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ten Barge JA, Baudat M, Meesters NJ, Kindt A, Joosten EA, Reiss IK, Simons SH, van den Bosch GE. Biomarkers for assessing pain and pain relief in the neonatal intensive care unit. FRONTIERS IN PAIN RESEARCH 2024; 5:1343551. [PMID: 38426011 PMCID: PMC10902154 DOI: 10.3389/fpain.2024.1343551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
Newborns admitted to the neonatal intensive care unit (NICU) regularly undergo painful procedures and may face various painful conditions such as postoperative pain. Optimal management of pain in these vulnerable preterm and term born neonates is crucial to ensure their comfort and prevent negative consequences of neonatal pain. This entails accurate and timely identification of pain, non-pharmacological pain treatment and if needed administration of analgesic therapy, evaluation of treatment effectiveness, and monitoring of adverse effects. Despite the widely recognized importance of pain management, pain assessment in neonates has thus far proven to be a challenge. As self-report, the gold standard for pain assessment, is not possible in neonates, other methods are needed. Several observational pain scales have been developed, but these often rely on snapshot and largely subjective observations and may fail to capture pain in certain conditions. Incorporation of biomarkers alongside observational pain scores holds promise in enhancing pain assessment and, by extension, optimizing pain treatment and neonatal outcomes. This review explores the possibilities of integrating biomarkers in pain assessment in the NICU.
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Affiliation(s)
- Judith A. ten Barge
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Mathilde Baudat
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Naomi J. Meesters
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Alida Kindt
- Metabolomics and Analytics Center, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Elbert A. Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Irwin K.M. Reiss
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Sinno H.P. Simons
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Gerbrich E. van den Bosch
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
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Ribeiro H, Alves R, Jorge J, Gonçalves AC, Sarmento-Ribeiro AB, Teixeira-Veríssimo M, Andrade JP, Dourado M. Monocytes in the Characterization of Pain in Palliative Patients with Severe Dementia-A Pilot Study. Int J Mol Sci 2023; 24:10723. [PMID: 37445910 DOI: 10.3390/ijms241310723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
In assessing and managing pain, when obtaining a self-report is impossible, therapeutic decision-making becomes more challenging. This study aimed to investigate whether monocytes and some membrane monocyte proteins, identified as a cluster of differentiation (CD), could be potential non-invasive peripheral biomarkers in identifying and characterizing pain in patients with severe dementia. We used 53 blood samples from non-oncological palliative patients, 44 patients with pain (38 of whom had dementia) and 0 without pain or dementia (controls). We evaluated the levels of monocytes and their subtypes, including classic, intermediate, and non-classic, and characterized the levels of specific phenotypic markers, namely CD11c, CD86, CD163, and CD206. We found that the relative concentrations of monocytes, particularly the percentage of classic monocytes, may be a helpful pain biomarker. Furthermore, the CD11c expression levels were significantly higher in patients with mixed pain, while CD163 and CD206 expression levels were significantly higher in patients with nociceptive pain. These findings suggest that the levels of monocytes, particularly the classic subtype, and their phenotype markers CD11c, CD163, and CD206 could serve as pain biomarkers in patients with severe dementia.
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Affiliation(s)
- Hugo Ribeiro
- Community Support Team in Palliative Care-Group of Health Centers Gaia, 4400-043 Vila Nova de Gaia, Portugal
- Faculty of Medicine, University do Porto, 4200-219 Porto, Portugal
- Faculty of Medicine, University of Coimbra, 3004-304 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR)-Group of Environment Genetics and Oncobiology (CIMAGO), FMUC, 3004-304 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), 3004-304 Coimbra, Portugal
| | - Raquel Alves
- Faculty of Medicine, University of Coimbra, 3004-304 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR)-Group of Environment Genetics and Oncobiology (CIMAGO), FMUC, 3004-304 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), 3004-304 Coimbra, Portugal
- Laboratory of Oncobiology and Hematology (LOH), Faculty of Medicine, University of Coimbra, University Clinics of Hematology and Oncology, 3004-304 Coimbra, Portugal
| | - Joana Jorge
- Faculty of Medicine, University of Coimbra, 3004-304 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR)-Group of Environment Genetics and Oncobiology (CIMAGO), FMUC, 3004-304 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), 3004-304 Coimbra, Portugal
- Laboratory of Oncobiology and Hematology (LOH), Faculty of Medicine, University of Coimbra, University Clinics of Hematology and Oncology, 3004-304 Coimbra, Portugal
| | - Ana Cristina Gonçalves
- Faculty of Medicine, University of Coimbra, 3004-304 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR)-Group of Environment Genetics and Oncobiology (CIMAGO), FMUC, 3004-304 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), 3004-304 Coimbra, Portugal
- Laboratory of Oncobiology and Hematology (LOH), Faculty of Medicine, University of Coimbra, University Clinics of Hematology and Oncology, 3004-304 Coimbra, Portugal
| | - Ana Bela Sarmento-Ribeiro
- Faculty of Medicine, University of Coimbra, 3004-304 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR)-Group of Environment Genetics and Oncobiology (CIMAGO), FMUC, 3004-304 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), 3004-304 Coimbra, Portugal
- Laboratory of Oncobiology and Hematology (LOH), Faculty of Medicine, University of Coimbra, University Clinics of Hematology and Oncology, 3004-304 Coimbra, Portugal
- Hematology Service, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal
| | - Manuel Teixeira-Veríssimo
- Faculty of Medicine, University of Coimbra, 3004-304 Coimbra, Portugal
- Hematology Service, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal
| | - José Paulo Andrade
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-219 Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-219 Porto, Portugal
| | - Marília Dourado
- Faculty of Medicine, University of Coimbra, 3004-304 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR)-Group of Environment Genetics and Oncobiology (CIMAGO), FMUC, 3004-304 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), 3004-304 Coimbra, Portugal
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Platelet Membrane Proteins as Pain Biomarkers in Patients with Severe Dementia. Biomedicines 2023; 11:biomedicines11020380. [PMID: 36830917 PMCID: PMC9953643 DOI: 10.3390/biomedicines11020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Pain is one of the most frequent health problems, and its evaluation and therapeutic approach largely depend on patient self-report. When it is not possible to obtain a self-report, the therapeutic decision becomes more difficult and limited. This study aims to evaluate whether some membrane platelet proteins could be of value in pain characterization. To achieve this goal, we used 53 blood samples obtained from palliative patients, 44 with non-oncological pain and nine without pain. We observed in patients with pain a decrease in the percentage of platelets expressing CD36, CD49f, and CD61 and in the expression levels of CD49f and CD61 when compared with patients without pain. Besides that, an increase in the percentage of platelets expressing CD62p was observed in patients with pain. These results suggest that the levels of these platelet cluster differentiations (CDs) could have some value as pain biomarkers objectively since they are not dependent on the patient's participation. Likewise, CD40 seems to have some importance as a biomarker of moderate and/or severe pain. The identification of pain biomarkers such as CD40, CD49f, CD62p and CD61 can lead to an adjustment of the therapeutic strategy, contributing to a faster and more adequate control of pain and reduction in patient-associated suffering.
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Hartrick CT. Exploiting Injury-Induced Peripheral Opioid Receptor Changes in Novel Analgesic Development for Chronic Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:883164. [PMID: 35557854 PMCID: PMC9090307 DOI: 10.3389/fpain.2022.883164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
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Systematic Review and Synthesis of Mechanism-based Classification Systems for Pain Experienced in the Musculoskeletal System. Clin J Pain 2020; 36:793-812. [DOI: 10.1097/ajp.0000000000000860] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Maharao N, Antontsev V, Hou H, Walsh J, Varshney J. Scalable in silico Simulation of Transdermal Drug Permeability: Application of BIOiSIM Platform. Drug Des Devel Ther 2020; 14:2307-2317. [PMID: 32606600 PMCID: PMC7296558 DOI: 10.2147/dddt.s253064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/07/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Transdermal drug delivery is gaining popularity as an alternative to traditional routes of administration. It can increase patient compliance because of its painless and noninvasive nature, aid compounds in bypassing presystemic metabolic effects, and reduce the likelihood of adverse effects through decreased systemic exposure. In silico physiological modeling is critical to predicting dermal exposure for a therapeutic and assessing the impact of different formulations on transdermal disposition. METHODS The present study aimed at developing a physiologically based transdermal platform, "BIOiSIM", that could be globally applied to a wide variety of compounds to predict their transdermal disposition. The platform integrates a 16-compartment model of compound pharmacokinetics and was used to simulate and predict drug exposure of three chemically and biologically distinct drug-like compounds. Machine learning optimization was composed of two components: exhaustive search algorithm (coarse-tuning) and descent (fine-tuning) integrated with the platform used to quantitatively determine parameters influencing pharmacokinetics (eg permeability, kperm) of test compounds. RESULTS The model successfully predicted drug exposure (AUC, Cmax and Tmax) following transdermal application of morphine, buprenorphine and nicotine in human subjects, mostly with less than two-fold absolute average fold error (AAFE). The model was further able to successfully characterize the relationship between observed systemic exposure and intended pharmacological effect. The predicted systemic concentration of morphine and plasma levels of endogenous pain biomarkers were used to estimate the effectiveness of a given therapeutic regimen. CONCLUSION BIOiSIM marks a novel approach to in silico prediction that will enable leveraging of machine learning technology in the pharmaceutical space. The approach to model development outlined results in scalable, accurate models and enables the generation of large parameter/coefficient datasets from in vivo clinical data that can be used in future work to train quantitative structure activity relationship (QSAR) models for predicting likelihood of compound utility as a transdermally administered therapeutic.
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Anastasi JK, Pakhomova AM. Assessment and Management of HIV Distal Sensory Peripheral Neuropathy: Understanding the Symptoms. J Nurse Pract 2020; 16:276-280. [PMID: 33679267 DOI: 10.1016/j.nurpra.2019.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Distal sensory peripheral neuropathy (HIV-DSP) affects upwards of 50% of people living with HIV. Causing often debilitating symptoms of tingling, numbness and burning, HIV-DSP can result in disability, unemployment and low quality of life. Comorbidities further complicate nursing care, heightening risk of polypharmacy and symptom exacerbation. Therefore, a neurological sensory assessment, combined with the patient's self-report of symptoms, can help nurse practitioners visualize, quantify and understand symptoms. Common pharmacological interventions include antiepileptics, antidepressants, analgesics and medical marijuana. The complexity of care for individuals with HIV-DSP merits a comprehensive approach. Implications for practice include interdisciplinary management with neurologists, podiatrists, mental health providers, and nurse-led counseling inclusive of patient safety teaching.
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Affiliation(s)
- Joyce K Anastasi
- Special Studies in Symptom Management New York University / NYU Meyers
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Sobas EM, Reinoso R, Cuadrado-Asensio R, Fernández I, Maldonado MJ, Pastor JC. Reliability of Potential Pain Biomarkers in the Saliva of Healthy Subjects: Inter-Individual Differences and Intersession Variability. PLoS One 2016; 11:e0166976. [PMID: 27907037 PMCID: PMC5132231 DOI: 10.1371/journal.pone.0166976] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/07/2016] [Indexed: 01/17/2023] Open
Abstract
AIM Salivary cortisol, α-amylase (sAA), secretory IgA (sIgA), testosterone, and soluble fraction of receptor II of TNFα (sTNFαRII) could serve as objective pain measures, but the normal variability of these potential biomarkers is unknown. PATIENTS & METHODS Saliva was collected with the passive secretion method from 34, pain-free subjects in two single samples at least 24 hours apart. Biomarker variation and intersession reliability were assessed with the intraclass correlation coefficient (ICC). Also, we calculated the within-subject standard deviation (Sw) and the reproducibility (2.77 × Sw) of intersession measures. RESULTS Salivary cortisol, sAA, sIgA, testosterone, and sTNFαRII yielded the following ICCs: 0.53, 0.003, 0.88, 0.42 and 0.83, respectively. We found no statistically significant systematic differences between sessions in any biomarker except for testosterone, which showed a decrease on the second day (p<0.001). The reproducibility for salivary cortisol, sAA, sIgA, testosterone, and sTNFαRII were 0.46 ng/ml, 12.88 U/ml, 11.7 μg/ml, 14.54 pg/ml and 18.29 pg/ml, respectively. Cortisol, testosterone and TNFαRII measurement variability showed a positive correlation with the magnitude (p<0.002), but no relationship was found for sAA and sIgA. CONCLUSIONS Salivary sIgA and sTNFαRII show a remarkable good reproducibility and, therefore, could be useful as pain biomarkers. When using the passive secretion method, intersession variations in salivary sIgA of more than 11.7 μg/ml may reflect true biomarker change. In the case of sTNFαRII this will depend of the magnitude. The estimates herein provided should help investigators and clinicians differentiate actual biomarker modification from measurement variability.
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Affiliation(s)
- Eva M. Sobas
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Escuela de Enfermería, Universidad de Valladolid, Valladolid, Spain
| | - Roberto Reinoso
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Visión I+D, Valladolid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Rubén Cuadrado-Asensio
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Miguel J. Maldonado
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - José C. Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Department of Ophthalmology, Hospital Clinico Universitario, Valladolid, Spain
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Bustamante HA, Rodríguez AR, Herzberg DE, Werner MP. Stress and pain response after oligofructose induced-lameness in dairy heifers. J Vet Sci 2016; 16:405-11. [PMID: 26243595 PMCID: PMC4701732 DOI: 10.4142/jvs.2015.16.4.405] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/12/2015] [Accepted: 07/03/2015] [Indexed: 11/20/2022] Open
Abstract
Lameness is one of the most painful conditions that affects dairy cattle. This study was conducted to evaluate clinical signs and plasma concentration of several pain and stress biomarkers after oligofructose-induced lameness in dairy heifers. Lameness was induced using an oligofructose overload model in 12 non-pregnant heifers. Clinical parameters and blood samples were obtained at 48 and 24 h and at 6, 12, 24, 36 and 48 h after induction of lameness. Clinical parameters included heart rate, respiratory rate, ruminal frequency and lameness score. Plasma biomarkers included cortisol, haptoglobin, norepinephrine, beta-endorphin and substance P. Differences were observed in all parameters between control and treated heifers. The plasma concentration of biomarkers increased significantly in treated animals starting 6 h after induction of lameness, reaching maximum levels at 24 h for cortisol, 48 h for haptoglobin, 6 h for norepinephrine, 12 h for substance P and at 24 h for beta-endorphin. Overall, our results confirm that lameness associated pain induced using the oligofructose model induced changes in clinical parameters and plasma biomarkers of pain and stress in dairy heifers.
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Affiliation(s)
- Hedie A Bustamante
- Veterinary Clinical Sciences Institute, School of Veterinary Sciences, Austral University of Chile, Valdivia 5110566, Chile
| | - Alfredo R Rodríguez
- Veterinary Clinical Sciences Institute, School of Veterinary Sciences, Austral University of Chile, Valdivia 5110566, Chile
| | - Daniel E Herzberg
- Veterinary Clinical Sciences Department, School of Veterinary Sciences, University of Concepcion, Concepcion 4070374, Chile
| | - Marianne P Werner
- Animal Science Institute, School of Veterinary Sciences, Austral University of Chile, Valdivia 5110566, Chile
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Gobbato L, Nart J, Bressan E, Mazzocco F, Paniz G, Lops D. Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial. Clin Oral Investig 2016; 20:2191-2202. [DOI: 10.1007/s00784-016-1721-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 01/12/2016] [Indexed: 02/04/2023]
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Abstract
Biomarkers are measurable characteristics reflective of the physiological or diseased state and a crucial feature in rendering personalized medicine more precise. Dysregulated expression of circulating microRNAs (miRNAs) in bodily fluids is being explored as noninvasive clinical biomarker for a variety of disorders including chronic pain. High-precision qPCR-based signal amplification of these miRNAs enables the detection of small changes making them ideal biomarker candidates. Presence of circulating miRNAs in exosomes, small vesicles that mediate intercellular communication, opens up novel avenues for target intervention and biomarker discovery. miRNA signatures specific to different pain conditions, and their reversal on treatment in patients and animal models can be beneficial in patient stratification, prognosis, and in bridging preclinical and clinical results. Identification of multiple miRNAs as opposed to reliance on one specific molecule as a biomarker could improve treatment efficacies in an extremely heterogeneous pain patient population. Additionally, owing to the stability of miRNAs, retrospective studies could be performed using banked samples from completed clinical trials. Irrespective of the phase and outcome, these studies can provide insights on molecular underpinnings influencing treatment outcome, or specific therapeutic intervention. Identification of miRNAs altered in chronic pain states will have a significant impact on the identification of right leads, targets, doses, and patients. Effective implementation of miRNA-based biomarkers would provide treatment guidance for clinicians, better clinical trial designs for pharmaceutical companies, all leading to individualized care and better treatment outcome for chronic pain patients.
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Affiliation(s)
- Sujay Ramanathan
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Seena K Ajit
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
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12
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Circulating microRNA Signatures in Rodent Models of Pain. Mol Neurobiol 2015; 53:3416-3427. [DOI: 10.1007/s12035-015-9281-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/02/2015] [Indexed: 01/29/2023]
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Merlin JS, Westfall AO, Chamot E, Saag M, Walcott M, Ritchie C, Kertesz S. Quantitative Evaluation of an Instrument to Identify Chronic Pain in HIV-Infected Individuals. AIDS Res Hum Retroviruses 2015; 31:623-7. [PMID: 25693683 DOI: 10.1089/aid.2014.0362] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A method to rapidly identify the presence of chronic pain would enhance the care of HIV-infected individuals, but such an instrument has not been assessed in this population to date. We assessed the construct validity of the two-question Brief Chronic Pain Questionnaire (BCPQ) in HIV-infected patients by assessing the association between BCPQ responses and known correlates of chronic pain. Participants in the University of Alabama Center for AIDS Research Network of Integrated Clinical Systems cohort completed the BCPQ, along with the EuroQOL to assess physical function, the PHQ-9 to assess depression, and the PHQ-anxiety module to assess anxiety. Among 100 participants, 25% were female, the mean age was 45 (SD 12), 63% were African American, 27% were publicly insured, the median CD4(+) T cell count was 572 cells/mm(3) (IQR 307-788), and 82% had an undetectable viral load. Participants with chronic pain were more likely to have impaired mobility (43% vs. 12%, p=0.001), difficulty with usual activities (47% vs. 12%, p<0.001), lower overall health state (70 vs. 84, p=0.002), pain today (80% vs. 27%, p<0.001), depression (30% vs. 15%, p=0.10), and anxiety (43% vs. 10%, p<0.001) than those without chronic pain. This study provides preliminary evidence for the BCPQ as a brief questionnaire to identify the presence of chronic pain in HIV care settings.
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Affiliation(s)
- Jessica S. Merlin
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew O. Westfall
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric Chamot
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael Saag
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Melonie Walcott
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine Ritchie
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California
- San Francisco VA Medical Center, San Francisco, California
| | - Stefan Kertesz
- Birmingham VA Medical Center, Birmingham, Alabama
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Bäckryd E, Ghafouri B, Larsson B, Gerdle B. Do low levels of beta-endorphin in the cerebrospinal fluid indicate defective top-down inhibition in patients with chronic neuropathic pain? A cross-sectional, comparative study. PAIN MEDICINE 2013; 15:111-9. [PMID: 24118997 DOI: 10.1111/pme.12248] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Pain medicine still lacks mechanism-specific biomarkers to guide diagnosis and treatment, and defective top-down modulation is an important factor in the pathophysiology of chronic pain conditions. Using modern analytical tools and advanced multivariate statistical analysis, the aim of this study was to revisit two classical potential biomarkers of pro- and anti-nociception in humans (substance P and beta-endorphin), focusing particularly on the cerebrospinal fluid (CSF). DESIGN Cross-sectional, comparative, observational study. SUBJECTS Patients with chronic, post-traumatic and/or post-surgical, neuropathic pain refractory to conventional treatment (N = 15) and healthy controls (N = 19) were included. METHODS Samples were taken from CSF and blood, and levels of substance P and beta-endorphin were investigated using a Luminex technology kit. RESULTS We found low levels of beta-endorphin in the CSF of neuropathic pain patients (66 ± 11 pcg/mL) compared with healthy controls (115 ± 14 pcg/mL) (P = 0.017). Substance P levels in the CSF did not differ (20 ± 2 pcg/mL, 26 ± 2, P = 0.08). However, our multivariate data analysis showed that belonging to the patient group was associated with low levels of both substances in the CSF. A higher correlation between the levels of beta-endorphin and substance P in CSF was found in healthy controls than in patients (rs = 0.725, P < 0.001 vs. rs = 0.574, P = 0.032). CONCLUSIONS Patients with chronic neuropathic pain due to trauma or surgery had low levels of beta-endorphin in the CSF. We speculate that this could indicate a defective top-down modulation of pain in chronic neuropathic pain. Our results also illustrate the importance of taking a system-wide, multivariate approach when searching for biomarkers.
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Affiliation(s)
- Emmanuel Bäckryd
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Pain and Rehabilitation Centre, UHL, County Council of Östergötland, Linköping, Sweden
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Abstract
The field of chronic pain medicine is currently facing enormous challenges. The incidence of chronic pain is increasing worldwide, particularly in the developed world. As a result, chronic pain is imposing a growing burden on Western societies in terms of cost of medical care and lost productivity. This burden is exacerbated by the fact that despite research efforts and a huge expenditure on treatment for chronic pain, clinicians have no highly effective treatments or definitive diagnostic measures for patients. The lack of an objective measure for pain impedes basic research into the biological and psychological mechanisms of chronic pain and clinical research into treatment efficacy. The development of objective measurements of pain and ability to predict treatment responses in the individual patient is critical to improving pain management. Finally, pain medicine must embrace the development of a new evidence-based therapeutic model that recognizes the highly individual nature of responsiveness to pain treatments, integrates bio-psycho-behavioural approaches, and requires proof of clinical effectiveness for the various treatments we offer our patients. In the long-term these approaches will contribute to providing better diagnoses and more effective treatments to lessen the current challenges in pain medicine.
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Affiliation(s)
- D Borsook
- P.A.I.N. Group, Department of Anesthesia and Radiology, Boston Children's Hospital, Harvard Medical School, Boston, USA.
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Olausson P, Gerdle B, Ghafouri N, Larsson B, Ghafouri B. Identification of proteins from interstitium of trapezius muscle in women with chronic myalgia using microdialysis in combination with proteomics. PLoS One 2012; 7:e52560. [PMID: 23300707 PMCID: PMC3531451 DOI: 10.1371/journal.pone.0052560] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/16/2012] [Indexed: 01/30/2023] Open
Abstract
Background Microdialysis (MD) of the trapezius muscle has been an attractive technique to investigating small molecules and metabolites in chronic musculoskeletal pain in human. Large biomolecules such as proteins also cross the dialysis membrane of the catheters. In this study we have applied in vivo MD in combination with two dimensional gel electrophoresis (2-DE) and mass spectrometry to identify proteins in the extracellular fluid of the trapezius muscle. Materials and Methods Dialysate from women with chronic trapezius myalgia (TM; n = 37), women with chronic wide spread pain (CWP; n = 18) and healthy controls (CON; n = 22) was collected from the trapezius muscle using a catheter with a cut-off point of 100 kDa. Proteins were separated by two-dimensional gel electrophoresis and visualized by silver staining. Detected proteins were identified by nano liquid chromatography in combination with tandem mass spectrometry. Results Ninety-seven protein spots were identified from the interstitial fluid of the trapezius muscle; 48 proteins in TM and 30 proteins in CWP had concentrations at least two-fold higher or lower than in CON. The identified proteins pertain to several functional classes, e.g., proteins involved in inflammatory responses. Several of the identified proteins are known to be involved in processes of pain such as: creatine kinase, nerve growth factor, carbonic anhydrase, myoglobin, fatty acid binding protein and actin aortic smooth muscle. Conclusions In this study, by using in vivo microdialysis in combination with proteomics a large number of proteins in muscle interstitium have been identified. Several of the identified proteins were at least two-fold higher or lower in chronic pain patients. The applied techniques open up for the possibility of investigating protein changes associated with nociceptive processes of chronic myalgia.
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Affiliation(s)
- Patrik Olausson
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, University of Linköping and Pain- and Rehabilitation Centre, County Council, Linköping, Sweden
| | - Björn Gerdle
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, University of Linköping and Pain- and Rehabilitation Centre, County Council, Linköping, Sweden
| | - Nazdar Ghafouri
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, University of Linköping and Pain- and Rehabilitation Centre, County Council, Linköping, Sweden
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Britt Larsson
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, University of Linköping and Pain- and Rehabilitation Centre, County Council, Linköping, Sweden
| | - Bijar Ghafouri
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, University of Linköping and Pain- and Rehabilitation Centre, County Council, Linköping, Sweden
- Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University and Centre of Occupational and Environmental Medicine, County Council, Linköping, Sweden
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