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Ribeiro NF, Leal-Junior ECP, Johnson DS, Demchak T, Machado CM, Dias LB, DE Oliveira MF, Lino MM, Rodrigues WD, Santo J, DE Barros CN, Casalechi HL, Tomazoni SS. Photobiomodulation therapy combined with static magnetic field is better than placebo in patients with fibromyalgia: a randomized placebo-controlled trial. Eur J Phys Rehabil Med 2023; 59:754-762. [PMID: 37847246 DOI: 10.23736/s1973-9087.23.07928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Fibromyalgia is a syndrome characterized by generalized chronic pain and tenderness in specific areas. Photobiomodulation therapy (PBMT) using low-level laser therapy and/or light emitting diode therapy is an electrophysical agent that can be used alone or together with a static magnetic field (PBMT-sMF) to promote analgesia in several health conditions. Little evidence exists regarding the effects of using PBMT and PBMT-sMF in patients with fibromyalgia; this evidence is conflicting. AIM We aimed to investigate the effects of using PBMT-sMF versus a placebo on reduction of the degree-of-pain rating, impact of fibromyalgia, pain intensity, and satisfaction with treatment in patients with fibromyalgia. DESIGN A prospectively registered, monocentric, randomized placebo-controlled trial, with blinding of patients, therapists, and assessors, was performed. SETTING The study was conducted at the Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT) in Brazil, between March and October 2020. POPULATION Ninety female patients with fibromyalgia were randomized to undergo either PBMT-sMF (N.=45) or placebo (N.=45) treatment. METHODS Patients from both groups received nine treatment sessions, three times a week, for 3 weeks. Clinical outcomes were collected at baseline, the end of treatment, and at the follow-up appointment 4 weeks post-treatment. The primary outcome was the degree-of-pain rating, measured by the reduction of the tender point count. RESULTS A decrease in the degree-of-pain rating was observed in patients allocated to the PBMT-sMF group, decreasing the number of tender points when compared to placebo group at the end of treatment (P<0.0001) and at the follow-up assessment (P<0.0001). Patients did not report any adverse events. CONCLUSIONS PBMT-sMF is superior to placebo, supporting its use in patients with fibromyalgia. CLINICAL REHABILITATION IMPACT PBMT-sMF might be considered an important adjuvant to the treatment regimens of patients with fibromyalgia.
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Affiliation(s)
- Neide F Ribeiro
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil
| | - Ernesto C P Leal-Junior
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil -
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- ELJ Consultancy, São Paulo, Brazil
| | | | | | - Caroline M Machado
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil
| | - Luana B Dias
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil
| | - Marcelo F DE Oliveira
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil
| | - Matheus M Lino
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil
| | - Wesley D Rodrigues
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil
| | - Jonathan Santo
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil
| | - Carolina N DE Barros
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil
| | - Heliodora L Casalechi
- Post-Graduate Program in Rehabilitation Sciences, Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, Brazil
| | - Shaiane S Tomazoni
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Atmani K, Wuestenberghs F, Baron M, Bouleté I, Guérin C, Bahlouli W, Vaudry D, do Rego JC, Cornu JN, Leroi AM, Coëffier M, Meleine M, Gourcerol G. Bladder-colon chronic cross-sensitization involves neuro-glial pathways in male mice. World J Gastroenterol 2022; 28:6935-6949. [PMID: 36632316 PMCID: PMC9827584 DOI: 10.3748/wjg.v28.i48.6935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/02/2022] [Accepted: 10/26/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome and bladder pain syndrome often overlap and are both characterized by visceral hypersensitivity. Since pelvic organs share common sensory pathways, it is likely that those syndromes involve a cross-sensitization of the bladder and the colon. The precise pathophysiology remains poorly understood.
AIM To develop a model of chronic bladder-colon cross-sensitization and to investigate the mech-anisms involved.
METHODS Chronic cross-organ visceral sensitization was obtained in C57BL/6 mice using ultrasound-guided intravesical injections of acetic acid under brief isoflurane anesthesia. Colorectal sensitivity was assessed in conscious mice by measuring intracolonic pressure during isobaric colorectal distensions. Myeloperoxidase, used as a marker of colorectal inflammation, was measured in the colon, and colorectal permeability was measured using chambers. c-Fos protein expression, used as a marker of neuronal activation, was assessed in the spinal cord (L6-S1 level) using immunohistochemistry. Green fluorescent protein on the fractalkine receptor-positive mice were used to identify and count microglia cells in the L6-S1 dorsal horn of the spinal cord. The expression of NK1 receptors and MAPK-p38 were quantified in the spinal cord using western blot.
RESULTS Visceral hypersensitivity to colorectal distension was observed after the intravesical injection of acetic acid vs saline (P < 0.0001). This effect started 1 h post-injection and lasted up to 7 d post-injection. No increased permeability or inflammation was shown in the bladder or colon 7 d post-injection. Visceral hypersensitivity was associated with the increased expression of c-Fos protein in the spinal cord (P < 0.0001). In green fluorescent protein on the fractalkine receptor-positive mice, intravesical acetic acid injection resulted in an increased number of microglia cells in the L6-S1 dorsal horn of the spinal cord (P < 0.0001). NK1 receptor and MAPK-p38 levels were increased in the spinal cord up to 7 d after injection (P = 0.007 and 0.023 respectively). Colorectal sensitization was prevented by intrathecal or intracerebroventricular injections of minocycline, a microglia inhibitor, by intracerebroventricular injection of CP-99994 dihydrochloride, a NK1 antagonist, and by intracerebroventricular injection of SB203580, a MAPK-p38 inhibitor.
CONCLUSION We describe a new model of cross-organ visceral sensitization between the bladder and the colon in mice. Intravesical injections of acetic acid induced a long-lasting colorectal hypersensitivity to distension, mediated by neuroglial interactions, MAPK-p38 phosphorylation and the NK1 receptor.
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Affiliation(s)
- Karim Atmani
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - Fabien Wuestenberghs
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Gastroenterology and Hepatology, Université Catholique de Louvain, CHU UCL Namur, Yvoir 5530, Belgium
- Department of Physiology, CHU Rouen, Université de Rouen Normandie, Rouen 76031, France
| | - Maximilien Baron
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Urology, CHU Rouen, Université de Rouen Normandie, Rouen 76000, France
| | - Illona Bouleté
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - Charlène Guérin
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - Wafa Bahlouli
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - David Vaudry
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Inserm, UMR 1245, Team Epigenetics and Pathophysiology of Neuro-developmental Disorders, Université de Rouen Normandie, Rouen 76000, France
| | - Jean Claude do Rego
- Behavioural Analysis Platform (SCAC), HeRacLeS Inserm US51-CNRS UAR2026, Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - Jean-Nicolas Cornu
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Urology, CHU Rouen, Université de Rouen Normandie, Rouen 76000, France
| | - Anne-Marie Leroi
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Physiology, CHU Rouen, Université de Rouen Normandie, Rouen 76031, France
| | - Moïse Coëffier
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Nutrition, CHU Rouen, Université de Rouen Normandie, Rouen 76000, France
| | - Mathieu Meleine
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Inserm U1107, NeuroDol, Clermont Auvergne University, Clermont-Ferrand 63000, France
| | - Guillaume Gourcerol
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Physiology, CHU Rouen, Université de Rouen Normandie, Rouen 76031, France
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AlOmair M, AlMalki H, Sarhan L, Shweel M, Asiri A, Almhjani E, Asiri A, AlQahtani H, Rahman A, Hasan E. Fibromyalgia Concomitant with Seropositive Rheumatoid Arthritis in a Tertiary Hospital in South-Western Saudi Arabia: Prevalence and Treatment Patterns. Open Rheumatol J 2022. [DOI: 10.2174/18743129-v16-e2209290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction:
Rheumatoid arthritis (RA) patients with fibromyalgia syndrome (FMS) report worse functional status and quality of life hence the association has important clinical implications. FMS can be challenging to treat, and the current evidence recommends a multidisciplinary treatment approach focused on symptom management.
Aim:
Information regarding the current prevalence of FMS in RA patients is lacking. Thus, this study aims to address the prevalence and predictors of FMS in seropositive RA patients and demonstrate our clinical practice in the management of FMS.
Methods:
Participants’ data was gathered from Aseer central hospital (ACH) rheumatology clinics and daycare units over a period of 2 years. Subjects were assessed using the 2010 American College of Rheumatology (ACR) criteria for FMS. Data were collected from medical records, including patient demographics, comorbidities and concomitant FMS-related data.
Results:
Out of 310 seropositive RA patients, 15% (n = 47) fulfilled the diagnostic criteria for FMS. Of them, 29, 11 and 7 were on pregabalin, amitriptyline and duloxetine, respectively. Half of FMS patients showed one or more therapy changes. A significant difference between RA patients with and without concomitant FMS was observed, including age, gender and comorbidities.
Conclusion:
In this retrospective study, a high prevalence of FMS in individuals with seropositive RA was identified. This study explores real-world practice in the treatment of FMS with remarkable findings regarding underdosing and lower discontinuation rate of pregabalin.
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Fibromyalgia-associated hyperalgesia is related to psychopathological alterations but not to gut microbiome changes. PLoS One 2022; 17:e0274026. [PMID: 36149895 PMCID: PMC9506607 DOI: 10.1371/journal.pone.0274026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/20/2022] [Indexed: 11/19/2022] Open
Abstract
Fibromyalgia-syndrome (FMS) is a complex disease characterized by chronic widespread pain and additional symptoms including depression, cognitive dysfunction (“fibro-fog”) and maldigestion. Our research team examined whether FMS-related pain parameters assessed by quantitative sensory testing (QST) and psychological disturbances are accompanied by alterations of the fecal microbiome. We recruited 25 patients with FMS and 26 age- and sex-matched healthy controls. Medical background, food habits, psychopathology and quality of life were assessed through questionnaires. Stool samples were analyzed by 16S rRNA gene amplification and sequencing. QST was performed according to the protocol of the German Network for Neuropathic Pain. QST showed that both lemniscal and spinothalamic afferent pathways are altered in FMS patients relative to healthy controls and that peripheral as well as central pain sensitization processes are manifest. Psychometric assessment revealed enhanced scores of depression, anxiety and stress. In contrast, neither the composition nor the alpha- and beta-diversity of the fecal microbiome was changed in FMS patients. FMS patients segregate from healthy controls in various parameters of QST and psychopathology, but not in terms of composition and diversity of the fecal microbiome. Despite consideration of several confounding factors, we conclude that the contribution of the gut microbiome to the pathophysiology of FMS is limited.
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Relevancia y necesidades del Síndrome del Intestino Irritable (SII): comparación con la Enfermedad Inflamatoria Intestinal (EII).(Por favor, si no te interesa el SII léelo). GASTROENTEROLOGIA Y HEPATOLOGIA 2022; 45:789-798. [DOI: 10.1016/j.gastrohep.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 12/07/2022]
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Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol 2020; 16:645-660. [DOI: 10.1038/s41584-020-00506-w] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
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Bouchoucha M, Mary F, Bon C, Bejou B, Airinei G, Benamouzig R. Sleep quality and functional gastrointestinal disorders. A psychological issue. J Dig Dis 2018; 19:84-92. [PMID: 29316246 DOI: 10.1111/1751-2980.12577] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/04/2017] [Accepted: 01/04/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Sleep disorders are often associated with functional gastrointestinal disorders (FGIDs). This study aims to evaluate the association of sleep disorders with specific FGIDs and to assess the related importance of psychological disorders. METHODS We included 1009 consecutive patients with FGIDs (70.9% females). The patients completed a Rome III questionnaire and after a psychological evaluation on anxiety and depression they were classified according to their sleep disorders using a 7-point grading scale: Groups 1-3, drowsiness (severe, moderate, mild); Group 4, no change; Groups 5-7, insomnia (mild, moderate, severe). Multinomial logistic regression using sleep group as a dependent variable with no sleep change as reference and body mass index, FGIDs, anxiety and depression as independent variables were used for statistical analysis. RESULTS Altogether 667 (66.1%) patients reported changes in sleep disorders, of whom 487 (48.3%) had decreased sleep and 180 (17.8%) had increased sleep while 342 (33.9%) reported no change. Depression was lower in patients with no change in sleep pattern and increased with the severity of their sleep disorder (P < 0.001). State-anxiety is associated with moderate drowsiness (P = 0.024), while trait anxiety is associated with mild insomnia (P = 0.048). FGIDs associated with sleep disorders included chest pain, epigastric pain syndrome, irritable bowel syndrome with constipation, diarrhea, bloating, fecal incontinence and proctalgia fugax. CONCLUSION Sleep disorders are associated with FGIDs, especially in the presence of depressive symptoms.
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Affiliation(s)
- Michel Bouchoucha
- Department of Physiology, Paris V René Descartes University, Paris, France.,Department of Gastroenterology, Avicenne Hospital, Bobigny, France
| | - Florence Mary
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France
| | - Cyriaque Bon
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France
| | - Bakhtiar Bejou
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France
| | - Gheorghe Airinei
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France
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Roizenblatt M, Rosa Neto NS, Tufik S, Roizenblatt S. Pain-related diseases and sleep disorders. Braz J Med Biol Res 2012; 45:792-8. [PMID: 22760852 PMCID: PMC3854323 DOI: 10.1590/s0100-879x2012007500110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/25/2012] [Indexed: 08/30/2023] Open
Abstract
Pain and sleep share mutual relations under the influence of cognitive and neuroendocrine changes. Sleep is an important homeostatic feature and, when impaired, contributes to the development or worsening of pain-related diseases. The aim of the present review is to provide a panoramic view for the generalist physician on sleep disorders that occur in pain-related diseases within the field of Internal Medicine, such as rheumatic diseases, acute coronary syndrome, digestive diseases, cancer, and headache.
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Affiliation(s)
- M Roizenblatt
- Departamento de Psicobiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ, Perez Y, Gatchel RJ. The development and psychometric validation of the central sensitization inventory. Pain Pract 2011; 12:276-85. [PMID: 21951710 DOI: 10.1111/j.1533-2500.2011.00493.x] [Citation(s) in RCA: 491] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Central sensitization (CS) has been proposed as a common pathophysiological mechanism to explain related syndromes for which no specific organic cause can be found. The term "central sensitivity syndrome (CSS)" has been proposed to describe these poorly understood disorders related to CS. The goal of this investigation was to develop the Central Sensitization Inventory (CSI), which identifies key symptoms associated with CSSs and quantifies the degree of these symptoms. The utility of the CSI, to differentiate among different types of chronic pain patients who presumably have different levels of CS impairment, was then evaluated. Study 1 demonstrated strong psychometric properties (test-retest reliability = 0.817; Cronbach's alpha = 0.879) of the CSI in a cohort of normative subjects. A factor analysis (including both normative and chronic pain subjects) yielded 4 major factors (all related to somatic and emotional symptoms), accounting for 53.4% of the variance in the dataset. In Study 2, the CSI was administered to 4 groups: fibromyalgia (FM); chronic widespread pain without FM; work-related regional chronic low back pain (CLBP); and normative control group. Analyses revealed that the patients with FM reported the highest CSI scores and the normative population the lowest (P < 0.05). Analyses also demonstrated that the prevalence of previously diagnosed CSSs and related disorders was highest in the FM group and lowest in the normative group (P < 0.001). Taken together, these 2 studies demonstrate the psychometric strength, clinical utility, and the initial construct validity of the CSI in evaluating CS-related clinical symptoms in chronic pain populations.
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Affiliation(s)
- Tom G Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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Kohyama J. Neurochemical and neuropharmacological aspects of circadian disruptions: an introduction to asynchronization. Curr Neuropharmacol 2011; 9:330-41. [PMID: 22131941 PMCID: PMC3131723 DOI: 10.2174/157015911795596522] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 03/04/2010] [Accepted: 10/28/2010] [Indexed: 02/06/2023] Open
Abstract
Circadian disruptions are common in modern society, and there is an urgent need for effective treatment strategies. According to standard diagnostic criteria, most adolescents showing both insomnia and daytime sleepiness are diagnosed as having behavioral-induced sleep efficiency syndrome resulting from insomnia due to inadequate sleep hygiene. However, a simple intervention of adequate sleep hygiene often fails to treat them. As a solution to this clinical problem, the present review first overviews the basic neurochemical and neuropharmachological aspects of sleep and circadian rhythm regulation, then explains several circadian disruptions from similar viewpoints, and finally introduces the clinical notion of asynchronization. Asynchronization is designated to explain the pathophysiology/pathogenesis of exhibition of both insomnia and hypersomnia in adolescents, which comprises disturbances in various aspects of biological rhythms. The major triggers for asynchronization are considered to be a combination of light exposure during the night, which disturbs the biological clock and decreases melatonin secretion, as well as a lack of light exposure in the morning, which prohibits normal synchronization of the biological clock to the 24-hour cycle of the earth and decreases the activity of serotonin. In the chronic phase of asynchronization, involvement of both wake- and sleep-promoting systems is suggested. Both conventional and alternative therapeutic approaches for potential treatment of asynchronization are suggested.
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Affiliation(s)
- Jun Kohyama
- Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32 Toudaizima, Urayasu 279-0001, Japan
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Mion F, Ducrotté P. [Irritable bowel syndrome: current aspects]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2009; 33 Suppl 1:S1-S2. [PMID: 19303533 DOI: 10.1016/s0399-8320(09)71518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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