1
|
Angeli F, Ricci F, Moscucci F, Sciomer S, Bucciarelli V, Bianco F, Mattioli AV, Pizzi C, Gallina S. Sex- and gender-related disparities in chest pain syndromes: the feminine mystique of chest pain. Curr Probl Cardiol 2024; 49:102457. [PMID: 38342350 DOI: 10.1016/j.cpcardiol.2024.102457] [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: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
Chest pain syndromes encompass a wide range of different clinical conditions, being coronary artery disease one of the most important and feared aetiology. Sex and gender disparities have been reported in pathophysiology, clinical presentations, diagnostic work-up and outcomes of patients admitted for chest pain. Biological differences in sexual hormones and neurological pain procession pathways have been proposed as contributors to disparities between men and women; however, gender-related disparities in socio-economic and psychological status have emerged as additional factors involved in these conditions. A better understanding of gender- and sex-related disparities will lead to improved clinical care and management of chest pain syndromes in both men and women. In this comprehensive review, we describe the existing knowledge regarding sex and gender-based differences in management and outcomes of chest pain syndromes in order to stimulate and promote the development of a more sex- and gender-oriented approach to these conditions.
Collapse
Affiliation(s)
- Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico n. 155, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, 'Sapienza', Rome University, Viale dell'Università, 37, 00185, Rome, Italy
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Francesco Bianco
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy.
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
2
|
Gungormus DB, Fernández-Martín M, Ortigosa-Luque ME, Pérez-Mármol JM. Effects of Nature-Based Multisensory Stimulation on Pain Mechanisms in Women with Fibromyalgia Syndrome: A Randomized Double-Blind Placebo-Controlled Trial. Pain Manag Nurs 2024; 25:46-55. [PMID: 37495473 DOI: 10.1016/j.pmn.2023.06.014] [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: 10/27/2022] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The term "nature-based sensory stimuli" refers to the sensory information produced by biotic and abiotic agents from natural environments. The literature has reported the beneficial effects of these agents on various pain dimensions in non-clinical populations. AIMS To evaluate the potential analgesic effects of nature-based multisensory stimulation in women with fibromyalgia syndrome. METHODS A randomized, double-blind, placebo-controlled, parallel-group trial with a 1:1 allocation ratio was conducted. Forty-two women with fibromyalgia syndrome interacted with either different plant species with flowers, stones, and soil organic matter or their synthetic imitations for 30 minutes. Outcome measurements were performed before and after the intervention, including clinical pain intensity using the Numeric Rating Scale, cold pain thresholds using the Cold Pressor Test, mechanical hyperalgesia and wind-up using a monofilament, and pressure pain thresholds using a pressure algometer. RESULTS Analyses revealed group × time interactions for clinical pain intensity (F = 7.915, p = .008), cold-water immersion time (F = 7.271, p = .010), mechanical hyperalgesia (F = 4.701, p = .036), and pressure pain threshold (p ≤ .017). Between-group differences were found in clinical pain intensity (p = .012), cold pain thresholds (p = .002), and pressure pain thresholds (p < .05). The experimental group exhibited reduced clinical pain intensity (p = .001) and increased pressure pain thresholds (p ≤ .034). CONCLUSIONS Women with fibromyalgia syndrome may benefit from multisensory stimulation using biotic and abiotic agents from natural environments for 30 minutes. Interacting with flowering plants and soil components appears to induce analgesic effects.
Collapse
Affiliation(s)
- Dogukan Baran Gungormus
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Mónica Fernández-Martín
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.
| | | | - José Manuel Pérez-Mármol
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| |
Collapse
|
3
|
Delon-Martin C, Lefaucheur JP, Hodaj E, Sorel M, Dumolard A, Payen JF, Hodaj H. Neural Correlates of Pain-Autonomic Coupling in Patients With Complex Regional Pain Syndrome Treated by Repetitive Transcranial Magnetic Stimulation of the Motor Cortex. Neuromodulation 2024; 27:188-199. [PMID: 37589642 DOI: 10.1016/j.neurom.2023.05.005] [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: 01/10/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES Complex regional pain syndrome (CRPS) is a chronic pain condition involving autonomic dysregulation. In this study, we report the results of an ancillary study to a larger clinical trial investigating the treatment of CRPS by neuromodulation. This ancillary study, based on functional magnetic resonance imaging (fMRI), evaluated the neural correlates of pain in patients with CRPS in relation to the sympathetic nervous system and for its potential relief after repetitive transcranial magnetic stimulation of the motor cortex. MATERIALS AND METHODS Eleven patients with CRPS at one limb (six women, five men, aged 52.0 ± 9.6 years) were assessed before and one month after the end of a five-month repetitive transcranial magnetic stimulation (rTMS) therapy targeting the motor cortex contralateral to the painful limb, by means of electrochemical skin conductance (ESC) measurement, daily pain intensity scores on a visual numerical scale (VNS), and fMRI with motor tasks (alternation of finger movements and rest). The fMRI scans were analyzed voxelwise using ESC and VNS pain score as regressors to derive their neural correlates. The criterion of response to rTMS therapy was defined as ≥30% reduction in VNS pain score one month after treatment compared with baseline. RESULTS At baseline, ESC values were reduced in the affected limb vs the nonaffected limb. There was a covariance of VNS with brain activation in a small region of the primary somatosensory cortex (S1) contralateral to the painful side on fMRI investigation. After rTMS therapy on motor cortex related to the painful limb, the VNS pain scores significantly decreased by 22% on average. The criterion of response was met in six of 11 patients (55%). In these responders, at one month after treatment, ESC value increased and returned to normal in the CRPS-affected limb, and overall, the increase in ESC correlated with the decrease in VNS after motor cortex rTMS therapy. At one month after treatment, there also was a covariance of both variables (ESC and VNS) with fMRI activation of the S1 region previously mentioned. The fMRI activation of other brain regions (middle frontal gyrus and temporo-parietal junction) showed correlation with ESC values before and after treatment. Finally, we found a positive correlation at one month after treatment (not at baseline) between VNS pain score and fMRI activation in the temporo-parietal junction contralateral to painful side. CONCLUSIONS This study first shows a functional pain-autonomic coupling in patients with CRPS, which could involve a specific S1 region. However, the modulation of sympathetic sudomotor activities expressed by ESC changes was rather correlated with functional changes in other brain regions. Finally, the pain relief observed at one month after rTMS treatment was associated with a reduced activation of the temporo-parietal junction on the side in which rTMS was performed. These findings open perspectives to define new targets or biomarkers for using rTMS to treat CRPS-associated pain. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT02817880.
Collapse
Affiliation(s)
- Chantal Delon-Martin
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France.
| | - Jean-Pascal Lefaucheur
- EA University Paris Est Créteil, Health Faculty, Créteil, France; AP-HP, Clinical Neurophysiology Unit, Henri Mondor Hospital, Créteil, France
| | - Enkeledja Hodaj
- CHU Grenoble Alpes, Clinical Investigation Center, Grenoble, France
| | - Marc Sorel
- Sud-Seine-et-Marne Hospital, Center for Pain Evaluation and Treatment, Nemours, France
| | | | - Jean-François Payen
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France; CHU Grenoble Alpes, Pain Center, Grenoble, France
| | - Hasan Hodaj
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France; CHU Grenoble Alpes, Pain Center, Grenoble, France
| |
Collapse
|
4
|
Moscato S, Orlandi S, Di Gregorio F, Lullini G, Pozzi S, Sabattini L, Chiari L, La Porta F. Feasibility interventional study investigating PAIN in neurorehabilitation through wearabLE SensorS (PAINLESS): a study protocol. BMJ Open 2023; 13:e073534. [PMID: 37993169 PMCID: PMC10668325 DOI: 10.1136/bmjopen-2023-073534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/28/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Millions of people survive injuries to the central or peripheral nervous system for which neurorehabilitation is required. In addition to the physical and cognitive impairments, many neurorehabilitation patients experience pain, often not widely recognised and inadequately treated. This is particularly true for multiple sclerosis (MS) patients, for whom pain is one of the most common symptoms. In clinical practice, pain assessment is usually conducted based on a subjective estimate. This approach can lead to inaccurate evaluations due to the influence of numerous factors, including emotional or cognitive aspects. To date, no objective and simple to use clinical methods allow objective quantification of pain and the diagnostic differentiation between the two main types of pain (nociceptive vs neuropathic). Wearable technologies and artificial intelligence (AI) have the potential to bridge this gap by continuously monitoring patients' health parameters and extracting meaningful information from them. Therefore, we propose to develop a new automatic AI-powered tool to assess pain and its characteristics during neurorehabilitation treatments using physiological signals collected by wearable sensors. METHODS AND ANALYSIS We aim to recruit 15 participants suffering from MS undergoing physiotherapy treatment. During the study, participants will wear a wristband for three consecutive days and be monitored before and after their physiotherapy sessions. Measurement of traditionally used pain assessment questionnaires and scales (ie, painDETECT, Doleur Neuropathique 4 Questions, EuroQoL-5-dimension-3-level) and physiological signals (photoplethysmography, electrodermal activity, skin temperature, accelerometer data) will be collected. Relevant parameters from physiological signals will be identified, and AI algorithms will be used to develop automatic classification methods. ETHICS AND DISSEMINATION The study has been approved by the local Ethical Committee (285-2022-SPER-AUSLBO). Participants are required to provide written informed consent. The results will be disseminated through contributions to international conferences and scientific journals, and they will also be included in a doctoral dissertation. TRIAL REGISTRATION NUMBER NCT05747040.
Collapse
Affiliation(s)
- Serena Moscato
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Silvia Orlandi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Health Science and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Di Gregorio
- UOC Medicina Riabilitativa e Neuroriabilitazione, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy
- Centro studi e ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum - Università di Bologna, Cesena, Italy
| | - Giada Lullini
- IRCCS Istituto delle Scienze Neurologuche di Bologna, Bologna, Italy
| | - Stefania Pozzi
- DATER Riabilitazione Ospedaliera, UA Riabilitazione, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy
| | | | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Health Science and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fabio La Porta
- IRCCS Istituto delle Scienze Neurologuche di Bologna, Bologna, Italy
| |
Collapse
|
5
|
Chang YC, Chen CM, Lay IS, Lee YC, Tu CH. The effects of laser acupuncture dosage at PC6 (Neiguan) on brain reactivity: a pilot resting-state fMRI study. Front Neurosci 2023; 17:1264217. [PMID: 37901421 PMCID: PMC10600496 DOI: 10.3389/fnins.2023.1264217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Previous studies indicated that laser acupuncture (LA) may effectively treat various medical conditions. However, brain responses associated with LA intervention have not been fully investigated. This study is focused on the effect of LA with different energy density (ED) in brain using resting-state functional magnetic resonance imaging (fMRI). We hypothesized that different ED would elicit various brain responses. We enrolled healthy adults participants and selected bilateral PC6 (Neiguan) as the intervention points. LA was applied, respectively, with ED of 0, 7.96, or 23.87 J/cm2. Two 500-s resting-state fMRI scans were acquired before and after intervention, respectively. The functional connectivity (FC) was calculated between autonomic nerve system-regulation associated brainstem structures and other brain regions. Compared to other dosages, the FC between rostral ventrolateral medulla and orbitofrontal cortex has more enhanced; the FC between caudal ventrolateral medulla, nucleus of the solitary tract/nucleus ambiguus, and dorsal motor nucleus of the vagus and somatosensory area has more weakened when ED was 23.87 J/cm2. Different dosages of LA have demonstrated varied regions of FC changes between regions of interest and other brain areas, which indicated that variations in EDs might influence the clinical efficacy and subsequent impacts through distinct neural pathways within the brain.
Collapse
Affiliation(s)
- Yi-Chuan Chang
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan
| | - Chun-Ming Chen
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Ing-Shiow Lay
- Department of Chinese Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Chen Lee
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Hao Tu
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
6
|
Luebke L, Gouverneur P, Szikszay TM, Adamczyk WM, Luedtke K, Grzegorzek M. Objective Measurement of Subjective Pain Perception with Autonomic Body Reactions in Healthy Subjects and Chronic Back Pain Patients: An Experimental Heat Pain Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:8231. [PMID: 37837061 PMCID: PMC10575054 DOI: 10.3390/s23198231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
Multiple attempts to quantify pain objectively using single measures of physiological body responses have been performed in the past, but the variability across participants reduces the usefulness of such methods. Therefore, this study aims to evaluate whether combining multiple autonomic parameters is more appropriate to quantify the perceived pain intensity of healthy subjects (HSs) and chronic back pain patients (CBPPs) during experimental heat pain stimulation. HS and CBPP received different heat pain stimuli adjusted for individual pain tolerance via a CE-certified thermode. Different sensors measured physiological responses. Machine learning models were trained to evaluate performance in distinguishing pain levels and identify key sensors and features for the classification task. The results show that distinguishing between no and severe pain is significantly easier than discriminating lower pain levels. Electrodermal activity is the best marker for distinguishing between low and high pain levels. However, recursive feature elimination showed that an optimal subset of features for all modalities includes characteristics retrieved from several modalities. Moreover, the study's findings indicate that differences in physiological responses to pain in HS and CBPP remain small.
Collapse
Affiliation(s)
- Luisa Luebke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, 23562 Lübeck, Germany; (L.L.); (T.M.S.); (K.L.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, 23562 Lübeck, Germany
| | - Philip Gouverneur
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany;
| | - Tibor M. Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, 23562 Lübeck, Germany; (L.L.); (T.M.S.); (K.L.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, 23562 Lübeck, Germany
| | - Wacław M. Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland;
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3026, USA
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, 23562 Lübeck, Germany; (L.L.); (T.M.S.); (K.L.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, 23562 Lübeck, Germany
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Lübeck, 23562 Lübeck, Germany;
- Department of Knowledge Engineering, University of Economics in Katowice, 40-287 Katowice, Poland
| |
Collapse
|
7
|
Wu CH, Hsu TW, Lai KL, Wang YF, Fuh JL, Wu HM, Lirng JF, Wang SJ, Chen SP. Disrupted Brain Functional Status in Patients with Reversible Cerebral Vasoconstriction Syndrome. Ann Neurol 2023; 94:772-784. [PMID: 37345341 DOI: 10.1002/ana.26724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the functional networks in subjects with reversible cerebral vasoconstriction syndrome (RCVS) using resting-state functional magnetic resonance imaging (rs-fMRI). METHODS We prospectively recruited patients with RCVS and healthy controls (HCs) between February 2017 and April 2021. The rs-fMRI data were analyzed using graph theory methods. We compared node-based global and regional topological metrics (Bundle 1) and network-based intranetwork and internetwork connectivity (Bundle 2) between RCVS patients and HCs. We also explored the associations of clinical and vascular (ie, the Lindegaard index, LI) parameters with significant rs-fMRI metrics. RESULTS A total of 104 RCVS patients and 93 HCs were included in the final analysis. We identified significantly decreased local efficiency of the left dorsal anterior insula (dAI; p = 0.0005) in RCVS patients within 30 days after disease onset as compared to HCs, which improved 1 month later. RCVS patients also had increased global efficiency (p = 0.009) and decreased average degree centrality (p = 0.045), clustering coefficient (p = 0.033), and assortativity values (p = 0.003) in node-based analysis. In addition, patients with RCVS had increased internetwork connectivity of the default mode network (DMN) with the salience (p = 0.027) and dorsal attention (p = 0.016) networks. Significant correlations between LI and regional local efficiency in left dAI (rs = -0.418, p = 0.042) was demonstrated. INTERPRETATION The significantly lower local efficiency of the left dAI, suggestive of impaired central autonomic modulation, was negatively correlated with vasoconstriction severity, which is highly plausible for the pathogenesis of RCVS. ANN NEUROL 2023;94:772-784.
Collapse
Affiliation(s)
- Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tun-Wei Hsu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Lin Lai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jong-Ling Fuh
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Pin Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
8
|
Borutta MC, Koehn J, de Oliveira DS, Del Vecchio A, Engelhorn T, Schwab S, Buchfelder M, Kinfe TM. The Impact of Burst Motor Cortex Stimulation on Cardiovascular Autonomic Modulation in Chronic Pain: A Feasibility Study for a New Approach to Objectively Monitor Therapeutic Effects. Pain Ther 2023; 12:1235-1251. [PMID: 37532960 PMCID: PMC10444743 DOI: 10.1007/s40122-023-00541-x] [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: 05/25/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Chronic refractory pain of various origin occurs in 30-45% of pain patients, and a considerable proportion remains resistant to pharmacological and behavioral therapies, requiring adjunctive neurostimulation therapies. Chronic pain is known to stimulate sympathetic outflow, yet the impact of burst motor cortex stimulation (burstMCS) on objectifiable autonomic cardiovascular parameters in chronic pain remains largely unknown. METHODS In three patients with chronic pain (2 facial pain/1 post-stroke pain), we compared pain intensity using a visual analog scale (VAS 1-10) and parameters of autonomic cardiovascular modulation at supine rest, during parasympathetic challenge with six cycles per minute of metronomic deep breathing, and during sympathetic challenge (active standing) at baseline and after 4 months of burstMCS compared to age-/gender-matched healthy controls. RESULTS While two out of three patients were responsive after 4 months of adjunctive burstMCS (defined as pain reduction of > 30%), no differences were found in any of the three patients regarding the R-R intervals of adjacent QRS complexes (RRI, 642 vs. 676 ms) and blood pressure (BP, 139/88 vs. 141/90 mmHg). Under resting conditions, parameters of parasympathetic tone [normalized units of high-frequency oscillations of RRI (RRI-HFnu power) 0.24 vs. 0.38, root-mean-square differences of successive RRI (RRI-RMSSD) 7.7 vs. 14.7 ms], total autonomic cardiac modulation [RRI total power 129.3 vs. 406.2 ms2, standard deviation of RRI (RRI-SD) 11.6 vs. 18.5 ms, coefficient of variation of RRI (RRI-CV) 1.9 vs. 3.7%], and baroreceptor reflex sensitivity (BRS, 1.9 vs. 2.3 ms/mmHg) increased, and parameters of sympathetic tone [normalized units of low-frequency oscillations of RRI (RRI-LFnu power) 0.76 vs. 0.62] and sympatho-vagal balance [ratio of RR-LF to RRI-HF power (RRI-LF/HF ratio) 3.4 vs. 1.9] decreased after 4 months of burstMCS. Low-frequency oscillations of systolic blood pressure (SBP-LF power), a parameter of sympathetic cardiovascular modulation, increased slightly (17.6 vs. 20.4 mmHg2). During parasympathetic stimulation, the expiratory-inspiratory ratio (E/I ratio) increased slightly, while upon sympathetic stimulation, the ratio between the shortest RRI around the 15th heartbeat and the longest RRI around the 30th heartbeat after standing up (RRI 30/15 ratio) remained unchanged. CONCLUSION Four months of adjunctive burstMCS was associated with an increase in parameters reflecting both total and parasympathetic autonomic modulation and baroreceptor reflex sensitivity. In contrast, sympathetic tone declined in our three patients, suggesting stimulation-associated improvement not only in subjectively perceived VAS pain scores, but also in objectifiable parameters of autonomic cardiovascular modulation.
Collapse
Affiliation(s)
- Matthias C Borutta
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Koehn
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Daniela Souza de Oliveira
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alessandro Del Vecchio
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas M Kinfe
- Division of Functional Neurosurgery and Stereotaxy, Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Schwabach Anlage 6, 91054, Erlangen, Germany.
| |
Collapse
|
9
|
Forte G, Troisi G, Favieri F, De Pascalis V, Langher V, Casagrande M. Inhibition and Heart Rate Variability in Experimentally Induced Pain. J Pain Res 2023; 16:3239-3249. [PMID: 37790193 PMCID: PMC10542212 DOI: 10.2147/jpr.s418238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/03/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Pain is a complex experience that requires executive functions (EFs) to be processed. The autonomic outcome of the neural networks involved in the cognitive evaluation of pain is reflected by heart rate variability (HRV), an index of self-regulation abilities. Although some results suggest a relationship between HRV, EFs, and pain, studies focusing on this three-way relationship are still scarce. Objective This study aims to investigate the relationship between pain, cognitive, and autonomic mechanisms, hypothesizing an association between resting HRV and both cognitive and motor inhibition as indices of executive functioning. This relationship was investigated after an experimental-induced pain. Methods Seventy-six young adults were exposed to the Cold Pressure Arm Warp to induce experimental pain. HRV was collected, and cognitive tasks were administered to assess executive performance. Results The results showed that (1) HRV indices significantly increased during pain stimulation, (2) cognitive inhibition was positively correlated with vagal indices and with pain parameters, (3) both inhibition tasks significantly predicted pain threshold while the performance on the Stroop Task predicted pain tolerance. Conclusion Results suggest a three-way relationship. Further research would focus on the role of HRV and cognitive strategies in pain management in chronic pain conditions.
Collapse
Affiliation(s)
- Giuseppe Forte
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, 00185, Italy
| | - Giovanna Troisi
- Department of Psychology, Sapienza University of Rome, Roma, 00185, Italy
| | - Francesca Favieri
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, 00185, Italy
| | | | - Viviana Langher
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, 00185, Italy
| | - Maria Casagrande
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, 00185, Italy
| |
Collapse
|
10
|
Kohli D, Madhu N, Korczeniewska OA, Eliav T, Arany S. Association between medication-induced xerostomia and orofacial pain: a systematic review. QUINTESSENCE INTERNATIONAL (BERLIN, GERMANY : 1985) 2023; 54:658-670. [PMID: 37305957 PMCID: PMC10527150 DOI: 10.3290/j.qi.b4154345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Xerostomia (or oral dryness) is most commonly caused by medications that affect saliva secretion, and is often accompanied by symptoms of orofacial pain. Medication-induced xerostomia may or may not be associated with objectively demonstrable hyposalivation. The present study attempted to systematically identify an association between medication-induced xerostomia and orofacial pain. METHOD AND MATERIALS A systematic search was conducted using the following databases: WoS, PubMed, SCOPUS, and MEDLINE. The search terms used were: xerostomia OR "dry mouth" AND medication AND ("oral pain" OR "orofacial pain" OR "craniofacial pain" OR "burning mouth" OR "glossodynia") NOT Sjögren's NOT cancer. Inclusion criteria were medication-induced xerostomia and reported symptoms of orofacial pain. Four researchers performed the selection process and quality assessment and two researchers conducted data extraction. RESULTS Seven studies with a total of 1,029 patients were included. These studies were conducted between 2009 and 2022 and consisted of cross-sectional studies, case-control studies, and one randomized crossover trial. The studies consisted of a total of 1,029 participants. All studies included male and female participants whose mean ages ranged from 43 to 100 years. CONCLUSIONS A positive association was found between medication-induced xerostomia and orofacial pain. No associations were found between salivary flow measurements (hyposalivation) and medication use. Future research should focus on saliva flow measurements, standardized assessment of medication-induced xerostomia, as well as the inclusion of accompanying orofacial pain diagnosis in the medical history to allow for higher level of evidence in establishing reliable predictors of medication-induced oral health damage to facilitate clinical prevention and management.
Collapse
Affiliation(s)
- Divya Kohli
- Department of Oral and Maxillofacial Surgery, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida
| | - Nikkita Madhu
- Department of Prosthodontics, University of Iowa College of Dentistry, Iowa City, Iowa
| | - Olga A. Korczeniewska
- Center for Orofacial Pain and Temporomandibular Disorders, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Tal Eliav
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Szilvia Arany
- Specialty Care, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| |
Collapse
|
11
|
Zang Y, Jiang D, Zhuang X, Chen S. Changes in the central nervous system in diabetic neuropathy. Heliyon 2023; 9:e18368. [PMID: 37609411 PMCID: PMC10440454 DOI: 10.1016/j.heliyon.2023.e18368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 08/24/2023] Open
Abstract
One of the most common chronic complications arising from diabetes is diabetic peripheral neuropathy. Depending on research statistics, approximately half of the people who have diabetes will suffer from diabetic peripheral neuropathy over time, which manifests as abnormal sensations in the distal extremities, and about 25%-50% of these patients have symptoms of neuralgia, called painful diabetic neuropathy. These patients often exhibit adverse emotional conditions, like anxiety or depression, which can reduce their quality of life. The pathogenesis of diabetic peripheral neuropathy is complex, and although persistent hyperglycemia plays a central role in the development of diabetic peripheral neuropathy, strict glycemic control does not eliminate the risk of diabetic peripheral neuropathy. This suggests the need to understand the role of the central nervous system in the development of diabetic peripheral neuropathy to modulate treatment regimens accordingly. Magnetic resonance imaging not only allows for the noninvasive detection of structural and functional alterations in the central nervous system, but also provides insight into the processing of abnormal information such as pain by the central nervous system, and most importantly, contributes to the development of more effective pain relief protocols. Therefore, this article will focus on the mechanisms and related imaging evidence of central alterations in diabetic peripheral neuropathy, especially in painful diabetic neuropathy.
Collapse
Affiliation(s)
- Yarui Zang
- Department of Endocrinology and Metabolism, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shandong, China
| | - Dongqing Jiang
- Department of Endocrinology and Metabolism, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shandong, China
| | - Xianghua Zhuang
- Department of Endocrinology and Metabolism, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shandong, China
| | - Shihong Chen
- Department of Endocrinology and Metabolism, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shandong, China
| |
Collapse
|
12
|
Iwakuma Y, Clonch DA, Liu J, Lam CM, Holwerda S. Cardiopulmonary baroreceptors modify pain intensity in patients with chronic back pain. RESEARCH SQUARE 2023:rs.3.rs-3154622. [PMID: 37502833 PMCID: PMC10371169 DOI: 10.21203/rs.3.rs-3154622/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective Baroreceptors play a significant role in nociceptive pain. However, the extent to which baroreceptors modulate nociception in patients with chronic pain is unclear. We tested the hypothesis that cardiopulmonary baroreceptor unloading via LBNP would significantly increase pressure pain threshold and habituation to heat pain among patients with chronic back pain. Methods Mechanical pressure pain threshold at the upper trapezius (hand-held algometer) and habituation to heat pain at the forearm were performed during sitting and supine position, and during baroreceptor unloading via lower body negative pressure (LBNP) of -10 mmHg in 12 patients with chronic back pain (54 ± 11 years of age). To determine whether pain reduction is normal during LBNP, studies were repeated in 7 young, healthy participants (23 ± 7). Results Mechanical pressure pain threshold (P < 0.01) and habituation to heat pain (P = 0.04) were significantly reduced during supine compared with sitting. Conversely, baroreceptor unloading via LBNP significantly increased pressure pain threshold (P = 0.03) and heat pain habituation (P < 0.01) compared with supine. In young healthy controls, pressure pain threshold was similarly affected when comparing sitting and supine (P = 0.01) and during LBNP (P < 0.01), whereas habituation to heat pain was unaltered when comparing sitting and supine (P = 0.93) and during LBNP (P = 0.90). Total peripheral resistance was increased during LBNP (P = 0.01) but not among young, healthy controls (P = 0.71). Conclusions The findings demonstrate cardiopulmonary baroreceptor modulation of nociceptive pain in patients with chronic pain. Interestingly, habituation to heat pain appears more readily modified by cardiopulmonary baroreceptors in patients with chronic back pain compared with young, healthy individuals.
Collapse
|
13
|
Shin HJ, Kim H, Han SH, Do SH, Na HS. Ultrasound assessment of residual gastric volume in older adults undergoing staged-bilateral total knee arthroplasty after consuming carbohydrate-containing fluids: a prospective observational study. Korean J Anesthesiol 2023; 76:128-134. [PMID: 36274254 PMCID: PMC10079000 DOI: 10.4097/kja.22378] [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: 06/29/2022] [Accepted: 10/17/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND We compared preoperative residual gastric volume (GV) between the first and second stages of total knee arthroplasty (TKA) in older adults after drinking carbohydrate-containing fluid 2 h prior to surgery. METHODS In this study, 36 patients, aged > 65 years, scheduled for staged bilateral TKA with one-week interval, were enrolled. The patients consumed 400 ml of carbohydrate-containing fluid 2 h prior to surgery. Before the induction of spinal anesthesia, the gastric antral cross-sectional area was measured at the first and second TKA using ultrasound, and the residual GV was calculated. The primary outcome was the residual GV. Qualitative GV (grades 0, 1, and 2) and analgesic consumption after the first TKA were assessed as secondary outcomes. RESULTS The GV (median [Q1, Q3]) was greater in the second-stage TKA (41.1 [22.5, 62.8] ml) than in the first-stage TKA (10.3 [0.0, 27.1] ml) (P < 0.001). In the qualitative assessment, the distribution was not different between the two stages of TKA (P = 0.219) and only one patient showed grade 2 gastric content in the second TKA. When opioid consumption was converted to an equivalent dose of morphine, an average of 53.9 mg of morphine was required after the first TKA. CONCLUSIONS Residual GV after drinking carbohydrate-containing fluid differed according to the stage of TKA, showing a larger residual GV in the second TKA than in the first one. In older adults scheduled to undergo bilateral staged TKA, caution is required in preoperative fasting practice, especially in second-stage surgery.
Collapse
Affiliation(s)
- Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heeyeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Hee Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
14
|
Heart rate variability is not suitable as surrogate marker for pain intensity in patients with chronic pain. Pain 2023:00006396-990000000-00252. [PMID: 36722463 DOI: 10.1097/j.pain.0000000000002868] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/03/2023] [Indexed: 02/02/2023]
Abstract
ABSTRACT The search towards more objective outcome measurements and consequently surrogate markers for pain started decades ago; however, no generally accepted biomarker for pain has qualified yet. The goal is to explore the value of heart rate variability (HRV) as surrogate marker for pain intensity chronic pain setting. Pain intensity scores and HRV were collected in 366 patients with chronic pain, through a cross-sectional multicenter study. Pain intensity was measured with both the Visual Analogue Scale and Numeric Rating Scale, while 16 statistical HRV parameters were derived. Canonical correlation analysis was performed to evaluate the correlation between the dependent pain variables and the HRV parameters. Surrogacy was determined for each HRV parameter with point estimates between 0 and 1 whereby values close to 1 indicate a strong association between the surrogate and the true endpoint at the patient level. Weak correlations were revealed between HRV parameters and pain intensity scores. The highest surrogacy point estimate was found for mean heart rate as marker for average pain intensity on the Numeric Rating Scale with point estimates of 0.0961 (95% CI from 0.0384 to 0.1537) and 0.0209 (95% CI from 0 to 0.05) for patients without medication use, and medication use respectively. This study indicated that HRV parameters as separate entities are no suitable surrogacy candidates for pain intensity, in a population of chronic pain patients. Further potential surrogate candidates and clinical robust true endpoints should be explored, in order to find a surrogate measure for the highly individual pain experience.
Collapse
|
15
|
Bossenger NR, Lewis GN, Rice DA, Shepherd D. The autonomic and nociceptive response to acute exercise is impaired in people with knee osteoarthritis. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 13:100118. [PMID: 36711216 PMCID: PMC9873673 DOI: 10.1016/j.ynpai.2023.100118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Objectives An acute bout of exercise typically leads to short term exercise induced hypoalgesia (EIH), but this response is more variable in many chronic pain populations, including knee osteoarthritis (OA) and fibromyalgia (FM). There is evidence of autonomic nervous system (ANS) dysfunction in some chronic pain populations that may contribute to impaired EIH, but this has not been investigated in people with knee OA. The aim of this study was to assess the acute effects of isometric exercise on the nociceptive and autonomic nervous systems in people with knee OA and FM, compared to pain-free controls. Methods A cross-sectional study was undertaken with 14 people with knee OA, 13 people with FM, and 15 pain free controls. Across two experimental sessions, baseline recordings and the response of the nociceptive and autonomic nervous systems to a 5-min submaximal isometric contraction of the quadriceps muscle was assessed. The nociceptive system was assessed using pressure pain thresholds at the knee and forearm. The ANS was assessed using high frequency heart rate variability, cardiac pre-ejection period, and electrodermal activity. Outcome measures were obtained before and during (ANS) or immediately after (nociceptive) the acute bout of exercise. Results Submaximal isometric exercise led to EIH in the control group. EIH was absent in both chronic pain groups. Both chronic pain groups showed lower vagal activity at rest. Furthermore, people with knee OA demonstrated reduced vagal withdrawal in response to acute isometric exercise compared to controls. Sympathetic reactivity was similar across groups. Discussion The findings of reduced tonic vagal activity and reduced autonomic modulation in response to isometric exercise raise the potential of a blunted ability to adapt to acute exercise stress and modulate nociception in people with knee OA. The impairment of EIH in knee OA may, in part, be due to ANS dysfunction.
Collapse
Affiliation(s)
- Neil R. Bossenger
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gwyn N. Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Corresponding author at: Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - David A. Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Waitematā Pain Services, Department of Anaesthesiology and Perioperative Medicine, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Daniel Shepherd
- Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
16
|
Vogel JJ. Pain specialist management of sexual pain: III-neuromodulation. Sex Med Rev 2023; 11:89-97. [PMID: 36763955 DOI: 10.1093/sxmrev/qeac006] [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: 10/04/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Some women with sexual pain do not respond to conservative multi-modal care modalities. Neuromodulation is a group of methods which alter nerve activity by delivering electrical energy or pharmaceutical agents directly to target neural structures. Multiple forms of neuromodulation may provide durable treatment options to fill the unmet therapeutic need of a certain population of women with chronic sexual pain. OBJECTIVES To provide a current review of neuromodulation treatments used for female sexual pain and introduce neuromodulation techniques which may be applied in novel ways to specific sexual pain phenotypes. METHODS Internet, PubMed and Cochrane Library were searched for relevant articles on female sexual pain within the clinical purview and scope of practice of pain management. RESULTS A thorough review of the literature was conducted to include basic science studies, clinical trials, systematic reviews, consensus statements, and case-reports. A sampling of information on real-world patient outcomes was included. The amount and quality of evidence for neuromodulation to treat female sexual pain is low-moderate. Descriptions of neuromodulation procedures for sexual pain were made and clinical studies reviewed. The effects of autonomic nervous system (ANS) dysregulation on the experience of pain were discussed with consideration of interventional procedures to facilitate restoration of ANS equilibrium. CONCLUSION Treating female sexual pain is complex. There are considerable numbers of women who have unsatisfactory sexual pain relief despite evidence-based interdisciplinary care. These women may benefit from referral to consider neuromodulation treatment options. Neuromodulation is a relatively new capability in the arsenal of pain management and other specialists that can be considered for women with treatment refractory sexual pain.
Collapse
Affiliation(s)
- John J Vogel
- Innovative Pain Care, Marietta, Georgia 30062, United States
| |
Collapse
|
17
|
Bonin EAC, Lejeune N, Szymkowicz E, Bonhomme V, Martial C, Gosseries O, Laureys S, Thibaut A. Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review. Front Syst Neurosci 2023; 17:1112206. [PMID: 37021037 PMCID: PMC10067681 DOI: 10.3389/fnsys.2023.1112206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.
Collapse
Affiliation(s)
- Estelle A. C. Bonin
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre Hospitalier Neurologique (CHN) William Lennox, Saint-Luc Hospital Group, Ottignies-Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Emilie Szymkowicz
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Liège University Hospital, Liège, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSS), University Laval, Québec City, QC, Canada
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- *Correspondence: Aurore Thibaut,
| |
Collapse
|
18
|
Neuromodulation as a Potential Disease-Modifying Therapy for Osteoarthritis. Curr Rheumatol Rep 2023; 25:1-11. [PMID: 36435890 DOI: 10.1007/s11926-022-01094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The following review discusses the therapeutic potential of targeting the autonomic nervous system (ANS) for osteoarthritis (OA) treatment and encourages the field to consider the candidacy of bioelectronic medicine as a novel OA treatment strategy. RECENT FINDINGS The study of OA pathogenesis has focused on changes occurring at the joint level. As such, treatments for OA have been aimed at the local joint environment, intending to resolve local inflammation and decrease pain. However, OA pathogenesis has shown to be more than joint wear and tear. Specifically, OA-related peripheral and central sensitization can prompt neuroplastic changes in the nervous system beyond the articular joint. These neuroplastic changes may alter physiologic systems, like the neuroimmune axis. In this way, OA and related comorbidities may share roots in the form of altered neuroimmune communication and autonomic dysfunction. ANS modulation may be able to modify OA pathogenesis or reduce the impact of OA comorbidities. Moreover, blocking chronic nociceptive drive from the joint may help to prevent maladaptive nervous system plasticity in OA.
Collapse
|
19
|
Sex-Related Effects of Adrenergic Drugs on Conditioned Pain Modulation: A Randomized Controlled Cross-Over Double-Blind Trial. Pain Res Manag 2022; 2022:2757101. [PMID: 36339068 PMCID: PMC9629924 DOI: 10.1155/2022/2757101] [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: 02/20/2022] [Revised: 09/15/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
Objective Endogenous pain inhibition can be investigated using conditioned pain modulation (CPM). CPM efficacy has been reported to be influenced by various factors, such as gender and cardiovascular (autonomic) activity. The aim of this study is to describe the effect of pharmacological manipulations of autonomic activity on CPM efficacy. Methods Thirty healthy participants were enrolled to assess CPM efficacy in 4 experimental sessions. The first session consisted of the determination of baseline CPM effectiveness. The three following sessions were performed in a randomized order and consisted of the injection of (1) esmolol, (2) ephedrine, or (3) placebo, before the conditioning stimulus. Pain intensity induced by using a contact heat stimulation thermode was compared before and after a cold-pressure conditioning stimulus to evaluate CPM effectiveness. Results Our results show that inhibiting sympathetic nervous activity with esmolol did not have a significant effect on CPM. Conversely, enhancing sympathetic nervous activity with ephedrine increased CPM effectiveness in healthy women but decreased it in men. Conclusions Increasing sympathetic activity with adrenergic agonists, such as ephedrine, could improve CPM effectiveness in women. It will be interesting to verify if the same results are present in patients suffering from chronic pain and if adrenergic agonists could have better therapeutic effects in women showing reduced CPM effectiveness.
Collapse
|
20
|
Jiang M, Wu W, Wang Y, Rahmani AM, Salanera S, Liljeberg P. Personal Pain Sensitivity Prediction from Ultra-short-term Resting Heart Rate Variability. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1137-1140. [PMID: 36086385 DOI: 10.1109/embc48229.2022.9871427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pain is a subjective experience with interpersonal perception sensitivity differences. Pain sensitivity is of scientific and clinical interest, as it is a risk factor for several pain conditions. Resting heart rate variability (HRV) is a potential pain sensitivity measure reflecting the parasympathetic tone and baroreflex function, but it remains unclear how well the prediction can achieve. This work investigated the relationship between different ultra-short-term HRV features and various pain sensitivity representations from heat and electrical pain tests. From leave-subject-out cross-validated results, we found that HRV can better predict a composite pain sensitivity score built from different tests and measures than a single measure in terms of the agreement between predictions and observations. Heat pain sensitivity was more possibly predicted than electrical pain. SDNN, RMSSD and LF better predicted the composite pain sensitivity score than other feature combinations, consis-tent with pain's physical and emotional attributes. It should be emphasized that the validity is probably limited within HRV at the resting state rather than an arbitrary measurement. This work implies a potential pain sensitivity prediction possibility that may be worth further validation.
Collapse
|
21
|
Yeater TD, Cruz CJ, Cruz-Almeida Y, Allen KD. Autonomic Nervous System Dysregulation and Osteoarthritis Pain: Mechanisms, Measurement, and Future Outlook. Curr Rheumatol Rep 2022; 24:175-183. [PMID: 35420372 PMCID: PMC9189055 DOI: 10.1007/s11926-022-01071-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW The autonomic nervous system is an important regulator of stress responses and exhibits functional changes in chronic pain states. This review discusses potential overlap among autonomic dysregulation, osteoarthritis (OA) progression, and chronic pain. From this foundation, we then discuss preclinical to clinical research opportunities to close gaps in our knowledge of autonomic dysregulation and OA. Finally, we consider the potential to generate new therapies for OA pain via modulation of the autonomic nervous system. RECENT FINDINGS Recent reviews provide a framework for the autonomic nervous system in OA progression; however, research is still limited on the topic. In other chronic pain states, functional overlaps between the central autonomic network and pain processing centers in the brain suggest relationships between concomitant dysregulation of the two systems. Non-pharmacological therapeutics, such as vagus nerve stimulation, mindfulness-based meditation, and exercise, have shown promise in alleviating painful symptoms of joint diseases, and these interventions may be partially mediated through the autonomic nervous system. The autonomic nervous system appears to be dysregulated in OA progression, and further research on rebalancing autonomic function may lead to novel therapeutic strategies for treating OA pain.
Collapse
Affiliation(s)
- Taylor D. Yeater
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Carlos J. Cruz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL, USA.,Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Kyle D. Allen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.,Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| |
Collapse
|
22
|
Szikszay TM, Adamczyk WM, Lévénez JLM, Gouverneur P, Luedtke K. Temporal properties of pain contrast enhancement using repetitive stimulation. Eur J Pain 2022; 26:1437-1447. [PMID: 35535976 DOI: 10.1002/ejp.1971] [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: 01/06/2022] [Revised: 03/21/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Offset analgesia (OA) is characterized by a disproportionately large reduction in pain following a small decrease in noxious stimulation and is based on temporal pain contrast enhancement (TPCE). The underlying mechanisms of this phenomenon are still poorly understood. This study is aiming to investigate whether TPCE can also be induced by repetitive stimulation, i.e., by stimuli clearly separated in time. METHODS A repetitive TPCE paradigm was induced in healthy, pain-free subjects (n = 33) using heat stimuli. Three different interstimulus intervals (ISIs) were used: 5, 15, and 25 seconds. All paradigms were contrasted with a control paradigm without temperature change. Participants continuously rated perceived pain intensity. In addition, electrodermal activity (EDA) was recorded as a surrogate measure of autonomic arousal. RESULTS Temporal pain contrast enhancement was confirmed for ISI 5 seconds (p < 0.001) and ISI 15 seconds (p = 0.005) but not for ISI 25 seconds (p = 0.07), however, the magnitude of TPCE did not differ between ISIs (p = 0.11). A TPCE-like effect was also detected with increased EDA values. CONCLUSIONS TPCE can be induced by repetitive stimulation. This finding may be explained by a combination of the mechanisms underlying the OA and a facilitated pain habituation.
Collapse
Affiliation(s)
- Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universitaet zu Luebeck, Luebeck, Germany
| | - Waclaw M Adamczyk
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universitaet zu Luebeck, Luebeck, Germany.,Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Juliette L M Lévénez
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universitaet zu Luebeck, Luebeck, Germany
| | - Philip Gouverneur
- Institute of Medical Informatics, University of Luebeck, Luebeck, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universitaet zu Luebeck, Luebeck, Germany
| |
Collapse
|
23
|
Ioachim G, Warren HJM, Powers JM, Staud R, Pukall CF, Stroman PW. Altered Pain in the Brainstem and Spinal Cord of Fibromyalgia Patients During the Anticipation and Experience of Experimental Pain. Front Neurol 2022; 13:862976. [PMID: 35599729 PMCID: PMC9120571 DOI: 10.3389/fneur.2022.862976] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic pain associated with fibromyalgia (FM) affects a large portion of the population but the underlying mechanisms leading to this altered pain are still poorly understood. Evidence suggests that FM involves altered neural processes in the central nervous system and neuroimaging methods such as functional magnetic resonance imaging (fMRI) are used to reveal these underlying alterations. While many fMRI studies of FM have been conducted in the brain, recent evidence shows that the changes in pain processing in FM may be linked to autonomic and homeostatic dysregulation, thus requiring further investigation in the brainstem and spinal cord. Functional magnetic resonance imaging data from 15 women with FM and 15 healthy controls were obtained in the cervical spinal cord and brainstem at 3 tesla using previously established methods. In order to investigate differences in pain processing in these groups, participants underwent trials in which they anticipated and received a predictable painful stimulus, randomly interleaved with trials with no stimulus. Differences in functional connectivity between the groups were investigated by means of structural equation modeling. The results demonstrate significant differences in brainstem/spinal cord network connectivity between the FM and control groups which also correlated with individual differences in pain responses. The regions involved in these differences in connectivity included the LC, hypothalamus, PAG, and PBN, which are known to be associated with autonomic homeostatic regulation, including fight or flight responses. This study extends our understanding of altered neural processes associated with FM and the important link between sensory and autonomic regulation systems in this disorder.
Collapse
Affiliation(s)
- Gabriela Ioachim
- Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | | | - Jocelyn M. Powers
- Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Roland Staud
- Department of Medicine, University of Florida, Seffner, FL, United States
| | - Caroline F. Pukall
- Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Patrick W. Stroman
- Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Department of Physics, Queen's University, Kingston, ON, Canada
- *Correspondence: Patrick W. Stroman
| |
Collapse
|
24
|
Chao CC, Tseng MT, Hsieh PC, Lin CHJ, Huang SL, Hsieh ST, Chiang MC. Brain Mechanisms of Pain and Dysautonomia in Diabetic Neuropathy: Connectivity Changes in Thalamus and Hypothalamus. J Clin Endocrinol Metab 2022; 107:e1167-e1180. [PMID: 34665863 DOI: 10.1210/clinem/dgab754] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT About one-third of diabetic patients suffer from neuropathic pain, which is poorly responsive to analgesic therapy and associated with greater autonomic dysfunction. Previous research on diabetic neuropathy mainly links pain and autonomic dysfunction to peripheral nerve degeneration resulting from systemic metabolic disturbances, but maladaptive plasticity in the central pain and autonomic systems following peripheral nerve injury has been relatively ignored. OBJECTIVE This study aimed to investigate how the brain is affected in painful diabetic neuropathy (PDN), in terms of altered structural connectivity (SC) of the thalamus and hypothalamus that are key regions modulating nociceptive and autonomic responses. METHODS We recruited 25 PDN and 13 painless (PLDN) diabetic neuropathy patients, and 27 healthy adults as controls. The SC of the thalamus and hypothalamus with limbic regions mediating nociceptive and autonomic responses was assessed using diffusion tractography. RESULTS The PDN patients had significantly lower thalamic and hypothalamic SC of the right amygdala compared with the PLDN and control groups. In addition, lower thalamic SC of the insula was associated with more severe peripheral nerve degeneration, and lower hypothalamic SC of the anterior cingulate cortex was associated with greater autonomic dysfunction manifested by decreased heart rate variability. CONCLUSION Our findings indicate that alterations in brain structural connectivity could be a form of maladaptive plasticity after peripheral nerve injury, and also demonstrate a pathophysiological association between disconnection of the limbic circuitry and pain and autonomic dysfunction in diabetes.
Collapse
Affiliation(s)
- Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Ming-Tsung Tseng
- Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei 10617, Taiwan
| | - Paul-Chen Hsieh
- Department of Dermatology, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Chien-Ho Janice Lin
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Yeong-An Orthopedic and Physical Therapy Clinic, Taipei 11155, Taiwan
| | - Shin-Leh Huang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Neurology, Fu Jen Catholic University Hospital, New Taipei City 24352, Taiwan
| | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, Taipei 10002, Taiwan
- Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei 10617, Taiwan
- Center of Precision Medicine, National Taiwan University College of Medicine, Taipei 10617, Taiwan
| | - Ming-Chang Chiang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| |
Collapse
|
25
|
Lin Y, Xiao Y, Wang L, Guo Y, Zhu W, Dalip B, Kamarthi S, Schreiber KL, Edwards RR, Urman RD. Experimental Exploration of Objective Human Pain Assessment Using Multimodal Sensing Signals. Front Neurosci 2022; 16:831627. [PMID: 35221908 PMCID: PMC8874020 DOI: 10.3389/fnins.2022.831627] [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: 12/08/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
Optimization of pain assessment and treatment is an active area of research in healthcare. The purpose of this research is to create an objective pain intensity estimation system based on multimodal sensing signals through experimental studies. Twenty eight healthy subjects were recruited at Northeastern University. Nine physiological modalities were utilized in this research, namely facial expressions (FE), electroencephalography (EEG), eye movement (EM), skin conductance (SC), and blood volume pulse (BVP), electromyography (EMG), respiration rate (RR), skin temperature (ST), blood pressure (BP). Statistical analysis and machine learning algorithms were deployed to analyze the physiological data. FE, EEG, SC, BVP, and BP proved to be able to detect different pain states from healthy subjects. Multi-modalities proved to be promising in detecting different levels of painful states. A decision-level multi-modal fusion also proved to be efficient and accurate in classifying painful states.
Collapse
Affiliation(s)
- Yingzi Lin
- Intelligent Human Machine Systems Laboratory, College of Engineering, Northeastern University, Boston, MA, United States
- *Correspondence: Yingzi Lin,
| | - Yan Xiao
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Li Wang
- Intelligent Human Machine Systems Laboratory, College of Engineering, Northeastern University, Boston, MA, United States
| | - Yikang Guo
- Intelligent Human Machine Systems Laboratory, College of Engineering, Northeastern University, Boston, MA, United States
| | - Wenchao Zhu
- Intelligent Human Machine Systems Laboratory, College of Engineering, Northeastern University, Boston, MA, United States
| | - Biren Dalip
- Intelligent Human Machine Systems Laboratory, College of Engineering, Northeastern University, Boston, MA, United States
| | - Sagar Kamarthi
- Intelligent Human Machine Systems Laboratory, College of Engineering, Northeastern University, Boston, MA, United States
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard University, Boston, MA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard University, Boston, MA, United States
| | - Richard D. Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard University, Boston, MA, United States
| |
Collapse
|
26
|
Tran JP, Horine SV. Title: Novel Analgesic Potential of ß2-Agonists for Neuropathic Pain via ß2-Agonist Action. Curr Pain Headache Rep 2022; 26:73-77. [PMID: 35129823 DOI: 10.1007/s11916-022-01006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Multimodal therapies are often employed to treat chronic pain, and ß2-agonists are a potential drug class that shows promise. The primary aim of this paper is to discuss the role of ß2-agonists as an adjunctive therapy for chronic pain based on the current literature. RECENT FINDINGS Recent studies in mouse models have shown that the ß2-adrenergic system plays an essential role in the analgesic properties of antidepressant drugs used to treat neuropathic pain and that the adrenergic relies on an intact endogenous opioid system to be effective. Studies also show that ß2-agonism alone is adequate to exert anti-allodynic effects in a mouse model. This paper summarized the basic physiology and pharmacology of the sympathetic nervous system and specifically the ß2-adrenergic system and summarized current literature in its involvement in the treatment of chronic neuropathic pain.
Collapse
Affiliation(s)
- Johnny P Tran
- NewYork-Presbyterian Hospital/Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA
| | - Storm V Horine
- Department of Anesthesiology, Memorial-Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
27
|
Forte G, Troisi G, Pazzaglia M, Pascalis VD, Casagrande M. Heart Rate Variability and Pain: A Systematic Review. Brain Sci 2022; 12:brainsci12020153. [PMID: 35203917 PMCID: PMC8870705 DOI: 10.3390/brainsci12020153] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background and Objective: Heart rate variability (HRV) as an index of the autonomic nervous system appears to be related to reactivity to experimental pain stimuli. HRV could better explain the contributions of sympathetic and parasympathetic activity response to nociceptive stimulation. The aim of this study was to systematically review and synthesize the current evidence on HRV in relation to the experience of pain in experimental tasks. Databases and Data Treatment: Studies indexed in the PubMed, PsycINFO, MEDLINE, WebOfScience, and Scopus databases were reviewed for eligibility. Studies on the autonomic response (i.e., HRV) to experimentally induced pain in healthy adults were included. Different methods of pain induction were considered (e.g., thermal, pressure, and electrical). Data were synthesized considering the association between HRV and both pain induction and subjective measures of pain. Results: Seventy-one studies were included. The results underline significant change in both the sympathetic and parasympathetic autonomic nervous systems during the painful stimulation independent of the pain induction method. The autonomic reaction to pain could be affected by several factors, such as sex, age, body mass index, breathing patterns, the intensity of the stimulation, and the affective state. Moreover, an association between the autonomic nervous system and the subjective experience of pain was found. Higher parasympathetic activity was associated with better self-regulation capacities and, accordingly, a higher pain inhibition capacity. Conclusions: HRV appears to be a helpful marker to evaluate nociceptive response in experimentally induced pain. Future studies are also needed in clinical samples to understand better the interindividual changes of autonomic response due to pain stimuli.
Collapse
Affiliation(s)
- Giuseppe Forte
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (M.P.); (V.D.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (M.C.)
| | - Giovanna Troisi
- Department of Clinical and Dynamic Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Mariella Pazzaglia
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (M.P.); (V.D.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Vilfredo De Pascalis
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (M.P.); (V.D.P.)
| | - Maria Casagrande
- Department of Clinical and Dynamic Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy;
- Correspondence: (G.F.); (M.C.)
| |
Collapse
|
28
|
Zito GA, Tarrano C, Jegatheesan P, Ekmen A, Béranger B, Rebsamen M, Hubsch C, Sangla S, Bonnet C, Delorme C, Méneret A, Degos B, Bouquet F, Brissard MA, Vidailhet M, Gallea C, Roze E, Worbe Y. Somatotopy of cervical dystonia in motor-cerebellar networks: Evidence from resting state fMRI. Parkinsonism Relat Disord 2021; 94:30-36. [PMID: 34875561 DOI: 10.1016/j.parkreldis.2021.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Cervical dystonia is the most frequent form of isolated focal dystonia. It is often associated with a dysfunction in brain networks, mostly affecting the basal ganglia, the cerebellum, and the somatosensory cortex. However, it is unclear if such a dysfunction is somato-specific to the brain areas containing the representation of the affected body part, and may thereby account for the focal expression of cervical dystonia. In this study, we investigated resting state functional connectivity in the areas within the motor cortex and the cerebellum containing affected and non-affected body representations in cervical dystonia patients. METHODS Eighteen patients affected by cervical dystonia and 21 healthy controls had resting state fMRI. The functional connectivity between the motor cortex and the cerebellum, as well as their corresponding measures of gray matter volume and cortical thickness, were compared between groups. We performed seed-based analyses, selecting the different body representation areas in the precentral gyrus as seed regions, and all cerebellar areas as target regions. RESULTS Compared to controls, patients exhibited increased functional connectivity between the bilateral trunk representation area of the motor cortex and the cerebellar vermis 6 and 7b, respectively. These functional abnormalities did not correlate with structural changes or symptom severity. CONCLUSIONS Our findings indicate that the abnormal function of the motor network is somato-specific to the areas encompassing the neck representation. Functional abnormalities in discrete relevant areas of the motor network could thus contribute to the focal expression of CD.
Collapse
Affiliation(s)
- Giuseppe A Zito
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Clément Tarrano
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France; Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Prasanthi Jegatheesan
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Asya Ekmen
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Benoît Béranger
- Center for NeuroImaging Research CENIR, Paris Brain Institute, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMR 7225, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging SCAN, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, CH, Switzerland.
| | - Cécile Hubsch
- Department of Neurology, Rothschild Foundation, 25-29 Rue Manin, 75019, Paris, France.
| | - Sophie Sangla
- Department of Neurology, Rothschild Foundation, 25-29 Rue Manin, 75019, Paris, France.
| | - Cécilia Bonnet
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Cécile Delorme
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France; Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Aurélie Méneret
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France; Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Bertrand Degos
- Neurology Unit, Assistance Publique-Hôpitaux de Paris, Avicenne University Hospital, Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France; Center for Interdisciplinary Research in Biology, Collège de France, Inserm U1050, CNRS UMR 7241, PSL University, 11 place Marcelin Berthelot, 75231, Paris, France.
| | - Floriane Bouquet
- Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Marion Apoil Brissard
- Department of Neurology, University of Caen Normandie Hospital Center, Av. de la Côte de Nacre, 14000, Caen, France.
| | - Marie Vidailhet
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France; Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Cécile Gallea
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Emmanuel Roze
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France; Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Yulia Worbe
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, 47-83 Boulevard de l'Hôpital, 75013, Paris, France; Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
| |
Collapse
|
29
|
Makovac E, Venezia A, Hohenschurz-Schmidt D, Dipasquale O, Jackson JB, Medina S, O'Daly O, Williams SCR, McMahon SB, Howard MA. The association between pain-induced autonomic reactivity and descending pain control is mediated by the periaqueductal grey. J Physiol 2021; 599:5243-5260. [PMID: 34647321 DOI: 10.1113/jp282013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022] Open
Abstract
There is a strict interaction between the autonomic nervous system (ANS) and pain, which might involve descending pain modulatory mechanisms. The periaqueductal grey (PAG) is involved both in descending pain modulation and ANS, but its role in mediating this relationship has not yet been explored. Here, we sought to determine brain regions mediating ANS and descending pain control associations. Thirty participants underwent conditioned pain modulation (CPM) assessments, in which they rated painful pressure stimuli applied to their thumbnail, either alone or with a painful cold contralateral stimulation. Differences in pain ratings between 'pressure-only' and 'pressure + cold' stimuli provided a measure of descending pain control. In 18 of the 30 participants, structural scans and two functional MRI assessments, one pain-free and one during cold-pain were acquired. Heart rate variability (HRV) was simultaneously recorded. Normalised low-frequency HRV (LF-HRVnu) and the CPM score were negatively correlated; individuals with higher LF-HRVnu during pain reported reductions in pain during CPM. PAG-ventro-medial prefrontal cortex (vmPFC) and PAG-rostral ventromedial medulla (RVM) functional connectivity correlated negatively with the CPM. Importantly, PAG-vmPFC functional connectivity mediated the strength of the LF-HRVnu-CPM association. CPM response magnitude was also negatively correlated with vmPFC GM volume. Our multi-modal approach, using behavioural, physiological and MRI measures, provides important new evidence of interactions between ANS and descending pain mechanisms. ANS dysregulation and dysfunctional descending pain modulation are characteristics of chronic pain. We suggest that further investigation of body-brain interactions in chronic pain patients may catalyse the development of new treatments. KEY POINTS: Heart rate variability (HRV) is associated with descending pain modulation as measured by the conditioned pain modulation protocol (CPM). There is an association between CPM scores and the functional connectivity between the periaqueductal grey (PAG) and ventro-medial prefrontal cortex (vmPFC). CPM scores are also associated with vmPFC grey matter volume. The strength of functional connectivity between the PAG and vmPFC mediates the association between HRV and CPM. Our data provide new evidence of interactions between the autonomic nervous system and descending pain mechanisms.
Collapse
Affiliation(s)
- Elena Makovac
- Department of Neuroimaging, King's College London, London, UK.,Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | | | - David Hohenschurz-Schmidt
- Department of Neuroimaging, King's College London, London, UK.,Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | | | - Jade B Jackson
- Department of Neuroimaging, King's College London, London, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Sonia Medina
- Department of Neuroimaging, King's College London, London, UK.,Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Owen O'Daly
- Department of Neuroimaging, King's College London, London, UK
| | | | - Stephen B McMahon
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | | |
Collapse
|
30
|
Increased Incidence of Premenstrual Syndrome in Females with Palmar Hyperhidrosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094697. [PMID: 33925001 PMCID: PMC8124344 DOI: 10.3390/ijerph18094697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 01/23/2023]
Abstract
Background: Premenstrual syndrome (PMS) is a common disorder affecting the quality of life of women of reproductive age. In a previous study, sex hormone imbalances and alterations in autonomic function were present in PMS, with parasympathetic dysfunction and sympathetic overactivity during the late luteal phase. Palmar hyperhidrosis (PH) presents with oversweating, heat and emotional stimulation, sympathetic hyperactivity and parasympathetic hypofunction. We hypothesized that the incidence of PMS is increased in females with PH. Methods: Data were retrieved from the Taiwanese National Health Insurance Database. The patients with PH were identified by the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) disease code 780.8. Female patients matched by age and index day were used as the control group. The incidence of PMS was considered an outcome by the ICD-9-CM disease code 625.4. The factors related to PMS were analyzed by Cox regression. Results: The adjusted hazard ratio for the incidence of PMS was 1.276 (95% confidence interval: 1.05–1.488) in females with PH. Conclusions: This study found a positive correlation between PMS and female PH patients. Patients and physicians must understand the relationship of PMS with autonomic function alterations and other risk factors to prevent this problematic disorder.
Collapse
|
31
|
Gibler RC, Jastrowski Mano KE. Systematic Review of Autonomic Nervous System Functioning in Pediatric Chronic Pain. Clin J Pain 2021; 37:281-294. [PMID: 33656000 DOI: 10.1097/ajp.0000000000000915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Chronic pain is a common and debilitating health problem that impacts up to one third of children and adolescents. The pathophysiological mechanisms of chronic pain are complex, but considerable research links dysfunction of the autonomic nervous system (ANS) and chronic pain in adults. No review of ANS functioning has been conducted in pediatric chronic pain. We systematically reviewed studies examining ANS activity among youth with primary chronic pain conditions. METHODS A systematic search of PsycINFO, PubMed, and CINAHL was conducted using specific search terms. Articles were included if studies measured heart rate, blood pressure, heart rate variability, galvanic skin responses, or pupillometry among children or adolescents with a chronic pain condition. Studies examining these factors in the context of a specific disease-related pain condition were excluded. RESULTS Of the 1304 articles screened, 15 studies met the criteria for inclusion in this review. All included studies were cross-sectional and primarily included youth with abdominal pain. Results revealed preliminary evidence of reduced parasympathetic activity among youth with pain as measured by heart rate variability. However, results were mixed across ANS indices. Measurement and procedural differences, in addition to a lack of control groups in some studies, limit the interpretability of the reviewed findings. DISCUSSION Additional studies with larger and more diverse samples of youth with various chronic primary pain conditions are needed to delineate possible relationships among ANS functioning and the development and maintenance of chronic pain in children and adolescents. Clinical implications and avenues for future research are discussed.
Collapse
Affiliation(s)
- Robert C Gibler
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | | |
Collapse
|
32
|
Livermore JJA, Klaassen FH, Bramson B, Hulsman AM, Meijer SW, Held L, Klumpers F, de Voogd LD, Roelofs K. Approach-Avoidance Decisions Under Threat: The Role of Autonomic Psychophysiological States. Front Neurosci 2021; 15:621517. [PMID: 33867915 PMCID: PMC8044748 DOI: 10.3389/fnins.2021.621517] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
Acutely challenging or threatening situations frequently require approach-avoidance decisions. Acute threat triggers fast autonomic changes that prepare the body to freeze, fight or flee. However, such autonomic changes may also influence subsequent instrumental approach-avoidance decisions. Since defensive bodily states are often not considered in value-based decision-making models, it remains unclear how they influence the decision-making process. Here, we aim to bridge this gap by discussing the existing literature on the potential role of threat-induced bodily states on decision making and provide a new neurocomputational framework explaining how these effects can facilitate or bias approach-avoid decisions under threat. Theoretical accounts have stated that threat-induced parasympathetic activity is involved in information gathering and decision making. Parasympathetic dominance over sympathetic activity is particularly seen during threat-anticipatory freezing, an evolutionarily conserved response to threat demonstrated across species and characterized by immobility and bradycardia. Although this state of freezing has been linked to altered information processing and action preparation, a full theoretical treatment of the interactions with value-based decision making has not yet been achieved. Our neural framework, which we term the Threat State/Value Integration (TSI) Model, will illustrate how threat-induced bodily states may impact valuation of competing incentives at three stages of the decision-making process, namely at threat evaluation, integration of rewards and threats, and action initiation. Additionally, because altered parasympathetic activity and decision biases have been shown in anxious populations, we will end with discussing how biases in this system can lead to characteristic patterns of avoidance seen in anxiety-related disorders, motivating future pre-clinical and clinical research.
Collapse
Affiliation(s)
- James J. A. Livermore
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Felix H. Klaassen
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Bob Bramson
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Anneloes M. Hulsman
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Sjoerd W. Meijer
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Leslie Held
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Floris Klumpers
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Lycia D. de Voogd
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Karin Roelofs
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| |
Collapse
|
33
|
Peçanha T, Meireles K, Pinto AJ, Rezende DAN, Iraha AY, Mazzolani BC, Smaira FI, Sales ARK, Bonfiglioli K, Sá-Pinto ALD, Lima FR, Irigoyen MC, Gualano B, Roschel H. Increased sympathetic and haemodynamic responses to exercise and muscle metaboreflex activation in post-menopausal women with rheumatoid arthritis. J Physiol 2020; 599:927-941. [PMID: 33180998 DOI: 10.1113/jp280892] [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] [Received: 09/30/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022] Open
Abstract
KEY POINTS Rheumatoid arthritis (RA) patients present exacerbated blood pressure responses to exercise, but little is known regarding the underlying mechanisms involved. This study assessed autonomic and haemodynamic responses to exercise and to the isolated activation of muscle metaboreflex in post-menopausal women with RA. Participants with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These responses were associated with multiple pro- and anti-inflammatory cytokines and with pain. The results of the present study support the suggestion that an abnormal reflex control of circulation is an important mechanism underlying the exacerbated cardiovascular response to exercise and increased cardiovascular risk in RA. ABSTRACT Studies have reported abnormal cardiovascular responses to exercise in rheumatoid arthritis (RA) patients, but little is known regarding the underlying mechanisms involved. This study assessed haemodynamic and sympathetic responses to exercise and to the isolated activation of muscle metaboreflex in women diagnosed with RA. Thirty-three post-menopausal women diagnosed with RA and 10 matched controls (CON) participated in this study. Mean arterial pressure (MAP), heart rate (HR) and muscle sympathetic nerve activity (MSNA frequency and incidence) were measured during a protocol of isometric knee extension exercise (3 min, 30% of maximal voluntary contraction), followed by post-exercise ischaemia (PEI). Participants with RA showed greater increases in MAP and MSNA during exercise and PEI than CON (ΔMAPexercise = 16 ± 11 vs. 9 ± 6 mmHg, P = 0.03; ΔMAPPEI = 15 ± 10 vs. 5 ± 5 mmHg, P = 0.001; ΔMSNAexercise = 17 ± 14 vs. 7 ± 9 bursts min-1 , P = 0.04; ΔMSNAPEI = 14 ± 10 vs. 6 ± 4 bursts min-1 , P = 0.04). Autonomic responses to exercise showed significant (P < 0.05) association with pro- (i.e. IFN-γ, IL-8, MCP-1 and TNFα) and anti-inflammatory (i.e. IL-1ra and IL-10) cytokines and with pain. In conclusion, post-menopausal women with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These findings provide mechanistic insights that may explain the abnormal cardiovascular responses to exercise in RA.
Collapse
Affiliation(s)
- Tiago Peçanha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Kamila Meireles
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Jéssica Pinto
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Diego Augusto Nunes Rezende
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Amanda Yuri Iraha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruna Caruso Mazzolani
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabiana Infante Smaira
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Allan Robson Kluser Sales
- Heart Institute, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
| | - Karina Bonfiglioli
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Lúcia de Sá-Pinto
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fernanda Rodrigues Lima
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Cláudia Irigoyen
- Heart Institute, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
34
|
Smith V, Warty RR, Sursas JA, Payne O, Nair A, Krishnan S, da Silva Costa F, Wallace EM, Vollenhoven B. The Effectiveness of Virtual Reality in Managing Acute Pain and Anxiety for Medical Inpatients: Systematic Review. J Med Internet Res 2020; 22:e17980. [PMID: 33136055 PMCID: PMC7669439 DOI: 10.2196/17980] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/27/2020] [Accepted: 10/02/2020] [Indexed: 01/29/2023] Open
Abstract
Background Virtual reality is increasingly being utilized by clinicians to facilitate analgesia and anxiolysis within an inpatient setting. There is however, a lack of a clinically relevant review to guide its use for this purpose. Objective To systematically review the current evidence for the efficacy of virtual reality as an analgesic in the management of acute pain and anxiolysis in an inpatient setting. Methods A comprehensive search was conducted up to and including January 2019 on PubMed, Ovid Medline, EMBASE, and Cochrane Database of Systematic reviews according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms included virtual reality, vr, and pain. Primary articles with a focus on acute pain in the clinical setting were considered for the review. Primary outcome measures included degree of analgesia afforded by virtual reality therapy, degree of anxiolysis afforded by virtual reality therapy, effect of virtual reality on physiological parameters, side effects precipitated by virtual reality, virtual reality content type, and type of equipment utilized. Results Eighteen studies were deemed eligible for inclusion in this systematic review; 67% (12/18) of studies demonstrated significant reductions in pain with the utilization of virtual reality; 44% (8/18) of studies assessed the effects of virtual reality on procedural anxiety, with 50% (4/8) of these demonstrating significant reductions; 28% (5/18) of studies screened for side effects with incidence rates of 0.5% to 8%; 39% (7/18) of studies evaluated the effects of virtual reality on autonomic arousal as a biomarker of pain, with 29% (2/7) demonstrating significant changes; 100% (18/18) of studies utilized a head mounted display to deliver virtual reality therapy, with 50% being in active form (participants interacting with the environment) and 50% being in passive form (participants observing the content only). Conclusions Available evidence suggests that virtual reality therapy can be applied to facilitate analgesia for acute pain in a variety of inpatient settings. Its effects, however, are likely to vary by patient population and indication. This highlights the need for individualized pilot testing of virtual reality therapy’s effects for each specific clinical use case rather than generalizing its use for the broad indication of facilitating analgesia. In addition, virtual reality therapy has the added potential of concurrently providing procedural anxiolysis, thereby improving patient experience and cooperation, while being associated with a low incidence of side effects (nausea, vomiting, eye strain, and dizziness). Furthermore, findings indicated a head mounted display should be utilized to deliver virtual reality therapy in a clinical setting with a slight preference for active over passive virtual reality for analgesia. There, however, appears to be insufficient evidence to substantiate the effect of virtual reality on autonomic arousal, and this should be considered at best to be for investigational uses, at present.
Collapse
Affiliation(s)
- Vinayak Smith
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.,Biorithm Pte Ltd, Singapore, Singapore
| | - Ritesh Rikain Warty
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.,Biorithm Pte Ltd, Singapore, Singapore
| | | | - Olivia Payne
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | - Sathya Krishnan
- Department of Paediatrics, West Gippsland Hospital, Warragul, Australia
| | - Fabricio da Silva Costa
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.,Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, Sao Paulo, Brazil
| | | | | |
Collapse
|