among patients with low pain tolerance at baseline (n=154), both EAET and CBT led to small but significant improvements in clinical pain severity (CBT mean=0.66, 95% confidence interval [0.24-1.07]; EAET mean=0.76 [0.34-1.17]). Conversely, in patients with normal pain tolerance (n=42), there was no significant improvement in clinical pain after CBT (0.13 [-0.88 to 1.14]), a small improvement after FM Education (0.81 [0.14-1.48]), but a much larger and statistically significant improvement after EAET (2.14 [1.23-3.04]). DISCUSSION Normal levels of pressure pain tolerance at baseline predicted greater improvement in clinical pain severity after EAET than CBT. Quantitative sensory testing may provide insights about individual responses to psychologically based therapies for individuals with chronic pain.
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8
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Urologic chronic pelvic pain syndrome: insights from the MAPP Research Network. Nat Rev Urol 2020; 16:187-200. [PMID: 30560936 DOI: 10.1038/s41585-018-0135-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Urologic chronic pelvic pain syndrome (UCPPS), which encompasses interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, is characterized by chronic pain in the pelvic region or genitalia that is often accompanied by urinary frequency and urgency. Despite considerable research, no definite aetiological risk factors or effective treatments have been identified. The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network uses a novel integrated strategy to characterize UCPPS as a systemic disorder that potentially involves multiple aetiologies. The first phase, MAPP I, included >1,000 participants who completed an intensive baseline assessment followed by a 12-month observational follow-up period. MAPP I studies showed that UCPPS pain and urinary symptoms co-vary, with only moderate correlation, and should be evaluated separately and that symptom flares are common and can differ considerably in intensity, duration and influence on quality of life. Longitudinal clinical changes in UCPPS correlated with structural and functional brain changes, and many patients experienced global multisensory hypersensitivity. Additionally, UCPPS symptom profiles were distinguishable by biological correlates, such as immune factors. These findings indicate that patients with UCPPS have objective phenotypic abnormalities and distinct biological characteristics, providing a new foundation for the study and clinical management of UCPPS.
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9
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Suzuki I, Ogawa M, Seino K, Nogawa M, Naito H, Yamakoshi KI, Tanaka S. NIR spectroscopic determination of urine components in spot urine: preliminary investigation towards optical point-of-care test. Med Biol Eng Comput 2019; 58:67-74. [PMID: 31745837 DOI: 10.1007/s11517-019-02063-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/02/2019] [Indexed: 02/06/2023]
Abstract
Presently, there is no convenient method to measure 24-h urinary Na excretion, which is an important index of daily Na intake, and 24-h urine collection involves a complex process. However, the Na-to-creatinine ratio (NCR) in spot urine has the potential to evaluate 24-h Na excretion and is useful for point-of-care testing. Thus, this study aimed to realize a near-infrared spectroscopic system to assess NCR in spot urine: (1) We attempted to estimate Na concentration using fewer than 10 wavelengths; (2) we calculated NCR using creatinine concentrations from our previous report and verified the NCR predictability. A calibration model was created using multi-linear regression analysis using 10 selected wavelengths in the range of Fourier-transform infrared spectrometer. Spot urine samples were obtained from healthy adults, and glucose powder was added to them to simulate diabetic samples. NCR was calculated using only six wavelengths, and the results confirmed the high accuracy of the estimated Na concentration even though inorganic components do not absorb near-infrared light. Our method enables to optically estimate NCR in spot urine, and it will be useful for point-of-care testing. Graphical abstract.
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Affiliation(s)
- Ikuto Suzuki
- Graduate School of Natural Science & Technology, Kanazawa University, Kanazawa, 920-1192, Japan.
| | - Mitsuhiro Ogawa
- Department of Information and Electronic Engineering, Faculty of Science and Engineering, Teikyo University, Utsunomiya, 320-8551, Japan
| | - Kimihiro Seino
- Graduate School of Natural Science & Technology, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Masamichi Nogawa
- Department of Clinical Engineering, Faculty of Health Sciences, Komatsu University, Komatsu, 923-0961, Japan
| | - Hisashi Naito
- Faculty of Frontier Engineering, Institute of Science & Engineering, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Ken-Ichi Yamakoshi
- Graduate School of Natural Science & Technology, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Shinobu Tanaka
- Faculty of Frontier Engineering, Institute of Science & Engineering, Kanazawa University, Kanazawa, 920-1192, Japan
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10
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Association Between the 2011 Fibromyalgia Survey Criteria and Multisite Pain Sensitivity in Knee Osteoarthritis. Clin J Pain 2019; 34:909-917. [PMID: 29642237 DOI: 10.1097/ajp.0000000000000619] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The present study evaluated the relationship between the 2011 American College of Rheumatology fibromyalgia (FM) survey criteria and quantitative sensory testing (QST). MATERIALS AND METHODS Patients with knee osteoarthritis scheduled to undergo knee arthroplasty completed the FM survey criteria and self-report measures assessing clinical symptoms. Patients also underwent a battery of QST procedures at the surgical knee and remote body sites, including pressure algometry, conditioned pain modulation, and temporal summation. All assessments were completed before surgery. FM survey criteria were used to calculate a continuous FM score indicating FM severity. RESULTS A total of 129 patients were analyzed. Of these, 52.7% were female, 93.8% were Caucasian, and 3.8% met the FM survey criteria for FM classification. Mean age for females (63.6 y) and males (64.7 y) was similar. Females and males differed significantly in nearly every outcome, including FM severity, clinical pain, anxiety, depression, and pressure pain sensitivity. In females, FM scores significantly correlated with pressure pain sensitivity, but not conditioned pain modulation or temporal summation, such that increased sensitivity was associated with greater FM severity at all body sites examined. In addition, as FM scores increased, the association between pain sensitivity at the surgical knee and pain sensitivity at remote body sites also increased. No relationship between FM score and QST was observed in males. DISCUSSION We demonstrated an association between diffuse hyperalgesia as measured by QST and FM severity in females with knee osteoarthritis. These results suggest that the FM survey criteria may represent a marker of pain centralization in females with potential utility in clinical decision making.
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Lai HH, Naliboff B, Liu AB, Amundsen CL, Shimony JS, Magnotta VA, Shaffer JJ, Gilliam RL, Wiseman JB, Helmuth ME, Andreev VP, Kirkali Z, Harte SE. The LURN Research Network Neuroimaging and Sensory Testing (NIST) Study: Design, protocols, and operations. Contemp Clin Trials 2018; 74:76-87. [PMID: 30248454 PMCID: PMC6203612 DOI: 10.1016/j.cct.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
The Neuroimaging and Sensory Testing (NIST) Study of the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is a cross-sectional, case-control study designed to investigate whether disrupted brain connectivity and sensory processing are associated with abnormal lower urinary tract symptoms (LUTS) in patients with overactive bladder syndrome (OAB). The NIST Study tests the hypotheses that patients with urinary urgency will demonstrate: (1) abnormal functional and structural connectivity of brain regions involved in urinary sensation on magnetic resonance imaging (MRI), and (2) hypersensitivity to painful (pressure) and non-painful (auditory) sensory stimuli on quantitative sensory testing (QST), compared to controls. Male and female adults (18 years or older) who present at one of the six participating LURN clinical centers for clinical care of their LUTS, with symptoms of urinary urgency with or without urgency urinary incontinence, are eligible to participate. The NIST Study is the largest MRI and QST study of its kind, yielding a neuroimaging and sensory testing dataset unprecedented in OAB research. Advanced multi-modal techniques are used to understand brain functional and structural connectivity, including gray matter volume, and sensory function. Unlike previous MRI studies which involved invasive catheterization and repeated cycles of non-physiologic bladder filling and emptying via a catheter, we use a water ingestion protocol to mimic more physiological bladder filling through natural diuresis. Furthermore, these data will be used in concert with other phenotyping data to improve our understanding of clinically meaningful subtypes of patients with LUTS in order to improve patient care and management outcomes.
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Affiliation(s)
- H Henry Lai
- Departments of Surgery (Urology) and Anesthesiology, Washington University in St. Louis, St. Louis, MO, United States.
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Alice B Liu
- Department of Urology, University of Washington, Seattle, WA, United States
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St Louis, St. Louis, MO, United States
| | - Vincent A Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Joseph J Shaffer
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Robin L Gilliam
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
| | | | | | - Victor P Andreev
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Steven E Harte
- Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan, Ann Arbor, MI, United States
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Williams DA. Phenotypic Features of Central Sensitization. JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH 2018; 23:e12135. [PMID: 30479469 PMCID: PMC6251410 DOI: 10.1111/jabr.12135] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The current manuscript reviews approaches for phenotyping central sensitization (CS). METHODS The manuscript covers the concept of diagnostic phenotyping, use of endophenotypes, biomarkers, and symptom clusters. Specifically, the components of CS that include general sensory sensitivity (assessed by quantitative sensory testing) and a symptom cluster denoting sleep difficulties, pain, affect, cognitive difficulties, and low energy (S.P.A.C.E.). RESULTS Each of the assessment domains are described with reference to CS and their presence in chronic overlapping pain conditions (COPCs) - conditions likely influenced by CS. CONCLUSIONS COPCs likely represent clinical diagnostic phenotypes of CS. Components of CS can also be assessed using QST or self-report instruments designed to assess single elements of CS or more general composite indices.
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Affiliation(s)
- David A Williams
- Department of Anesthesiology, University of Michigan Health System, 24 Frank Lloyd Wright Drive, P.O. Box 385, Lobby M, Ann Arbor, MI 48106
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13
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Harper DE, Ichesco E, Schrepf A, Hampson JP, Clauw DJ, Schmidt-Wilcke T, Harris RE, Harte SE. Resting Functional Connectivity of the Periaqueductal Gray Is Associated With Normal Inhibition and Pathological Facilitation in Conditioned Pain Modulation. THE JOURNAL OF PAIN 2018; 19:635.e1-635.e15. [PMID: 29360608 DOI: 10.1016/j.jpain.2018.01.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/18/2017] [Accepted: 01/03/2018] [Indexed: 12/14/2022]
Abstract
Conditioned pain modulation (CPM), a psychophysical paradigm that is commonly used to infer the integrity of endogenous pain-altering systems by observation of the effect of one noxious stimulus on another, has previously identified deficient endogenous analgesia in fibromyalgia (FM) and other chronic pain conditions. The mechanisms underlying this deficiency, be they insufficient inhibition and/or active facilitation, are largely unknown. The present cross-sectional study used a combination of behavioral CPM testing, voxel-based morphometry, and resting state functional connectivity to identify neural correlates of CPM in healthy controls (HC; n = 14) and FM patients (n = 15), and to probe for differences that could explain the pain-facilitative CPM that was observed in our patient sample. Voxel-based morphometry identified a cluster encompassing the periaqueductal gray (PAG) that contained significantly less gray matter volume in FM patients. Higher resting connectivity between this cluster and cortical pain processing regions was associated with more efficient inhibitory CPM in both groups, whereas PAG connectivity with the dorsal pons was associated with greater CPM inhibition only in HC. Greater PAG connectivity to the caudal pons/rostral medulla, which was pain-inhibitory in HC, was associated with pain facilitation in FM patients. PERSPECTIVE These findings indicate that variation in the strength of the PAG resting functional connectivity can explain some of the normal variability in CPM. In addition, pain-facilitative CPM observed in FM patients likely involves attenuation of pain inhibitory as well as amplification of pain facilitative processes in the central nervous system.
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Affiliation(s)
- Daniel E Harper
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Eric Ichesco
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Johnson P Hampson
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Tobias Schmidt-Wilcke
- Department of Neurology, St. Mauritius Therapieklinik, Meerbusch, Germany; Department of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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Duffy KJ, Flickinger KL, Kristan JT, Repine MJ, Gianforcaro A, Hasley RB, Feroz S, Rupp JM, Al-Baghli J, Pacella ML, Suffoletto BP, Callaway CW. Quantitative sensory testing measures individual pain responses in emergency department patients. J Pain Res 2017; 10:1241-1253. [PMID: 28579822 PMCID: PMC5449126 DOI: 10.2147/jpr.s132485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Refining and individualizing treatment of acute pain in the emergency department (ED) is a high priority, given that painful complaints are the most common reasons for ED visits. Few tools exist to objectively measure pain perception in the ED setting. We speculated that variation in perception of fixed painful stimuli would explain individual variation in reported pain and response to treatment among ED patients. Materials and methods In three studies, we 1) describe performance characteristics of brief quantitative sensory testing (QST) in 50 healthy volunteers, 2) test effects of 10 mg oxycodone versus placebo on QST measures in 18 healthy volunteers, and 3) measure interindividual differences in nociception and treatment responses in 198 ED patients with a painful complaint during ED treatment. QST measures adapted for use in the ED included pressure sensation threshold, pressure pain threshold (PPT), pressure pain response (PPR), and cold pain tolerance (CPT) tests. Results First, all QST measures had high inter-rater reliability and test–retest reproducibility. Second, 10 mg oxycodone reduced PPR, increased PPT, and prolonged CPT. Third, baseline PPT and PPR revealed hyperalgesia in 31 (16%) ED subjects relative to healthy volunteers. In 173 (88%) ED subjects who completed repeat testing 30 minutes after pain treatment, PPT increased and PPR decreased (Cohen’s dz 0.10–0.19). Verbal pain scores (0–10) for the ED complaint decreased by 2.2 (95% confidence intervals [CI]: 1.9, 2.6) (Cohen’s dz 0.97) but did not covary with the changes in PPT and PPR (r=0.05–0.13). Treatment effects were greatest in ED subjects with a history of treatment for anxiety or depression (Cohen’s dz 0.26–0.43) or with baseline hyperalgesia (Cohen’s dz 0.40–0.88). Conclusion QST reveals individual differences in perception of fixed painful stimuli in ED patients, including hyperalgesia. Subgroups of ED patients with hyperalgesia and psychiatric history report larger treatment effects on ED pain and QST measures.
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Affiliation(s)
- Kevin J Duffy
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katharyn L Flickinger
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey T Kristan
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melissa J Repine
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandro Gianforcaro
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca B Hasley
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Saad Feroz
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica M Rupp
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jumana Al-Baghli
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria L Pacella
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian P Suffoletto
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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de la Coba P, Bruehl S, Moreno-Padilla M, Reyes del Paso GA. Responses to Slowly Repeated Evoked Pain Stimuli in Fibromyalgia Patients: Evidence of Enhanced Pain Sensitization. PAIN MEDICINE 2017; 18:1778-1786. [DOI: 10.1093/pm/pnw361] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Supplemental Digital Content is Available in the Text. Sensitivity to visual stimuli is increased in patients with fibromyalgia and improved with administration of pregabalin. Pain can be elicited through all mammalian sensory pathways yet cross-modal sensory integration, and its relationship to clinical pain, is largely unexplored. Centralized chronic pain conditions such as fibromyalgia are often associated with symptoms of multisensory hypersensitivity. In this study, female patients with fibromyalgia demonstrated cross-modal hypersensitivity to visual and pressure stimuli compared with age- and sex-matched healthy controls. Functional magnetic resonance imaging revealed that insular activity evoked by an aversive level of visual stimulation was associated with the intensity of fibromyalgia pain. Moreover, attenuation of this insular activity by the analgesic pregabalin was accompanied by concomitant reductions in clinical pain. A multivariate classification method using support vector machines (SVM) applied to visual-evoked brain activity distinguished patients with fibromyalgia from healthy controls with 82% accuracy. A separate SVM classification of treatment effects on visual-evoked activity reliably identified when patients were administered pregabalin as compared with placebo. Both SVM analyses identified significant weights within the insular cortex during aversive visual stimulation. These data suggest that abnormal integration of multisensory and pain pathways within the insula may represent a pathophysiological mechanism in some chronic pain conditions and that insular response to aversive visual stimulation may have utility as a marker for analgesic drug development.
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17
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Abstract
BACKGROUND AND OBJECTIVES This study was designed to test whether a brief quantitative sensory testing assessment could be used to detect hyperalgesia in patients with suspected opioid-induced hyperalgesia (OIH). METHODS Twenty patients on long-term opioid therapy with suspected OIH were recruited along with 20 healthy controls. Pressure pain threshold, Pain50, a measure of intermediate suprathreshold pressure pain sensitivity, and tolerance levels were evaluated. As a secondary outcome, changes in pressure pain sensitivity after intravenous administration of placebo (saline) and fentanyl (1.5 μg/kg) were assessed. RESULTS There were no significant differences in pain measures between healthy controls and patients. However, there was an association between higher doses of opioids and having a lower pain tolerance (r = -0.46, P = 0.041) and lower Pain50 (r = -0.46, P = 0.044), which was consistent with the hypothesis. Patients on more than 100 mg oral morphine equivalents displayed decreased pressure pain tolerance compared with patients taking less than 100 mg oral morphine equivalents (P = 0.042). In addition, male patients showed a hyperalgesic response to fentanyl administration, which was significant for the Pain50 measure (P = 0.002). CONCLUSIONS Whereas there were no differences between patients suspected of having OIH and the healthy controls, the finding that higher doses of opioids were associated with more sensitivity suggests that dose might be an important factor in the development of hyperalgesia. In addition, male patients demonstrated a hyperalgesic response after a bolus of fentanyl. Future studies are needed to develop better diagnostics for detecting hyperalgesia in the clinical setting.
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19
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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] [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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20
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Schrepf A, Bradley CS, O'Donnell M, Luo Y, Harte SE, Kreder K, Lutgendorf S. Toll-like receptor 4 and comorbid pain in Interstitial Cystitis/Bladder Pain Syndrome: a multidisciplinary approach to the study of chronic pelvic pain research network study. Brain Behav Immun 2015; 49:66-74. [PMID: 25771510 PMCID: PMC4567436 DOI: 10.1016/j.bbi.2015.03.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a condition characterized by pelvic pain and urinary symptoms. Some IC/BPS patients have pain confined to the pelvic region, while others suffer widespread pain. Inflammatory processes have previously been linked to pelvic pain in IC/BPS, but their association with widespread pain in IC/BPS has not been characterized. METHODS Sixty-six women meeting criteria for IC/BPS completed self-report measures of pain as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP), collected 3days of saliva for cortisol assays, and provided blood samples. Peripheral blood mononuclear cells (PBMCs) were stimulated with Toll-like Receptor (TLR) 2 and 4 agonists and cytokines were measured in supernatant; IL-6 was also measured in plasma. Associations between inflammatory variables and the likelihood of endorsing extra-pelvic pain, or the presence of a comorbid syndrome, were tested by logistic regression and General Linear Models, respectively. A subset of patients (n=32) completed Quantitative Sensory Testing. RESULTS A one standard deviation increase in TLR-4 inflammatory response was associated with a 1.59 greater likelihood of endorsing extra-pelvic pain (p=.019). Participants with comorbid syndromes also had higher inflammatory responses to TLR-4 stimulation in PBMCs (p=.016). Lower pressure pain thresholds were marginally associated with higher TLR-4 inflammatory responses (p=.062), and significantly associated with higher IL-6 in plasma (p=.031). CONCLUSIONS TLR-4 inflammatory responses in PBMCs are a marker of widespread pain in IC/BPS, and should be explored in other conditions characterized by medically unexplained pain.
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Affiliation(s)
- Andrew Schrepf
- Department of Psychology, University of Iowa, United States
| | - Catherine S Bradley
- Department of Urology, University of Iowa, United States; Department of Obstetrics and Gynecology, University of Iowa, United States
| | | | - Yi Luo
- Department of Urology, University of Iowa, United States
| | - Steven E Harte
- Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan, United States
| | - Karl Kreder
- Department of Urology, University of Iowa, United States; Department of Obstetrics and Gynecology, University of Iowa, United States
| | - Susan Lutgendorf
- Department of Psychology, University of Iowa, United States; Department of Urology, University of Iowa, United States; Department of Obstetrics and Gynecology, University of Iowa, United States.
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Adnadjevic D, Graven-Nielsen T. Pressure algometry with a rotational fanning probe improves the detection of experimental muscle hyperalgesia. PAIN MEDICINE 2014; 16:537-43. [PMID: 25529363 DOI: 10.1111/pme.12631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Muscle hyperalgesia is typically evaluated by pressure algometry applying linear stimulation. Combining linear pressure stimulation with additional minor variations of the pressure in different directions may optimize the detection of pain sensitivity in hyperalgesic muscle. METHODS Pressure pain thresholds (PPTs) to linear pressure stimulations were assessed on the extensor carpi radialis brevis (ECRB) muscle in 18 healthy subjects with a computer-controlled pressure algometer. During constant pressure stimulation (5 seconds) equal to the PPT, rotational (45 to 180°), linear vibrational (15 to 50 Hz), or radial vibrational (5 to 25 Hz) stimulations were applied via regular and fanning rounded probes (1 cm2). The pressure pain intensity was rated on an electronic visual analogue scale (VAS). Muscle hyperalgesia was induced in nine subjects by injections of nerve growth factor (NGF) into the ECRB muscle, and isotonic saline was injected as a control condition in other nine subjects on day 0. The PPT and related pressure pain sensitivity were assessed on day -1, day +1, and day +4. RESULTS The PPT at day +1 was decreased in the NGF group compared with day -1 and the controls (P < 0.01). Preinjection (day -1) analysis showed that VAS scores were increased for rotation compared with linear stimulation alone (P < 0.001). During NGF-induced muscle, hyperalgesia linear pressure stimulation with rotation of the fanning probe induced higher VAS scores than with the regular probe within the NGF group as well as between NGF and control groups (P < 0.02). CONCLUSIONS Rotational stimulation together with pressure stimulation was more efficient than classical pressure algometry in detecting muscle hyperalgesia.
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Affiliation(s)
- Djordje Adnadjevic
- Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Adnadjevic D, Graven-Nielsen T. Vibration and rotation during biaxial pressure algometry is related with decreased and increased pain sensations. PAIN MEDICINE 2014; 15:2095-104. [PMID: 25220654 DOI: 10.1111/pme.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE During palpation, the pressure intensity and direction include minor deviations suggesting that standardized variations of the pressure intensity during pressure algometry may optimize the stimulus efficacy. This study examined the perceived pain outcome and reliability of a biaxial (bidirectional) algometer exerting rotational and vibratory stimulation on top of the basic pressure. METHODS In 24 healthy subjects, pressure pain thresholds (PPTs) were recorded with a linear pressure gradient (30 kPa/s) applied by a 1-cm(2) probe bilaterally on the tibialis anterior muscle via biaxial and handheld algometers. During constant pressure stimulation (5 seconds, 75%, 100%, 125% PPT), rotational (45°, 90°, and 180°), linear vibrational (15, 25, and 50 Hz), and radial vibrational stimulations (5, 15, and 25 Hz) were applied randomly via regular and fanning rounded probes (1 cm(2)). Subjects rated perceived pain on a 10-cm visual analogue scale on two occasions separated by 1 week period. RESULTS Repeated measures analysis of variance revealed enhanced effect of rotation angle (P < 0.001), probe (P < 0.001), and radial vibration frequency (P < 0.02), and suppressing effect of axial vibration frequency (P < 0.03) on pain perception, relative to basic pressure alone. PPT reliability of biaxial and handheld algometers showed averaged intraclass correlation coefficient of 0.94 and 0.945, and coefficient of variations of 15.4 and 13.5%, respectively. CONCLUSIONS PPT assessment and multidirectional stimulations can be exerted reliably via biaxial algometer. Linear vibrational stimulation effect on pressure pain perception verified the inhibitory interaction between simultaneous pressure stimulation of low-threshold mechanoreceptors and nociceptors, while radial vibration and rotational stimulation showed facilitatory effects.
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Affiliation(s)
- Djordje Adnadjevic
- Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Resting state connectivity correlates with drug and placebo response in fibromyalgia patients. NEUROIMAGE-CLINICAL 2014; 6:252-61. [PMID: 25379438 PMCID: PMC4215460 DOI: 10.1016/j.nicl.2014.09.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 07/08/2014] [Accepted: 09/11/2014] [Indexed: 11/21/2022]
Abstract
Fibromyalgia is a chronic pain syndrome characterized by widespread pain, fatigue, and memory and mood disturbances. Despite advances in our understanding of the underlying pathophysiology, treatment is often challenging. New research indicates that changes in functional connectivity between brain regions, as can be measured by magnetic resonance imaging (fcMRI) of the resting state, may underlie the pathogenesis of this and other chronic pain states. As such, this parameter may be able to be used to monitor changes in brain function associated with pharmacological treatment, and might also be able to predict treatment response. We performed a resting state fcMRI trial using a randomized, placebo-controlled, cross-over design to investigate mechanisms of action of milnacipran (MLN), a selective serotonin and norepinephrine reuptake inhibitor (SNRI), in fibromyalgia patients. Our aim was to identify functional connectivity patterns at baseline that would differentially predict treatment response to MLN as compared to placebo. Since preclinical studies of MLN suggest that this medication works by augmenting antinociceptive processes, we specifically investigated brain regions known to be involved in pain inhibition. 15 fibromyalgia patients completed the study, consisting of 6 weeks of drug and placebo intake (order counterbalanced) with an interspersed 2 week wash out period. As a main finding we report that reductions in clinical pain scores during MLN were associated with decreased functional connectivity between pro-nociceptive regions and antinociceptive pain regions at baseline, specifically between the rostral part of the anterior cingulate cortex (ACC) and the insular cortex (IC), as well as between the periaqueductal gray (PAG) and the IC: patients with lower preexisting functional connectivity had the greatest reduction in clinical pain. This pattern was not observed for the placebo period. However a more robust placebo response was associated with lower baseline functional connectivity between the ACC and the dorsolateral prefrontal cortex. This study indicates that ACC–IC connectivity might play a role in the mechanism of action of MLN, and perhaps more importantly fcMRI might be a useful tool to predict pharmacological treatment response. Resting brain connectivity predicts clinical pain response to milnacipran. Different brain connectivity patterns predicted response to placebo treatment. Personalized analgesic therapy may be facilitated by brain imaging.
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Key Words
- 5-HT, serotonin
- ACC, anterior cingulate cortex
- BPI, brief pain inventory
- CNS, central nervous system
- Chronic pain
- DLPFC, dorsolateral prefrontal cortex
- DMN, default mode network
- FEW, family wise error
- Fibromyalgia
- Functional connectivity
- IC, insular cortex
- IPL, inferior parietal lobule
- MCC, mid-cingulate cortex
- MLN, milnacipran
- NE, norepinephrine
- PAG, periaqueductal gray
- PCC, posterior cingulate cortex
- QST, quantitative sensory testing
- SNRI
- SNRI, selective serotonin and norepinephrine reuptake inhibitor
- SPM, statistical parametric mapping
- TMS, transcranial magnetic stimulation
- fMRI
- fMRI, functional magnetic resonance imaging
- fcMRI, functional connectivity magnetic resonance imaging
- rs-fc, resting state functional connectivity
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Landis JR, Williams DA, Lucia MS, Clauw DJ, Naliboff BD, Robinson NA, van Bokhoven A, Sutcliffe S, Schaeffer AJ, Rodriguez LV, Mayer EA, Lai HH, Krieger JN, Kreder KJ, Afari N, Andriole GL, Bradley CS, Griffith JW, Klumpp DJ, Hong BA, Lutgendorf SK, Buchwald D, Yang CC, Mackey S, Pontari MA, Hanno P, Kusek JW, Mullins C, Clemens JQ. The MAPP research network: design, patient characterization and operations. BMC Urol 2014; 14:58. [PMID: 25085119 PMCID: PMC4126395 DOI: 10.1186/1471-2490-14-58] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/23/2014] [Indexed: 12/30/2022] Open
Abstract
Background The “Multidisciplinary Approach to the Study of Chronic Pelvic Pain” (MAPP) Research Network was established by the NIDDK to better understand the pathophysiology of urologic chronic pelvic pain syndromes (UCPPS), to inform future clinical trials and improve clinical care. The evolution, organization, and scientific scope of the MAPP Research Network, and the unique approach of the network’s central study and common data elements are described. Methods The primary scientific protocol for the Trans-MAPP Epidemiology/Phenotyping (EP) Study comprises a multi-site, longitudinal observational study, including bi-weekly internet-based symptom assessments, following a comprehensive in-clinic deep-phenotyping array of urological symptoms, non-urological symptoms and psychosocial factors to evaluate men and women with UCPPS. Healthy controls, matched on sex and age, as well as “positive” controls meeting the non-urologic associated syndromes (NUAS) criteria for one or more of the target conditions of Fibromyalgia (FM), Chronic Fatigue Syndrome (CFS) or Irritable Bowel Syndrome (IBS), were also evaluated. Additional, complementary studies addressing diverse hypotheses are integrated into the Trans-MAPP EP Study to provide a systemic characterization of study participants, including biomarker discovery studies of infectious agents, quantitative sensory testing, and structural and resting state neuroimaging and functional neurobiology studies. A highly novel effort to develop and assess clinically relevant animal models of UCPPS was also undertaken to allow improved translation between clinical and mechanistic studies. Recruitment into the central study occurred at six Discovery Sites in the United States, resulting in a total of 1,039 enrolled participants, exceeding the original targets. The biospecimen collection rate at baseline visits reached nearly 100%, and 279 participants underwent common neuroimaging through a standardized protocol. An extended follow-up study for 161 of the UCPPS participants is ongoing. Discussion The MAPP Research Network represents a novel, comprehensive approach to the study of UCPPS, as well as other concomitant NUAS. Findings are expected to provide significant advances in understanding UCPPS pathophysiology that will ultimately inform future clinical trials and lead to improvements in patient care. Furthermore, the structure and methodologies developed by the MAPP Network provide the foundation upon which future studies of other urologic or non-urologic disorders can be based. Trial registration ClinicalTrials.gov identifier: NCT01098279 “Chronic Pelvic Pain Study of Individuals with Diagnoses or Symptoms of Interstitial Cystitis and/or Chronic Prostatitis (MAPP-EP)”. http://clinicaltrials.gov/show/NCT01098279
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Quentin Clemens
- Department of Urology, Division of Neurourology and Pelvic Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA.
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Moloney TM, Witney AG. Pressure pain thresholds increase after preconditioning 1 Hz repetitive transcranial magnetic stimulation with transcranial direct current stimulation. PLoS One 2014; 9:e92540. [PMID: 24658333 PMCID: PMC3962424 DOI: 10.1371/journal.pone.0092540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 02/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The primary motor cortex (M1) is an effective target of non-invasive cortical stimulation (NICS) for pain threshold modulation. It has been suggested that the initial level of cortical excitability of M1 plays a key role in the plastic effects of NICS. OBJECTIVE Here we investigate whether transcranial direct current stimulation (tDCS) primed 1 Hz repetitive transcranial magnetic stimulation (rTMS) modulates experimental pressure pain thresholds and if this is related to observed alterations in cortical excitability. METHOD 15 healthy, male participants received 10 min 1 mA anodal, cathodal and sham tDCS to the left M1 before 15 min 1 Hz rTMS in separate sessions over a period of 3 weeks. Motor cortical excitability was recorded at baseline, post-tDCS priming and post-rTMS through recording motor evoked potentials (MEPs) from right FDI muscle. Pressure pain thresholds were determined by quantitative sensory testing (QST) through a computerized algometer, on the palmar thenar of the right hand pre- and post-stimulation. RESULTS Cathodal tDCS-primed 1 Hz-rTMS was found to reverse the expected suppressive effect of 1 Hz rTMS on cortical excitability; leading to an overall increase in activity (p<0.001) with a parallel increase in pressure pain thresholds (p<0.01). In contrast, anodal tDCS-primed 1 Hz-rTMS resulted in a corresponding decrease in cortical excitability (p<0.05), with no significant effect on pressure pain. CONCLUSION This study demonstrates that priming the M1 before stimulation of 1 Hz-rTMS modulates experimental pressure pain thresholds in a safe and controlled manner, producing a form of analgesia.
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Affiliation(s)
- Tonya M. Moloney
- Department of Physiology, Trinity College Institute of Neuroscience and Trinity Centre for BioEngineering, Trinity College, Dublin, Ireland
| | - Alice G. Witney
- Department of Physiology, Trinity College Institute of Neuroscience and Trinity Centre for BioEngineering, Trinity College, Dublin, Ireland
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