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Kawka M, Lucas A, Riad AM, Hawkins D, de Madaria E, West H, Jakaityte I, Lee MJ, Kouli O, Ruanne R, Gujjuri RR, Brown S, Cambridge WA, Pandanaboyana S, Kamarajah SK, McLean KA. Quality of life instruments in acute and chronic pancreatitis: a consensus-based standards for the selection of health measurement instruments (COSMIN) approach. HPB (Oxford) 2024:S1365-182X(24)01260-7. [PMID: 38735815 DOI: 10.1016/j.hpb.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Pancreatitis is a common surgical emergency, associated with pain and poor quality of life for patients. However, assessment of patient-reported outcome measures in these patients is unclear. This study aimed to identify and evaluate the methodological quality of the health-related quality of life instruments used for patients with acute or chronic pancreatitis. METHODS Prospective studies that evaluated health-related quality of life in acute or chronic pancreatitis were identified from systematic review of MEDLINE, EMBASE, and Web of Science until 28th June 2023 (PROSPERO: CRD42021274743). Instrument characteristics were extracted, and methodological quality assessed using COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) guidelines and GRADE approach. Narrative synthesis was conducted, with recommendations for use based on COSMIN criteria, evaluated according to World Health Organisation (WHO) quality of life domains. RESULTS From 3850 records screened, 41 quality of life instruments were identified across 138 studies included. The majority (69.8%, n = 26) were designed to assess general health-related quality of life, whereas the remainder were abdominal-specific (n = 5) or pancreas-specific (n = 10). Only ten instruments (24.3%) demonstrated sufficient content validity, incorporating items in ≥5 WHO quality of life domains. However, only nine instruments (21.9%) incorporated public and patient involvement. Only the Gastrointestinal Quality of Life Index and PAN-PROMISE met the criteria to be recommended for use based on COSMIN methodological assessment. CONCLUSION There is significant heterogeneity in instruments used to assess quality of life after pancreatitis, with almost all instruments considered insufficient. Robust, validated, and relevant instruments are needed to better understand and determine appropriate interventions to improve quality of life for these patients.
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Mari T, Henderson J, Ali SH, Hewitt D, Brown C, Stancak A, Fallon N. Machine learning and EEG can classify passive viewing of discrete categories of visual stimuli but not the observation of pain. BMC Neurosci 2023; 24:50. [PMID: 37715119 PMCID: PMC10504739 DOI: 10.1186/s12868-023-00819-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023] Open
Abstract
Previous studies have demonstrated the potential of machine learning (ML) in classifying physical pain from non-pain states using electroencephalographic (EEG) data. However, the application of ML to EEG data to categorise the observation of pain versus non-pain images of human facial expressions or scenes depicting pain being inflicted has not been explored. The present study aimed to address this by training Random Forest (RF) models on cortical event-related potentials (ERPs) recorded while participants passively viewed faces displaying either pain or neutral expressions, as well as action scenes depicting pain or matched non-pain (neutral) scenarios. Ninety-one participants were recruited across three samples, which included a model development group (n = 40) and a cross-subject validation group (n = 51). Additionally, 25 participants from the model development group completed a second experimental session, providing a within-subject temporal validation sample. The analysis of ERPs revealed an enhanced N170 component in response to faces compared to action scenes. Moreover, an increased late positive potential (LPP) was observed during the viewing of pain scenes compared to neutral scenes. Additionally, an enhanced P3 response was found when participants viewed faces displaying pain expressions compared to neutral expressions. Subsequently, three RF models were developed to classify images into faces and scenes, neutral and pain scenes, and neutral and pain expressions. The RF model achieved classification accuracies of 75%, 64%, and 69% for cross-validation, cross-subject, and within-subject classifications, respectively, along with reasonably calibrated predictions for the classification of face versus scene images. However, the RF model was unable to classify pain versus neutral stimuli above chance levels when presented with subsequent tasks involving images from either category. These results expand upon previous findings by externally validating the use of ML in classifying ERPs related to different categories of visual images, namely faces and scenes. The results also indicate the limitations of ML in distinguishing pain and non-pain connotations using ERP responses to the passive viewing of visually similar images.
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Affiliation(s)
- Tyler Mari
- Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Jessica Henderson
- Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - S Hasan Ali
- Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Danielle Hewitt
- Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Christopher Brown
- Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Andrej Stancak
- Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Nicholas Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, 2.21 Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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Marinkovic K, Woodruff D, White DR, Caudle MM, Cronan T. Neural indices of multimodal sensory and autonomic hyperexcitability in fibromyalgia. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 14:100140. [PMID: 38033709 PMCID: PMC10687342 DOI: 10.1016/j.ynpai.2023.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 12/02/2023]
Abstract
Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain and psychological distress. Research suggests people with FM experience increased somatosensory sensitization which generalizes to other sensory modalities and may indicate neural hyperexcitability. However, the available evidence is limited, and studies including measures of neural responsivity across sensory domains and both central and peripheral aspects of the neuraxis are lacking. Thirty-nine participants (51.5 ± 13.6 years of age) with no history of neurological disorders, psychosis, visual, auditory, or learning deficits, were recruited for this study. People with FM (N = 19) and control participants (CNT, N = 20) did not differ on demographic variables and cognitive capacity. Participants completed a task that combined innocuous auditory stimuli with electrocutaneous stimulation (ECS), delivered at individually-selected levels that were uncomfortable but not painful. Event-related potentials (ERPs) and electrodermal activity were analyzed to examine the central and sympathetic indices of neural responsivity. FM participants reported greater sensitivity to ECS and auditory stimulation, as well as higher levels of depression, anxiety, ADHD, and an array of pain-related experiences than CNT. In response to ECS, the P50 deflection was greater in FM than CNT participants, reflecting early somatosensory hyperexcitability. The P50 amplitude was positively correlated with the FM profile factor obtained with a principal component analysis. The N100 to innocuous tones and sympathetic reactivity to ECS were greater in FM participants, except in the subgroup treated with gabapentinoids, which aligns with previous evidence of symptomatic improvement with GABA-mimetic medications. These results support the principal tenet of generalized neural hyperexcitability in FM and provide preliminary mechanistic insight into the impact of GABA-mimetic pharmacological therapy on ameliorating the neural excitation dominance.
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Affiliation(s)
- Ksenija Marinkovic
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr., San Diego, CA 92182, USA
- Department of Radiology, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Denali Woodruff
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
| | - David R. White
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
| | - Morgan M. Caudle
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr., San Diego, CA 92182, USA
| | - Terry Cronan
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr., San Diego, CA 92182, USA
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Rockholt MM, Kenefati G, Doan LV, Chen ZS, Wang J. In search of a composite biomarker for chronic pain by way of EEG and machine learning: where do we currently stand? Front Neurosci 2023; 17:1186418. [PMID: 37389362 PMCID: PMC10301750 DOI: 10.3389/fnins.2023.1186418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/12/2023] [Indexed: 07/01/2023] Open
Abstract
Machine learning is becoming an increasingly common component of routine data analyses in clinical research. The past decade in pain research has witnessed great advances in human neuroimaging and machine learning. With each finding, the pain research community takes one step closer to uncovering fundamental mechanisms underlying chronic pain and at the same time proposing neurophysiological biomarkers. However, it remains challenging to fully understand chronic pain due to its multidimensional representations within the brain. By utilizing cost-effective and non-invasive imaging techniques such as electroencephalography (EEG) and analyzing the resulting data with advanced analytic methods, we have the opportunity to better understand and identify specific neural mechanisms associated with the processing and perception of chronic pain. This narrative literature review summarizes studies from the last decade describing the utility of EEG as a potential biomarker for chronic pain by synergizing clinical and computational perspectives.
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Affiliation(s)
- Mika M. Rockholt
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - George Kenefati
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Lisa V. Doan
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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Zebhauser PT, Hohn VD, Ploner M. Resting-state electroencephalography and magnetoencephalography as biomarkers of chronic pain: a systematic review. Pain 2023; 164:1200-1221. [PMID: 36409624 PMCID: PMC10184564 DOI: 10.1097/j.pain.0000000000002825] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Abstract
ABSTRACT Reliable and objective biomarkers promise to improve the assessment and treatment of chronic pain. Resting-state electroencephalography (EEG) is broadly available, easy to use, and cost efficient and, therefore, appealing as a potential biomarker of chronic pain. However, results of EEG studies are heterogeneous. Therefore, we conducted a systematic review (PROSPERO CRD42021272622) of quantitative resting-state EEG and magnetoencephalography (MEG) studies in adult patients with different types of chronic pain. We excluded populations with severe psychiatric or neurologic comorbidity. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Semiquantitative data synthesis was conducted using modified albatross plots. We included 76 studies after searching MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and EMBASE. For cross-sectional studies that can serve to develop diagnostic biomarkers, we found higher theta and beta power in patients with chronic pain than in healthy participants. For longitudinal studies, which can yield monitoring and/or predictive biomarkers, we found no clear associations of pain relief with M/EEG measures. Similarly, descriptive studies that can yield diagnostic or monitoring biomarkers showed no clear correlations of pain intensity with M/EEG measures. Risk of bias was high in many studies and domains. Together, this systematic review synthesizes evidence on how resting-state M/EEG might serve as a diagnostic biomarker of chronic pain. Beyond, this review might help to guide future M/EEG studies on the development of pain biomarkers.
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Affiliation(s)
- Paul Theo Zebhauser
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Vanessa D. Hohn
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Markus Ploner
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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Ramalingam V, Cheong SK, Lee PF. Study of EEG alpha wave response on the effects of video-guided deep breathing on pain rehabilitation. Technol Health Care 2023; 31:37-46. [PMID: 35723127 DOI: 10.3233/thc-213531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Athletes with chronic ankle pain (CAP) are more inclined to suffer from physical and psychological pain depending on the severity of the injuries, which might trigger the powerless feeling on future sports participation. Therefore, an efficient and simple method is useful to integrate into conventional physiotherapy (CP) for maintaining mental wellness. OBJECTIVE This research aimed to verify the effects and progress of video-guided deep breathing (DB) integrated into CP through study on the changes of alpha waves and pain scale. METHODS Alpha waves were recorded using an electroencephalogram (EEG) and a visual analogue scale (VAS) to assess pain intensity before and after the intervention (6 weeks). Thirty CAP participants were recruited and randomly assigned to two groups: group A for video-guided DB integration into their CP and group B for CP. The effects of pre and post intervention were analyzed using a paired t-test with statistical significance set at p< 0.05. RESULTS Profound results from the research have shown that the participants who received both the DB+CP revealed a significant increase in alpha wave (p< 0.05) at occipital region. CONCLUSION The significant result reveals an increase in alpha waves in the occipital region after 6 weeks and indicates that the video-guided DB with a smartphone application is able to produce a change in CAP participants. This supports the DB integration to the CP for altering the pain perception.
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Affiliation(s)
| | - Soon Keng Cheong
- Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Bandar Sungai Long, Kajang, Selangor, Malaysia
| | - Poh Foong Lee
- Lee Kong Chian Faculty of Engineering and Science, University Tunku Abdul Rahman, Bandar Sungai Long, Kajang, Selangor, Malaysia
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Electroencephalographic characteristics of children and adolescents with chronic musculoskeletal pain. Pain Rep 2022; 7:e1054. [PMID: 36601627 PMCID: PMC9788982 DOI: 10.1097/pr9.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The pathophysiology of pediatric musculoskeletal (MSK) pain is unclear, contributing to persistent challenges to its management. Objectives This study hypothesizes that children and adolescents with chronic MSK pain (CPs) will show differences in electroencephalography (EEG) features at rest and during thermal pain modalities when compared with age-matched controls. Methods One hundred forty-two CP patients and 45 age-matched healthy controls (HCs) underwent a standardized thermal tonic heat and cold stimulations, while a 21-electrode headset collected EEG data. Cohorts were compared with respect to their EEG features of spectral power, peak frequency, permutation entropy, weight phase-lag index, directed phase-lag index, and node degree at 4 frequency bands, namely, delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz), at rest and during the thermal conditions. Results At rest, CPs showed increased global delta (P = 0.0493) and beta (P = 0.0002) power in comparison with HCs. These findings provide further impetus for the investigation and prevention of long-lasting developmental sequalae of early life chronic pain processes. Although no cohort differences in pain intensity scores were found during the thermal pain modalities, CPs and HCs showed significant difference in changes in EEG spectral power, peak frequency, permutation entropy, and network functional connectivity at specific frequency bands (P < 0.05) during the tonic heat and cold stimulations. Conclusion This suggests that EEG can characterize subtle differences in heat and cold pain sensitivity in CPs. The complementation of EEG and evoked pain in the clinical assessment of pediatric chronic MSK pain can better detect underlying pain mechanisms and changes in pain sensitivity.
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Kumar P, Abubakar AA, Sazili AQ, Kaka U, Goh YM. Application of Electroencephalography in Preslaughter Management: A Review. Animals (Basel) 2022; 12:ani12202857. [PMID: 36290243 PMCID: PMC9597730 DOI: 10.3390/ani12202857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/16/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Electroencephalography (EEG) can be reliable for assessing the brain’s electrical activity of preslaughter stress and pain. The duration between the ventral neck cut and induction of a state of unconsciousness/insensibility is crucial in the slaughtering of animals, reducing pain, fear, and distress. Various EEG variables, such as median frequency (F50), the total power of EEG spectrum (Ptot), waves patterns (amplitude and frequencies), epileptiform EEG, index of consciousness, and isoelectric EEG, are used to identify a valid indicator of the state of unconsciousness. Association among various behavioral, physiological, and hematological parameters with EEG variables could provide an overall assessment and deep insights into the animal stress levels or welfare status during various managemental and preslaughter operations, such as transport, stunning, and slaughtering operations. The application of EEG could help in further refining the stunning technologies and slaughter protocols in livestock, poultry, and fish. The present review analyzed the application of EEG as a neurophysiological tool for assessing animal welfare during the critical state of preslaughter handling and slaughter, thus ensuring proper compliance with animal welfare principles.
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Affiliation(s)
- Pavan Kumar
- Institute of Tropical Agriculture and Food Security, Universiti Putra Malaysia, Serdang 43400, Malaysia
- Department of Livestock Products Technology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, India
| | - Ahmed A. Abubakar
- Institute of Tropical Agriculture and Food Security, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Awis Qurni Sazili
- Department of Animal Science, Faculty of Agriculture, Universiti Putra Malaysia, Serdang 43400, Malaysia
- Halal Products Research Institute, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Ubedullah Kaka
- Halal Products Research Institute, Universiti Putra Malaysia, Serdang 43400, Malaysia
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang 43400, Malaysia
- Correspondence: (U.K.); (Y.-M.G.)
| | - Yong-Meng Goh
- Department of Veterinary Preclinical Sciences, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang 43400, Malaysia
- Correspondence: (U.K.); (Y.-M.G.)
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Resting-state occipital alpha power is associated with treatment outcome in patients with chronic migraine. Pain 2022; 163:1324-1334. [PMID: 35708466 DOI: 10.1097/j.pain.0000000000002516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/05/2021] [Indexed: 01/03/2023]
Abstract
ABSTRACT Preventive treatment is crucial for patients with chronic migraine (CM). This study explored the association between resting-state cortical oscillations and 3-month treatment outcome in patients with CM. Treatment-naïve patients with CM were recruited with their demographic data, psychosocial data, and headache profiles as well as the healthy controls (HCs). Resting-state cortical activities were recorded using an electroencephalogram and analysed using source-based and electrode-based spectral power method. The regions of interest were the bilateral primary somatosensory (S1) and visual (V1) cortices. After 3-month treatment with flunarizine, patients with CM were categorized into responders and nonresponders. Demographic, clinical, and electroencephalogram data from 72 patients with CM and 50 HCs were analysed. Elevated anxiety, depression, and stress were observed in patients with CM. Theta power in bilateral S1 and alpha and gamma powers in the right S1 increased in patients with CM. Nonresponders (n = 34) exhibited larger alpha powers in bilateral V1 than those in responders (n = 38). Alpha powers also exhibited significant correlations with changes of monthly headache days. Notably, in responders and nonresponders, occipital alpha powers did not differ at baseline and in the third month. In conclusion, patients with CM who were not responsive to preventive treatment were associated with augmented resting-state occipital alpha activity. Moreover, changes in migraine attack frequency were associated with baseline occipital alpha power. However, the prognostic feature of visual alpha oscillation seems to be inherent because it is not altered by flunarizine treatment. These findings may be useful for developing personalised migraine treatment plans.
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Wei M, Liao Y, Liu J, Li L, Huang G, Huang J, Li D, Xiao L, Zhang Z. EEG Beta-Band Spectral Entropy Can Predict the Effect of Drug Treatment on Pain in Patients With Herpes Zoster. J Clin Neurophysiol 2022; 39:166-173. [PMID: 32675727 DOI: 10.1097/wnp.0000000000000758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medication is the main approach for early treatment of herpes zoster, but it could be ineffective in some patients. It is highly desired to predict the medication responses to control the degree of pain for herpes zoster patients. The present study is aimed to elucidate the relationship between medication outcome and neural activity using EEG and to establish a machine learning model for early prediction of the medication responses from EEG. METHODS The authors acquired and analyzed eye-closed resting-state EEG data 1 to 2 days after medication from 70 herpes zoster patients with different drug treatment outcomes (measured 5-6 days after medication): 45 medication-sensitive pain patients and 25 medication-resistant pain patients. EEG power spectral entropy of each frequency band was compared at each channel between medication-sensitive pain and medication-resistant pain patients, and those features showing significant difference between two groups were used to predict medication outcome with different machine learning methods. RESULTS Medication-sensitive pain patients showed significantly weaker beta-band power spectral entropy in the central-parietal regions than medication-resistant pain patients. Based on these EEG power spectral entropy features and a k-nearest neighbors classifier, the medication outcome can be predicted with 80% ± 11.7% accuracy, 82.5% ± 14.7% sensitivity, 77.7% ± 27.3% specificity, and an area under the receiver operating characteristic curve of 0.85. CONCLUSIONS EEG beta-band power spectral entropy in the central-parietal region is predictive of the effectiveness of drug treatment on herpes zoster patients, and it could potentially be used for early pain management and therapeutic prognosis.
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Affiliation(s)
- Mengying Wei
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
| | - Yuliang Liao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, China; and
| | - Jia Liu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
| | - Linling Li
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
| | - Gan Huang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
| | - Jiabin Huang
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, China; and
| | - Disen Li
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, China; and
| | - Lizu Xiao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, China; and
| | - Zhiguo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
- Peng Cheng Laboratory, Shenzhen, China
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Zhang Z, Gewandter JS, Geha P. Brain Imaging Biomarkers for Chronic Pain. Front Neurol 2022; 12:734821. [PMID: 35046881 PMCID: PMC8763372 DOI: 10.3389/fneur.2021.734821] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
The prevalence of chronic pain has reached epidemic levels. In addition to personal suffering chronic pain is associated with psychiatric and medical co-morbidities, notably substance misuse, and a huge a societal cost amounting to hundreds of billions of dollars annually in medical cost, lost wages, and productivity. Chronic pain does not have a cure or quantitative diagnostic or prognostic tools. In this manuscript we provide evidence that this situation is about to change. We first start by summarizing our current understanding of the role of the brain in the pathogenesis of chronic pain. We particularly focus on the concept of learning in the emergence of chronic pain, and the implication of the limbic brain circuitry and dopaminergic signaling, which underly emotional learning and decision making, in this process. Next, we summarize data from our labs and from other groups on the latest brain imaging findings in different chronic pain conditions focusing on results with significant potential for translation into clinical applications. The gaps in the study of chronic pain and brain imaging are highlighted in throughout the overview. Finally, we conclude by discussing the costs and benefits of using brain biomarkers of chronic pain and compare to other potential markers.
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Affiliation(s)
- Zhengwu Zhang
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer S Gewandter
- Anesthesiology and Perioperative Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Paul Geha
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Del Monte Neuroscience Institute, University of Rochester, Rochester, NY, United States
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Mari T, Henderson J, Maden M, Nevitt S, Duarte R, Fallon N. Systematic Review of the Effectiveness of Machine Learning Algorithms for Classifying Pain Intensity, Phenotype or Treatment Outcomes Using Electroencephalogram Data. THE JOURNAL OF PAIN 2021; 23:349-369. [PMID: 34425248 DOI: 10.1016/j.jpain.2021.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
Recent attempts to utilize machine learning (ML) to predict pain-related outcomes from Electroencephalogram (EEG) data demonstrate promising results. The primary aim of this review was to evaluate the effectiveness of ML algorithms for predicting pain intensity, phenotypes or treatment response from EEG. Electronic databases MEDLINE, EMBASE, Web of Science, PsycINFO and The Cochrane Library were searched. A total of 44 eligible studies were identified, with 22 presenting attempts to predict pain intensity, 15 investigating the prediction of pain phenotypes and seven assessing the prediction of treatment response. A meta-analysis was not considered appropriate for this review due to heterogenos methods and reporting. Consequently, data were narratively synthesized. The results demonstrate that the best performing model of the individual studies allows for the prediction of pain intensity, phenotypes and treatment response with accuracies ranging between 62 to 100%, 57 to 99% and 65 to 95.24%, respectively. The results suggest that ML has the potential to effectively predict pain outcomes, which may eventually be used to assist clinical care. However, inadequate reporting and potential bias reduce confidence in the results. Future research should improve reporting standards and externally validate models to decrease bias, which would increase the feasibility of clinical translation. PERSPECTIVE: This systematic review explores the state-of-the-art machine learning methods for predicting pain intensity, phenotype or treatmentresponse from EEG data. Results suggest that machine learning may demonstrate clinical utility, pending further research and development. Areas for improvement, including standardized processing, reporting and the need for better methodological assessment tools, are discussed.
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Affiliation(s)
- Tyler Mari
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | | | - Michelle Maden
- Department of Health Data Science, Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Health Data Science, Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rui Duarte
- Department of Health Data Science, Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychology, University of Liverpool, Liverpool, UK
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Mouraux A, Bloms-Funke P, Boesl I, Caspani O, Chapman SC, Di Stefano G, Finnerup NB, Garcia-Larrea L, Goetz M, Kostenko A, Pelz B, Pogatzki-Zahn E, Schubart K, Stouffs A, Truini A, Tracey I, Troconiz IF, Van Niel J, Vela JM, Vincent K, Vollert J, Wanigasekera V, Wittayer M, Phillips KG, Treede RD. IMI2-PainCare-BioPain-RCT3: a randomized, double-blind, placebo-controlled, crossover, multi-center trial in healthy subjects to investigate the effects of lacosamide, pregabalin, and tapentadol on biomarkers of pain processing observed by electroencephalography (EEG). Trials 2021; 22:404. [PMID: 34140041 PMCID: PMC8212499 DOI: 10.1186/s13063-021-05272-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background IMI2-PainCare-BioPain-RCT3 is one of four similarly designed clinical studies aiming at profiling a set of functional biomarkers of drug effects on the nociceptive system that could serve to accelerate the future development of analgesics, by providing a quantitative understanding between drug exposure and effects of the drug on nociceptive signal processing in human volunteers. IMI2-PainCare-BioPain-RCT3 will focus on biomarkers derived from non-invasive electroencephalographic (EEG) measures of brain activity. Methods This is a multisite single-dose, double-blind, randomized, placebo-controlled, 4-period, 4-way crossover, pharmacodynamic (PD) and pharmacokinetic (PK) study in healthy subjects. Biomarkers derived from scalp EEG measurements (laser-evoked brain potentials [LEPs], pinprick-evoked brain potentials [PEPs], resting EEG) will be obtained before and three times after administration of three medications known to act on the nociceptive system (lacosamide, pregabalin, tapentadol) and placebo, given as a single oral dose in separate study periods. Medication effects will be assessed concurrently in a non-sensitized normal condition and a clinically relevant hyperalgesic condition (high-frequency electrical stimulation of the skin). Patient-reported outcomes will also be collected. A sequentially rejective multiple testing approach will be used with overall alpha error of the primary analysis split between LEP and PEP under tapentadol. Remaining treatment arm effects on LEP or PEP or effects on EEG are key secondary confirmatory analyses. Complex statistical analyses and PK-PD modeling are exploratory. Discussion LEPs and PEPs are brain responses related to the selective activation of thermonociceptors and mechanonociceptors. Their amplitudes are dependent on the responsiveness of these nociceptors and the state of the pathways relaying nociceptive input at the level of the spinal cord and brain. The magnitude of resting EEG oscillations is sensitive to changes in brain network function, and some modulations of oscillation magnitude can relate to perceived pain intensity, variations in vigilance, and attentional states. These oscillations can also be affected by analgesic drugs acting on the central nervous system. For these reasons, IMI2-PainCare-BioPain-RCT3 hypothesizes that EEG-derived measures can serve as biomarkers of target engagement of analgesic drugs for future Phase 1 clinical trials. Phase 2 and 3 clinical trials could also benefit from these tools for patient stratification. Trial registration This trial was registered 25/06/2019 in EudraCT (2019%2D%2D001204-37).
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Affiliation(s)
- André Mouraux
- Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium.
| | - Petra Bloms-Funke
- Translational Science & Intelligence, Grünenthal GmbH, Aachen, Germany
| | - Irmgard Boesl
- Clinical Science Development, Grünenthal GmbH, Aachen, Germany
| | - Ombretta Caspani
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | | | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Luis Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | | | - Anna Kostenko
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | | | | | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Iñaki F Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | | | - Jose Miguel Vela
- Drug Discovery & Preclinical Development, ESTEVE Pharmaceuticals, Barcelona, Spain
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health (NDWRH), University of Oxford, Oxford, UK
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vishvarani Wanigasekera
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Matthias Wittayer
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Rolf-Detlef Treede
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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14
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Weon HW, Byun YE, Lim HJ. Quantitative EEG (QEEG) Analysis of Emotional Interaction between Abusers and Victims in Intimate Partner Violence: A Pilot Study. Brain Sci 2021; 11:brainsci11050570. [PMID: 33946692 PMCID: PMC8145537 DOI: 10.3390/brainsci11050570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The perpetrators of intimate partner violence (IPV) and their victims have different emotional states. Abusers typically have problems associated with low self-esteem, low self-awareness, violence, anger, and communication, whereas victims experience mental distress and physical pain. The emotions surrounding IPV for both abuser and victim are key influences on their behavior and their relationship. Methods: The objective of this pilot study was to examine emotional and psychological interactions between IPV abusers and victims using quantified electroencephalogram (QEEG). Two abuser–victim case couples and one non-abusive control couple were recruited from the Mental Image Recovery Program for domestic violence victims in Seoul, South Korea, from 7–30 June 2017. Data collection and analysis were conducted using BrainMaster and NeuroGuide. The emotional pattern characteristics between abuser and victim were examined and compared to those of the non-abusive couple. Results: Emotional states and reaction patterns were different for the non-abusive and IPV couples. Strong delta, theta, and beta waves in the right frontal and left prefrontal lobes were observed in IPV case subjects. This indicated emotional conflict, anger, and a communication block or impaired communication between abuser and victim. Conclusions: Our study findings suggest brainwave control training via neurofeedback could be a possible therapy in managing emotional and communication problems related to IPV.
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Affiliation(s)
- Hee-Wook Weon
- Department of Brain & Cognitive Science, Seoul University of Buddhism, Seoul 08559, Korea;
| | - Youn-Eon Byun
- Department of Youth Science, Kyonggi University, Suwon 16227, Korea;
| | - Hyun-Ja Lim
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
- Correspondence:
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15
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Rocha HA, Marks J, Woods AJ, Staud R, Sibille K, Keil A. Re-test reliability and internal consistency of EEG alpha-band oscillations in older adults with chronic knee pain. Clin Neurophysiol 2020; 131:2630-2640. [PMID: 32947197 PMCID: PMC7815204 DOI: 10.1016/j.clinph.2020.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/18/2020] [Accepted: 07/21/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Chronic pain studies investigating the ability to detect sensory processing differences related to thalamic gating using electroencephalographic (EEG) alpha have yielded conflicting results. Alpha's basic psychometric properties in pain populations requires further study. The present study reports on the test-retest reliability and internal consistency of EEG alpha power in older adults with chronic knee pain. METHODS Repeated EEG alpha power measurements were taken of older adults (N = 31) with chronic knee pain across two sessions separated by a ten-day period associated with a pilot clinical trial study. Recordings included resting periods (eyes open and eyes closed) as well as periods involving a pain management activity. RESULTS Most single alpha-power measures and all within-participant averages of alpha obtained within a session showed high internal consistency (Cronbach's α > 0.7) and satisfactory-to-excellent re-test reliability (Pearson's rs > 0.6) of both alpha power and alpha blocking (eyes closed minus eyes open) across repeated conditions. CONCLUSIONS EEG alpha power seems mostly reliable and consistent, particularly when participants' eyes are closed, after a period of habituation, and when alpha measures are averaged as within-participant estimates. SIGNIFICANCE This analysis suggests that within-subject averages of EEG alpha are the most reliable for developing indices of chronic knee pain.
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Affiliation(s)
- Harold A Rocha
- Institute on Aging, University of Florida, FL, USA; Pain Research and Intervention Center of Excellence, University of Florida, FL, USA; Department of Psychology, University of Florida, FL, USA.
| | - John Marks
- Institute on Aging, University of Florida, FL, USA; Pain Research and Intervention Center of Excellence, University of Florida, FL, USA
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, FL, USA
| | - Roland Staud
- Pain Research and Intervention Center of Excellence, University of Florida, FL, USA
| | - Kimberly Sibille
- Institute on Aging, University of Florida, FL, USA; Pain Research and Intervention Center of Excellence, University of Florida, FL, USA
| | - Andreas Keil
- Department of Psychology, University of Florida, FL, USA
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16
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De Ridder D, Vanneste S. The Bayesian brain in imbalance: Medial, lateral and descending pathways in tinnitus and pain: A perspective. PROGRESS IN BRAIN RESEARCH 2020; 262:309-334. [PMID: 33931186 DOI: 10.1016/bs.pbr.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tinnitus and pain share similarities in their anatomy, pathophysiology, clinical picture and treatments. Based on what is known in the pain field, a heuristic model can be proposed for the pathophysiolgy of tinnitus. This heuristic pathophysiological model suggests that pain and tinnitus are the consequence of an imbalance between two pain/tinnitus evoking pathways, i.e., a lateral sensory pathway and a medial affective pathway, both of which are not balanced anymore by a pain/noise inhibitory pathway. Mechanistically, based on the Bayesian brain concept, it can be explained by a switch occuring under influence of the rostral to dorsal anterior cingulate cortex of its prior predictions, i.e., a reference resetting, in which the pain/tinnitus state is considered as the new reference state. This reference resetting is confirmed by the nucleus accumbens as part of the reward system and maintained by connectivity changes between the nucleus accumbens and the pregenual anterior cingulate cortex. As a consequence it can be suggested to treat pain/tinnitus via reconditioning, either surgically or non-surgically. The model can also be used to develop objective measures for tinnitus and pain via supervised machine learning.
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Affiliation(s)
- Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Sven Vanneste
- Global Brain Health Institute & Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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17
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Gkolias V, Amaniti A, Triantafyllou A, Papakonstantinou P, Kartsidis P, Paraskevopoulos E, Bamidis PD, Hadjileontiadis L, Kouvelas D. Reduced pain and analgesic use after acoustic binaural beats therapy in chronic pain - A double-blind randomized control cross-over trial. Eur J Pain 2020; 24:1716-1729. [PMID: 32564499 DOI: 10.1002/ejp.1615] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Binaural Beats (BB) consist of two artificial acoustic stimuli with different frequency, presented simultaneously but independently to each ear. The human brain perceives and synchronizes to this frequency difference (entrainment). Aim of this study was to test the hypothesis that brain entrainment to a lower function rhythm, with BB application, can decrease pain perception and analgesic medication use, in chronic pain patients. METHODS In a double blind, randomized, cross-over trial, BB at 5Hz (theta rhythm) were applied for 30 minutes, under simultaneous electroencephalogram recordings, followed by liberal, on demand use by chronic pain patients for a week, compared to sham stimulation (SS). Pain as the main outcome (numeric scale, NRS), stress (STAI) and medication usage (defined daily doses, DDD) were assessed at baseline, 30 minutes and week's end. RESULTS Perceived pain (NRS) was significantly reduced in BB intervention (5.6±2.3 to 3.4±2.6, p<0.001), compared to SS (5.2±2.1 to 4.8±2.3, p=0.78), during the first 30-minute phase, as well as at the week's end (to 3.9±2.5 compared to 5.5±2.6 respectively, p<0.001). The mean EEG theta power at 5Hz was significantly increased only during BB application. Stress was significantly reduced at 30 minutes in both interventions but remained reduced only in the BB group at the week's end. Analgesic medication consumption (DDD, g) during the week was significantly less in the BB intervention (3.9±3.7 vs. 4.6±4.1, p<0.05), while reporting equal to SS mean levels of pain. CONCLUSIONS Acoustic BB reduced pain intensity, stress and analgesic use, compared to SS, in chronic pain patients. SIGNIFICANCE This study provides evidence that theta rhythm binaural beats can alleviate pain intensity, both after a brief 30 minute and a longer one week on-demand intervention. The subsequent significant reduction in analgesic medication consumption in chronic pain patients' daily living could offer a valuable tool, augmenting the effect of existing pain therapies.
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Affiliation(s)
- Vasileios Gkolias
- Laboratory of Clinical Pharmacology, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Amaniti
- AHEPA University Hospital, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiota Papakonstantinou
- AHEPA University Hospital, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Kartsidis
- Laboratory of Medical Physics, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Paraskevopoulos
- Laboratory of Medical Physics, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Laboratory of Medical Physics, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leontios Hadjileontiadis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Electrical and Computer Engineering, Khalifa University of Science and Technology, Abu Dhabi, UAE
| | - Dimitrios Kouvelas
- Laboratory of Clinical Pharmacology, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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18
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Neuroimaging-based biomarkers for pain: state of the field and current directions. Pain Rep 2019; 4:e751. [PMID: 31579847 PMCID: PMC6727991 DOI: 10.1097/pr9.0000000000000751] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/20/2019] [Accepted: 04/07/2019] [Indexed: 12/15/2022] Open
Abstract
Chronic pain is an endemic problem involving both peripheral and brain pathophysiology. Although biomarkers have revolutionized many areas of medicine, biomarkers for pain have remained controversial and relatively underdeveloped. With the realization that biomarkers can reveal pain-causing mechanisms of disease in brain circuits and in the periphery, this situation is poised to change. In particular, brain pathophysiology may be diagnosable with human brain imaging, particularly when imaging is combined with machine learning techniques designed to identify predictive measures embedded in complex data sets. In this review, we explicate the need for brain-based biomarkers for pain, some of their potential uses, and some of the most popular machine learning approaches that have been brought to bear. Then, we evaluate the current state of pain biomarkers developed with several commonly used methods, including structural magnetic resonance imaging, functional magnetic resonance imaging and electroencephalography. The field is in the early stages of biomarker development, but these complementary methodologies have already produced some encouraging predictive models that must be tested more extensively across laboratories and clinical populations.
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19
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Keyl P, Schneiders M, Schuld C, Franz S, Hommelsen M, Weidner N, Rupp R. Differences in Characteristics of Error-Related Potentials Between Individuals With Spinal Cord Injury and Age- and Sex-Matched Able-Bodied Controls. Front Neurol 2019; 9:1192. [PMID: 30766510 PMCID: PMC6365444 DOI: 10.3389/fneur.2018.01192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Non-invasive brain-computer interfaces (BCI) represent an emerging technology for enabling persons with impaired or lost grasping and reaching functions due to high spinal cord injury (SCI) to control assistive devices. A major drawback of BCIs is a high rate of false classifications. The robustness and performance of BCIs might be improved using cerebral electrophysiological correlates of error recognition (error-related potentials, ErrPs). As ErrPs have never been systematically examined in subjects with SCI, this study compares the characteristics of ErrPs in individuals with SCI with those of able-bodied control subjects. Methods: ErrPs at FCz and Cz were analyzed in 11 subjects with SCI (9 male, median age 28 y) and in 11 sex- and age-matched controls. Moving a shoulder joystick according to a visual cue, subjects received feedback about the match/mismatch of the performed movement. ErrPs occurring after "error"-feedback were evaluated by comparing means of voltage values within three consecutive time windows after feedback (wP1, wN1, wP2 containing peak voltages P1, N1, P2) using repeated-measurement analysis of variance. Results: In the control group, mean voltage values for the "error" and "correct" feedback condition differed significantly around N1 (FCz: 254 ms, Cz: 252 ms) and P2 (FCz: 347 ms, Cz: 345 ms), but not around P1 (FCz: 181 ms, Cz: 179 ms). ErrPs of the control and the SCI group showed similar morphology, however mean amplitudes of ErrPs were significantly smaller in individuals with SCI compared to controls for wN1 (FCz: control = -1.55 μV, SCI = -0.27 μV, p = 0.02; Cz: control = -1.03 μV, SCI = 0.11 μV, p = 0.04) and wP2 (FCz: control = 2.79 μV, SCI = 1.29 μV, p = 0.011; Cz: control = 2.12 μV, SCI = 0.81 μV, p = 0.003). Mean voltage values in wP1, wN1, and wP2 did not correlate significantly with either chronicity after or level of injury. Conclusion: The morphology of ErrPs in subjects with and without SCI is comparable, however, with reduced mean amplitude in wN1 and wP2 in the SCI group. Further studies should evaluate whether ErrP-classification can be used for online correction of false BCI-commands in individuals with SCI.
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Affiliation(s)
- Philipp Keyl
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Schneiders
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Nobert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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20
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Koyama S, LeBlanc BW, Smith KA, Roach C, Levitt J, Edhi MM, Michishita M, Komatsu T, Mashita O, Tanikawa A, Yoshikawa S, Saab CY. An Electroencephalography Bioassay for Preclinical Testing of Analgesic Efficacy. Sci Rep 2018; 8:16402. [PMID: 30401974 PMCID: PMC6219560 DOI: 10.1038/s41598-018-34594-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022] Open
Abstract
We present a multimodal method combining quantitative electroencephalography (EEG), behavior and pharmacology for pre-clinical screening of analgesic efficacy in vivo. The method consists of an objective and non-invasive approach for realtime assessment of spontaneous nociceptive states based on EEG recordings of theta power over primary somatosensory cortex in awake rats. Three drugs were chosen: (1) pregabalin, a CNS-acting calcium channel inhibitor; (2) EMA 401, a PNS-acting angiotensin II type 2 receptor inhibitor; and (3) minocycline, a CNS-acting glial inhibitor. Optimal doses were determined based on pharmacokinetic studies and/or published data. The effects of these drugs at single or multiple doses were tested on the attenuation of theta power and paw withdrawal latency (PWL) in a rat model of neuropathic pain. We report mostly parallel trends in the reversal of theta power and PWL in response to administration of pregabalin and EMA 401, but not minocycline. We also note divergent trends at non-optimal doses and following prolonged drug administration, suggesting that EEG theta power can be used to detect false positive and false negative outcomes of the withdrawal reflex behavior, and yielding novel insights into the analgesic effects of these drugs on spontaneous nociceptive states in rats.
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Affiliation(s)
- Suguru Koyama
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA.,Laboratory for Pharmacology, Asahi KASEI Pharma Corporation, Shizuoka, Japan
| | - Brian W LeBlanc
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Kelsey A Smith
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Catherine Roach
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Joshua Levitt
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Muhammad M Edhi
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Mai Michishita
- Laboratory for Pharmacology, Asahi KASEI Pharma Corporation, Shizuoka, Japan
| | - Takayuki Komatsu
- Laboratory for Pharmacology, Asahi KASEI Pharma Corporation, Shizuoka, Japan
| | - Okishi Mashita
- Laboratory for Safety Assessment & ADME, Asahi KASEI Pharma Corporation, Shizuoka, Japan
| | - Aki Tanikawa
- Laboratory for Safety Assessment & ADME, Asahi KASEI Pharma Corporation, Shizuoka, Japan
| | - Satoru Yoshikawa
- Laboratory for Pharmacology, Asahi KASEI Pharma Corporation, Shizuoka, Japan
| | - Carl Y Saab
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA. .,Department of Neuroscience, Brown University, Providence, RI, USA.
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21
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Zhou R, Wang J, Qi W, Liu FY, Yi M, Guo H, Wan Y. Elevated Resting State Gamma Oscillatory Activities in Electroencephalogram of Patients With Post-herpetic Neuralgia. Front Neurosci 2018; 12:750. [PMID: 30405337 PMCID: PMC6205978 DOI: 10.3389/fnins.2018.00750] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/28/2018] [Indexed: 11/23/2022] Open
Abstract
In acute and ongoing pain, the spontaneous oscillatory activity of electroencephalogram (EEG) has been characterized by suppression of alpha band oscillations and enhancement of gamma band oscillations. In pathological chronic pain which is more severe and common in clinic practice, it is of great interest to investigate the oscillatory activity especially at the broad gamma frequency bands. Our present study explored the resting state oscillatory activities of EEG in patients with post-herpetic neuralgia (PHN) over 3 months which is a typical neuropathic pain model in clinical researches. It was found that the PHN patients showed anxiety and depression revealed by Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) examinations. Power spectrum analysis revealed that the power at gamma frequency band (from 40 to 70 Hz) of EEG was significantly higher in the PHN patients, and positively correlated with pain intensity, anxiety, and depression indexes. Further, increased gamma activity derived from the prefrontal cortex and the cerebellum were revealed by cluster-based sensor level and the beamforming source level analyses. These results suggest the enhanced gamma oscillatory activity in the prefrontal cortex and cerebellum is a characteristic marker in chronic neuropathic pain patients.
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Affiliation(s)
- Rui Zhou
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Jing Wang
- Department of Neurobiology, School of Basic Medical Sciences, Beijing Institute For Brain Disorders, Capital Medical University, Beijing, China
| | - Wenjing Qi
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Feng-Yu Liu
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Ming Yi
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Huailian Guo
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - You Wan
- Neuroscience Research Institute, Peking University, Beijing, China.,Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, China
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22
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Abstract
Pain modulates rhythmic neuronal activity recorded by Electroencephalography (EEG) in humans. Our laboratory previously showed that rat models of acute and neuropathic pain manifest increased power in primary somatosensory cortex (S1) recorded by electrocorticography (ECoG). In this study, we hypothesized that pain increases EEG power and corticocortical coherence in different rat models of pain, whereas treatments with clinically effective analgesics reverse these changes. Our results show increased cortical power over S1 and prefrontal cortex (PFC) in awake, freely behaving rat models of acute, inflammatory and neuropathic pain. Coherence between PFC and S1 is increased at a late, but not early, time point during the development of neuropathic pain. Electroencephalography power is not affected by ibuprofen in the acute pain model. However, pregabalin and mexiletine reverse the changes in power and S1-PFC coherence in the inflammatory and neuropathic pain models. These data suggest that quantitative EEG might be a valuable predictor of pain and analgesia in rodents.
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Boivin GP, Hickman DL, Creamer-Hente MA, Pritchett-Corning KR, Bratcher NA. Review of CO₂ as a Euthanasia Agent for Laboratory Rats and Mice. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2017; 56:491-499. [PMID: 28903819 PMCID: PMC5605172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/19/2017] [Accepted: 05/18/2017] [Indexed: 06/07/2023]
Abstract
Selecting an appropriate, effective euthanasia agent is controversial. Several recent publications provide clarity on the use of CO2 in laboratory rats and mice. This review examines previous studies on CO2 euthanasia and presents the current body of knowledge on the subject. Potential areas for further investigation and recommendations are provided.
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Affiliation(s)
- Gregory P Boivin
- Department of Pathology, Wright State University, Dayton, Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Debra L Hickman
- Laboratory Animal Resource Center, Indiana University, Indianapolis, Indiana;,
| | | | - Kathleen R Pritchett-Corning
- Office of Animal Resources, Harvard University, Cambridge, Massachusetts, Department of Comparative Medicine, University of Washington, Seattle, Washington
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24
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Susta M, Nemcova V, Bizik G, Sonka K. Emotion stimulus processing in narcolepsy with cataplexy. J Sleep Res 2016; 26:30-37. [DOI: 10.1111/jsr.12444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/06/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Marek Susta
- St Elisabeth University of Health and Social Sciences; Bratislava Slovakia
- 1st Faculty of Medicine; Department of Neurology; Charles University and General University Hospital; Prague 2 Czech Republic
| | - Veronika Nemcova
- 1st Faculty of Medicine; Department of Anatomy; Charles University; Prague 2 Czech Republic
| | - Gustav Bizik
- Department of Psychiatry; Aalborg University Hospital; Aalborg Denmark
| | - Karel Sonka
- 1st Faculty of Medicine; Department of Neurology; Charles University and General University Hospital; Prague 2 Czech Republic
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25
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Gram M, Erlenwein J, Petzke F, Falla D, Przemeck M, Emons MI, Reuster M, Olesen SS, Drewes AM. Prediction of postoperative opioid analgesia using clinical-experimental parameters and electroencephalography. Eur J Pain 2016; 21:264-277. [PMID: 27470494 DOI: 10.1002/ejp.921] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Opioids are often used for pain treatment, but the response is often insufficient and dependent on e.g. the pain condition, genetic factors and drug class. Thus, there is an urgent need to identify biomarkers to enable selection of the appropriate drug for the individual patient, a concept known as personalized medicine. Quantitative sensory testing (QST) and clinical parameters can provide some guidance for response, but better and more objective biomarkers are urgently warranted. Electroencephalography (EEG) may be suitable since it assesses the central nervous system where opioids mediate their effects. METHODS Clinical parameters, QST and EEG (during rest and tonic pain) was recorded from patients the day prior to total hip replacement surgery. Postoperative pain treatment was performed using oxycodone and piritramide as patient-controlled analgesia. Patients were stratified into responders and non-responders based on pain ratings 24 h post-surgery. Parameters were analysed using conventional group-wise statistical methods. Furthermore, EEG was analysed by machine learning to predict individual response. RESULTS Eighty-one patients were included, of which 51 responded to postoperative opioid treatment (30 non-responders). Conventional statistics showed that more severe pre-existing chronic pain was prevalent among non-responders to opioid treatment (p = 0.04). Preoperative EEG analysis was able to predict responders with an accuracy of 65% (p = 0.009), but only during tonic pain. CONCLUSIONS Chronic pain grade before surgery is associated with the outcome of postoperative pain treatment. Furthermore, EEG shows potential as an objective biomarker and might be used to predict postoperative opioid analgesia. SIGNIFICANCE The current clinical study demonstrates the viability of EEG as a biomarker and with results consistent with previous experimental results. The combined method of machine learning and electroencephalography offers promising results for future developments of personalized pain treatment.
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Affiliation(s)
- M Gram
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - J Erlenwein
- Pain Clinic, Department of Anesthesiology, University Hospital, Georg-August-University of Göttingen, Germany
| | - F Petzke
- Pain Clinic, Department of Anesthesiology, University Hospital, Georg-August-University of Göttingen, Germany
| | - D Falla
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, UK
| | - M Przemeck
- Department of Anesthesiology and Intensive Care, Annastift, Hannover, Germany
| | - M I Emons
- Pain Clinic, Department of Anesthesiology, University Hospital, Georg-August-University of Göttingen, Germany
| | - M Reuster
- Pain Clinic, Department of Anesthesiology, University Hospital, Georg-August-University of Göttingen, Germany
| | - S S Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.,Clinical Institute, Aalborg University Hospital, Denmark
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26
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Electroencephalographic Patterns in Chronic Pain: A Systematic Review of the Literature. PLoS One 2016; 11:e0149085. [PMID: 26914356 PMCID: PMC4767709 DOI: 10.1371/journal.pone.0149085] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 01/27/2016] [Indexed: 01/08/2023] Open
Abstract
The main objective of this study is to review and summarize recent findings on electroencephalographic patterns in individuals with chronic pain. We also discuss recent advances in the use of quantitative Electroencephalography (qEEG) for the assessment of pathophysiology and biopsychosocial factors involved in its maintenance over time. Data collection took place from February 2014 to July 2015 in PubMed, SciELO and PEDro databases. Data from cross-sectional studies and longitudinal studies, as well as clinical trials involving chronic pain participants were incorporated into the final analysis. Our primary findings related to chronic pain were an increase of theta and alpha EEG power at rest, and a decrease in the amplitude of evoked potentials after sensory stimulation and cognitive tasks. This review suggests that qEEG could be considered as a simple and objective tool for the study of brain mechanisms involved in chronic pain, as well as for identifying the specific characteristics of chronic pain condition. In addition, results show that qEEG probably is a relevant outcome measure for assessing changes in therapeutic studies.
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27
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Olesen AE, Olofsen E, Andresen T, Graversen C, Drewes AM, Dahan A. Stochastic Pharmacokinetic-Pharmacodynamic Analysis of the Effect of Transdermal Buprenorphine on Electroencephalogram and Analgesia. Anesth Analg 2016; 121:1165-75. [PMID: 26372412 DOI: 10.1213/ane.0000000000000939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The analgesic effect of opioids is often based on subjective one dimensional measurements. Electroencephalography (EEG) offers a possibility to objectively quantify the brain's activity before and after the administration of opioids. The aim of this study was to investigate the pharmacokinetic-pharmacodynamic (PKPD) properties of the buprenorphine transdermal patch on resting EEG and pain tolerance. METHOD Twenty-two healthy male subjects (mean age 23.1 ± 3.8 years) were studied. They received a 144-hour buprenorphine (20 μg/h) or placebo transdermal patch in this experimental, randomized, crossover, double-blind study. Skin heat pain tolerance was measured on the arm before the recordings of resting EEG. From the EEG, the ratio of slow and fast oscillations was calculated for further analysis. A population PKPD model with a stochastic differential equation for drug absorption from the patch was used to analyze the PK and PD data simultaneously by use of the statistical analysis package NONMEM. RESULTS Buprenorphine increased EEG ratio (P = 0.0006) and skin pain tolerance (P = 0.0008) compared with placebo. The stochastic model adequately characterized the concentration-time and effect-time courses for both the skin heat stimulation and the resting EEG outcomes with variations in the drug's absorption rate during the 144-hour treatment period. As measured by the potency parameter, the EEG effect was 10 ± 3 (median ± SE) times more sensitive to buprenorphine than the skin pain test. CONCLUSIONS Using a stochastic PKPD analysis, the effect of a 144-hour buprenorphine patch application on resting EEG and skin pain tolerance was quantified successfully. Both end points were affected by buprenorphine, although the resting EEG was more sensitive to buprenorphine. The stochastic PKPD analysis allowed the computation of a time-dependent variability in drug absorption from patch to blood. The data suggest that the resting EEG is an attractive and objective alternative for assessing opioid effect.
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Affiliation(s)
- Anne Estrup Olesen
- From the *Mech-Sense, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; †Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark; ‡Department of Anesthesiology, Leiden University Medical Center, RC Leiden, The Netherlands; and §Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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28
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Abstract
BACKGROUND Chronic abdominal pain is one of the major symptoms in people with chronic pancreatitis. The role of pregabalin in people with chronic pancreatic pain due to chronic pancreatitis is uncertain. OBJECTIVES To assess the benefits and harms of pregabalin in people with chronic abdominal pain due to chronic pancreatitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2015, issue 6, and MEDLINE, EMBASE, Science Citation Index Expanded, trials registers until June 2015. We also searched the references of included trials to identify further trials. SELECTION CRITERIA We considered only randomised controlled trials (RCT) performed in people with chronic pancreatic pain due to chronic pancreatitis, irrespective of language, blinding, or publication status for inclusion in the review. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials and independently extracted data. We calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) with RevMan 5, based on intention-to-treat analysis. MAIN RESULTS Only one study, funded by Pfizer, met the inclusion criteria for the review. A total of 64 participants (with chronic pain due to chronic pancreatitis) were randomly assigned to receive escalating doses of pregabalin (150 mg per day to 600 mg per day; 34 participants) or matching placebo (30 participants). Participants received pregabalin or placebo for three weeks on an outpatient basis; the outcomes were measured at the end of the treatment (i.e. three weeks from commencement of treatment). Potential participants taking concomitant analgesic medication and expected to stay on a stable regime during the trial were allowed to enter the study. This trial was at low risk of bias. The overall quality of evidence was low or moderate.Only the short-term outcomes were available in this trial. The medium and long-term outcomes, number of work days lost, and length of hospital stay due to admissions for pain control were not available. This trial found that the changes in opiate use (MD -26.00 mg; 95% CI -47.36 to -4.64; participants = 64; moderate-quality evidence), and pain score percentage changes from baseline (MD -12.00; 95% CI -21.82 to -2.18; participants = 64; moderate-quality evidence) were better in participants taking pregabalin compared to those taking placebo. This trial also found that there were more adverse events in participants taking pregabalin compared to those taking placebo (RR 1.71; 95% CI 1.20 to 2.43; participants = 64). The differences between pregabalin and placebo were imprecise for short-term health-related quality of life measured with the EORTC CLQ-30 questionnaire (MD 11.40; 95% CI -3.28 to 26.08; participants = 64; moderate-quality evidence), proportion of people with serious adverse events (RR 1.76; 95% CI 0.35 to 8.96; participants = 64; low-quality evidence), and proportion of people requiring hospital admissions (RR 0.44; 95% CI 0.04 to 4.62; participants = 64; low quality evidence). AUTHORS' CONCLUSIONS Based on low- to moderate-quality evidence, short-term use of pregabalin decreases short-term opiate use, and short-term pain scores, but increases the adverse events compared to placebo, in people with chronic pain due to chronic pancreatitis. The clinical implication of the decreases in short-term opiate use and short-term pain scores is not known.Future trials assessing the role of pregabalin in decreasing chronic pain in chronic pancreatitis should assess the medium- or long-term effects of pregabalin and should include outcomes such as, quality of life, treatment-related adverse events, number of work days lost, number of hospital admissions, and the length of hospital stay, in addition to pain scores, to assess the clinical and socioeconomic impact.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Charnelle Lusuku
- The University of NottinghamSchool of MedicineNottinghamUKNG7 2UH
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
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Anderson MA, Akshintala V, Albers KM, Amann ST, Belfer I, Brand R, Chari S, Cote G, Davis BM, Frulloni L, Gelrud A, Guda N, Humar A, Liddle RA, Slivka A, Gupta RS, Szigethy E, Talluri J, Wassef W, Wilcox CM, Windsor J, Yadav D, Whitcomb DC. Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group. Pancreatology 2016; 16:83-94. [PMID: 26620965 PMCID: PMC4761301 DOI: 10.1016/j.pan.2015.10.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/29/2015] [Accepted: 10/31/2015] [Indexed: 12/11/2022]
Abstract
DESCRIPTION Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. METHODS Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. RESULTS Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. MANAGEMENT There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. CONCLUSIONS Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.
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Affiliation(s)
| | | | - Kathryn M Albers
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Inna Belfer
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Randall Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Suresh Chari
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Greg Cote
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Brian M Davis
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luca Frulloni
- Department of Medicine, University of Verona, Verona, Italy
| | - Andres Gelrud
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nalini Guda
- Department of Gastroenterology, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Abhinav Humar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Adam Slivka
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jyothsna Talluri
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wahid Wassef
- Department of Medicine, University of Massachusetts, Worcester, MA, USA
| | - C Mel Wilcox
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Dhiraj Yadav
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - David C Whitcomb
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Cell Biology & Molecular Physiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA.
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30
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Abstract
Pancreatic nerves undergo prominent alterations during the evolution and progression of human chronic pancreatitis and pancreatic cancer. Intrapancreatic nerves increase in size (neural hypertrophy) and number (increased neural density). The proportion of autonomic and sensory fibres (neural remodelling) is switched, and are infiltrated by perineural inflammatory cells (pancreatic neuritis) or invaded by pancreatic cancer cells (neural invasion). These neuropathic alterations also correlate with neuropathic pain. Instead of being mere histopathological manifestations of disease progression, pancreatic neural plasticity synergizes with the enhanced excitability of sensory neurons, with Schwann cell recruitment toward cancer and with central nervous system alterations. These alterations maintain a bidirectional interaction between nerves and non-neural pancreatic cells, as demonstrated by tissue and neural damage inducing neuropathic pain, and activated neurons releasing mediators that modulate inflammation and cancer growth. Owing to the prognostic effects of pain and neural invasion in pancreatic cancer, dissecting the mechanism of pancreatic neuroplasticity holds major translational relevance. However, current in vivo models of pancreatic cancer and chronic pancreatitis contain many discrepancies from human disease that overshadow their translational value. The present Review discusses novel possibilities for mechanistically uncovering the role of the nervous system in pancreatic disease progression.
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Affiliation(s)
- Ihsan Ekin Demir
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Güralp O Ceyhan
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany
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31
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Abstract
PURPOSE OF REVIEW Pain is the most common symptom of chronic pancreatitis, with a profound socioeconomic impact. Historical management paradigms failed, as they did not adequately address the fundamental underlying mechanisms. The present article describes the neurobiology of pain and sensitization in this condition, in an effort to explain prior failings and provide future directions for managing pain in chronic pancreatitis. RECENT FINDINGS A number of recent advances have been made in understanding the neurobiology of pain for this condition. This has been coupled with clinical advances in assessing sensitization to pain in these patients, which has been shown to predict response to medical and surgical therapy. SUMMARY Pain in chronic pancreatitis is complex. Addressing the mechanical and morphological findings in chronic pancreatitis without addressing the underlying neurobiological mechanisms is destined to fail. New advances in our understanding of the neurobiology of pain in chronic pancreatitis helps to explain prior failings and provides future direction for managing pain in patients afflicted by this disease.
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32
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Bouwense SA, Olesen SS, Drewes AM, van Goor H, Wilder-Smith OH. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients. J Pain Res 2015. [PMID: 26203273 PMCID: PMC4506030 DOI: 10.2147/jpr.s84484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pain control in chronic pancreatitis is a major challenge; the mechanisms behind analgesic treatment are poorly understood. This study aims to investigate the differences in pain sensitivity and modulation in chronic pancreatitis patients, based on their clinical response (responders vs nonresponders) to placebo or pregabalin treatment. METHODS This study was part of a randomized, double-blind, placebo-controlled trial evaluating the analgesic effects of pregabalin and placebo in chronic pancreatitis. Post hoc, patients were assigned to one of four groups, ie, responders and nonresponders to pregabalin (n=16; n=15) or placebo (n=12; n=17) treatment. Responders were defined as patients with >30% pain reduction after 3 weeks of treatment. We measured change in pain sensitivity before and after the treatment using electric pain detection thresholds (ePDT) in dermatomes C5 (generalized effects) and Ventral T10 (segmental effects). Descending endogenous pain modulation was quantified via conditioned pain modulation (CPM) paradigm. RESULTS Sixty patients were analyzed in a per-protocol analysis. ePDT change in C5 was significant vs baseline and greater in pregabalin (1.3 mA) vs placebo responders (-0.1 mA; P=0.015). This was not so for ePDT in Ventral T10. CPM increased more in pregabalin (9%) vs placebo responders (-17%; P<0.001). CPM changed significantly vs baseline only for pregabalin responders (P=0.006). CONCLUSION This hypothesis-generating study provides the first evidence that pain relief with pregabalin is associated with anti-hyperalgesic effects and increased endogenous inhibitory modulation. No such effects were observed in patients experiencing pain relief with the placebo treatment. The mechanisms underlying analgesic response to placebo vs drug treatments are different and, together with their interactions, deserve further study.
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Affiliation(s)
- Stefan Aw Bouwense
- Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - Søren S Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Harry van Goor
- Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - Oliver Hg Wilder-Smith
- Pain and Nociception Neuroscience Research Group, Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
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Haas S, Brock C, Krogh K, Gram M, Lundby L, Drewes AM, Laurberg S. Abnormal neuronal response to rectal and anal stimuli in patients with idiopathic fecal incontinence. Neurogastroenterol Motil 2015; 27:954-62. [PMID: 25903483 DOI: 10.1111/nmo.12567] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The pathophysiology behind idiopathic fecal incontinence (IFI) is poorly understood. We hypothesized abnormal sensory pathways along the brain-gut axis as a key player in this disease, reflected in cortical evoked potentials (CEP) from mechanical stimuli of the rectum and the anal canal. METHODS CEPs were recorded during repeated rapid balloon distensions of the rectum and anal canal in 19 women with IFI (mean age: 60 ± 14, mean Wexner score: 14.7 ± 2.9) and in 19 healthy women (mean age: 56 ± 11, mean Wexner score: 1.1 ± 1.3). Latencies, amplitudes and topography of CEPs elicited by rectal distension were compared between the groups. CEPs from both rectal and anal distensions were examined using spectral band analysis of single sweeps determining the relative amplitude of five spectral bands as a proxy of neuronal processing. KEY RESULTS Compared to controls IFI patients had prolonged latency of CEPs from rectal distension by up to 27% (p < 0.001) while amplitudes and topography were similar (all p > 0.7 and all p > 0.23). Spectral analysis of CEPs from rectal distensions showed no difference (all p > 0.1) between groups. However, analysis of CEPs following distension of the anal canal resulted in abnormally low activity in beta (8-12 Hz; p < 0.001) band and high activity in the gamma (32-70 Hz; p = 0.04) band in patients. CONCLUSIONS & INFERENCES IFI seems to be associated with impaired ano-rectal sensory functions in both the afferent fibers to the brain and the cortical processing of anal sensory pathways. This may play a central role for the pathogenesis of IFI.
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Affiliation(s)
- S Haas
- Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - C Brock
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - K Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - M Gram
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - L Lundby
- Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - S Laurberg
- Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
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34
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Gram M, Graversen C, Olesen AE, Drewes AM. Machine learning on encephalographic activity may predict opioid analgesia. Eur J Pain 2015; 19:1552-61. [PMID: 26095578 DOI: 10.1002/ejp.734] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Opioids are used for the treatment of pain. However, 30-50% of patients have insufficient effect to the opioid initially selected by the physician, and there is an urgent need for biomarkers to select responders to the most appropriate drug. Since opioids mediate their effect in the central nervous system, this study aimed to investigate if electroencephalography (EEG) during rest or pain before treatment could predict the analgesic response. METHODS EEG from 62 channels was recorded in volunteers during rest and tonic pain (cold pressor test). Morphine (30 mg) or placebo was then administered, and the pain test repeated 60 min after. Washout period between drugs was 7 days. Based on pain ratings, subjects were stratified into responders and non-responders. Spectral analysis was performed on the EEG. Conventional statistics on group basis were used and, furthermore, the most discriminative EEG features were subjected to support vector machine classification to predict the response for the individual subjects. RESULTS Conventional statistics on the frequency bands revealed no differences between responders and non-responders. On the individual basis, no differences between groups were found using resting EEG. However, EEG during cold pain was able to classify responders with an accuracy of 72% (p = 0.01) and the result was reproducible using baseline data from both study days. CONCLUSIONS Machine learning based on EEG before treatment enabled separation between responders and non-responders. This study represents the first step towards the prediction of opioid analgesia based on EEG features prior to drug administration, and advocates for the use of machine learning in future studies.
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Affiliation(s)
- M Gram
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - C Graversen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - A E Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.,Clinical Institute, Aalborg University Hospital, Denmark
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35
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Schröder W, Lambert DG, Ko MC, Koch T. Functional plasticity of the N/OFQ-NOP receptor system determines analgesic properties of NOP receptor agonists. Br J Pharmacol 2015; 171:3777-800. [PMID: 24762001 DOI: 10.1111/bph.12744] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/07/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022] Open
Abstract
Despite high sequence similarity between NOP (nociceptin/orphanin FQ opioid peptide) and opioid receptors, marked differences in endogenous ligand selectivity, signal transduction, phosphorylation, desensitization, internalization and trafficking have been identified; underscoring the evolutionary difference between NOP and opioid receptors. Activation of NOP receptors affects nociceptive transmission in a site-specific manner, with antinociceptive effects prevailing after peripheral and spinal activation, and pronociceptive effects after supraspinal activation in rodents. The net effect of systemically administered NOP receptor agonists on nociception is proposed to depend on the relative contribution of peripheral, spinal and supraspinal activation, and this may depend on experimental conditions. Functional expression and regulation of NOP receptors at peripheral and central sites of the nociceptive pathway exhibits a high degree of plasticity under conditions of neuropathic and inflammatory pain. In rodents, systemically administered NOP receptor agonists exerted antihypersensitive effects in models of neuropathic and inflammatory pain. However, they were largely ineffective in acute pain while concomitantly evoking severe motor side effects. In contrast, systemic administration of NOP receptor agonists to non-human primates (NHPs) exerted potent and efficacious antinociception in the absence of motor and sedative side effects. The reason for this species difference with respect to antinociceptive efficacy and tolerability is not clear. Moreover, co-activation of NOP and μ-opioid peptide (MOP) receptors synergistically produced antinociception in NHPs. Hence, both selective NOP receptor as well as NOP/MOP receptor agonists may hold potential for clinical use as analgesics effective in conditions of acute and chronic pain.
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Affiliation(s)
- W Schröder
- Department of Translational Science, Global Innovation, Grünenthal GmbH, Aachen, Germany
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Cambiaghi M, Magri L, Cursi M. Importance of EEG in validating the chronic effects of drugs: suggestions from animal models of epilepsy treated with rapamycin. Seizure 2015; 27:30-9. [PMID: 25891924 DOI: 10.1016/j.seizure.2015.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/12/2015] [Accepted: 02/15/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The development of new drugs for the treatment of epilepsy is a major challenge for modern neurology and its first steps demand basic research. Preclinical studies on animal models of epilepsy are mainly based on the analysis of brain electrical activity to detect seizures, when they are not just limited to behavioral tests like the Racine scale. METHODS In the present review, we discuss the importance of using time-locked video and EEG recordings (Video-EEG) coupled with behavioral tests as tools to monitor and analyze the effects of anti-epileptic drugs in pre-clinical research. Particularly, we focus on the utility of a multimodal approach based on EEG/behavioral analysis to study the beneficial effects of chronic rapamycin treatment as a potential anti-epileptogenic therapy for a broad spectrum of epilepsy, including both genetic (as in tuberous sclerosis complex) and acquired diseases. RESULTS Changes and synchronization of neuronal activity of different areas have been correlated with specific behavior in both physiological and pathological conditions. In the epileptic brain, during a seizure there is an abnormal activation of many cells all at once, altering different networks. CONCLUSION A multimodal approach based on video, EEG analysis and behavioral tests would be the best option in preclinical studies of epilepsy.
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Affiliation(s)
- Marco Cambiaghi
- Università degli Studi di Torino, Department of Neuroscience, Turin, Italy.
| | - Laura Magri
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Marco Cursi
- Clinical Neurophysiology Unit, Department of Neurology, Scientific Institute San Raffaele, Milan, Italy
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Malver LP, Brokjaer A, Staahl C, Graversen C, Andresen T, Drewes AM. Electroencephalography and analgesics. Br J Clin Pharmacol 2015; 77:72-95. [PMID: 23593934 DOI: 10.1111/bcp.12137] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/05/2013] [Indexed: 11/29/2022] Open
Abstract
To assess centrally mediated analgesic mechanisms in clinical trials with pain patients, objective standardized methods such as electroencephalography (EEG) has many advantages. The aim of this review is to provide the reader with an overview of present findings in analgesics assessed with spontaneous EEG and evoked brain potentials (EPs) in humans. Furthermore, EEG methodologies will be discussed with respect to translation from animals to humans and future perspectives in predicting analgesic efficacy. We searched PubMed with MeSH terms 'analgesics', 'electroencephalography' and 'evoked potentials' for relevant articles. Combined with a search in their reference lists 15 articles on spontaneous EEG and 55 papers on EPs were identified. Overall, opioids produced increased activity in the delta band in the spontaneous EEG, but increases in higher frequency bands were also seen. The EP amplitudes decreased in the majority of studies. Anticonvulsants used as analgesics showed inconsistent results. The N-methyl-D-aspartate receptor antagonist ketamine showed an increase in the theta band in spontaneous EEG and decreases in EP amplitudes. Tricyclic antidepressants increased the activity in the delta, theta and beta bands in the spontaneous EEG while EPs were inconsistently affected. Weak analgesics were mainly investigated with EPs and a decrease in amplitudes was generally observed. This review reveals that both spontaneous EEG and EPs are widely used as biomarkers for analgesic drug effects. Methodological differences are common and a more uniform approach will further enhance the value of such biomarkers for drug development and prediction of treatment response in individual patients.
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Affiliation(s)
- Lasse Paludan Malver
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
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Brokjær A, Olesen AE, Kreilgaard M, Graversen C, Gram M, Christrup LL, Dahan A, Drewes AM. Objective markers of the analgesic response to morphine in experimental pain research. J Pharmacol Toxicol Methods 2015; 73:7-14. [PMID: 25659520 DOI: 10.1016/j.vascn.2015.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/20/2015] [Accepted: 01/28/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In experimental pain research the effect of opioids is normally assessed by verbal subjective response to analgesia. However, as many confounders in pain assessment exist, objective bed-side assessment of the effect is highly warranted. Therefore, we aimed to assess the effect of morphine on three objective pharmacodynamic markers (pupil diameter, prolactin concentration and resting electroencephalography (EEG)) and compare the changes from placebo with subjective analgesia on experimental muscle pain for convergent validation. METHODS Fifteen healthy male participants received placebo or 30 mg rectal morphine at two separate sessions. At baseline and several time points after drug administration, the central effects of morphine were assessed by experimental muscle pain, pupil diameter, prolactin concentration and resting EEG. RESULTS Morphine increased tolerance to muscle pain, together with significant reductions in pupil diameter and increase in prolactin concentration (all P < 0.001). Miosis was induced simultaneously with the onset of analgesic effect 30 min after dosing, while a significant increase in prolactin concentration was seen after 45 min. The change in pupil diameter was negatively correlated to change in tolerated muscle pressure (r = -0.40, P < 0.001), whereas the increase in prolactin concentration was positively correlated (r = 0.32, P = 0.001). The effect of morphine on EEG was seen as a decrease in the relative theta (4-7.5 Hz) activity (P = 0.03), but was not significant until 120 min after dosing and did not correlate to the increase in tolerated muscle pressure (r = -0.1, P=0.43). DISCUSSION Prolactin concentration and pupil diameter showed similar temporal development, had good dynamic ranges and were sensitive to morphine. Thus, both measures proved to be sensitive measures of morphine effects. EEG may give additive information on the brain's response to pain, however more advanced analysis may be necessary. We therefore recommend using pupil diameter in studies where a simple and reliable objective measure of the morphine-induced central activation is needed.
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Affiliation(s)
- Anne Brokjær
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.
| | - Anne Estrup Olesen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
| | - Mads Kreilgaard
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
| | - Carina Graversen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.
| | - Mikkel Gram
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.
| | - Lona Louring Christrup
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Bouwense SAW, de Vries M, Schreuder LTW, Olesen SS, Frøkjær JB, Drewes AM, van Goor H, Wilder-Smith OHG. Systematic mechanism-orientated approach to chronic pancreatitis pain. World J Gastroenterol 2015; 21:47-59. [PMID: 25574079 PMCID: PMC4284360 DOI: 10.3748/wjg.v21.i1.47] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/23/2014] [Accepted: 11/19/2014] [Indexed: 02/07/2023] Open
Abstract
Pain in chronic pancreatitis (CP) shows similarities with other visceral pain syndromes (i.e., inflammatory bowel disease and esophagitis), which should thus be managed in a similar fashion. Typical causes of CP pain include increased intrapancreatic pressure, pancreatic inflammation and pancreatic/extrapancreatic complications. Unfortunately, CP pain continues to be a major clinical challenge. It is recognized that ongoing pain may induce altered central pain processing, e.g., central sensitization or pro-nociceptive pain modulation. When this is present conventional pain treatment targeting the nociceptive focus, e.g., opioid analgesia or surgical/endoscopic intervention, often fails even if technically successful. If central nervous system pain processing is altered, specific treatment targeting these changes should be instituted (e.g., gabapentinoids, ketamine or tricyclic antidepressants). Suitable tools are now available to make altered central processing visible, including quantitative sensory testing, electroencephalograpy and (functional) magnetic resonance imaging. These techniques are potentially clinically useful diagnostic tools to analyze central pain processing and thus define optimum management approaches for pain in CP and other visceral pain syndromes. The present review proposes a systematic mechanism-orientated approach to pain management in CP based on a holistic view of the mechanisms involved. Future research should address the circumstances under which central nervous system pain processing changes in CP, and how this is influenced by ongoing nociceptive input and therapies. Thus we hope to predict which patients are at risk for developing chronic pain or not responding to therapy, leading to improved treatment of chronic pain in CP and other visceral pain disorders.
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Johnson CB, Mellor DJ, Hemsworth PH, Fisher AD. A scientific comment on the welfare of domesticated ruminants slaughtered without stunning. N Z Vet J 2014; 63:58-65. [PMID: 25238631 DOI: 10.1080/00480169.2014.964345] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This review provides a scientific comment on the welfare of ruminants slaughtered by ventral-neck incision without stunning. Evidence is derived from studies of calves, sheep and goats. Reference is also made to findings in other mammals including humans. Pain is an inherently subjective experience and only indirect indices are available in animals. Neurophysiological tools are widely used in humans to assess pain and have demonstrated that electroencephalographic (EEG) variables correlate well with subjective evaluations of pain. These neurophysiological tools have also been applied in animal studies. In humans pain is associated with major cutting injuries and it is widely accepted that farm animals also experience pain due to such injuries. Overwhelming international scientific opinion has long been that slaughter by neck incision of conscious animals causes pain. A series of studies in calves demonstrated that slaughter by ventral-neck incision is likely to be perceived as painful. It is proposed that, as in cattle, non-stunned sheep and goats would experience pain in a similar manner. The precise assessment of the point after slaughter at which non-stunned animals become insensible remains a major methodological challenge. In sheep it is at least 2-8 seconds, but may be 8-20 seconds in duration. In cattle the mean duration is similar, but can commonly be extended to longer than 60 seconds with occasional instances of even greater durations. Taken together, these findings indicate that because the slaughter of cattle, sheep and goats by ventral-neck incision without prior stunning is likely to cause pain, this poses a risk to animal welfare.
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Affiliation(s)
- C B Johnson
- a Animal Welfare Science and Bioethics Centre (AWSBC), Institute of Veterinary, Animal and Biomedical Sciences , Massey University , Palmerston North , New Zealand
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Graversen C, Malver LP, Kurita GP, Staahl C, Christrup LL, Sjøgren P, Drewes AM. Altered Frequency Distribution in the Electroencephalogram is Correlated to the Analgesic Effect of Remifentanil. Basic Clin Pharmacol Toxicol 2014; 116:414-22. [DOI: 10.1111/bcpt.12330] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Carina Graversen
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Lasse P. Malver
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Geana P. Kurita
- The Multidisciplinary Pain Centre; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Section of Palliative Medicine; Department of Oncology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Camilla Staahl
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Lona L. Christrup
- Department of Drug Design and Pharmacology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Per Sjøgren
- Section of Palliative Medicine; Department of Oncology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Asbjørn M. Drewes
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
- Center for Sensory-Motor Interactions (SMI); Department of Health Science and Technology; Aalborg University; Aalborg Denmark
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Nielsen LM, Olesen AE, Branford R, Christrup LL, Sato H, Drewes AM. Association Between Human Pain-Related Genotypes and Variability in Opioid Analgesia: An Updated Review. Pain Pract 2014; 15:580-94. [DOI: 10.1111/papr.12232] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/04/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Lecia M. Nielsen
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
- Department of Drug Design and Pharmacology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Anne E. Olesen
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Ruth Branford
- Department of Palliative Medicine; Royal Marsden Hospital; London UK
| | - Lona L. Christrup
- Department of Drug Design and Pharmacology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Hiroe Sato
- Interstitial Lung Disease Unit; Royal Brompton Hospital & National Heart and Lung Institute; Imperial College London; London UK
| | - Asbjørn M. Drewes
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
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Abstract
Pregabalin is a γ-aminobutyric acid analogue that is primarily prescribed in psychiatry for management of generalized anxiety disorder. The belief in its low potential for abuse has placed it in a superior position to other anxiolytic agents. However, more recent, concerns have been raised about the addictive potential of pregabalin. This problem has not received much attention nor has the mechanism of its development. There is also a lack of understanding of the difference in the experience of abusing pregabalin in contrast to abusing other illicit drugs. We report the case of a 55-year-old patient with a background history of multiple psychoactive substances misuse who elaborated on his own personal experience of pregabalin abuse. He consumed a month’s supply of this medication over 2 days and realized an enhancement in sexual desire and excitement. This effect should be considered when prescribing pregabalin.
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Gram M, Graversen C, Olesen SS, Drewes AM. Dynamic spectral indices of the electroencephalogram provide new insights into tonic pain. Clin Neurophysiol 2014; 126:763-71. [PMID: 25213351 DOI: 10.1016/j.clinph.2014.07.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to investigate reliability of electroencephalography (EEG) during rest and tonic pain. Furthermore, changes in EEG between the two states as well as dynamics and relation to pain ratings were investigated. METHODS On two separate days EEG was recorded in 39 subjects during rest and tonic pain (cold pressor test: left hand held in 2°C water for 2 min.) while pain intensity was rated continuously. Dynamic spectral analysis was performed on the EEG. Between-day reliability of spectral indices was assessed and correlations to pain ratings were investigated. RESULTS EEG reliability was high during both states. The relative spectral indices increased in delta (1-4 Hz; P=0.0002), beta3 (18-32 Hz; P<0.0001) and gamma (32-70 Hz; P<0.0001) bands during tonic pain, and decreased in theta (4-8 Hz; P<0.0001), alpha1 (8-10 Hz; P<0.0001), alpha2 (10-12 Hz; P<0.0001) bands. Theta, beta3 and gamma bands correlated significantly to the area-under-curve of pain ratings, but only theta was dynamic and correlated to the pain ratings (R=0.88, P<0.0001). CONCLUSIONS EEG assessed during tonic pain is a valid experimental pain model both in terms of reliability between days and in connection between cortical activity and pain perception. SIGNIFICANCE EEG during tonic pain is more pain-specific and should be used in future basic and pharmacological studies.
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Affiliation(s)
- M Gram
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - C Graversen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - S S Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Center for Sensory-Motor Interactions (SMI), Department of Health Science and Technology, Aalborg University, Denmark.
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Gram M, Graversen C, Nielsen AK, Arendt-Nielsen T, Mørch CD, Andresen T, Drewes AM. A novel approach to pharmaco-EEG for investigating analgesics: assessment of spectral indices in single-sweep evoked brain potentials. Br J Clin Pharmacol 2014; 76:951-63. [PMID: 23521205 DOI: 10.1111/bcp.12120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 03/12/2013] [Indexed: 01/29/2023] Open
Abstract
AIMS To compare results from analysis of averaged and single-sweep evoked brain potentials (EPs) by visual inspection and spectral analysis in order to identify an objective measure for the analgesic effect of buprenorphine and fentanyl. METHODS Twenty-two healthy males were included in a randomized study to assess the changes in EPs after 110 sweeps of painful electrical stimulation to the median nerve following treatment with buprenorphine, fentanyl or placebo patches. Bone pressure, cutaneous heat and electrical pain ratings were assessed. EPs and pain assessments were obtained before drug administration, 24, 48, 72 and 144 h after beginning of treatment. Features from EPs were extracted by three different approaches: (i) visual inspection of amplitude and latency of the main peaks in the average EPs, (ii) spectral distribution of the average EPs and (iii) spectral distribution of the EPs from single-sweeps. RESULTS Visual inspection revealed no difference between active treatments and placebo (all P > 0.05). Spectral distribution of the averaged potentials showed a decrease in the beta (12-32 Hz) band for fentanyl (P = 0.036), which however did not correlate with pain ratings. Spectral distribution in the single-sweep EPs revealed significant increases in the theta, alpha and beta bands for buprenorphine (all P < 0.05) as well as theta band increase for fentanyl (P = 0.05). For buprenorphine, beta band activity correlated with bone pressure and cutaneous heat pain (both P = 0.04, r = 0.90). CONCLUSION In conclusion single-sweep spectral band analysis increases the information on the response of the brain to opioids and may be used to identify the response to analgesics.
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Affiliation(s)
- Mikkel Gram
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; Center for Sensory-Motor Interactions (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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D'Haese JG, Ceyhan GO, Demir IE, Tieftrunk E, Friess H. Treatment options in painful chronic pancreatitis: a systematic review. HPB (Oxford) 2014; 16:512-21. [PMID: 24033614 PMCID: PMC4048072 DOI: 10.1111/hpb.12173] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/05/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Longlasting and unbearable pain is the most common and striking symptom of chronic pancreatitis. Accordingly, pain relief and improvement in patients' quality of life are the primary goals in the treatment of this disease. This systematic review aims to summarize the available data on treatment options. METHODS A systematic search of MEDLINE/PubMed and the Cochrane Library was performed according to the PRISMA statement for reporting systematic reviews and meta-analysis. The search was limited to randomized controlled trials and meta-analyses. Reference lists were then hand-searched for additional relevant titles. The results obtained were examined individually by two independent investigators for further selection and data extraction. RESULTS A total of 416 abstracts were reviewed, of which 367 were excluded because they were obviously irrelevant or represented overlapping studies. Consequently, 49 full-text articles were systematically reviewed. CONCLUSIONS First-line medical options include the provision of pain medication, adjunctive agents and pancreatic enzymes, and abstinence from alcohol and tobacco. If medical treatment fails, endoscopic treatment offers pain relief in the majority of patients in the short term. However, current data suggest that surgical treatment seems to be superior to endoscopic intervention because it is significantly more effective and, especially, lasts longer.
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Affiliation(s)
- Jan G D'Haese
- Department of Surgery, Rechts der Isar Clinic, Technical University of Munich, Munich, Germany
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de Vries M, van Rijckevorsel DCM, Wilder-Smith OHG, van Goor H. Dronabinol and chronic pain: importance of mechanistic considerations. Expert Opin Pharmacother 2014; 15:1525-34. [PMID: 24819592 DOI: 10.1517/14656566.2014.918102] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Although medicinal cannabis has been used for many centuries, the therapeutic potential of delta-9-tetrahydrocannabinol (Δ9-THC; international non-proprietary name = dronabinol) in current pain management remains unclear. Several pharmaceutical products with defined natural or synthesized Δ9-THC content have been developed, resulting in increasing numbers of clinical trials investigating the analgesic efficacy of dronabinol in various pain conditions. Different underlying pain mechanisms, including sensitization of nociceptive sensory pathways and alterations in cognitive and autonomic processing, might explain the varying analgesic effects of dronabinol in chronic pain states. AREAS COVERED The pharmacokinetics, pharmacodynamics and mechanisms of action of products with a defined dronabinol content are summarized. Additionally, randomized clinical trials investigating the analgesic efficacy of pharmaceutical cannabis based products are reviewed for the treatment of chronic nonmalignant pain. EXPERT OPINION We suggest a mechanism-based approach beyond measurement of subjective pain relief to evaluate the therapeutic potential of dronabinol in chronic pain management. Development of objective mechanistic diagnostic biomarkers reflecting altered sensory and cognitive processing in the brain is essential to evaluate dronabinol induced analgesia, and to permit identification of responders and/or non-responders to dronabinol treatment.
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Affiliation(s)
- Marjan de Vries
- Radboud University Medical Center, Department of Surgery, Pain and Nociception Neuroscience Research Group , Route 690, PO Box 9101, 6500 HB Nijmegen , The Netherlands +31 024 361 0903 ; +31 024 354 0501 ;
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Bouwense SA, Ahmed Ali U, ten Broek RP, Issa Y, van Eijck CH, Wilder-Smith OH, van Goor H. Altered central pain processing after pancreatic surgery for chronic pancreatitis. Br J Surg 2014; 100:1797-804. [PMID: 24227367 DOI: 10.1002/bjs.9322] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic abdominal pain is common in chronic pancreatitis (CP) and may involve altered central pain processing. This study evaluated the relationship between pain processing and pain outcome after pancreatic duct decompression and/or pancreatic resection in patients with CP. METHODS Patients with CP underwent quantitative sensory testing. Pain processing was measured via electrical pain detection (ePDT) and electrical pain tolerance (ePTT) thresholds in dermatomes C5 and L4. Inhibitory descending pain control mechanisms were assessed using the conditioned pain modulation (CPM) paradigm. Healthy controls and patients with CP were compared, and patients with CP and a poor pain outcome (visual analogue scale (VAS) score greater than 30) were compared with those with a good pain outcome (VAS score 30 or less). RESULTS Forty-eight patients with CP had lower ePDT, ePTT and CPM responses compared with values in 15 healthy controls (P < 0·030). The sum of ePDT values was lower in patients with a poor pain outcome than in those with a good outcome (median 7·1 versus 11·2 mA; P = 0·008). There was a correlation with the VAS score and the sum of ePDT values (rs = -0·45, P = 0·016) and ePTT values (rs = -0·46, P = 0·011), and CPM response (rs = -0·43, P = 0·006) in patients with CP. CONCLUSION After pain-relieving pancreatic surgery, patients with CP exhibit altered central pain processing compared with that in healthy controls. Poor pain outcomes are associated with more central sensitization and more pronociceptive descending pain modulation, and this should be considered when managing persistent pain after pain-relieving surgery for CP.
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Affiliation(s)
- S A Bouwense
- Department of Surgery, Rotterdam, The Netherlands
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de Vries M, Wilder-Smith OHG, Jongsma MLA, van den Broeke EN, Arns M, van Goor H, van Rijn CM. Altered resting state EEG in chronic pancreatitis patients: toward a marker for chronic pain. J Pain Res 2013; 6:815-24. [PMID: 24379694 PMCID: PMC3843642 DOI: 10.2147/jpr.s50919] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Electroencephalography (EEG) may be a promising source of physiological biomarkers accompanying chronic pain. Several studies in patients with chronic neuropathic pain have reported alterations in central pain processing, manifested as slowed EEG rhythmicity and increased EEG power in the brain's resting state. We aimed to investigate novel potential markers of chronic pain in the resting state EEG of patients with chronic pancreatitis. PARTICIPANTS Resting state EEG data from 16 patients with persistent abdominal pain due to chronic pancreatitis (CP) were compared to data from healthy controls matched for age, sex and education. METHODS The peak alpha frequency (PAF) and power amplitude in the alpha band (7.5-13 Hz) were compared between groups in four regions of interest (frontal, central, parietal, and occipital) and were correlated with pain duration. RESULTS The average PAF was lowered in CP patients compared with that in healthy controls, observed as a statistically significant between-group effect (mean 9.9 versus 9.5 Hz; P=0.049). Exploratory post hoc analysis of average PAF per region of interest revealed a significant difference, particularly in the parietal and occipital regions. In addition, we observed a significant correlation between pain duration and PAF and showed increased shifts in PAF with longer pain durations. No significant group differences were found in peak power amplitudes. CONCLUSION CP pain is associated with alterations in spontaneous brain activity, observed as a shift toward lower PAF. This shift correlates with the duration of pain, which demonstrates that PAF has the potential to be a clinically feasible biomarker for chronic pain. These findings could be helpful for assisting diagnosis, establishing optimal treatment, and studying efficacy of new therapeutic agents in chronic pain patients.
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Affiliation(s)
- Marjan de Vries
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Oliver HG Wilder-Smith
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marijtje LA Jongsma
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Martijn Arns
- Research Institute Brainclinics Nijmegen, Nijmegen, The Netherlands
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Clementina M van Rijn
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
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Talukdar R, Reddy DN. Pain in chronic pancreatitis: Managing beyond the pancreatic duct. World J Gastroenterol 2013; 19:6319-6328. [PMID: 24151350 PMCID: PMC3801302 DOI: 10.3748/wjg.v19.i38.6319] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 07/31/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Chronic pancreatitis (CP) continues to be a clinical challenge. Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care. Unfortunately, in spite of using several treatment approaches in the clinical setting, there is no single specific treatment modality that can be earmarked as a cure for this disease. Traditionally, ductal hypertension has been associated with causation of pain in CP; and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct. Recent studies on humans (clinical and laboratory based) and experimental models have put forward several mechanisms, including neuroimmune alterations, which could be responsible for pain. This might explain the partial or no response to single modality treatment in a significant proportion of patients. The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches (other than ductal decompression) to handle persistent or recurrent pain. We focus primarily on parenchymal and neural components; and discuss the role of antioxidants and the existing controversies, drugs that interfere with neural transmission, pancreatic enzyme supplementation, celiac neurolysis, and pancreatic resection procedures. The review concludes with the treatment approach that we follow at our institute.
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