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Korwisi B, Hay G, Forget P, Ryan D, Treede RD, Rief W, Barke A. Patients' perspective on the chronic pain classification in the 11th revision of the International Classification of Diseases (ICD-11): results from an international web-based survey. Pain 2024:00006396-990000000-00584. [PMID: 38709273 DOI: 10.1097/j.pain.0000000000003248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/09/2024] [Indexed: 05/07/2024]
Abstract
ABSTRACT The 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) aims at improving the lives of persons with the lived experience of chronic pain by providing clearly defined and clinically useful diagnoses that can reduce stigma, facilitate communication, and improve access to pain management, among others. The aim of this study was to assess the perspective of people with chronic pain on these diagnoses. An international web-based survey was distributed among persons with the lived experience of chronic pain. After having seen an information video, participants rated the diagnoses on 8 endorsement scales (eg, diagnostic fit, stigma) that ranged from -5 to +5 with 0 representing the neutral point of no expected change. Overall ratings and differences between participants with chronic primary pain (CPP) and chronic secondary pain (CSP) were analyzed. N = 690 participants were included in the data analysis. The ratings on all endorsement scales were significantly higher than the neutral point of 0. The highest ratings were obtained for "openness" (2.95 ± 1.93) and "overall opinion" (1.87 ± 1.98). Participants with CPP and CSP did not differ in their ratings; however, those with CSP indicated an improved diagnostic fit of the new diagnoses, whereas participants with CPP rated the diagnostic fit of the new diagnoses similar to the fit of their current diagnoses. These results show that persons with the lived experience of chronic pain accept and endorse the new diagnoses. This endorsement is an important indicator of the diagnoses' clinical utility and can contribute to implementation and advocacy.
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Affiliation(s)
- Beatrice Korwisi
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University of Duisburg-Essen, Essen, Germany
| | - Ginea Hay
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Patrice Forget
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Anaesthesia Department, NHS Grampian, Aberdeen, United Kingdom
- Societal Impact of Pain (SIP) Platform, Brussels, Belgium
| | - Deirdre Ryan
- Societal Impact of Pain (SIP) Platform, Brussels, Belgium
- Pain Alliance Europe (PAE), Brussels, Belgium
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience (MCTN), Department of Neurophysiology, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University of Duisburg-Essen, Essen, Germany
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Drusko A, Renz M, Schmidt H, Rosin M, Simon J, Beiner E, Charalambides M, Meyer-Lindenberg A, Treede RD, Tost H, Tesarz J. Measuring interpersonal trauma: Development and validation of the German version of the victimization experience schedule (VES). J Psychosom Res 2024; 179:111626. [PMID: 38430794 DOI: 10.1016/j.jpsychores.2024.111626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Interpersonal victimization experiences (VEs) significantly affect mental and physical health, particularly in disorders associated with life-time adversities, like fibromyalgia syndrome (FMS) and major depressive disorder (MDD). However, assessing VEs comprehensively remains challenging due to limited tools that encompass sub-traumatic events, such as bullying or discrimination, and contextual dimensions. We aimed to address this gap by validating the Victimization Experience Schedule (VES) in German, examining its reliability, and assessing VEs in clinical populations with FMS and MDD. METHODS We investigated the relationship between VEs and clinical symptoms in individuals with FMS, MDD and healthy controls (N = 105) in a case-control study. We also analyzed correlations between different types of VEs and categories of early childhood abuse and posttraumatic-stress-disorder instruments. Additionally, we validated our findings in an independent sample of individuals with FMS (N = 97) from a clinical study. RESULTS We observed excellent inter-rater reliability (Kw = 0.90-0.99), and VEs assessed using the VES were in alignment with subcategories of early childhood abuse. The prevalence of VEs extended beyond the categories covered by traditional survey instruments and was higher in individuals with MDD (4.0 ± 2.6) and FMS (5.9 ± 3.1) compared to controls (1.5 ± 1.7). We consistently identified a significant association between the number of VEs, the associated subjective distress, and clinical scores. Furthermore, distinct correlation patterns between VEs and clinical outcomes emerged across different cohorts. CONCLUSION Our study emphasizes the VES's value in understanding VEs within MDD and FMS. These experiences span from traumatic to sub-traumatic and correlate with posttraumatic-stress and clinical symptoms, underscoring the VES's importance as an assessment tool.
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Affiliation(s)
- Armin Drusko
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Malika Renz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany
| | - Hannah Schmidt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany; Department of Neurophysiology, MCTN, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Michelle Rosin
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Joe Simon
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Eva Beiner
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Monica Charalambides
- Hammersmith & Fulham Community Rehab, West London NHS Trust, London, United Kingdom
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany; DZPG (German Centre for Mental Health - Partner Site Heidelberg/ Mannheim/ Ulm), Germany
| | - Rolf-Detlef Treede
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany; Department of Neurophysiology, MCTN, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany; DZPG (German Centre for Mental Health - Partner Site Heidelberg/ Mannheim/ Ulm), Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany; DZPG (German Centre for Mental Health - Partner Site Heidelberg/ Mannheim/ Ulm), Germany.
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Martel RD, Papafragou G, Weigand S, Rolke R, Prawitt D, Birklein F, Treede RD, Magerl W. Interindividual variability in cold-pressor pain sensitivity is not explained by peripheral vascular responding and generalizes to a C-nociceptor-specific pain phenotype. Pain 2024; 165:e1-e14. [PMID: 38284423 DOI: 10.1097/j.pain.0000000000003049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 07/07/2023] [Indexed: 01/30/2024]
Abstract
ABSTRACT Pain sensitivity of healthy subjects in the cold-pressor (CP) test was proposed to be dichotomously distributed and to represent a pain sensitivity trait. Still, it has not been systematically explored which factors influence this pain sensitivity readout. The aim of this study was to distinguish potential contributions of local tissue-related factors such as perfusion and thermoregulation or gain settings in nociceptive systems. Cold-pressor-sensitive and CP-insensitive students screened from a medical student laboratory course were recruited for a CP retest with additional cardiovascular and bilateral local vascular monitoring. In addition, comprehensive quantitative sensory testing according to Deutscher Forschungsverbund Neuropathischer Schmerz standards and a sustained pinch test were performed. Cold pressor was reproducible across sessions (Cohen kappa 0.61 ± 0.14, P < 0.005). At 30 seconds in ice water, CP-sensitive subjects exhibited not only more pain (78.6 ± 26.3 vs 29.5 ± 17.5, P < 0.0001) but also significantly stronger increases in mean arterial blood pressure (12.6 ± 9.3 vs 5.6 ± 8.1 mm Hg, P < 0.05) and heart rate (15.0 ± 8.2 vs 7.1 ± 6.2 bpm, P < 0.005), and lower baroreflex sensitivity, but not local or vasoconstrictor reflex-mediated microcirculatory responses. Cold-pressor-sensitive subjects exhibited significantly lower pain thresholds also for cold, heat, and blunt pressure, and enhanced pain summation, but no significant differences in Aδ-nociceptor-mediated punctate mechanical pain. In conclusion, differences in nociceptive signal processing drove systemic cardiovascular responses. Baroreceptor activation suppressed pain and cardiovascular responses more efficiently in CP-insensitive subjects. Cold-pressor sensitivity generalized to a pain trait of C-fiber-mediated nociceptive channels, which was independent of local thermal and vascular changes in the ice-water-exposed hand. Thus, the C-fiber pain trait reflects gain setting of the nociceptive system.
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Affiliation(s)
- Richard D Martel
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany. Martel is now with the Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany. Papafragou is now with the Vitos Orthopädische Klinik Kassel, Kassel, Germany. Weigand is now with the Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. Rolke is now with the Department of Palliative Care, RWTH Aachen, Aachen, Germany
| | - Georgios Papafragou
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany. Martel is now with the Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany. Papafragou is now with the Vitos Orthopädische Klinik Kassel, Kassel, Germany. Weigand is now with the Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. Rolke is now with the Department of Palliative Care, RWTH Aachen, Aachen, Germany
| | - Sylvia Weigand
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany. Martel is now with the Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany. Papafragou is now with the Vitos Orthopädische Klinik Kassel, Kassel, Germany. Weigand is now with the Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. Rolke is now with the Department of Palliative Care, RWTH Aachen, Aachen, Germany
| | | | - Dirk Prawitt
- Pediatric Medicine, Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany. Martel is now with the Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany. Papafragou is now with the Vitos Orthopädische Klinik Kassel, Kassel, Germany. Weigand is now with the Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. Rolke is now with the Department of Palliative Care, RWTH Aachen, Aachen, Germany
| | - Walter Magerl
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany. Martel is now with the Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany. Papafragou is now with the Vitos Orthopädische Klinik Kassel, Kassel, Germany. Weigand is now with the Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. Rolke is now with the Department of Palliative Care, RWTH Aachen, Aachen, Germany
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Clarke S, Rogers R, Wanigasekera V, Fardo F, Pia H, Nochi Z, Macian N, Leray V, Finnerup NB, Pickering G, Mouraux A, Truini A, Treede RD, Garcia-Larrea L, Tracey I. Systematic review and co-ordinate based meta-analysis to summarize the utilization of functional brain imaging in conjunction with human models of peripheral and central sensitization. Eur J Pain 2024. [PMID: 38381488 DOI: 10.1002/ejp.2251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Functional magnetic resonance imaging, in conjunction with models of peripheral and/or central sensitization, has been used to assess analgesic efficacy in healthy humans. This review aims to summarize the use of these techniques to characterize brain mechanisms of hyperalgesia/allodynia and to evaluate the efficacy of analgesics. DATABASES AND DATA TREATMENT Searches were performed (PubMed-Medline, Cochrane, Web of Science and Clinicaltrials.gov) to identify and review studies. A co-ordinate based meta-analysis (CBMA) was conducted to quantify neural activity that was reported across multiple independent studies in the hyperalgesic condition compared to control, using GingerALE software. RESULTS Of 217 publications, 30 studies met the inclusion criteria. They studied nine different models of hyperalgesia/allodynia assessed in the primary (14) or secondary hyperalgesia zone (16). Twenty-three studies focused on neural correlates of hyperalgesic conditions and showed consistent changes in the somatosensory cortex, prefrontal cortices, insular cortex, anterior cingulate cortex, thalamus and brainstem. The CBMA on 12 studies that reported activation coordinates for a contrast comparing the hyperalgesic state to control produced six activation clusters (significant at false discovery rate of 0.05) with more peaks for secondary (17.7) than primary zones (7.3). Seven studies showed modulation of brain activity by analgesics in five of the clusters but also in four additional regions. CONCLUSIONS This meta-analysis revealed substantial but incomplete overlap between brain areas related to neural mechanisms of hyperalgesia and those reflecting the efficacy of analgesic drugs. Studies testing in the secondary zone were more sensitive to evaluate analgesic efficacy on central sensitization at brainstem or thalamocortical levels. SIGNIFICANCE Experimental pain models that provide a surrogate for features of pathological pain conditions in healthy humans and functional imaging techniques are both highly valuable research tools. This review shows that when used together, they provide a wealth of information about brain activity during pain states and analgesia. These tools are promising candidates to help bridge the gap between animal and human studies, to improve translatability and provide opportunities for identification of new targets for back-translation to animal studies.
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Affiliation(s)
- Sophie Clarke
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford, UK
| | - Richard Rogers
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford, UK
| | - Vishvarani Wanigasekera
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford, UK
| | - Francesca Fardo
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Hossein Pia
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Zahra Nochi
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Nicolas Macian
- Platform of Clinical Investigation, Inserm CIC 1405, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Leray
- Platform of Clinical Investigation, Inserm CIC 1405, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Nanna Brix Finnerup
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Gisèle Pickering
- Platform of Clinical Investigation, Inserm CIC 1405, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
- Inserm 1107, University Clermont Auvergne, Clermont-Ferrand, France
| | - André Mouraux
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
| | - Luis Garcia-Larrea
- NeuroPain Lab, Lyon Centre for Neuroscience Inserm U1028 and University Claude Bernard, Lyon, France
- Pain Center Neurological Hospital (CETD), Hospices Civils de Lyon, Lyon, France
| | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford, UK
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Treede RD. Interactions between 2 subtypes of central sensitization in rats and humans: spinal long-term potentiation and brainstem controls. Pain 2024:00006396-990000000-00490. [PMID: 38198229 DOI: 10.1097/j.pain.0000000000003167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Central Institute for Mental Health (CIMH), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
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Vollert J, Fardo F, Attal N, Baron R, Bouhassira D, Enax-Krumova EK, Freynhagen R, Hansson P, Jensen TS, Kersebaum D, Maier C, Pogatzki-Zahn E, Rice AS, Sachau J, Schaldemose EL, Segerdahl M, Sendel M, Tölle TR, Finnerup NB, Treede RD. Paradoxical heat sensation as a manifestation of thermal hypesthesia: a study of 1090 patients with lesions of the somatosensory system. Pain 2024; 165:216-224. [PMID: 37578447 PMCID: PMC10723641 DOI: 10.1097/j.pain.0000000000003014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023]
Abstract
ABSTRACT Paradoxical heat sensation (PHS) is the perception of warmth when the skin is cooled. Paradoxical heat sensation rarely occurs in healthy individuals but more frequently in patients suffering from lesions or disease of the peripheral or central nervous system. To further understand mechanisms and epidemiology of PHS, we evaluated the occurrence of PHS in relation to disease aetiology, pain levels, quantitative sensory testing parameters, and Neuropathic Pain Symptom Inventory (NPSI) items in patients with nervous system lesions. Data of 1090 patients, including NPSI scores from 404 patients, were included in the analysis. We tested 11 quantitative sensory testing parameters for thermal and mechanical detection and pain thresholds, and 10 NPSI items in a multivariate generalised linear model with PHS, aetiology, and pain (yes or no) as fixed effects. In total, 30% of the neuropathic patients reported PHS in contrast to 2% of healthy individuals. The frequency of PHS was not linked to the presence or intensity of pain. Paradoxical heat sensation was more frequent in patients living with polyneuropathy compared with central or unilateral peripheral nerve lesions. Patients who reported PHS demonstrated significantly lower sensitivity to thermal perception, with lower sensitivity to normally painful heat and cold stimuli. Neuropathic Pain Symptom Inventory scores were lower for burning and electric shock-like pain quality for patients with PHS. Our findings suggest that PHS is associated with loss of small thermosensory fibre function normally involved in cold and warm perception. Clinically, presence of PHS could help screening for loss of small fibre function as it is straightforward to measure or self-reported by patients.
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Affiliation(s)
- Jan Vollert
- Pain Research, MSk Lab, Department of Surgery and Cancer, Imperial College, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
| | - Francesca Fardo
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nadine Attal
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France, Université Versailles-Saint-Quentin, Versailles, France
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Didier Bouhassira
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France, Université Versailles-Saint-Quentin, Versailles, France
| | - Elena K. Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bochum, Germany
| | - Rainer Freynhagen
- Department of Anaesthesiology, Critical Care Medicine, Pain Therapy and Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital, Tutzing, Germany
- Department of Anaesthesiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Per Hansson
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Troels S. Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Dilara Kersebaum
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Christoph Maier
- University Hospital of Pediatrics and Adolescent Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
| | - Andrew S.C. Rice
- Pain Research, MSk Lab, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ellen L. Schaldemose
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Märta Segerdahl
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- MS Medical Consulting, Stockholm, Sweden
| | - Manon Sendel
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Thomas R. Tölle
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Nanna B. Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
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Drusko A, Renz M, Schmidt H, Schlömp L, Papaiannou V, Schmidt N, Tost H, Treede RD, Eich W, Tesarz J. Clinical Phenomenology of Fibromyalgia Syndrome in Male Patients: Same But Different. J Pain 2023; 24:2162-2174. [PMID: 37422159 DOI: 10.1016/j.jpain.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/25/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
The majority of knowledge about fibromyalgia syndrome (FMS) derives from studies of female patients. Little is known about the clinical characteristics and treatment outcomes of male patients with FMS. In this retrospective cohort study with a prospective posttreatment follow-up, we investigated whether male patients with FMS differ from female patients in terms of 1) symptom burden, 2) psychological characteristics, and 3) clinical treatment response. We identified 263 male (4%) out of 5,541 patients with FMS completing a 3-week multimodal pain-treatment program. Male patients (51.3 ± 9.1 years) were age- and time-matched (1:4) with female patients (N = 1,052, 51.3 ± 9.0 years). Data on clinical characteristics, psychological comorbidities, and treatment responses were obtained from medical records and validated questionnaires. Levels of perceived pain, psychological comorbidity, and functional capacity were similar between genders, although male patients with FMS showed a higher prevalence of alcohol abuse. Compared to female patients, male patients experienced themselves less often as overly accommodating (Cohen's d = -.42) but more often as self-sacrificing (d = .26) or intrusive (d = .23). Regarding pain coping, male patients were less likely to utilize mental distraction, rest- and relaxation techniques, or counteractive activities (d = .18-.27). Male patients showed a slightly worse overall response rate than women (69% vs 77%), although differences between individual outcome measures were small (d < .2). Although male and female patients in our cohort were similar in clinical presentation and treatment response, the gender-specific differences in interpersonal problems and pain coping suggest consideration of these aspects in the treatment of male patients with FMS. PERSPECTIVE: Knowledge about fibromyalgia mostly derives from studies of female patients. Identifying and understanding gender-specific differences in fibromyalgia is an important roadmap in the treatment of this syndrome by focusing on specific gender aspects such as differences in interpersonal problems and pain coping mechanisms.
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Affiliation(s)
- Armin Drusko
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Malika Renz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Hannah Schmidt
- Department of Neurophysiology, MCTN, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Lea Schlömp
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | | | - Norbert Schmidt
- ACURA Clinic of Psychosomatic Medicine, Baden-Baden, Baden-Württemberg, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, MCTN, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
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Coxon L, Vollert J, Perro D, Lunde CE, Ferreira-Gomes J, Charrua A, Abreu-Mendes P, Krassowski M, Birch J, Meijlink J, Hummelshoj L, Hoffmann A, Aziz Q, Arendt-Nielsen L, Pogatzki-Zahn E, Evans E, Demetriou L, McMahon SB, Missmer SA, Becker CM, Zondervan KT, Horne AW, Cruz F, Sieberg CB, Treede RD, Nagel J, Vincent K. Comprehensive quantitative sensory testing shows altered sensory function in women with chronic pelvic pain: results from the Translational Research in Pelvic Pain (TRiPP) Study. Pain 2023; 164:2528-2539. [PMID: 37289573 PMCID: PMC10578421 DOI: 10.1097/j.pain.0000000000002955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023]
Abstract
ABSTRACT Chronic pelvic pain (CPP), despite its high prevalence, is still relatively poorly understood mechanistically. This study, as part of the Translational Research in Pelvic Pain (TRiPP) project, has used a full quantitative sensory testing (QST) paradigm to profile n = 85 women with and without CPP (endometriosis or bladder pain specifically). We used the foot as a control site and abdomen as the test site. Across 5 diagnostically determined subgroups, we found features which are common across different aetiologies, eg, gain of function in pressure pain threshold (PPT) when assessing responses from the lower abdomen or pelvis (referred pain site). However, disease-specific phenotypes were also identified, eg, greater mechanical allodynia in endometriosis, despite there being large heterogeneities within diagnostic groups. The most common QST sensory phenotype was mechanical hyperalgesia (>50% across all the groups). A "healthy' sensory phenotype was seen in <7% of CPP participants. Specific QST measures correlated with sensory symptoms assessed by the painDETECT questionnaire (pressure-evoked pain [painDETECT] and PPT [QST] [ r = 0.47, P < 0.001]; mechanical hyperalgesia (painDETECT) and mechanical pain sensitivity [MPS from QST] [ r = 0.38, P = 0.009]). The data suggest that participants with CPP are sensitive to both deep tissue and cutaneous inputs, suggesting that central mechanisms may be important in this cohort. We also see phenotypes such as thermal hyperalgesia, which may be the result of peripheral mechanisms, such as irritable nociceptors. This highlights the importance of stratifying patients into clinically meaningful phenotypes, which may have implications for the development of better therapeutic strategies for CPP.
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Affiliation(s)
- Lydia Coxon
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jan Vollert
- University Hospital Muenster, Muenster, Germany
- Heidelberg University, Mannheim, Germany
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Danielle Perro
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Claire E. Lunde
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | | | - Ana Charrua
- IBMC/I3S, Faculty of Medicine of Porto & Hospital São João, Porto, Portugal
| | - Pedro Abreu-Mendes
- IBMC/I3S, Faculty of Medicine of Porto & Hospital São João, Porto, Portugal
| | - Michal Krassowski
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Judy Birch
- Pelvic Pain Support Network, Poole, United Kingdom
| | - Jane Meijlink
- International Painful Bladder Foundation, Naarden, the Netherlands
| | | | - Anja Hoffmann
- Bayer AG, Research & Development, Pharmaceuticals, Berlin, Germany
| | - Qasim Aziz
- Queen Mary University of London, London, United Kingdom
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | | | - Emma Evans
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Lysia Demetriou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Stephen B. McMahon
- Formerly of Neurorestoration Group, Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom
| | - Stacey A. Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Christian M. Becker
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Krina T. Zondervan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | | | - Francisco Cruz
- IBMC/I3S, Faculty of Medicine of Porto & Hospital São João, Porto, Portugal
| | - Christine B. Sieberg
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | | | - Jens Nagel
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
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9
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Flor H, Noguchi K, Treede RD, Turk DC. The role of evolving concepts and new technologies and approaches in advancing pain research, management, and education since the establishment of the International Association for the Study of Pain. Pain 2023; 164:S16-S21. [PMID: 37831955 DOI: 10.1097/j.pain.0000000000003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/09/2023] [Indexed: 10/15/2023]
Abstract
ABSTRACT The decades since the inauguration of the International Association for the Study of Pain have witnessed major advances in scientific concepts (such as the biopsychosocial model and chronic primary pain as a disease in its own right) and in new technologies and approaches (from molecular biology to brain imaging) that have inspired innovations in pain research. These have guided progress in pain management and education about pain for healthcare professionals, the general public, and administrative agencies.
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Affiliation(s)
- Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Koichi Noguchi
- Laboratory of Pain Mechanism Research, Hyogo Medical University, Hyogo, Japan
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
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10
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de Andrade DC, Mylius V, Perez-Lloret S, Cury RG, Bannister K, Moisset X, Taricani Kubota G, Finnerup NB, Bouhassira D, Chaudhuri KR, Graven-Nielsen T, Treede RD. Pain in Parkinson disease: mechanistic substrates, main classification systems, and how to make sense out of them. Pain 2023; 164:2425-2434. [PMID: 37318012 DOI: 10.1097/j.pain.0000000000002968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 06/16/2023]
Abstract
ABSTRACT Parkinson disease (PD) affects up to 2% of the general population older than 65 years and is a major cause of functional loss. Chronic pain is a common nonmotor symptom that affects up to 80% of patients with (Pw) PD both in prodromal phases and during the subsequent stages of the disease, negatively affecting patient's quality of life and function. Pain in PwPD is rather heterogeneous and may occur because of different mechanisms. Targeting motor symptoms by dopamine replacement or with neuromodulatory approaches may only partially control PD-related pain. Pain in general has been classified in PwPD according to the motor signs, pain dimensions, or pain subtypes. Recently, a new classification framework focusing on chronic pain was introduced to group different types of PD pains according to mechanistic descriptors: nociceptive, neuropathic, or neither nociceptive nor neuropathic. This is also in line with the International Classification of Disease-11 , which acknowledges the possibility of chronic secondary musculoskeletal or nociceptive pain due to disease of the CNS. In this narrative review and opinion article, a group of basic and clinical scientists revise the mechanism of pain in PD and the challenges faced when classifying it as a stepping stone to discuss an integrative view of the current classification approaches and how clinical practice can be influenced by them. Knowledge gaps to be tackled by coming classification and therapeutic efforts are presented, as well as a potential framework to address them in a patient-oriented manner.
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Affiliation(s)
- Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Veit Mylius
- Department of Neurology, Centre for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
- Department of Neurology, Kantonsspital, St. Gallen, Switzerland
| | - Santiago Perez-Lloret
- Observatorio de Salud Pública, Universidad Católica Argentina, Consejo de Investigaciones Científicas y Técnicas (UCA-CONICET), Buenos Aires, Argentina
- Facultad de Medicina, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Rubens G Cury
- Movement Disorders Center, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Gabriel Taricani Kubota
- Department of Neurology, Centre for Neurorehabilitation, Valens, Switzerland
- Pain Center, University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
- Center for Pain Treatment, Institute of Cancer of the State of Sao Paulo, University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Kallol Ray Chaudhuri
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence in Care and Research, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
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11
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Wang D, Treede RD, Köhr G. Electrophysiological evidence that TRPM3 is a candidate in latent spinal sensitization of chronic low back pain. Neurosci Lett 2023; 816:137509. [PMID: 37802417 DOI: 10.1016/j.neulet.2023.137509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
Latent spinal sensitization is one key mechanism developing at the early stage of chronic low back pain (LBP). TRPM3-mediated calcium transients of dorsal root ganglia (DRG) neurons are considered critical presynaptic signals involved in this latent sensitization. However, postsynaptic consequences in input laminae of the spinal cord have not been addressed so far. Here, by electrophysiological recordings in acute spinal cord slices from adult rats, we show that perfusion of the TRPM3 agonist pregnenolone sulfate (PregS) induced a significant increase in the frequency but not amplitude of spontaneous postsynaptic currents in lamina I and II neurons. This frequency increase started slowly during PregS perfusion but was reversible following washout. This result is consistent with a presynaptic action of the neurosteroid PregS, indicating the presynaptic expression of functional TRPM3 in the superficial dorsal horn of adult rats. Thus, PregS-induced TRPM3 activation enhances spinal synaptic strength, implying a mediating role of TRPM3 between neuroendocrine and nociceptive signaling, which might as well exist in chronic LBP primed by chronic stress that promotes the biosynthesis of PregS.
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Affiliation(s)
- Dan Wang
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany; Deptartment of Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Georg Köhr
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany; Physiology of Neural Networks, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany.
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12
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Guiloff RJ, Campero M, Barraza GR, Treede RD, Matamala JM, Castillo JL. Pain-Related Vertex Evoked Potentials. Comparison of Surface Electrical to Heat Stimulation. J Clin Neurophysiol 2023; 40:616-624. [PMID: 37931163 DOI: 10.1097/wnp.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Demonstration of nociceptive fiber abnormality is important for diagnosing neuropathic pain and small fiber neuropathies. This is usually assessed by brief heat pulses using lasers, contact heat, or special electrodes. We hypothesized that pain-related evoked potentials to conventional surface electrical stimulation (PREPse) can index Aδ afferences despite tactile Aß fibers coactivation. PREPse may be more readily used clinically than contact heat evoked potentials (CHEPS). METHODS Twenty-eight healthy subjects. Vertex (Cz-A1/A2) recordings. Electrical stimulation of middle finger and second toe with conventional ring, and forearm/leg skin with cup, electrodes. Contact heat stimulation to forearm and leg. Compression ischemic nerve blockade. RESULTS PREPse peripheral velocities were within the midrange of Aδ fibers. N1-P1 amplitude increased with pain numerical rating scale graded (0-10) electrical stimulation (n = 25) and decreased with increasing stimulation frequency. Amplitudes were unchanged by different presentation orders of four stimulation intensities. PREPse N1 (∼130 milliseconds) and N2 (∼345 milliseconds) peaks were approximately 40 milliseconds earlier than that with CHEPS. PREPse and CHEPS N1-N2 interpeak latency (∼207 milliseconds) were similar. PREPse became unrecordable with nerve blockade of Aδ fibers. CONCLUSIONS PREPse earlier N1 and N2 peaks, and similar interpeak N1-N2 latencies and central conduction velocities, or synaptic delays, to CHEPS are consistent with direct stimulation of Aδ fibers. The relation of vertex PREPse amplitude and pain, or the differential effects of frequency stimulation, is similar to pain-related evoked potential to laser, special electrodes, or contact heat stimulation. The relationship to Aδ was validated by conduction velocity and nerve block. Clinical utility of PREPse compared with CHEPS needs validation in somatosensory pathways lesions.
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Affiliation(s)
- Roberto J Guiloff
- Faculty of Medicine University of Chile, Santiago, Chile
- Imperial College, London, United Kingdom
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Mario Campero
- Faculty of Medicine University of Chile, Santiago, Chile
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Gonzalo R Barraza
- Neuromuscular Unit, Department of Neurology and Neurosurgery, Hospital Clinico Universidad de Chile, Santiago, Chile
| | | | - Jose M Matamala
- Faculty of Medicine University of Chile, Santiago, Chile
- Department of Neurological Science, Hospital El Salvador, Santiago, Chile
| | - Jose L Castillo
- Department of Neurological Science, Hospital El Salvador, Santiago, Chile
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13
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Eiamtanasate S, Smithiseth K, Zinboonyahgoon N, Korwisi B, Barke A, Rief W, Treede RD. The invisible cost of pain management by the current International Classification of Diseases coding system: a study in a tertiary care inpatient setting. Pain 2023; 164:2009-2015. [PMID: 37027141 DOI: 10.1097/j.pain.0000000000002899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/10/2023] [Indexed: 04/08/2023]
Abstract
ABSTRACT The International Classification of Diseases ( ICD ) is applied worldwide for public health data collection among other use cases. However, the current version of the ICD ( ICD-10 ), to which the reimbursement system is linked in many countries, does not represent chronic pain properly. This study aims to compare the ICD-10 with the ICD-11 in hospitalized patients in terms of specificity, clinical utility, and reimbursement for pain management. The medical records of hospitalized patients consulted for pain management at Siriraj Hospital, Thailand, were reviewed, and all pain-related diagnoses were coded into ICD-10 and ICD-11 . The data of 397 patients showed unspecified pain was coded 78% in the ICD-10 and only 0.5% in the ICD-11 version. The difference gap in the proportion of unspecified pain between the 2 versions is wider than in the outpatient setting. The 3 most common codes for ICD-10 were other chronic pain, low back pain, and pain in limb. The 3 most common codes for ICD-11 were chronic cancer pain, chronic peripheral neuropathic pain, and chronic secondary musculoskeletal pain. As in many other countries, no pain-related ICD-10 codes were coded for routine reimbursement. The simulated reimbursement fee remained the same when adding 397 pain-related codings, even if the cost of pain management, such as cost of labor, existed. Compared with the ICD-10 version, the ICD-11 is more specific and makes pain diagnoses more visible. Thus, shifting from ICD-10 to ICD-11 has the potential to improve both the quality of care and the reimbursement for pain management.
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Affiliation(s)
- Sarasate Eiamtanasate
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Nantthasorn Zinboonyahgoon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University Duisburg-Essen, Essen, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
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14
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Heumüller-Klug S, Maurer K, Tapia-Laliena MÁ, Sticht C, Christmann A, Mörz H, Khasanov R, Wink E, Schulte S, Greffrath W, Treede RD, Wessel LM, Schäfer KH. Impact of cryopreservation on viability, gene expression and function of enteric nervous system derived neurospheres. Front Cell Dev Biol 2023; 11:1196472. [PMID: 37377739 PMCID: PMC10291272 DOI: 10.3389/fcell.2023.1196472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction: Impairment of both the central and peripheral nervous system is a major cause of mortality and disability. It varies from an affection of the brain to various types of enteric dysganglionosis. Congenital enteric dysganglionosis is characterized by the local absence of intrinsic innervation due to deficits in either migration, proliferation or differentiation of neural stem cells. Despite surgery, children's quality of life is reduced. Neural stem cell transplantation seems a promising therapeutic approach, requiring huge amounts of cells and multiple approaches to fully colonize the diseased areas completely. A combination of successful expansion and storage of neural stem cells is needed until a sufficient amount of cells is generated. This must be combined with suitable cell transplantation strategies, that cover all the area affected. Cryopreservation provides the possibility to store cells for long time, unfortunately with side effects, i.e., upon vitality. Methods: In this study we investigate the impact of different freezing and thawing protocols (M1-M4) upon enteric neural stem cell survival, protein and gene expression, and cell function. Results: Freezing enteric nervous system derived neurospheres (ENSdN) following slow-freezing protocols (M1-3) resulted in higher survival rates than flash-freezing (M4). RNA expression profiles were least affected by freezing protocols M1/2, whereas the protein expression of ENSdN remained unchanged after treatment with protocol M1 only. Cells treated with the most promising freezing protocol (M1, slow freezing in fetal calf serum plus 10% DMSO) were subsequently investigated using single-cell calcium imaging. Freezing of ENSdN did not alter the increase in intracellular calcium in response to a specific set of stimuli. Single cells could be assigned to functional subgroups according to response patterns and a significant shift towards cells responding to nicotine was observed after freezing. Discussion: The results demonstrate that cryopreservation of ENSdN is possible with reduced viability, only slight changes in protein/gene expression patterns and without an impact on the neuronal function of different enteric nervous system cell subtypes, with the exception of a subtle upregulation of cells expressing nicotinergic acetylcholine receptors. In summary, cryopreservation presents a good method to store sufficient amounts of enteric neural stem cells without neuronal impairment, in order to enable subsequent transplantation of cells into compromised tissues.
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Affiliation(s)
- Sabine Heumüller-Klug
- Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kristina Maurer
- Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - María Á. Tapia-Laliena
- Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Carsten Sticht
- Medical Research Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anne Christmann
- AGENS, University of Applied Sciences Kaiserslautern Campus Zweibrücken, Kaiserslautern, Germany
| | - Handan Mörz
- Mannheim Center for Translational Neuroscience (MCTN), Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rasul Khasanov
- Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Elvira Wink
- Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Steven Schulte
- AGENS, University of Applied Sciences Kaiserslautern Campus Zweibrücken, Kaiserslautern, Germany
| | - Wolfgang Greffrath
- Mannheim Center for Translational Neuroscience (MCTN), Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience (MCTN), Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lucas M. Wessel
- Department of Pediatric Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karl-Herbert Schäfer
- AGENS, University of Applied Sciences Kaiserslautern Campus Zweibrücken, Kaiserslautern, Germany
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15
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Reneman MF, Selb M, Korwisi B, Barke A, Escorpizo RS, Tu SW, Treede RD. Towards harmonizing the concepts and definitions of pain in the World Health Organization's Family of International Classifications. Pain 2023; 164:1240-1244. [PMID: 36728950 PMCID: PMC10184558 DOI: 10.1097/j.pain.0000000000002854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/16/2022] [Accepted: 11/01/2022] [Indexed: 02/03/2023]
Abstract
Supplemental Digital Content is Available in the Text.
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Affiliation(s)
- Michiel F. Reneman
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Melissa Selb
- ICF Research Branch, Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Division of Clinical Psychology and Intervention, Institute of Psychology, University Duisburg Essen, Essen, Germany
| | - Reuben S. Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, United States
| | - Samson W. Tu
- Center for BioMedical Informatics Research, Stanford University, Stanford, CA, United States
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
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16
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Demetriou L, Krassowski M, Abreu Mendes P, Garbutt K, Vitonis AF, Wilkins E, Coxon L, Arendt-Nielsen L, Aziz Q, Birch J, Horne AW, Hoffman A, Hummelshoj L, Lunde CE, Meijlink J, Perro D, Rahmioglu N, Terry KL, Pogatzki-Zahn E, Sieberg CB, Treede RD, Becker CM, Cruz F, Missmer SA, Zondervan KT, Nagel J, Vincent K. Clinical profiling of specific diagnostic subgroups of women with chronic pelvic pain. Front Reprod Health 2023; 5:1140857. [PMID: 37325239 PMCID: PMC10266100 DOI: 10.3389/frph.2023.1140857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Chronic pelvic pain (CPP) is a common condition affecting up to 26.6% of women, with many suffering for several years before diagnosis and/or treatment. Its clinical presentation is varied and there are frequently comorbid conditions both within and outside the pelvis. We aim to explore whether specific subgroups of women with CPP report different clinical symptoms and differing impact of pain on their quality of life (QoL). Methods The study is part of the Translational Research in Pelvic Pain (TRiPP) project which is a cross-sectional observational cohort study. The study includes 769 female participants of reproductive age who completed an extensive set of questions derived from standardised WERF EPHect questionnaires. Within this population we defined a control group (reporting no pelvic pain, no bladder pain syndrome, and no endometriosis diagnosis, N = 230) and four pain groups: endometriosis-associated pain (EAP, N = 237), interstitial cystitis/bladder pain syndrome (BPS, N = 72), comorbid endometriosis-associated pain and BPS (EABP, N = 120), and pelvic pain only (PP, N = 127). Results Clinical profiles of women with CPP (13-50 years old) show variability of clinical symptoms. The EAP and EABP groups scored higher than the PP group (p < 0.001) on the pain intensity scales for non-cyclical pelvic pain and higher than both the BPS and PP groups (p < 0.001) on the dysmenorrhoea scale. The EABP group also had significantly higher scores for dyspareunia (p < 0.001), even though more than 50% of sexually active participants in each pain group reported interrupting and/or avoiding sexual intercourse due to pain in the last 12 months. Scores for the QoL questionnaire (SF-36) reveal that CPP patients had significantly lower QoL across all SF-36 subscales (p < 0.001). Significant effects were also observed between the pain groups for pain interference with their work (p < 0.001) and daily lives (p < 0.001), with the EABP suffering more compared to the EAP and PP groups (p < 0.001). Discussion Our results demonstrate the negative impact that chronic pain has on CPP patients' QoL and reveal an increased negative impact of pain on the comorbid EABP group. Furthermore, it demonstrates the importance of dyspareunia in women with CPP. Overall, our results demonstrate the need for further exploration of interventions targeting QoL more broadly and suggest that novel approaches to classifying women with CPP are needed.
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Affiliation(s)
- Lysia Demetriou
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Michal Krassowski
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Pedro Abreu Mendes
- IBMC/I3S and Faculty of Medicine of Porto, Hospital S João, Porto, Portugal
| | - Kurtis Garbutt
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Allison F. Vitonis
- Boston Center for Endometriosis, Brigham and Women’s Hospital and Boston Children’s Hospital, Boston, MA, United States
- Department of Obstetrics and Gynaecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Elizabeth Wilkins
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Lydia Coxon
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Judy Birch
- Pelvic Pain Support Network, Poole, United Kingdom
| | - Andrew W. Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Anja Hoffman
- Research & Development, Pharmaceuticals Experimental Medicine, Bayer AG, Berlin, Germany
| | | | - Claire E. Lunde
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, & Pain Medicine, Boston Children’s Hospital, Boston, MA, London, United States
| | - Jane Meijlink
- International Painful Bladder Foundation, Naarden, Netherlands
| | - Danielle Perro
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Nilufer Rahmioglu
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Kathryn L. Terry
- Boston Center for Endometriosis, Brigham and Women’s Hospital and Boston Children’s Hospital, Boston, MA, United States
- Department of Obstetrics and Gynaecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Christine B. Sieberg
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, & Pain Medicine, Boston Children’s Hospital, Boston, MA, London, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, Mannheim, Germany
| | - Christian M. Becker
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Francisco Cruz
- IBMC/I3S and Faculty of Medicine of Porto, Hospital S João, Porto, Portugal
| | - Stacey A. Missmer
- Boston Center for Endometriosis, Brigham and Women’s Hospital and Boston Children’s Hospital, Boston, MA, United States
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Obstetrics, Gynecology, and Reproductive Biology; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Krina T. Zondervan
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jens Nagel
- Pharmaceuticals Division, Research and Early Development, Therapeutic Area Endocrinology, Metabolism and Reproductive Health, Exploratory Pathobiology, Bayer AG, Wuppertal, Germany
| | - Katy Vincent
- Oxford Endometriosis Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
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Wandner LD, Bloms-Funke P, Bova G, Domenichiello A, Hoffmann A, Iyengar S, Karp BI, Letzen J, Liedgens H, Mohapatra DP, Nagel J, Pelleymounter MA, Pogatzki-Zahn E, Pogorzala L, Vollert J, Woller SA, Treede RD. INTEGRATE-Pain: a transatlantic consortium to advance development of effective pain management. Pain Med 2023:7084781. [PMID: 36951530 DOI: 10.1093/pm/pnad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Laura D Wandner
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | | | - Giulia Bova
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | - Anthony Domenichiello
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | | | - Smriti Iyengar
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | - Barbara I Karp
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | - Janelle Letzen
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | | | - Durga P Mohapatra
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | | | - Mary Ann Pelleymounter
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | | | - Leah Pogorzala
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | - Jan Vollert
- University Hospital Muenster, Germany
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, Mannheim, Germany
- Imperial College London, Department of Surgery & Cancer, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Sarah A Woller
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), United States
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, Mannheim, Germany
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18
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Pia H, Nochi Z, Kristensen AG, Pelz B, Goetz M, Hoeink JN, Blockeel AJ, Mouraux A, Truini A, Finnerup NB, Phillips KG, Treede RD, Tankisi H. The test–retest reliability of large and small fiber nerve excitability testing with threshold tracking. Clin Neurophysiol Pract 2023; 8:71-78. [PMID: 37181417 PMCID: PMC10172996 DOI: 10.1016/j.cnp.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/08/2023] [Accepted: 03/26/2023] [Indexed: 04/09/2023] Open
Abstract
Objective Standard nerve excitability testing (NET) predominantly assesses Aα- and Aβ-fiber function, but a method examining small afferents would be of great interest in pain studies. Here, we examined the properties of a novel perception threshold tracking (PTT) method that preferentially activates Aδ-fibers using weak currents delivered by a novel multipin electrode and compared its reliability with NET. Methods Eighteen healthy subjects (mean age:34.06 ± 2.0) were examined three times with motor and sensory NET and PTT in morning and afternoon sessions on the same day (intra-day reliability) and after a week (inter-day reliability). NET was performed on the median nerve, while PTT stimuli were delivered through a multipin electrode located on the forearm. During PTT, subjects indicated stimulus perception via a button press and the intensity of the current was automatically increased or decreased accordingly by Qtrac software. This allowed changes in the perception threshold to be tracked during strength-duration time constant (SDTC) and threshold electrotonus protocols. Results The coefficient of variation (CoV) and interclass coefficient of variation (ICC) showed good-excellent reliability for most NET parameters. PTT showed poor reliability for both SDTC and threshold electrotonus parameters. There was a significant correlation between large (sensory NET) and small (PTT) fiber SDTC when all sessions were pooled (r = 0.29, p = 0.03). Conclusions Threshold tracking technique can be applied directly to small fibers via a psychophysical readout, but with the current technique, the reliability is poor. Significance Further studies are needed to examine whether Aβ-fiber SDTC may be a surrogate biomarker for peripheral nociceptive signalling.
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19
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Drusko A, Baumeister D, McPhee Christensen M, Kold S, Fisher VL, Treede RD, Powers A, Graven-Nielsen T, Tesarz J. A novel computational approach to pain perception modelling within a Bayesian framework using quantitative sensory testing. Sci Rep 2023; 13:3196. [PMID: 36823292 PMCID: PMC9950064 DOI: 10.1038/s41598-023-29758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Pain perception can be studied as an inferential process in which prior information influences the perception of nociceptive input. To date, there are no suitable psychophysical paradigms to measure this at an individual level. We developed a quantitative sensory testing paradigm allowing for quantification of the influence of prior expectations versus current nociceptive input during perception. Using a Pavlovian-learning task, we investigated the influence of prior expectations on the belief about the varying strength of association between a painful electrical cutaneous stimulus and a visual cue in healthy subjects (N = 70). The belief in cue-pain associations was examined with computational modelling using a Hierarchical Gaussian Filter (HGF). Prior weighting estimates in the HGF model were compared with the established measures of conditioned pain modulation (CPM) and temporal summation of pain (TSP) assessed by cuff algometry. Subsequent HGF-modelling and estimation of the influence of prior beliefs on perception showed that 70% of subjects had a higher reliance on nociceptive input during perception of acute pain stimuli, whereas 30% showed a stronger weighting of prior expectations over sensory evidence. There was no association between prior weighting estimates and CPM or TSP. The data demonstrates relevant individual differences in prior weighting and suggests an importance of top-down cognitive processes on pain perception. Our new psychophysical testing paradigm provides a method to identify individuals with traits suggesting greater reliance on prior expectations in pain perception, which may be a risk factor for developing chronic pain and may be differentially responsive to learning-based interventions.
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Affiliation(s)
- Armin Drusko
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - David Baumeister
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Megan McPhee Christensen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Sebastian Kold
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Victoria Lynn Fisher
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, Heidelberg, Germany
| | - Albert Powers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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20
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Franz S, Heutehaus L, Tappe-Theodor A, Weidner N, Treede RD, Schuh-Hofer S. Noxious radiant heat evokes bi-component nociceptive withdrawal reflexes in spinal cord injured humans-A clinical tool to study neuroplastic changes of spinal neural circuits. Front Hum Neurosci 2023; 17:1141690. [PMID: 37200949 PMCID: PMC10185789 DOI: 10.3389/fnhum.2023.1141690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
Investigating nocifensive withdrawal reflexes as potential surrogate marker for the spinal excitation level may widen the understanding of maladaptive nociceptive processing after spinal cord injury (SCI). The aim of this prospective, explorative cross-sectional observational study was to investigate the response behavior of individuals with SCI to noxious radiant heat (laser) stimuli and to assess its relation to spasticity and neuropathic pain, two clinical consequences of spinal hyperexcitability/spinal disinhibition. Laser stimuli were applied at the sole and dorsum of the foot and below the fibula head. Corresponding reflexes were electromyography (EMG) recorded ipsilateral. Motor responses to laser stimuli were analyzed and related to clinical readouts (severity of injury/spasticity/pain), using established clinical assessment tools. Twenty-seven participants, 15 with SCI (age 18-63; 6.5 years post-injury; AIS-A through D) and 12 non-disabled controls, [non-disabled controls (NDC); age 19-63] were included. The percentage of individuals with SCI responding to stimuli (70-77%; p < 0.001), their response rates (16-21%; p < 0.05) and their reflex magnitude (p < 0.05) were significantly higher compared to NDC. SCI-related reflexes clustered in two time-windows, indicating involvement of both A-delta- and C-fibers. Spasticity was associated with facilitated reflexes in SCI (Kendall-tau-b p ≤ 0.05) and inversely associated with the occurrence/severity of neuropathic pain (Fisher's exact p < 0.05; Eta-coefficient p < 0.05). However, neuropathic pain was not related to reflex behavior. Altogether, we found a bi-component motor hyperresponsiveness of SCI to noxious heat, which correlated with spasticity, but not neuropathic pain. Laser-evoked withdrawal reflexes may become a suitable outcome parameter to explore maladaptive spinal circuitries in SCI and to assess the effect of targeted treatment strategies. Registration: https://drks.de/search/de/trial/DRKS00006779.
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Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
- Steffen Franz,
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Anke Tappe-Theodor
- Department of Molecular Pharmacology, Medical Faculty Heidelberg, Institute of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Sigrid Schuh-Hofer
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
- Department of Neurology and Epileptology, University of Tübingen, Tübingen, Germany
- *Correspondence: Sigrid Schuh-Hofer,
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Treede RD. Pain research in 2022: nociceptors and central sensitisation. Lancet Neurol 2023; 22:24-25. [PMID: 36517162 DOI: 10.1016/s1474-4422(22)00485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim 68167, Germany.
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22
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Di Pietro G, Di Stefano G, Leone C, Di Lionardo A, Sgro E, Blockeel AJ, Caspani O, Garcia-Larrea L, Mouraux A, Phillips KG, Treede RD, Valeriani M, Truini A. Erratum to ‘The N13 spinal component of somatosensory evoked potentials is modulated by heterotopic noxious conditioning stimulation suggesting an involvement of spinal wide dynamic range neurons’. Neurophysiol Clin 2022; 52:410-411. [DOI: 10.1016/j.neucli.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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23
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Leone C, Di Stefano G, Di Pietro G, Bloms-Funke P, Boesl I, Caspani O, Chapman SC, Finnerup NB, Garcia-Larrea L, Li T, Goetz M, Mouraux A, Pelz B, Pogatzki-Zahn E, Schilder A, Schnetter E, Schubart K, Tracey I, Troconiz IF, Van Niel H, Hernandez JMV, Vincent K, Vollert J, Wanigasekera V, Wittayer M, Phillips KG, Truini A, Treede RD. IMI2-PainCare-BioPain-RCT2 protocol: a randomized, double-blind, placebo-controlled, crossover, multicenter trial in healthy subjects to investigate the effects of lacosamide, pregabalin, and tapentadol on biomarkers of pain processing observed by non-invasive neurophysiological measurements of human spinal cord and brainstem activity. Trials 2022; 23:739. [PMID: 36064434 PMCID: PMC9442941 DOI: 10.1186/s13063-022-06431-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background IMI2-PainCare-BioPain-RCT2 is one of four similarly designed clinical studies aiming at profiling a set of functional biomarkers of drug effects on specific compartments of the nociceptive system that could serve to accelerate the future development of analgesics. IMI2-PainCare-BioPain-RCT2 will focus on human spinal cord and brainstem activity using biomarkers derived from non-invasive neurophysiological measurements. Methods This is a multisite, single-dose, double-blind, randomized, placebo-controlled, 4-period, 4-way crossover, pharmacodynamic (PD) and pharmacokinetic (PK) study in healthy subjects. Neurophysiological biomarkers of spinal and brainstem activity (the RIII flexion reflex, the N13 component of somatosensory evoked potentials (SEP) and the R2 component of the blink reflex) will be recorded before and at three distinct time points after administration of three medications known to act on the nociceptive system (lacosamide, pregabalin, tapentadol), and placebo, given as a single oral dose in separate study periods. Medication effects on neurophysiological measures will be assessed in a clinically relevant hyperalgesic condition (high-frequency electrical stimulation of the skin), and in a non-sensitized normal condition. Patient-reported outcome measures (pain ratings and predictive psychological traits) will also be collected; and blood samples will be taken for pharmacokinetic modelling. A sequentially rejective multiple testing approach will be used with overall alpha error of the primary analysis split between the two primary endpoints, namely the percentage amplitude changes of the RIII area and N13 amplitude under tapentadol. Remaining treatment arm effects on RIII, N13 and R2 recovery cycle are key secondary confirmatory analyses. Complex statistical analyses and PK-PD modelling are exploratory. Discussion The RIII component of the flexion reflex is a pure nociceptive spinal reflex widely used for investigating pain processing at the spinal level. It is sensitive to different experimental pain models and to the antinociceptive activity of drugs. The N13 is mediated by large myelinated non-nociceptive fibers and reflects segmental postsynaptic response of wide dynamic range dorsal horn neurons at the level of cervical spinal cord, and it could be therefore sensitive to the action of drugs specifically targeting the dorsal horn. The R2 reflex is mediated by large myelinated non-nociceptive fibers, its circuit consists of a polysynaptic chain lying in the reticular formation of the pons and medulla. The recovery cycle of R2 is widely used for assessing brainstem excitability. For these reasons, IMI2-PainCare-BioPain-RCT2 hypothesizes that spinal and brainstem neurophysiological measures can serve as biomarkers of target engagement of analgesic drugs for future Phase 1 clinical trials. Phase 2 and 3 clinical trials could also benefit from these tools for patient stratification. Trial registration This trial was registered on 02 February 2019 in EudraCT (2019-000755-14).
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Affiliation(s)
- Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy.
| | | | | | - Petra Bloms-Funke
- Translational Science & Intelligence, Grünenthal GmbH, Aachen, Germany
| | - Irmgard Boesl
- Clinical Science Development, Grünenthal GmbH, Aachen, Germany
| | - Ombretta Caspani
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sonya C Chapman
- Neuroscience Next Generation Therapeutics, Eli Lilly and Company, Lilly Innovation Center, Cambridge, MA, USA.,Eli Lilly and Company, Arlington Square, Bracknell, UK
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Luis Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - Tom Li
- Teva Pharmaceutical Industries Ltd., Petah Tikva, Israel
| | | | - André Mouraux
- Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium
| | | | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Schilder
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Erik Schnetter
- University Computing Centre, University of Heidelberg, Heidelberg, Germany
| | | | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Inaki F Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Hans Van Niel
- Mature Products Development, Grünenthal GmbH, Aachen, Germany
| | - Jose Miguel Vela Hernandez
- Welab Barcelona, Barcelona, Spain.,Drug Discovery & Preclinical Development, ESTEVE Pharmaceuticals, Barcelona, Spain
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health (NDWRH), University of Oxford, Oxford, UK
| | - Jan Vollert
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.,Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vishvarani Wanigasekera
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Matthias Wittayer
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Keith G Phillips
- Neuroscience Next Generation Therapeutics, Eli Lilly and Company, Lilly Innovation Center, Cambridge, MA, USA.,Eli Lilly and Company, Arlington Square, Bracknell, UK
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Shraim MA, Sluka KA, Sterling M, Arendt-Nielsen L, Argoff C, Bagraith KS, Baron R, Brisby H, Carr DB, Chimenti RL, Courtney CA, Curatolo M, Darnall BD, Ford JJ, Graven-Nielsen T, Kolski MC, Kosek E, Liebano RE, Merkle SL, Parker R, Reis FJJ, Smart K, Smeets RJEM, Svensson P, Thompson BL, Treede RD, Ushida T, Williamson OD, Hodges PW. Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a Delphi expert consensus study. Pain 2022; 163:1812-1828. [PMID: 35319501 PMCID: PMC9294075 DOI: 10.1097/j.pain.0000000000002577] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Classification of musculoskeletal pain based on underlying pain mechanisms (nociceptive, neuropathic, and nociplastic pain) is challenging. In the absence of a gold standard, verification of features that could aid in discrimination between these mechanisms in clinical practice and research depends on expert consensus. This Delphi expert consensus study aimed to: (1) identify features and assessment findings that are unique to a pain mechanism category or shared between no more than 2 categories and (2) develop a ranked list of candidate features that could potentially discriminate between pain mechanisms. A group of international experts were recruited based on their expertise in the field of pain. The Delphi process involved 2 rounds: round 1 assessed expert opinion on features that are unique to a pain mechanism category or shared between 2 (based on a 40% agreement threshold); and round 2 reviewed features that failed to reach consensus, evaluated additional features, and considered wording changes. Forty-nine international experts representing a wide range of disciplines participated. Consensus was reached for 196 of 292 features presented to the panel (clinical examination-134 features, quantitative sensory testing-34, imaging and diagnostic testing-14, and pain-type questionnaires-14). From the 196 features, consensus was reached for 76 features as unique to nociceptive (17), neuropathic (37), or nociplastic (22) pain mechanisms and 120 features as shared between pairs of pain mechanism categories (78 for neuropathic and nociplastic pain). This consensus study generated a list of potential candidate features that are likely to aid in discrimination between types of musculoskeletal pain.
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Affiliation(s)
- Muath A Shraim
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA, United States
| | - Michele Sterling
- The University of Queensland, RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Brisbane, QLD, Australia
| | - Lars Arendt-Nielsen
- Department Medical Gastroenterology Aalborg Hospital, Aalborg University CNAP School of Medicine, Denmark
| | | | - Karl S Bagraith
- Interdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology at Neurozentrum (House D), Kiel, Germany
| | - Helena Brisby
- Department of Orthopaedics, Institution of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel B Carr
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Carol A Courtney
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Michele Curatolo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Jon J Ford
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Bundoora, VIC, Australia
| | - Thomas Graven-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
| | - Melissa C Kolski
- Feinberg School of Medicine, Shirley Ryan AbilityLab, Northwestern University, Chicago, IL, United States
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Richard E Liebano
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Physiotherapeutic Resources Laboratory/Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Shannon L Merkle
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Felipe J J Reis
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Keith Smart
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- CIR Rehabilitation, Eindhoven, the Netherlands
| | - Peter Svensson
- Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Bronwyn L Thompson
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Neurophysiology Mannheim Center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Owen D Williamson
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada
| | - Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD, Australia
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25
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van Niel J, Bloms-Funke P, Caspani O, Cendros JM, Garcia-Larrea L, Truini A, Tracey I, Chapman SC, Marco-Ariño N, Troconiz IF, Phillips K, Finnerup NB, Mouraux A, Treede RD. Pharmacological Probes to Validate Biomarkers for Analgesic Drug Development. Int J Mol Sci 2022; 23:ijms23158295. [PMID: 35955432 PMCID: PMC9368481 DOI: 10.3390/ijms23158295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 12/10/2022] Open
Abstract
There is an urgent need for analgesics with improved efficacy, especially in neuropathic and other chronic pain conditions. Unfortunately, in recent decades, many candidate analgesics have failed in clinical phase II or III trials despite promising preclinical results. Translational assessment tools to verify engagement of pharmacological targets and actions on compartments of the nociceptive system are missing in both rodents and humans. Through the Innovative Medicines Initiative of the European Union and EFPIA, a consortium of researchers from academia and the pharmaceutical industry was established to identify and validate a set of functional biomarkers to assess drug-induced effects on nociceptive processing at peripheral, spinal and supraspinal levels using electrophysiological and functional neuroimaging techniques. Here, we report the results of a systematic literature search for pharmacological probes that allow for validation of these biomarkers. Of 26 candidate substances, only 7 met the inclusion criteria: evidence for nociceptive system modulation, tolerability, availability in oral form for human use and absence of active metabolites. Based on pharmacokinetic characteristics, three were selected for a set of crossover studies in rodents and healthy humans. All currently available probes act on more than one compartment of the nociceptive system. Once validated, biomarkers of nociceptive signal processing, combined with a pharmacometric modelling, will enable a more rational approach to selecting dose ranges and verifying target engagement. Combined with advances in classification of chronic pain conditions, these biomarkers are expected to accelerate analgesic drug development.
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Affiliation(s)
| | - Petra Bloms-Funke
- Translational Science & Intelligence, Grünenthal GmbH, 52099 Aachen, Germany;
| | - Ombretta Caspani
- Mannheim Center for Translational Neurosciences (MCTN), Department of Neurophysiology, University of Heidelberg, 69120 Mannheim, Germany; (O.C.); (R.-D.T.)
| | | | - Luis Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, 69100 Lyon, France;
| | - Andrea Truini
- Department of Human Neuroscience, Sapienzia University, 00185 Rome, Italy;
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK;
| | - Sonya C. Chapman
- Eli Lilly and Company, Arlington Square, Bracknell RG12 1PU, UK;
| | - Nicolás Marco-Ariño
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, 31009 Pamplona, Spain; (N.M.-A.); (I.F.T.)
| | - Iñaki F. Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, 31009 Pamplona, Spain; (N.M.-A.); (I.F.T.)
| | - Keith Phillips
- Eli Lilly and Company, Erl Wood, Bracknell GU20 6PH, UK;
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark;
| | - André Mouraux
- Institute of Neuroscience (IoNS), UCLouvain, B-1200 Brussels, Belgium
- Correspondence:
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neurosciences (MCTN), Department of Neurophysiology, University of Heidelberg, 69120 Mannheim, Germany; (O.C.); (R.-D.T.)
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26
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Jubileum E, Binzen U, Treede RD, Greffrath W. Temporal and spatial summation of laser heat stimuli in cultured nociceptive neurons of the rat. Pflugers Arch 2022; 474:1003-1019. [PMID: 35867188 PMCID: PMC9393153 DOI: 10.1007/s00424-022-02728-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022]
Abstract
We studied the efficacy of a near-infrared laser (1475 nm) to activate rat dorsal root ganglion (DRG) neurons with short punctate radiant heat pulses (55 µm diameter) and investigated temporal and spatial summation properties for the transduction process for noxious heat at a subcellular level. Strength-duration curves (10–80 ms range) indicated a minimum power of 30.2mW for the induction of laser-induced calcium transients and a chronaxia of 13.9 ms. However, threshold energy increased with increasing stimulus duration suggesting substantial radial cooling of the laser spot. Increasing stimulus duration demonstrated suprathreshold intensity coding of calcium transients with less than linear gains (Stevens exponents 0.29/35mW, 0.38/60mW, 0.46/70mW). The competitive TRPV1 antagonist capsazepine blocked responses to short near-threshold stimuli and significantly reduced responses to longer duration suprathreshold heat. Heating 1/3 of the soma of a neuron was sufficient to induce calcium transients significantly above baseline (p < 0.05), but maximum amplitude was only achieved by centering the laser over the entire neuron. Heat-induced calcium increase was highest in heated cell parts but rapidly reached unstimulated areas reminiscent of spreading depolarization and opening of voltage-gated calcium channels. Full intracellular equilibrium took about 3 s, consistent with a diffusion process. In summary, we investigated transduction mechanisms for noxious laser heat pulses in native sensory neurons at milliseconds temporal and subcellular spatial resolution and characterized strength duration properties, intensity coding, and spatial summation within single neurons. Thermal excitation of parts of a nociceptor spread via both membrane depolarization and intracellular calcium diffusion.
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Affiliation(s)
- Elisabeth Jubileum
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, 68167, Mannheim, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Rheinhessen Clinics, Hartmühlenweg 2-4, 55122, Mainz, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Uta Binzen
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, 68167, Mannheim, Germany.,Department of Cardiovascular Physiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, 68167, Mannheim, Germany
| | - Wolfgang Greffrath
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, 68167, Mannheim, Germany.
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27
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Li L, Zou Y, Liu B, Yang R, Yang J, Sun M, Li Z, Xu X, Li G, Liu S, Greffrath W, Treede RD, Li G, Liang S. Correction to "Contribution of the P2X4 Receptor in Rat Hippocampus to the Comorbidity of Chronic Pain and Depression". ACS Chem Neurosci 2022; 13:2348. [PMID: 35839517 DOI: 10.1021/acschemneuro.2c00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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28
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Gierthmühlen J, Böhmer J, Attal N, Bouhassira D, Freynhagen R, Haanpää M, Hansson P, Jensen TS, Kennedy J, Maier C, Rice AS, Sachau J, Segerdahl M, Sindrup S, Tölle T, Treede RD, Ventzel L, Vollert J, Baron R. Association of sensory phenotype with quality of life, functionality, and emotional well-being in patients suffering from neuropathic pain. Pain 2022; 163:1378-1387. [PMID: 34561391 PMCID: PMC9199110 DOI: 10.1097/j.pain.0000000000002501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Neuropathic pain highly affects quality of life, well-being, and function. It has recently been shown based on cluster analysis studies that most patients with neuropathic pain may be categorized into 1 of 3 sensory phenotypes: sensory loss, mechanical hyperalgesia, and thermal hyperalgesia. If these phenotypes reflect underlying pathophysiological mechanisms, they may be more relevant for patient management than underlying neurological diagnosis or pain intensity. The aim of this study was thus to examine the impact of these sensory phenotypes on mental health, functionality, and quality of life. Data of 433 patients from the IMI/EuroPain network database were analyzed, and results of HADS-D/A, Pain Catastrophizing Scale, Euro Quality of Life 5D/-VAS, Brief Pain Inventory, and Graded Chronic Pain Scale between the sensory phenotypes were compared using multiple regression analysis. There was no difference in chronic pain grade, pain intensity, depression, or anxiety scores between phenotypes. Pain interference (Brief Pain Inventory) was higher (P = 0.002); self-reported health state lower (Euro Quality of Life 5D VAS, P = 0.02); and problems regarding mobility (P = 0.008), usual activities (P = 0.004), and self-care (P = 0.039) more prominent (EQ5-D) in the sensory loss compared with the thermal hyperalgesia phenotype. Patients with sensory loss also showed higher pain catastrophizing scores (P = 0.006 and 0.022, respectively) compared with the 2 other groups. Sensory phenotype is associated with the impact of neuropathic pain conditions on well-being, daily functionality, and quality of life but is less associated with pain intensity. These results suggest that the somatosensory phenotype should be considered for personalized pain management.
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Affiliation(s)
- Janne Gierthmühlen
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Johann Böhmer
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Nadine Attal
- Inserm U987, APHP, UVSQ, Paris-Saclay University, CHU Ambroise Pare, Boulogne-Billancourt, France
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, CHU Ambroise Pare, Boulogne-Billancourt, France
| | - Rainer Freynhagen
- Department of Anaesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing, Germany
- Department of Anaesthesiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Maija Haanpää
- Department of Neurosurgery, Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | - Per Hansson
- Department of Pain Management and Research, Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Troels Staehelin Jensen
- Department of Clinical Medicine, Neurological Research and Dansih Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | | | - Christoph Maier
- University Hospital of Pediatrics and Adolescent Medicine, Ruhr-University Bochum, Germany
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Märta Segerdahl
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden and MS Medical Consulting, Stockholm, Sweden
| | - Sören Sindrup
- Department of Neurology, Odense University Hospital OUH, Odense, Denmark
| | - Thomas Tölle
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Rolf-Detlef Treede
- Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Lise Ventzel
- Department of Pain Management and Research, Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Vollert
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
- Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
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29
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Kender Z, Groener JB, Jende JME, Kurz FT, Fleming T, Sulaj A, Schuh-Hofer S, Treede RD, Bendszus M, Szendroedi J, Nawroth PP, Kopf S. Diabetic neuropathy is a generalized phenomenon with impact on hand functional performance and quality of life. Eur J Neurol 2022; 29:3081-3091. [PMID: 35700123 DOI: 10.1111/ene.15446] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/08/2022] [Accepted: 06/05/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Diabetic sensorimotor peripheral neuropathy (DSPN) is usually considered to affect predominantly the lower limbs (LL-N), while the impact of upper limb neuropathy (UL-N) on hand functional performance and quality of life (QoL) has not been evaluated systematically. This study aims to investigate the prevalence and characteristics of UL-N and its functional and psychosocial consequences in type 2 diabetes. METHODS Individuals with type 2 diabetes (n=141) and an age- and sex-matched control group (n=73) underwent comprehensive assessment of neuropathy, hand functional performance and psychosocial status. RESULTS The prevalence of UL-N was 30.5% in patients with diabetes and that of LL-N 49.6%, with 25.5% exhibiting both. Patients with diabetes showed similar sensory phenotype regarding both large and small fiber functions in hands and feet. Patients with UL-N showed reduced manual dexterity, but normal hand grip force. Additionally, there was a correlation between reduced dexterity and sensory deficits. Patients with UL-N had reduced estimates of psychosocial health including health-related QoL compared to control subjects and patients without UL-N. UL-N correlated with the severity of LL-N, but not with duration of diabetes, glycaemia, age, or sex. CONCLUSIONS This study points to a substantial prevalence of UL-N in type 2 diabetes. The sensory phenotype of patients with UL-N was similar to LL-N and was characterized by loss of sensory function. Our study demonstrated an association of UL-N with impaired manual dexterity and reduced health-related QoL. Thus, upper limb sensorimotor functions should be assessed early in patients with diabetes.
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Affiliation(s)
- Zoltan Kender
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Munich-, Neuherberg, Germany
| | - Jan B Groener
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Munich-, Neuherberg, Germany.,Medicover Neuroendokrinologie, Munich, Germany
| | - Johann M E Jende
- University Hospital of Heidelberg, Department of Neuroradiology, Heidelberg, Germany
| | - Felix T Kurz
- University Hospital of Heidelberg, Department of Neuroradiology, Heidelberg, Germany.,German Cancer Research Center, Heidelberg, Germany
| | - Thomas Fleming
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Munich-, Neuherberg, Germany
| | - Alba Sulaj
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Munich-, Neuherberg, Germany
| | - Sigrid Schuh-Hofer
- Department of Neurophysiology, MCTN, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, MCTN, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Bendszus
- University Hospital of Heidelberg, Department of Neuroradiology, Heidelberg, Germany
| | - Julia Szendroedi
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Munich-, Neuherberg, Germany.,Joint Heidelberg-ICD Translational Diabetes Programme, Helmholtz-Zentrum, Munich, Germany
| | - Peter P Nawroth
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Munich-, Neuherberg, Germany.,Joint Heidelberg-ICD Translational Diabetes Programme, Helmholtz-Zentrum, Munich, Germany
| | - Stefan Kopf
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany.,German Center for Diabetes Research (DZD), Munich-, Neuherberg, Germany
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30
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Pan LLH, Wang YF, Ling YH, Lai KL, Chen SP, Chen WT, Treede RD, Wang SJ. Pain sensitivities predict prophylactic treatment outcomes of flunarizine in chronic migraine patients: A prospective study. Cephalalgia 2022; 42:899-909. [PMID: 35400174 DOI: 10.1177/03331024221080572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to assess the differences in quantitative sensory testing between chronic migraine and healthy controls and to explore the association between pain sensitivities and outcomes in chronic migraine following preventive treatment. METHODS In this prospective open-label study, preventive-naïve chronic migraine and healthy controls were recruited, and cold, heat, mechanical punctate, and pressure pain thresholds over the dermatomes of first branch of trigeminal nerve and first thoracic nerve were measured by quantitative sensory testing at baseline. Chronic migraines were treated with flunarizine and treatment response was defined as ≥50% reduction in the number of monthly headache days over the 12-week treatment period. RESULTS Eighty-four chronic migraines and fifty age-and-sex-matched healthy controls were included in the analysis. The chronic migraine had higher cold pain thresholds over the dermatomes of the first branch of trigeminal nerve and the first thoracic nerve (p < 0.001 and < 0.001), lower pressure pain thresholds over the dermatomes of the first thoracic nerve (p = 0.003), heat pain thresholds over the dermatomes of the first branch of the trigeminal nerve and the first thoracic nerve (p < 0.001 and p = 0.015) than healthy controls. After treatment, 24/84 chronic migraine had treatment response. The responders with relatively normal pain sensitivity had higher heat pain thresholds over the dermatome of the first branch of the trigeminal nerve (p = 0.002), mechanical punctate pain thresholds over the dermatomes of the first branch of the trigeminal nerve (p = 0.023), and pressure pain thresholds over the dermatomes of the first branch of the trigeminal nerve (p = 0.026) than the hypersensitive non-responders. Decision tree analysis showed that patients with mechanical punctate pain threshold over the dermatomes of the first branch of the trigeminal nerve > 158 g (p = 0.020) or heat pain threshold over the dermatome of the first branch of the trigeminal nerve > 44.9°C (p = 0.002) were more likely to be responders. CONCLUSIONS Chronic migraine were generally more sensitive compared to healthy controls. Preventive treatment with flunarizine should be recommended particularly for chronic migraine who have relatively normal sensitivity to mechanical punctate or heat pain.Trial registration: This study was registered on ClinicalTrials.gov (Identifier: NCT02747940).
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Affiliation(s)
- Li-Ling Hope Pan
- Brain Research Center, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hsiang Ling
- College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Lin Lai
- College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Pin Chen
- Brain Research Center, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ta Chen
- Brain Research Center, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, 38004Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Rolf-Detlef Treede
- Chair of Neurophysiology, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Shuu-Jiun Wang
- Brain Research Center, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,College of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei, Taiwan
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Dusch M, Mayer M, Treede RD, Fischer MR, Berndt M. [Project report on fostering scientific competencies in pain medicine in the context of student education]. Schmerz 2022; 36:398-405. [PMID: 35244773 DOI: 10.1007/s00482-022-00628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/25/2022]
Abstract
AIM The training of scientific skills and competencies is an essential part of academic medical studies. As part of the MaReCuM model study program at Heidelberg University's Mannheim Medical School, a fifth-year rotation on scientific skills in the field of pain medicine was implemented. This paper describes this competence-oriented rotation as well as the investigation of the educational effect. METHOD A total of 114 fifth-year medical students participated in the survey (response rate: 83%). The control group completed the fifth year prior to the implementation of the rotation. The experimental group was required to participate in the rotation and the real healthcare research study "Case management program: low back pain". A survey of both groups was conducted on the first day of the rotation and at the end of the module. RESULTS The innovative and competency-based learning unit was successfully implemented as part of the MaReCuM model study program and carried out with partners in general practice as well as the Mannheim Institute of Public Health. The participating students accepted the rotation well. There was no measurable effect on the subjective learning success of the rotation in the evaluation. DISCUSSION To the authors' knowledge, this educational approach has never been tested before in a German study program. The presented rotation offers an additional option for the training of scientific competencies as part of medical studies. The missing of a measurable effect could be due to the extensive experience of the medical students as well as the limitations on participation in a real healthcare study. An additional learning opportunity could be created by connecting the preexisting lectures to a longitudinal module on scholarly competencies. The implementation of the program also offers a unique opportunity for educational research on the acquisition of scientific competencies in medical students.
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Affiliation(s)
- Martin Dusch
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Manfred Mayer
- Mannheim Institute of Public Health, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
| | - Rolf-Detlef Treede
- Centrum für Biomedizin und Medizintechnik Mannheim, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
| | - Martin R Fischer
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München, LMU München, München, Deutschland
| | - Markus Berndt
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München, LMU München, München, Deutschland
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Korwisi B, Garrido Suárez BB, Goswami S, Gunapati NR, Hay G, Hernández Arteaga MA, Hill C, Jones D, Joshi M, Kleinstäuber M, López Mantecón AM, Nandi G, Papagari CSR, Rabí Martínez MDC, Sarkar B, Swain N, Templer P, Tulp M, White N, Treede RD, Rief W, Barke A. Reliability and clinical utility of the chronic pain classification in the 11th Revision of the International Classification of Diseases from a global perspective: results from India, Cuba, and New Zealand. Pain 2022; 163:e453-e462. [PMID: 34393200 DOI: 10.1097/j.pain.0000000000002379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic pain affects 1 in 5 persons and contributes substantially to the global burden of disease. The 11th Revision of the International Classification of Diseases (ICD-11) includes a comprehensive classification of chronic pain. The aim of this ecological implementation field study was to evaluate the classification's interrater reliability and clinical utility in countries with different income levels. The study was conducted in 4 pain clinics in Cuba, India, and New Zealand. Twenty-one clinicians used the ICD-11 to diagnose and code n = 353 patients with chronic pain. Of these, 111 were assessed by 2 clinicians, and Fleiss' kappa was calculated to establish interrater reliability for any diagnosis assigned to ≥15 patients. The clinicians rated the clinical utility of all diagnoses. The interrater reliability could be calculated for 11 diagnoses. It was substantial for 10 diagnoses and moderate for 1 (kappa: 0.596-0.783). The mean clinical utility of the ICD-11 chronic pain diagnoses was rated as 8.45 ± 1.69/10. Clinical utility was rated higher for ICD-11 than for the commonly used classification systems (P < 0.001, η2 = 0.25) and differed between all centers (P < 0.001, η2 = 0.60). The utility of the ICD-11 diagnoses was rated higher than the commonly used diagnoses in Dunedin and Havana, and no difference was found in Kolkata and Hyderabad. The study showed the high interrater reliability of the new chronic pain diagnoses. The perceived clinical utility of the diagnoses indicates their superiority or equality compared with the classification systems currently used in pain clinics. These results suggest the global applicability of the classification in specialized pain treatment settings.
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Affiliation(s)
- Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Bárbara Beatriz Garrido Suárez
- Department of Pharmacology, Institute of Marine Science (ICIMAR), Havana, Cuba
- Pain Clinic, Hospital 10 de Octubre, Havana, Cuba
| | - Subrata Goswami
- ESI Institute of Pain Management, ESI Hospital Sealdah, Kolkata, India
| | | | - Ginea Hay
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | | | - Charlotte Hill
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - David Jones
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | | | - Maria Kleinstäuber
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
- Department of Psychological Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Ana Marta López Mantecón
- Pain Clinic, Hospital 10 de Octubre, Havana, Cuba
- Rheumatological Disease Reference Centre, Hospital 10 de Octubre, Havana, Cuba
| | - Gargi Nandi
- ESI Institute of Pain Management, ESI Hospital Sealdah, Kolkata, India
| | | | | | - Biplab Sarkar
- ESI Institute of Pain Management, ESI Hospital Sealdah, Kolkata, India
| | - Nicola Swain
- Department of Psychological Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Paul Templer
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Maartje Tulp
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Naomi White
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience (MCTN), Department of Neurophysiology, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Division of Clinical and Biological Psychology, Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Ingolstadt, Germany
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Nochi Z, Pia H, Bloms-Funke P, Boesl I, Caspani O, Chapman SC, Fardo F, Genser B, Goetz M, Kostenko AV, Leone C, Li T, Mouraux A, Pelz B, Pogatzki-Zahn E, Schilder A, Schnetter E, Schubart K, Stouffs A, Tracey I, Troconiz IF, Truini A, Van Niel J, Vela JM, Vincent K, Vollert J, Wanigasekera V, Wittayer M, Tankisi H, Finnerup NB, Phillips KG, Treede RD. IMI2-PainCare-BioPain-RCT1: study protocol for a randomized, double-blind, placebo-controlled, crossover, multi-center trial in healthy subjects to investigate the effects of lacosamide, pregabalin, and tapentadol on biomarkers of pain processing observed by peripheral nerve excitability testing (NET). Trials 2022; 23:163. [PMID: 35183242 PMCID: PMC8857873 DOI: 10.1186/s13063-022-06087-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/05/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Few new drugs have been developed for chronic pain. Drug development is challenged by uncertainty about whether the drug engages the human target sufficiently to have a meaningful pharmacodynamic effect. IMI2-PainCare-BioPain-RCT1 is one of four similarly designed studies that aim to link different functional biomarkers of drug effects on the nociceptive system that could serve to accelerate the future development of analgesics. This study focusses on biomarkers derived from nerve excitability testing (NET) using threshold tracking of the peripheral nervous system.
Methods
This is a multisite single-dose, subject and assessor-blind, randomized, placebo-controlled, 4-period, 4-way crossover, pharmacodynamic (PD), and pharmacokinetic (PK) study in healthy subjects. Biomarkers derived from NET of large sensory and motor fibers and small sensory fibers using perception threshold tracking will be obtained before and three times after administration of three medications known to act on the nociceptive system (lacosamide, pregabalin, tapentadol) and placebo, given as a single oral dose with at least 1 week apart. Motor and sensory NET will be assessed on the right wrist in a non-sensitized normal condition while perception threshold tracking will be performed bilaterally on both non-sensitized and sensitized forearm skin. Cutaneous high-frequency electrical stimulation is used to induce hyperalgesia. Blood samples will be taken for pharmacokinetic purposes and pain ratings as well as predictive psychological traits will be collected. A sequentially rejective multiple testing approach will be used with overall alpha error of the primary analysis split across the two primary outcomes: strength-duration time constant (SDTC; a measure of passive membrane properties and nodal persistent Na+ conductance) of large sensory fibers and SDTC of large motor fibers comparing lacosamide and placebo. The key secondary endpoint is the SDTC measured in small sensory fibers. Remaining treatment arm effects on key NET outcomes and PK modelling are other prespecified secondary or exploratory analyses.
Discussion
Measurements of NET using threshold tracking protocols are sensitive to membrane potential at the site of stimulation. Sets of useful indices of axonal excitability collectively may provide insights into the mechanisms responsible for membrane polarization, ion channel function, and activity of ionic pumps during the process of impulse conduction. IMI2-PainCare-BioPain-RCT1 hypothesizes that NET can serve as biomarkers of target engagement of analgesic drugs in this compartment of the nociceptive system for future Phase 1 clinical trials. Phase 2 and 3 clinical trials could also benefit from these tools for patient stratification.
Trial registration
This trial was registered 25/06/2019 in EudraCT (2019-000942-36).
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Barke A, Korwisi B, Jakob R, Konstanjsek N, Rief W, Treede RD. Classification of chronic pain for the International Classification of Diseases (ICD-11): results of the 2017 international World Health Organization field testing. Pain 2022; 163:e310-e318. [PMID: 33863861 PMCID: PMC8756346 DOI: 10.1097/j.pain.0000000000002287] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/20/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Because chronic pain has been poorly represented in the International Statistical Classification of Diseases and Related Health Problems (ICD) despite its significant contribution to the burden of disease worldwide, the International Association for the Study of Pain (IASP) developed a classification of chronic pain that was included in the ICD-11 version as "MG30" and approved by the World Health Assembly in 2019. The objective of this field test was to determine how well the classification of chronic pain works in the context of the ICD-11. A web-based survey using the WHO-FiT platform recruited 177 healthcare professionals from all WHO regions. After a training on coding chronic pain hosted by the IASP Web site, participants evaluated 18 diagnostic codes (lines) of the 2017 frozen version of the ICD-11 and 12 vignettes (cases) describing chronic pain conditions. Correctness, ambiguity, and perceived difficulty of the coding were compared between the ICD-11 and the ICD-10 and the applicability of the morbidity rules for the ICD-11 verified. In the line coding, 43.0% of correct chronic pain diagnoses assigned with the ICD-10 contrasted with 63.2% with the ICD-11. Especially in cases in which the chronic pain is regarded as the symptom of an underlying disease, the ICD-11 (63.5%) commanded more correct diagnoses than the ICD-10 (26.8%). The case coding was on average 83.9% accurate, only in 1.6% of cases any difficulty was perceived. The morbidity rules were applied correctly in 74.1% of cases. From a coding perspective, the ICD-11 is superior to the ICD-10 in every respect, offering better accuracy, difficulty, and ambiguity in coding chronic pain conditions.
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Affiliation(s)
- Antonia Barke
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstätt, Germany
| | - Beatrice Korwisi
- Division of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Robert Jakob
- Department of Classification and Terminologies, World Health Organization, Geneva, Switzerland
| | - Nenad Konstanjsek
- Department of Classification and Terminologies, World Health Organization, Geneva, Switzerland
| | - Winfried Rief
- Division of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
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Pan LLH, Treede RD, Wang SJ. Mechanical Punctate Pain Thresholds in Patients With Migraine Across Different Migraine Phases: A Narrative Review. Front Neurol 2022; 12:801437. [PMID: 35153981 PMCID: PMC8831741 DOI: 10.3389/fneur.2021.801437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose of the Review We reviewed the studies of mechanical punctate pain thresholds (MPTs) in patients with migraine and summarized their findings focusing on the differences in MPT measurement and MPTs in different phases of migraine. Methods We searched the English-written articles that investigate the MPTs in the migraine population published in peer-reviewed journals with full-text using the PubMed, Web of Science, and Google Scholar databases. Moreover, we manually searched the references from the articles for possibly related studies. Main Findings We collected 276 articles and finally included twelve studies in this review. Most of the studies that included MPTs were measured with traditional von Frey filaments. The cephalic areas were always included in the assessment. Most studies compared the inter-ictal MPT in patients with migraine to controls. Among them, the majority found no significant differences; however, there were studies found either higher or lower levels of MPTs in migraine. Even though the studies provided the criteria to define the inter-ictal phase, not all of them followed up with the subjects regarding the next migraine attack. In studies that compared MPT between phases, lower MPTs were found during peri-ictal phases. Summary Changes to MPT in migraine patients were inconclusive. The selection of measurement methods as well as properly defined migraine phases should be considered for future studies.
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Affiliation(s)
- Li-Ling Hope Pan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Rolf-Detlef Treede
- Chair of Neurophysiology, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- *Correspondence: Shuu-Jiun Wang
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36
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Verdugo RJ, Matamala JM, Inui K, Kakigi R, Valls-Solé J, Hansson P, Bernhard Nilsen K, Lombardi R, Lauria G, Petropoulos IN, Malik RA, Treede RD, Baumgärtner U, Jara PA, Campero M. Review of techniques useful for the assessment of sensory small fiber neuropathies: Report from an IFCN expert group. Clin Neurophysiol 2022; 136:13-38. [DOI: 10.1016/j.clinph.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/09/2023]
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Pogatzki-Zahn EM, Liedgens H, Hummelshoj L, Meissner W, Weinmann C, Treede RD, Vincent K, Zahn P, Kaiser U. Developing consensus on core outcome domains for assessing effectiveness in perioperative pain management: results of the PROMPT/IMI-PainCare Delphi Meeting. Pain 2021; 162:2717-2736. [PMID: 34181367 DOI: 10.1097/j.pain.0000000000002254] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Postoperative pain management is still insufficient, leading to major deficits, including patient suffering, impaired surgical recovery, long-term opioid intake, and postsurgical chronic pain. Yet, identifying the best treatment options refers to a heterogeneous outcome assessment in clinical trials, not always reflecting relevant pain-related aspects after surgery and therefore hamper evidence synthesis. Establishing a core outcome set for perioperative pain management of acute pain after surgery may overcome such limitations. An international, stepwise consensus process on outcome domains ("what to measure") for pain management after surgery, eg, after total knee arthroplasty, sternotomy, breast surgery, and surgery related to endometriosis, was performed. The process, guided by a steering committee, involved 9 international stakeholder groups and patient representatives. The face-to-face meeting was prepared by systematic literature searches identifying common outcome domains for each of the 4 surgical procedures and included breakout group sessions, world-café formats, plenary panel discussions, and final voting. The panel finally suggested an overall core outcome set for perioperative pain management with 5 core outcome domains: physical function (for a condition-specific measurement), pain intensity at rest, pain intensity during activity, adverse events, and self-efficacy. Innovative aspects of this work were inclusion of the psychological domain self-efficacy, as well as the specific assessment of pain intensity during activity and physical function recommended to be assessed in a condition-specific manner. The IMI-PROMPT core outcome set seeks to improve assessing efficacy and effectiveness of perioperative pain management in any clinical and observational studies as well as in clinical practice.
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Affiliation(s)
- Esther M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | | | - Lone Hummelshoj
- Endometriosis.org, United Kingdom; World Endometriosis Society, Vancover, Canada; World Endometriosis Research Foundation, London, United Kingdom
| | - Winfried Meissner
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Claudia Weinmann
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Rolf-Detlef Treede
- Neurophysiology, Medical Faculty Mannheim, University Heidelberg, Heidelberg, Germany
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Peter Zahn
- Department of Anaesthesiology and Intensive Care Medicine, Palliative Care Medicine and Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ulrike Kaiser
- Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
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Leone C, Di Lionardo A, Di Pietro G, Di Stefano G, Falco P, Blockeel AJ, Caspani O, Garcia-Larrea L, Mouraux A, Phillips KG, Treede RD, Truini A. How different experimental models of secondary hyperalgesia change the nociceptive flexion reflex. Clin Neurophysiol 2021; 132:2989-2995. [PMID: 34715423 DOI: 10.1016/j.clinph.2021.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/05/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In this neurophysiological study in healthy humans, we assessed how central sensitization induced by either high-frequency stimulation (HFS) or topical capsaicin application modulates features of the RIII reflex response. The ability of these stimuli to engage the endogenous pain modulatory system was also tested. METHODS In 26 healthy participants we elicited an RIII reflex using suprathreshold stimulation of the sural nerve. Subsequently HFS or capsaicin were applied to the foot and the RIII reflex repeated after 15 minutes. Contact heating of the volar forearm served as the heterotopic test stimulus to probe activation of the endogenous pain modulatory system. RESULTS HFS significantly reduced the pain threshold by 29% and the RIII reflex threshold by 20%. Capsaicin significantly reduced the pain threshold by 17% and the RIII reflex threshold by 18%. Both HFS and capsaicin left RIII reflex size unaffected. Numerical Rating Scale (NRS) pain scores elicited by the heterotopic noxious heat stimulus were unaffected by capsaicin and slightly increased by HFS. CONCLUSIONS HFS and capsaicin similarly modulated the pain threshold and RIII reflex threshold, without a concomitant inhibitory effect of the endogenous pain modulatory system. SIGNIFICANCE Our neurophysiological study supports the use of the RIII reflex in investigating central sensitization in humans.
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Affiliation(s)
- C Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - A Di Lionardo
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - G Di Pietro
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - G Di Stefano
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - P Falco
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - A J Blockeel
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - O Caspani
- Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - L Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Pain Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - A Mouraux
- Université Catholique de Louvain, Institute of Neuroscience (IoNS), Faculty of Medicine, Bruxelles, Belgium
| | - K G Phillips
- Lilly United Kingdom Erl Wood Manor Windlesham, Surrey, United Kingdom
| | - R D Treede
- Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - A Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy.
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Pietro GD, Stefano GD, Leone C, Lionardo AD, Sgrò E, Blockeel AJ, Caspani O, Garcia-Larrea L, Mouraux A, Phillips KG, Treede RD, Valeriani M, Truini A. The N13 spinal component of somatosensory evoked potentials is modulated by heterotopic noxious conditioning stimulation suggesting an involvement of spinal wide dynamic range neurons. Neurophysiol Clin 2021; 51:517-523. [PMID: 34756635 DOI: 10.1016/j.neucli.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Although somatosensory evoked potentials (SEPs) after median nerve stimulation are widely used in clinical practice, the dorsal horn generator of the N13 SEP spinal component is not clearly understood. To verify whether wide dynamic range neurons in the dorsal horn of the spinal cord are involved in the generation of the N13 SEP, we tested the effect of heterotopic noxious conditioning stimulation, which modulates wide dynamic range neurons, on N13 SEP in healthy humans. METHODS In 12 healthy subjects, we performed the cold pressor test on the left foot as a heterotopic noxious conditioning stimulus to modulate wide dynamic range neurons. To verify the effectiveness of heterotopic noxious conditioning stimulation, we tested the pressure pain threshold at the thenar muscles of the right hand and recorded SEPs after right median nerve stimulation before, during and after the cold pressor test. RESULTS The cold pressor test increased pressure pain threshold by 15% (p = 0.04). During the cold pressor test, the amplitude of the N13 component was significantly lower than that recorded at baseline (by 25%, p = 0.04). DISCUSSION In this neurophysiological study in healthy humans, we showed that a heterotopic noxious conditioning stimulus significantly reduced N13 SEP amplitude. This finding suggests that the N13 SEP might be generated by the segmental postsynaptic response of dorsal horn wide dynamic range neurons.
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Affiliation(s)
| | | | - Caterina Leone
- Department of Human Neuroscience, University Sapienza, Rome, Italy
| | | | - Emanuele Sgrò
- Department of Human Neuroscience, University Sapienza, Rome, Italy
| | - Anthony James Blockeel
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Ombretta Caspani
- Department of Neurophysiology, Mannheim Center for translational Neuroscience (MCTN), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Luis Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Pain Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - André Mouraux
- Université Catholique de Louvain, Institute of Neuroscience (IoNS), Faculty of Medicine, Bruxelles, Belgium
| | - Keith Geoffrey Phillips
- Neuroscience Next Generation Therapeutics, Eli Lilly and Company, Lilly Innovation Center, Cambridge, MA 02142, USA
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for translational Neuroscience (MCTN), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Massimiliano Valeriani
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy; Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Andrea Truini
- Department of Human Neuroscience, University Sapienza, Rome, Italy.
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Di Lionardo A, Di Stefano G, Leone C, Di Pietro G, Sgro E, Malara E, Cosentino C, Mollica C, Blockeel AJ, Caspani O, Garcia-Larrea L, Mouraux A, Treede RD, Phillips KG, Valeriani M, Truini A. Modulation of the N13 component of the somatosensory evoked potentials in an experimental model of central sensitization in humans. Sci Rep 2021; 11:20838. [PMID: 34675309 PMCID: PMC8531029 DOI: 10.1038/s41598-021-00313-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/01/2021] [Indexed: 11/09/2022] Open
Abstract
The N13 component of somatosensory evoked potential (N13 SEP) represents the segmental response of dorsal horn neurons. In this neurophysiological study, we aimed to verify whether N13 SEP might reflect excitability changes of dorsal horn neurons during central sensitization. In 22 healthy participants, we investigated how central sensitization induced by application of topical capsaicin to the ulnar nerve territory of the hand dorsum modulated N13 SEP elicited by ulnar nerve stimulation. Using a double-blind placebo-controlled crossover design, we also tested whether pregabalin, an analgesic drug with proven efficacy on the dorsal horn, influenced capsaicin-induced N13 SEP modulation. Topical application of capsaicin produced an area of secondary mechanical hyperalgesia, a sign of central sensitization, and increased the N13 SEP amplitude but not the peripheral N9 nor the cortical N20-P25 amplitude. This increase in N13 SEP amplitude paralleled the mechanical hyperalgesia and persisted for 120 min. Pregabalin prevented the N13 SEP modulation associated with capsaicin-induced central sensitization, whereas capsaicin application still increased N13 SEP amplitude in the placebo treatment session. Our neurophysiological study showed that capsaicin application specifically modulates N13 SEP and that this modulation is prevented by pregabalin, thus suggesting that N13 SEP may reflect changes in dorsal horn excitability and represent a useful biomarker of central sensitization in human studies.
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Affiliation(s)
- A Di Lionardo
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy
| | - G Di Stefano
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy
| | - C Leone
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy
| | - G Di Pietro
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy
| | - E Sgro
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy
| | - E Malara
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy
| | - C Cosentino
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy
| | - C Mollica
- Department of Statistical Sciences, Sapienza University, Rome, Italy
| | - A J Blockeel
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - O Caspani
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - L Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.,Pain Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - A Mouraux
- UCLouvain, Institute of Neuroscience (IoNS), Brussels, Belgium
| | - R D Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - K G Phillips
- Neuroscience Next Generation Therapeutics, Eli Lilly and Company, Lilly Innovation Center, Cambridge, MA, 02142, USA
| | - M Valeriani
- Department of Neuroscience, Headache Center, Bambino Gesù Children's Hospital, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Andrea Truini
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy.
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Nunez-Badinez P, De Leo B, Laux-Biehlmann A, Hoffmann A, Zollner TM, Saunders PT, Simitsidellis I, Charrua A, Cruz F, Gomez R, Tejada MA, McMahon SB, Lo Re L, Barthas F, Vincent K, Birch J, Meijlink J, Hummelshoj L, Sweeney PJ, Armstrong JD, Treede RD, Nagel J. Preclinical models of endometriosis and interstitial cystitis/bladder pain syndrome: an Innovative Medicines Initiative-PainCare initiative to improve their value for translational research in pelvic pain. Pain 2021; 162:2349-2365. [PMID: 34448751 PMCID: PMC8374713 DOI: 10.1097/j.pain.0000000000002248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/19/2023]
Abstract
ABSTRACT Endometriosis (ENDO) and interstitial cystitis/bladder pain syndrome (IC/BPS) are chronic pain conditions for which better treatments are urgently needed. Development of new therapies with proven clinical benefit has been slow. We have conducted a review of existing preclinical in vivo models for ENDO and IC/BPS in rodents, discussed to what extent they replicate the phenotype and pain experience of patients, as well as their relevance for translational research. In 1009 publications detailing ENDO models, 41% used autologous, 26% syngeneic, 18% xenograft, and 11% allogeneic tissue in transplantation models. Intraperitoneal injection of endometrial tissue was the subcategory with the highest construct validity score for translational research. From 1055 IC/BPS publications, most interventions were bladder centric (85%), followed by complex mechanisms (8%) and stress-induced models (7%). Within these categories, the most frequently used models were instillation of irritants (92%), autoimmune (43%), and water avoidance stress (39%), respectively. Notably, although pelvic pain is a hallmark of both conditions and a key endpoint for development of novel therapies, only a small proportion of the studies (models of ENDO: 0.5%-12% and models of IC/BPS: 20%-44%) examined endpoints associated with pain. Moreover, only 2% and 3% of publications using models of ENDO and IC/BPS investigated nonevoked pain endpoints. This analysis highlights the wide variety of models used, limiting reproducibility and translation of results. We recommend refining models so that they better reflect clinical reality, sharing protocols, and using standardized endpoints to improve reproducibility. We are addressing this in our project Innovative Medicines Initiative-PainCare/Translational Research in Pelvic Pain.
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Affiliation(s)
| | - Bianca De Leo
- Bayer AG, Research & Development, Pharmaceuticals, Berlin, Germany
| | | | - Anja Hoffmann
- Bayer AG, Research & Development, Pharmaceuticals, Berlin, Germany
| | | | - Philippa T.K. Saunders
- Centre for Inflammation Research, The University of Edinburgh, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Ioannis Simitsidellis
- Centre for Inflammation Research, The University of Edinburgh, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Ana Charrua
- I3S—Instituto de Investigação e Inovação em Saúde, and Faculty of Medicine of Porto, Porto, Portugal
| | - Francisco Cruz
- I3S—Instituto de Investigação e Inovação em Saúde, and Faculty of Medicine of Porto, Porto, Portugal
| | - Raul Gomez
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | - Stephen B. McMahon
- Neurorestoration Group, Wolfson Centre for Age Related Diseases, King's College London, London, United Kingdom
| | - Laure Lo Re
- Neurorestoration Group, Wolfson Centre for Age Related Diseases, King's College London, London, United Kingdom
| | | | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Judy Birch
- Pelvic Pain Support Network, Poole, United Kingdom
| | - Jane Meijlink
- International Painful Bladder Foundation, Naarden, the Netherlands
| | | | | | - J. Douglas Armstrong
- Actual Analytics, Edinburgh, United Kingdom
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jens Nagel
- Bayer AG, Research & Development, Pharmaceuticals, Berlin, Germany
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42
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Korwisi B, Barke A, Treede RD. Evidence- and consensus-based adaption of the IASP complex regional pain syndrome diagnostic criteria to the ICD-11 category of chronic primary pain: a successful cooperation of the IASP with the World Health Organization. Pain 2021; 162:2313-2314. [PMID: 34448750 DOI: 10.1097/j.pain.0000000000002246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Division of Clinical and Biological Psychology, Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Ingolstadt, Germany
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience (MCTN), Department of Neurophysiology, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
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43
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Enax-Krumova EK, Baron R, Treede RD, Vollert J. Contralateral sensitisation is not specific for complex regional pain syndrome. Comment on Br J Anaesth 2021; 127: e1-3. Br J Anaesth 2021; 127:e173-e176. [PMID: 34419241 DOI: 10.1016/j.bja.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/05/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elena K Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany.
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Jan Vollert
- Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Department of Neurophysiology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany; Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Korwisi B, Hay G, Attal N, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Giamberardino MA, Kaasa S, Kosek E, Lavand'homme P, Nicholas M, Perrot S, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang SJ, Treede RD, Rief W, Barke A. Classification algorithm for the International Classification of Diseases-11 chronic pain classification: development and results from a preliminary pilot evaluation. Pain 2021; 162:2087-2096. [PMID: 33492033 DOI: 10.1097/j.pain.0000000000002208] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/11/2020] [Indexed: 01/04/2023]
Abstract
ABSTRACT The International Classification of Diseases-11 (ICD-11) chronic pain classification includes about 100 chronic pain diagnoses on different diagnostic levels. Each of these diagnoses requires specific operationalized diagnostic criteria to be present. The classification comprises more than 200 diagnostic criteria. The aim of the Classification Algorithm for Chronic Pain in ICD-11 (CAL-CP) is to facilitate the use of the classification by guiding users through these diagnostic criteria. The diagnostic criteria were ordered hierarchically and visualized in accordance with the standards defined by the Society for Medical Decision Making Committee on Standardization of Clinical Algorithms. The resulting linear decision tree underwent several rounds of iterative checks and feedback by its developers, as well as other pain experts. A preliminary pilot evaluation was conducted in the context of an ecological implementation field study of the classification itself. The resulting algorithm consists of a linear decision tree, an introduction form, and an appendix. The initial decision trunk can be used as a standalone algorithm in primary care. Each diagnostic criterion is represented in a decision box. The user needs to decide for each criterion whether it is present or not, and then follow the respective yes or no arrows to arrive at the corresponding ICD-11 diagnosis. The results of the pilot evaluation showed good clinical utility of the algorithm. The CAL-CP can contribute to reliable diagnoses by structuring a way through the classification and by increasing adherence to the criteria. Future studies need to evaluate its utility further and analyze its impact on the accuracy of the assigned diagnoses.
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Affiliation(s)
- Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Ginea Hay
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Nadine Attal
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Michael I Bennett
- Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom
| | - Rafael Benoliel
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, Newark, NJ, United States
| | - Milton Cohen
- St Vincent's Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Stefan Evers
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
- Department of Medicine, University of Münster, Münster, Germany
| | - Maria Adele Giamberardino
- Department of Medicine and Science of Aging, CAST, G D'Annunzio University of Chieti, Chieti, Italy
- European Palliative Care Research Centre (PRC),Department of Cancer Treatment, University Hospital Oslo, Oslo, Norway
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Cancer Research and Molecular Medicine, Department of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Clinical Neuroscience, Karolinska Institute, and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Kosek
- Department of Surgical Sciences Uppsala University, Uppsala, Sweden
- Department of Anesthesiology, Acute Postoperative Pain Service, Saint Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Patricia Lavand'homme
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, Australia
| | - Michael Nicholas
- Pain Clinic, Cochin Hospital, Paris University, INSERM U987, Paris, France
| | - Serge Perrot
- Department of Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Perth, Australia
| | - Stephan Schug
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Blair H Smith
- Department of Dentistry and Oral Health, Section of Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark
| | - Peter Svensson
- Research Group Health Psychology, Department of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Johan W S Vlaeyen
- TRACE, Center for Translational Health Research, KU Leuven, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
- The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Brain Research Center and School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Rolf-Detlef Treede
- Division of Clinical and Biological Psychology, Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
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Zinboonyahgoon N, Luansritisakul C, Eiamtanasate S, Duangburong S, Sanansilp V, Korwisi B, Barke A, Rief W, Treede RD. Comparing the ICD-11 chronic pain classification with ICD-10: how can the new coding system make chronic pain visible? A study in a tertiary care pain clinic setting. Pain 2021; 162:1995-2001. [PMID: 33449507 DOI: 10.1097/j.pain.0000000000002196] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pain is a frequent reason for patients to ask for medical services. However, systematic information about the extent and impact of pain, especially in developing countries, has not been available up to now. We evaluated whether the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD) can fill this gap by coding all electronic out-patient medical records of the pain clinic at Siriraj Hospital in Thailand in 2019 (8714 visits), using the ICD-10 and ICD-11 browsers referenced on the WHO websites. The 3 most frequent pain-related codes in ICD-10 were R52.2 "other chronic pain" (29%), M54.5 "low back pain" (18%), and M79.6 "pain in limb" (13%). In ICD-11, the 3 most frequent codes were MG30.31 "chronic secondary musculoskeletal pain associated with structural changes" (28%), MG30.51 "chronic peripheral neuropathic pain" (26%), and MG30.10 "chronic cancer pain" (23%). Thus, using the currently valid ICD-10 system, roughly one-third of patient encounters were coded as "other chronic pain," and the next 2 were specifying the pain region rather than any underlying cause. By contrast, ICD-11 coding of the same patients identified underlying causes (bones and joints, somatosensory nervous system, cancer, or surgery), which provide guidance towards differential patient management. In our pain clinic, most patients suffered from chronic cancer pain, chronic neuropathic pain, and chronic secondary musculoskeletal pain, which were poorly defined or nonexistent in the current ICD-10 coding system. Compared with the ICD-10, the ICD-11 provides more detailed diagnostic categories and is more informative for clinical use, research, and resource allocation for pain-related conditions.
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Affiliation(s)
- Nantthasorn Zinboonyahgoon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Siriraj, Bangkok, Thailand
| | - Choopong Luansritisakul
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Siriraj, Bangkok, Thailand
| | - Sarasate Eiamtanasate
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Siriraj, Bangkok, Thailand
| | - Sirikan Duangburong
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Siriraj, Bangkok, Thailand
| | - Virachat Sanansilp
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Siriraj, Bangkok, Thailand
| | - Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Clinical and Biological Psychology, Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
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Mouraux A, Bloms-Funke P, Boesl I, Caspani O, Chapman SC, Di Stefano G, Finnerup NB, Garcia-Larrea L, Goetz M, Kostenko A, Pelz B, Pogatzki-Zahn E, Schubart K, Stouffs A, Truini A, Tracey I, Troconiz IF, Van Niel J, Vela JM, Vincent K, Vollert J, Wanigasekera V, Wittayer M, Phillips KG, Treede RD. IMI2-PainCare-BioPain-RCT3: a randomized, double-blind, placebo-controlled, crossover, multi-center trial in healthy subjects to investigate the effects of lacosamide, pregabalin, and tapentadol on biomarkers of pain processing observed by electroencephalography (EEG). Trials 2021; 22:404. [PMID: 34140041 PMCID: PMC8212499 DOI: 10.1186/s13063-021-05272-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background IMI2-PainCare-BioPain-RCT3 is one of four similarly designed clinical studies aiming at profiling a set of functional biomarkers of drug effects on the nociceptive system that could serve to accelerate the future development of analgesics, by providing a quantitative understanding between drug exposure and effects of the drug on nociceptive signal processing in human volunteers. IMI2-PainCare-BioPain-RCT3 will focus on biomarkers derived from non-invasive electroencephalographic (EEG) measures of brain activity. Methods This is a multisite single-dose, double-blind, randomized, placebo-controlled, 4-period, 4-way crossover, pharmacodynamic (PD) and pharmacokinetic (PK) study in healthy subjects. Biomarkers derived from scalp EEG measurements (laser-evoked brain potentials [LEPs], pinprick-evoked brain potentials [PEPs], resting EEG) will be obtained before and three times after administration of three medications known to act on the nociceptive system (lacosamide, pregabalin, tapentadol) and placebo, given as a single oral dose in separate study periods. Medication effects will be assessed concurrently in a non-sensitized normal condition and a clinically relevant hyperalgesic condition (high-frequency electrical stimulation of the skin). Patient-reported outcomes will also be collected. A sequentially rejective multiple testing approach will be used with overall alpha error of the primary analysis split between LEP and PEP under tapentadol. Remaining treatment arm effects on LEP or PEP or effects on EEG are key secondary confirmatory analyses. Complex statistical analyses and PK-PD modeling are exploratory. Discussion LEPs and PEPs are brain responses related to the selective activation of thermonociceptors and mechanonociceptors. Their amplitudes are dependent on the responsiveness of these nociceptors and the state of the pathways relaying nociceptive input at the level of the spinal cord and brain. The magnitude of resting EEG oscillations is sensitive to changes in brain network function, and some modulations of oscillation magnitude can relate to perceived pain intensity, variations in vigilance, and attentional states. These oscillations can also be affected by analgesic drugs acting on the central nervous system. For these reasons, IMI2-PainCare-BioPain-RCT3 hypothesizes that EEG-derived measures can serve as biomarkers of target engagement of analgesic drugs for future Phase 1 clinical trials. Phase 2 and 3 clinical trials could also benefit from these tools for patient stratification. Trial registration This trial was registered 25/06/2019 in EudraCT (2019%2D%2D001204-37).
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Affiliation(s)
- André Mouraux
- Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium.
| | - Petra Bloms-Funke
- Translational Science & Intelligence, Grünenthal GmbH, Aachen, Germany
| | - Irmgard Boesl
- Clinical Science Development, Grünenthal GmbH, Aachen, Germany
| | - Ombretta Caspani
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | | | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Luis Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | | | - Anna Kostenko
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | | | | | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Iñaki F Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | | | - Jose Miguel Vela
- Drug Discovery & Preclinical Development, ESTEVE Pharmaceuticals, Barcelona, Spain
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health (NDWRH), University of Oxford, Oxford, UK
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vishvarani Wanigasekera
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Matthias Wittayer
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Rolf-Detlef Treede
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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47
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Enax-Krumova E, Attal N, Bouhassira D, Freynhagen R, Gierthmühlen J, Hansson P, Kuehler BM, Maier C, Sachau J, Segerdahl M, Tölle T, Treede RD, Ventzel L, Baron R, Vollert J. Contralateral Sensory and Pain Perception Changes in Patients With Unilateral Neuropathy. Neurology 2021; 97:e389-e402. [PMID: 34011572 DOI: 10.1212/wnl.0000000000012229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/19/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To test whether contralateral sensory abnormalities in the clinically unaffected area of patients with unilateral neuropathic pain are due to the neuropathy or pain mechanisms. METHODS We analyzed the contralateral clinically unaffected side of patients with unilateral painful or painless neuropathy (peripheral nerve injury [PNI], postherpetic neuropathy [PHN], radiculopathy) by standardized quantitative sensory testing following a validated protocol. Primary outcome was the independent contribution of the following variables on the contralateral sensory function using generalized linear regression models: pain intensity, disease duration, etiology, body area, and sensory patterns in the most painful area. RESULTS Among 424 patients (PNI n = 256, PHN n = 78, radiculopathy n = 90), contralateral sensory abnormalities were frequent in both painful (n = 383) and painless (n = 41) unilateral neuropathy, demonstrating sensory loss for thermal and mechanical nonpainful stimuli and both sensory loss and gain for painful test stimuli. Analysis by etiology revealed contralateral pinprick hyperalgesia in PHN and PNI. Analysis by ipsilateral sensory phenotype demonstrated mirror-image pinprick hyperalgesia in both mechanical and thermal hyperalgesia phenotypes. Pain intensity, etiology, and affected body region predicted changes in only single contralateral somatosensory parameters. Disease duration had no impact on the contralateral sensory function. CONCLUSION Mechanisms of sensory loss seem to spread to the contralateral side in both painful and painless neuropathies. Contralateral spread of pinprick hyperalgesia was restricted to the 2 ipsilateral phenotypes that suggest sensitization; this suggest a contribution of descending net facilitation from supraspinal areas, which was reported in rodent models of neuropathic pain but not yet in human patients.
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Affiliation(s)
- Elena Enax-Krumova
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark.
| | - Nadine Attal
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Didier Bouhassira
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Rainer Freynhagen
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Janne Gierthmühlen
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Per Hansson
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Bianca M Kuehler
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Christoph Maier
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Juliane Sachau
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Märta Segerdahl
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Thomas Tölle
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Rolf-Detlef Treede
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Lise Ventzel
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Ralf Baron
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
| | - Jan Vollert
- From the Department of Neurology (E.E.-K.), BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany; INSERM U-987 (N.A., D.B.), Centre D'Evaluation et de Traitement de La Douleur, CHU Ambroise Paré, Boulogne-Billancourt; Université Versailles-Saint-Quentin (N.A., D.B.), Versailles, France; Department of Anaesthesiology (R.F.), Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital Feldafing; Department of Anaesthesiology (R.F.), Klinikum rechts der Isar, Technische Universität München, Munich; Division of Neurological Pain Research and Therapy (J.G., J.S., R.B.), Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; Department of Pain Management and Research (P.H.), Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Molecular Medicine and Surgery (P.H.), Karolinska Institutet, Stockholm, Sweden; Pain Medicine (B.K., J.V.), Chelsea and Westminster Hospital NHS Foundation Trust; Pain Research (B.K.), Department Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea and Westminster Campus, London, UK; University Hospital of Pediatrics and Adolescent Medicine (C.M.), Ruhr-University Bochum, Germany; MS Medical Consulting (M.S.); Karolinska Institute (M.S.), Department of Physiology and Pharmacology, Stockholm, Sweden; Department of Neurology (T.T.), Klinikum rechts der Isar, Technische Universität München, Munich; Department of Neurophysiology (R.-D.T., J.V.), Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Heidelberg University, Germany; Danish Pain Research Center (L.V.), Department of Clinical Medicine, and Department of Oncology (L.V.), Aarhus University Hospital, Denmark
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Quesada C, Kostenko A, Ho I, Leone C, Nochi Z, Stouffs A, Wittayer M, Caspani O, Brix Finnerup N, Mouraux A, Pickering G, Tracey I, Truini A, Treede RD, Garcia-Larrea L. Human surrogate models of central sensitization: A critical review and practical guide. Eur J Pain 2021; 25:1389-1428. [PMID: 33759294 PMCID: PMC8360051 DOI: 10.1002/ejp.1768] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 12/11/2022]
Abstract
Background As in other fields of medicine, development of new medications for management of neuropathic pain has been difficult since preclinical rodent models do not necessarily translate to the clinics. Aside from ongoing pain with burning or shock‐like qualities, neuropathic pain is often characterized by pain hypersensitivity (hyperalgesia and allodynia), most often towards mechanical stimuli, reflecting sensitization of neural transmission. Data treatment We therefore performed a systematic literature review (PubMed‐Medline, Cochrane, WoS, ClinicalTrials) and semi‐quantitative meta‐analysis of human pain models that aim to induce central sensitization, and generate hyperalgesia surrounding a real or simulated injury. Results From an initial set of 1569 reports, we identified and analysed 269 studies using more than a dozen human models of sensitization. Five of these models (intradermal or topical capsaicin, low‐ or high‐frequency electrical stimulation, thermode‐induced heat‐injury) were found to reliably induce secondary hyperalgesia to pinprick and have been implemented in multiple laboratories. The ability of these models to induce dynamic mechanical allodynia was however substantially lower. The proportion of subjects who developed hypersensitivity was rarely provided, giving rise to significant reporting bias. In four of these models pharmacological profiles allowed to verify similarity to some clinical conditions, and therefore may inform basic research for new drug development. Conclusions While there is no single “optimal” model of central sensitization, the range of validated and easy‐to‐use procedures in humans should be able to inform preclinical researchers on helpful potential biomarkers, thereby narrowing the translation gap between basic and clinical data. Significance Being able to mimic aspects of pathological pain directly in humans has a huge potential to understand pathophysiology and provide animal research with translatable biomarkers for drug development. One group of human surrogate models has proven to have excellent predictive validity: they respond to clinically active medications and do not respond to clinically inactive medications, including some that worked in animals but failed in the clinics. They should therefore inform basic research for new drug development.
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Affiliation(s)
- Charles Quesada
- NeuroPain lab, Lyon Centre for Neuroscience Inserm U1028, Lyon, France.,Pain Center Neurological Hospital (CETD), Hospices Civils de Lyon, Lyon, France
| | - Anna Kostenko
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Idy Ho
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Zahra Nochi
- Danish Pain Research Center, Dept of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alexandre Stouffs
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | - Matthias Wittayer
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Ombretta Caspani
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Dept of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - André Mouraux
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | | | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Luis Garcia-Larrea
- NeuroPain lab, Lyon Centre for Neuroscience Inserm U1028, Lyon, France.,Pain Center Neurological Hospital (CETD), Hospices Civils de Lyon, Lyon, France
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49
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Li L, Zou Y, Liu B, Yang R, Yang J, Sun M, Li Z, Xu X, Li G, Liu S, Greffrath W, Treede RD, Li G, Liang S. Correction to Contribution of the P2X4 Receptor in Rat Hippocampus to the Comorbidity of Chronic Pain and Depression. ACS Chem Neurosci 2021; 12:1463. [PMID: 33830723 DOI: 10.1021/acschemneuro.1c00168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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50
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Magerl W, Thalacker E, Vogel S, Schleip R, Klein T, Treede RD, Schilder A. Tenderness of the Skin after Chemical Stimulation of Underlying Temporal and Thoracolumbar Fasciae Reveals Somatosensory Crosstalk between Superficial and Deep Tissues. Life (Basel) 2021; 11:life11050370. [PMID: 33919303 PMCID: PMC8143345 DOI: 10.3390/life11050370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/17/2021] [Accepted: 04/17/2021] [Indexed: 01/14/2023] Open
Abstract
Musculoskeletal pain is often associated with pain referred to adjacent areas or skin. So far, no study has analyzed the somatosensory changes of the skin after the stimulation of different underlying fasciae. The current study aimed to investigate heterotopic somatosensory crosstalk between deep tissue (muscle or fascia) and superficial tissue (skin) using two established models of deep tissue pain (namely focal high frequency electrical stimulation (HFS) (100 pulses of constant current electrical stimulation at 10× detection threshold) or the injection of hypertonic saline in stimulus locations as verified using ultrasound). In a methodological pilot experiment in the TLF, different injection volumes of hypertonic saline (50–800 µL) revealed that small injection volumes were most suitable, as they elicited sufficient pain but avoided the complication of the numbing pinprick sensitivity encountered after the injection of a very large volume (800 µL), particularly following muscle injections. The testing of fascia at different body sites revealed that 100 µL of hypertonic saline in the temporal fascia and TLF elicited significant pinprick hyperalgesia in the overlying skin (–26.2% and –23.5% adjusted threshold reduction, p < 0.001 and p < 0.05, respectively), but not the trapezius fascia or iliotibial band. Notably, both estimates of hyperalgesia were significantly correlated (r = 0.61, p < 0.005). Comprehensive somatosensory testing (DFNS standard) revealed that no test parameter was changed significantly following electrical HFS. The experiments demonstrated that fascia stimulation at a sufficient stimulus intensity elicited significant across-tissue facilitation to pinprick stimulation (referred hyperalgesia), a hallmark sign of nociceptive central sensitization.
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Affiliation(s)
- Walter Magerl
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Emanuela Thalacker
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Simon Vogel
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Health Sciences, Technical University of Munich, 80333 Munich, Germany;
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Thomas Klein
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Andreas Schilder
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
- Correspondence: ; Tel.: +49-621-383-71400; Fax: +49-621-383-71401
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