RESUMO
Introduction: In chronic pain conditions such as fibromyalgia (FM), pain amplification within the central nervous system, or "central sensitization," may contribute to the development and maintenance of chronic pain. Chronic pain treatments include opioid therapy, and opioid therapy may maladaptively increase central sensitization, particularly in patients who take opioids long-term. However, it has remained unknown how central sensitization is impacted in patients who use opioids long-term. Methods: To investigate how long-term opioid therapy affects central sensitization, we used the validated measure of temporal summation. The temporal summation measurement consists of applying a series of noxious stimuli to a patient's skin and then calculating changes in the patient's pain rating to each stimulus. Using this measurement, we evaluated temporal summation in study participants with fibromyalgia who take opioids long-term (i.e., greater than 90 days duration; n = 24, opioid-FM). We compared opioid-FM responses to 2 control groups: participants with fibromyalgia who do not take opioids (n = 33, non-opioid FM), and healthy controls (n = 31). For the temporal summation measurement, we applied a series of 10 noxious heat stimuli (sensitivity-adjusted temperatures) to the ventral forearm (2s duration of each stimulus, applied once every 3 s). Additionally, we collected responses to standard pain and cognitive-affective questionnaires to assess pain severity and other factors. Results and discussion: Group differences in sensitivity-adjusted stimulus temperatures were observed, with only the non-opioid FM group requiring significantly lower stimulus temperatures (The opioid-FM group also required lower temperatures, but not significantly different from the control group). However, all 3 groups exhibited similar magnitudes of temporal summation. Across combined FM groups, temporal summation negatively correlated with pain severity (r = -0.31, p = 0.021). Within the opioid-FM group, higher pain sensitivity to heat (i.e., lower sensitivity-adjusted temperatures) showed a trend relationship with higher opioid dosage (r = -0.45, p = 0.036), potentially reflective of opioid-related hyperalgesia. Our findings also indicated that heightened pain severity may skew sensitivity-adjusted temporal summation, thereby limiting its utility for measuring central sensitization. Overall, in participants taking opioids, temporal summation may be influenced by hypersensitivity to heat pain, which appeared to vary with opioid dosage.
RESUMO
Millions of people in Asia are facing challenges from undernutrition, obesity, and diet-related non-communicable diseases. Unilever, as a global food business, has a simple approach to nutrition strategy: 'better products' help people to enjoy 'better diets' and live 'better lives.' For 'Better Products,' Unilever strives to improve the taste and nutritional qualities of all our products. By 2020, we commit to double the proportion of our entire global portfolio meeting the highest nutrition standards, based on globally recognised dietary guidelines. Unilever sets a clear plan to achieve reduction of sodium, saturated fat, trans fat, sugar, and calories in our products. Unilever developed fortified seasoning and spread products in 2013 for Vietnam, Indonesia, and the Philippines in collaboration with government bodies to address nutrient deficiencies. For 'Better Diets and Better Lives,' Unilever uses targeted communication to raise awareness and promote behavior change for healthy lifestyles. We committed to full nutrition labeling on our food products by 2015. We contribute experience to science-based regional initiatives on product labeling as well as nutrient profiling. Unilever collaborated with international, regional and country bodies to promote consumer understanding and food accessibility on public health priorities such as proper salt consumption, healthier meals, and employee well-being programs. Looking ahead, we are continuing to improve the nutritional profile of our products as well as our communication to improve diets and lives. Collaboration between industry, government and public health organizations is needed to address complex diet and life style issues.