RÉSUMÉ
BACKGROUND: Electroencephalography (EEG) is a promising tool for identifying the physiological biomarkers of fibromyalgia (FM). Evidence suggests differences in power band and density between individuals with FM and healthy controls. EEG changes appear to be associated with pain intensity; however, their relationship with the quality of pain has not been examined. We aimed to investigate whether abnormal EEG in the frontal and central points of the 10-20 EEG system in individuals with FM is associated with pain's sensory-discriminative and affective-motivational dimensions. The association between EEG and the two dimensions of emotional disorders (depression and anxiety) was also investigated. METHODS: In this cross-sectional pilot study, pain experience (pain rating index [PRI]) and two dimensions of emotional disorders (depression and anxiety) were assessed using the McGill Pain Questionnaire (PRI-sensory and PRI-affective) and Hospital Anxiety and Depression Scale (HADS), respectively. In quantitative EEG analysis, the relative spectral power of each frequency band (delta, theta, alpha, and beta) was identified in the frontal and central points during rest. RESULTS: A negative correlation was found between the relative spectral power for the delta bands in the frontal (r= -0.656; p = 0.028) and central points (r= -0.624; p = 0.040) and the PRI-affective scores. A positive correlation was found between the alpha bands in the frontal (r = 0.642; p = 0.033) and central points (r = 0.642; p = 0.033) and the PRI-affective scores. A negative correlation between the delta bands in the central points and the anxiety subscale of the HADS (r = -0.648; p = 0.031) was detected. CONCLUSION: The affective-motivational dimension of pain and mood disorders may be related to abnormal patterns of electrical activity in patients with FM. TRIAL REGISTRATION: Retrospectively registered on ClinicalTrials.gov (NCT05962658).
Sujet(s)
Anxiété , Électroencéphalographie , Fibromyalgie , Mesure de la douleur , Humains , Fibromyalgie/physiopathologie , Fibromyalgie/diagnostic , Fibromyalgie/psychologie , Fibromyalgie/complications , Projets pilotes , Femelle , Électroencéphalographie/méthodes , Études transversales , Adulte d'âge moyen , Adulte , Mesure de la douleur/méthodes , Mâle , Anxiété/diagnostic , Anxiété/psychologie , Dépression/diagnostic , Dépression/psychologie , Douleur/diagnostic , Douleur/physiopathologie , Douleur/psychologieRÉSUMÉ
Astrocytes play an active role in the function of the brain integrating neuronal activity and regulating back neuronal dynamic. They have recently emerged as active contributors of brain's emergent properties such as perceptions. Here, we analyzed the role of astrocytes in pain perception from the lens of systems neuroscience, and we do this by analyzing how astrocytes encode nociceptive information within brain processing areas and how they are key regulators of the internal state that determines pain perception. Specifically, we discuss the dynamic interactions between astrocytes and neuromodulators, such as noradrenaline, highlighting their role in shaping the level of activation of the neuronal ensemble, thereby influencing the experience of pain. Also, we will discuss the possible implications of an "Astro-NeuroMatrix" in the integration of pain across sensory, affective, and cognitive dimensions of pain perception.
Sujet(s)
Astrocytes , Perception de la douleur , Humains , Perception de la douleur/physiologie , Encéphale , Animaux , Neurosciences , Norépinéphrine/métabolisme , Douleur/physiopathologie , Neurones/physiologieRÉSUMÉ
Viscosity-vaso-occlusion (VVO) and haemolysis-endothelial dysfunction (HED) are pathophysiological mechanisms and clinical subphenotypes of sickle cell disease (SCD). Recurrent vaso-occlusive crises (VOC) may lead to neuroplastic changes and pain sensitization. Among 257 SCD participants, we assessed the relationship of subphenotypes with pain sensitivity using quantitative sensory testing to identify heat pain thresholds (HPT) and pressure pain thresholds (PPT). VOC history and sleep, social and emotional functioning were assessed using the Adult Sickle Cell Quality of Life Measurement Information System. The 'elbow method' determined the optimal number of clusters as three. Clustering was performed using K-prototypes. Among clusters 2 and 3, VOC frequency and severity were higher. Clusters 1 and 3 had lower haemoglobin, higher reticulocytes and lactate dehydrogenase and more leg ulcers. In multivariate regression, cluster 3 was associated with approximately 13.6% lower PPT compared to cluster 1, and female sex was associated with decreases in PPT and HPT at the hands and feet (p < 0.001). Hydroxyurea use and unit increases in sleep functioning and age were associated with approximately 20.1% higher foot-PPT, 6.8% higher hand-PPT and 2.5% higher hand-HPT and foot-HPT respectively. Findings suggest that a third subphenotype with mixed VVO and HED features and worse pain sensitization may exist.
Sujet(s)
Drépanocytose , Viscosité sanguine , Hémolyse , Humains , Drépanocytose/complications , Drépanocytose/physiopathologie , Mâle , Femelle , Adulte , Seuil nociceptif , Jamaïque , Douleur/étiologie , Douleur/physiopathologie , Jeune adulte , Endothélium vasculaire/physiopathologie , Adulte d'âge moyen , Adolescent , Qualité de vie , AntillaisRÉSUMÉ
Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain accompanied by fatigue and muscle atrophy. Although its etiology is not known, studies have shown that FM patients exhibit altered function of the sympathetic nervous system (SNS), which regulates nociception and muscle plasticity. Nevertheless, the precise SNS-mediated mechanisms governing hyperalgesia and skeletal muscle atrophy in FM remain unclear. Thus, we employed two distinct FM-like pain models, involving intramuscular injections of acidic saline (pH 4.0) or carrageenan in prepubertal female rats, and evaluated the catecholamine content, adrenergic signaling and overall muscle proteolysis. Subsequently, we assessed the contribution of the SNS to the development of hyperalgesia and muscle atrophy in acidic saline-injected rats treated with clenbuterol (a selective ß2-adrenergic receptor agonist) and in animals maintained under baseline conditions and subjected to epinephrine depletion through adrenodemedullation (ADM). Seven days after inducing an FM-like model with acidic saline or carrageenan, we observed widespread mechanical hyperalgesia along with loss of strength and/or muscle mass. These changes were associated with reduced catecholamine content, suggesting a common underlying mechanism. Notably, treatment with a ß2-agonist alleviated hyperalgesia and prevented muscle atrophy in acidic saline-induced FM-like pain, while epinephrine depletion induced mechanical hyperalgesia and increased muscle proteolysis in animals under baseline conditions. Together, the results suggest that reduced sympathetic activity is involved in the development of pain and muscle atrophy in the murine model of FM analyzed.
Sujet(s)
Clenbutérol , Modèles animaux de maladie humaine , Fibromyalgie , Hyperalgésie , Amyotrophie , Système nerveux sympathique , Animaux , Femelle , Fibromyalgie/anatomopathologie , Fibromyalgie/physiopathologie , Amyotrophie/anatomopathologie , Amyotrophie/physiopathologie , Hyperalgésie/physiopathologie , Hyperalgésie/anatomopathologie , Système nerveux sympathique/physiopathologie , Système nerveux sympathique/effets des médicaments et des substances chimiques , Système nerveux sympathique/anatomopathologie , Clenbutérol/pharmacologie , Rats , Carragénane/toxicité , Rat Sprague-Dawley , Douleur/anatomopathologie , Douleur/physiopathologie , Épinéphrine , Muscles squelettiques/anatomopathologie , Muscles squelettiques/effets des médicaments et des substances chimiques , Muscles squelettiques/physiopathologie , Catécholamines/métabolisme , Agonistes bêta-adrénergiques/pharmacologieRÉSUMÉ
ABSTRACT: The rostral ventromedial medulla (RVM) is a crucial structure in the descending pain modulatory system, playing a key role as a relay for both the facilitation and inhibition of pain. The chronic social defeat stress (CSDS) model has been widely used to study stress-induced behavioral impairments associated with depression in rodents. Several studies suggest that CSDS also causes changes related to chronic pain. In this study, we aimed to investigate the involvement of the RVM in CSDS-induced behavioral impairments, including those associated with chronic pain. We used chemogenetics to activate or inhibit the RVM during stress. The results indicated that the RVM is a vital hub influencing stress outcomes. Rostral ventromedial medulla activation during CSDS ameliorates all the stress outcomes, including social avoidance, allodynia, hyperalgesia, anhedonia, and behavioral despair. In addition, RVM inhibition in animals exposed to a subthreshold social defeat stress protocol induces a susceptible phenotype, facilitating all stress outcomes. Finally, chronic RVM inhibition-without any social stress stimulus-induces chronic pain but not depressive-like behaviors. Our findings provide insights into the comorbidity between chronic pain and depression by indicating the involvement of the RVM in establishing social stress-induced behavioral responses associated with both chronic pain and depression.
Sujet(s)
Dépression , Modèles animaux de maladie humaine , Moelle allongée , Stress psychologique , Animaux , Stress psychologique/physiopathologie , Stress psychologique/psychologie , Stress psychologique/complications , Mâle , Moelle allongée/physiopathologie , Dépression/physiopathologie , Souris , Souris de lignée C57BL , Hyperalgésie/physiopathologie , Hyperalgésie/psychologie , Douleur/psychologie , Douleur/physiopathologie , Défaite sociale , Comportement animal/physiologieRÉSUMÉ
BACKGROUND: Lateral elbow tendinopathy is a common musculoskeletal disorder. Effectiveness of non-invasive therapies for this health condition are unclear. OBJECTIVE: To investigate the effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy. METHODS: Searches were conducted on MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Library, SPORTDiscus and PsycINFO without language or date restrictions up to May 3rd, 2023. Randomized trials investigating the effectiveness of any non-invasive therapy compared with control or other invasive interventions were included. Two independent reviewers screened eligible trials, extracted data, and assessed the risk of bias of included trials and certainty of the evidence. RESULTS: Twenty-two different therapies investigated in 47 randomized trials were included in the quantitative analysis. Moderate certainty evidence showed that betamethasone valerate medicated plaster may reduce disability (mean difference -6.7; 95% CI -11.4, -2.0) in the short-term when compared with placebo. Low certainty evidence showed that acupuncture may reduce disability (MD -9.1; 95% CI -11.7, -6.4) in the short-term when compared with sham. Moderate to very low certainty of evidence also showed small to no effect of non-invasive therapies on pain intensity, maximum grip strength, and disability outcomes in the short-term compared to control or invasive interventions. Most therapies had only very low certainty of evidence to support their use. CONCLUSIONS: Decision-making processes for lateral elbow tendinopathy should be carefully evaluated, taking into consideration that most investigated interventions have very low certainty of evidence. There is an urgent call for larger high-quality trials.
Sujet(s)
Force de la main , Qualité de vie , Humains , Force de la main/physiologie , Tendinopathie/thérapie , Tendinopathie/physiopathologie , Douleur/physiopathologieRÉSUMÉ
BACKGROUND: Patients with Parkinson's disease (PD) often report chronic pain, which is one of the most complex non-motor symptoms. Therefore, this study aims to review the literature on the characteristics of pain in patients with PD. METHODS: A systematic literature review was conducted following MOOSE recommendations. Observational studies reporting pain in patients with PD were included. No time restrictions were applied, but studies in Portuguese, Spanish, and English were considered. The search was performed in PubMed®, LILACS, and SciELO databases. RESULTS: Twenty-six articles of observational studies were identified, reporting an average pain prevalence of 67.36%, emphasizing the significance of this symptom in the PD population. Pain was reported in various body regions, including lower limbs, upper limbs, lumbar spine, cervical spine, and other joints. Pain classification varied, encompassing musculoskeletal pain, PD-related pain, neuropathic pain, and dystonic pain, among others. DISCUSSION: Pain in patients with PD is a prevalent and multifactorial condition, significantly impacting patients' quality of life. CONCLUSION: Heterogeneity in data across included studies was observed, highlighting the need for additional research to elucidate the underlying mechanisms of pain in patients with PD and develop effective therapeutic strategies to address this symptom and improve the quality of life for individuals living with the disease.
Sujet(s)
Maladie de Parkinson , Humains , Maladie de Parkinson/complications , Maladie de Parkinson/épidémiologie , Douleur/étiologie , Douleur/épidémiologie , Douleur/diagnostic , Douleur/physiopathologie , Qualité de vieRÉSUMÉ
Esta revisión busca proporcionar a los profesionales de la salud una mayor comprensión del dolor para su actividad clínica-asistencial. Basados en la hipóte-sis de neuroplasticidad presentada inicialmente por Ramón y Cajal y la teoría de la compuerta en la vía dolorosa presentada por Melzack y Wall, se ha ela-borado una revisión bibliográfica con el objetivo de abordar la modulación de la vía nociceptiva desde un punto de vista fisiopatológico. Asimismo, se presen-tan los principales resultados obtenidos durante los últimos años en nuestro laboratorio usando ratas Wistar hembras como modelo de dolor experimental. Finalmente, se describe un circuito original de modu-lación central a nivel del subnúcleo caudal del trigé-mino con una visión integral de los componentes del sistema nociceptivo orofacial, para ayudar al clínico a comprender situaciones de sensibilización central con perpetuación del dolor y cómo paulatinamente el sistema nervioso central pone en marcha un sistema de modulación para adaptarse y alcanzar un estado similar al basal (AU)
This review aims to provide health professionals with a better understanding of pain for their clinical-care activity. Based on the neuroplasticity hypothesis initially presented by Ramón and Cajal, and the gate theory in the pain pathway presented by Melzack and Wall, a literature review has been carried out with the aim of addressing the modulation of the nociceptive pathway from a pathophysiological point of view. The main results obtained in recent years in our laboratory using female Wistar rats as an experimental pain model are also presented. Finally, an original central modulation circuit at the level of the caudal trigeminal subnucleus is described with a comprehensive view of the components of the orofacial nociceptive system, to help the clinician to understand situations of central sensitization with perpetuation of pain and how the central nervous system gradually sets in motion a modulation system to adapt and reach a state similar to the basal one (AU)
Sujet(s)
Humains , Animaux , Rats , Douleur/physiopathologie , Système nerveux central/physiologie , Nociception/physiologie , Plasticité neuronale/physiologie , Astrocytes , Rat Wistar , Hyperalgésie/physiopathologie , InterneuronesRÉSUMÉ
Sex is an important variable in translational biomedical research. While overt sex differences have been reported for pain and fear-like behaviors in humans and rodents, these differences in other popular model organisms, such as zebrafish, remain poorly understood. Here, we evaluate potential sex differences in zebrafish behavioral responses to pain (intraperitoneal administration of 5% acetic acid) and fear stimuli (exposure to alarm substance). Overall, both male and female zebrafish exposed to pain (acetic acid injection) show lesser distance traveled, fewer top entries and more writhing-like pain-related behavior vs. controls, whereas female fish more robustly (than males) altered some other pain-like behaviors (e.g., increasing freezing episodes and time in top) in this model. In contrast, zebrafish of both sexes responded equally strongly to fear evoked by acute alarm substance exposure. Collectively, these findings emphasize the growing importance of studying sex differences in zebrafish behavioral and pain models.
Sujet(s)
Peur/physiologie , Réaction de catalepsie/physiologie , Douleur/physiopathologie , Caractères sexuels , Animaux , Femelle , Mâle , Danio zébréRÉSUMÉ
Beyond the temporal-spatial identification of the noxious stimulus and the characterization of its attributes, pain perception involves the retrieval of memories related to previous painful experiences, the use of adaptive learning, as well as the individual's ability to process and obtain knowledge, which adds a cognitive dimension to this complex sensation. The present review aims to define the neuronal substrates involved in pain processing and cognition, to understand how these processes interact to help modulate pain, and to consider the effect of some analgesic treatments on cognitive performance. Some of the anatomical substrates that are in charge of processing and modulating pain are also involved with certain cognitive processes, such as attention and the generation of expectations, which could be advantageous, and could even represent the foundations of a complemen- tary analgesic option, which eventually might be useful in intolerant or refractory patients or could even help to reduce the prescribed doses of the drugs typically used for pain management.
Más allá de la identificación temporo-espacial del estímulo nocivo y de la caracterización de sus atributos, la percepción del dolor supone la recuperación de recuerdos relacionados con experiencias dolorosas previas, el uso de aprendizaje adaptativo, así como la capacidad del individuo para procesar y obtener conocimientos, lo cual añade una dimensión cognitiva a esta compleja sensación. La presente revisión tiene como objetivos definir los sustratos neuronales implicados en el procesamiento del dolor y en la cognición, entender cómo esos procesos interactúan para contribuir a modular el dolor y considerar el efecto de algunos tratamientos analgésicos en el desempeño cognitivo. Parte de los sustratos anatómicos que tienen a su cargo el procesamiento y la modulación del dolor, también están relacionados con ciertos procesos cognitivos, como la atención y la generación de expectativas, lo cual podría resultar ventajoso, e incluso podría representar las bases de una opción analgésica complementaria que, eventualmente sería de utilidad en pacientes intolerantes o fármaco-resistentes, o hasta podría coadyuvar a disminuir las dosis prescritas de los fármacos típicamente empleados para el manejo del dolor.
Sujet(s)
Humains , Douleur/psychologie , Cognition , Gestion de la douleur/méthodes , Douleur/physiopathologie , Perception de la douleur/physiologieRÉSUMÉ
OBJECTIVES: Abdominal pain is the primary symptom of chronic pancreatitis (CP), but pain is difficult to assess, and objective methods for pain assessment are lacking. The characterization of the sensory component of pain as a surrogate for nociception can be achieved by sensory testing using standardized stimuli. Herein, we describe the rationale for and development of an international consortium to better understand and characterize CP pain. METHODS: A collaboration was initially formed between the University of Aalborg, Johns Hopkins University, and the University of Pittsburgh. This group refined the protocol for pancreatic quantitative sensory testing (P-QST) and then expanded the collaboration with plans for incorporating P-QST into prospective studies. RESULTS: The collaboration has successfully developed a P-QST nomogram. Chronic pancreatitis patients identified with P-QST as having widespread hyperalgesia had higher pain intensity scores, higher prevalence of constant pain, and decreased quality of life. Psychiatric comorbidities were independent of pain phenotypes. Multiple studies are underway to validate these findings and evaluate their utility in clinical trials. CONCLUSIONS: Development of the P-QST Consortium will facilitate collaborative efforts to use P-QST as a means for evaluation and characterization of pain in CP patients, and optimize methods to guide individualized pain management approaches.
Sujet(s)
Douleur abdominale/diagnostic , Mesure de la douleur/méthodes , Douleur/diagnostic , Pancréatite chronique/diagnostic , Pancréatite chronique/physiopathologie , Douleur abdominale/physiopathologie , Adulte , Femelle , Humains , Mâle , Nomogrammes , Douleur/physiopathologie , Gestion de la douleur/méthodes , Pancréas/physiopathologie , Pancréatite chronique/thérapie , Études prospectives , Qualité de vie , Reproductibilité des résultats , Centres de soins tertiaires/statistiques et données numériquesRÉSUMÉ
BACKGROUND: Red ear syndrome (RES) was first described by Lance in 1994. It is characterized by recurrent attacks of redness of the ear, accompanied by burning pain, increased temperature, dysesthesia, and nosological relationship with headache. CASE: We report the case of a 43-year-old woman with migraine who developed RES. Redness episodes occurred at the same time of the day. She had a good therapeutic response to gabapentin. CONCLUSIONS: To the best of our knowledge, this is the first case of RES in which redness episodes occurred at the same time of the day.
Sujet(s)
Rythme circadien , Oreille , Érythème/physiopathologie , Migraines/physiopathologie , Douleur/physiopathologie , Adulte , Femelle , Gabapentine/usage thérapeutique , Humains , Paresthésie/physiopathologieRÉSUMÉ
Pain is one of the most common and troublesome non-motor symptoms of Parkinson's disease (PD). The King's Parkinson's Disease Pain Scale (KPPS) is the first scale of its kind to evaluate the burden and characterization of various phenotypes of pain in individuals with PD. The purpose of this study was to adapt the KPPS to Brazilian culture and to assess its content validity using the Delphi method. The process of adapting the original instrument to the Brazilian context occurred in six stages according to international standards. Following the pilot tests with individuals with PD, the pre-final version of the KPPS-Brazil was developed and submitted to judges to assess content validity. Three evaluation rounds were conducted, in which several corrections and changes suggested by the judges were accepted. The Content Validity Index (CVI) was calculated to determine the judges' degree of agreement. The results demonstrated that the KPPS-Brazil showed a quite satisfactory level of semantic, idiomatic, cultural, and conceptual equivalence. The judges' opinion showed adequate content validity for all of the KPPS-Brazil items and the scale. The use of the KPPS-Brazil will enable an adequate assessment of pain in individuals with PD, contributing to clinical practice and research.
Sujet(s)
Douleur/diagnostic , Sujet âgé , Brésil , Comparaison interculturelle , Femelle , Humains , Mâle , Adulte d'âge moyen , Douleur/physiopathologie , Mesure de la douleur , Reproductibilité des résultatsRÉSUMÉ
Exposure to stress might influence pain sensitivity; however, little is known about whether post-traumatic stress disorder (PTSD)-like symptoms alter pain sensitivity and how it can happen. Male rats were exposed to the inescapable footshock paired with either social isolation or a control condition (not exposed to footshock but subjected to social isolation). After 7, 14, or 21 days, memory retention was evaluated. In the following three days, animals underwent the following tests: open-field, social interaction and formalin tests. Another group of animals were subjected to the object recognition test and to von Frey filaments. In other cohorts of animals, saline, fluoxetine, or desipramine were injected intrathecally and immunohistochemistry was performed to investigate whether PTSD-like symptoms alter the expression of c-Fos in serotonergic and noradrenergic neurons. Inescapable footshock induced the development of PTSD-like symptoms. Animals with PTSD-like symptoms showed an increase in the number of flinches in the formalin test and a reduction in mechanical threshold in the von Frey test at both retention intervals. The social interaction was negatively correlated with the nociceptive response in the formalin test. Fluoxetine or desipramine prevented the nociceptive response to chemical stimulus in the formalin test. In addition, in animals with PTSD-like symptoms, there was a reduction in c-Fos expression in serotonergic and noradrenergic neurons. Our results are important for the association of increased sensitivity to pain as one of the clinical manifestations that are present in the development of PTSD, and a possible treatment for increased pain sensitivity in male individuals with PTSD.
Sujet(s)
Douleur/physiopathologie , Troubles de stress post-traumatique/physiopathologie , Neurones adrénergiques/métabolisme , Neurones adrénergiques/physiologie , Animaux , Comportement animal , Fluoxétine/pharmacologie , Mâle , Norépinéphrine/métabolisme , Douleur/métabolisme , Gestion de la douleur/psychologie , Seuil nociceptif/effets des médicaments et des substances chimiques , Rats , Rat Wistar , Neurones sérotonergiques/métabolisme , Neurones sérotonergiques/physiologie , Comportement social , Troubles de stress post-traumatique/métabolismeRÉSUMÉ
BACKGROUND: People with HIV (PWH) experience chronic pain and respiratory symptoms, which are closely related in the general population. Pain may affect the impaired pulmonary function seen in PWH beyond its association with HIV alone. Our objective was to investigate the relationship of pain severity to pulmonary function, respiratory symptoms, and sleep disturbance in PWH. SETTING: Study sites included the University of Pittsburgh, University of California San Francisco, and University of Washington. METHODS: Pain, dyspnea, and sleep were assessed using the Brief Chronic Pain Questionnaire, St. George's Respiratory Questionnaire, and Pittsburgh Sleep Quality Index. Participants performed prebronchodilator and postbronchodilator spirometry and 6-minute walk test. Associations between pain severity, lung function, dyspnea, and sleep were assessed with bivariate and multiple quantile regression analysis adjusted for age, sex, race, body mass index, and smoking status. RESULTS: Of 159 PWH, the median age was 56 years with 30.8% women. Two-thirds experienced pain in the past week, with 40.3% reporting chronic pain. Pain severity was higher with female sex (P = 0.038), non-White race (P = 0.005), current smoking (P = 0.003), and lower CD4+ count (P = 0.035). In adjusted analysis, higher pain severity was correlated with reduced postbronchodilator forced expiratory volume in 1 second %predicted (P = 0.008), reduced postbronchodilator forced vital capacity %predicted (P = 0.019), and chronic obstructive pulmonary disease (P = 0.032). Greater pain severity was strongly associated with a higher St. George's Respiratory Questionnaire score (P < 0.001) and sleep disturbance (P < 0.001). CONCLUSIONS: In PWH, pain is common and associated with airflow obstruction, dyspnea, and sleep disturbance. Future studies assessing pain severity and pulmonary function over time could clarify the direction of this association and the impact on quality of life.
Sujet(s)
Infections à VIH/physiopathologie , Poumon/physiopathologie , Douleur/physiopathologie , Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Tests de la fonction respiratoireRÉSUMÉ
BACKGROUND: Neurodegenerative diseases are sporadic hereditary conditions characterized by progressive dysfunction of the nervous system. Among the symptoms, vestibulopathy is one of the causes of discomfort and a decrease in quality of life. Hereditary spastic paraplegia is a heterogeneous group of hereditary degenerative diseases involving the disorder of a single gene and is characterized by the progressive retrograde degeneration of fibers in the spinal cord. OBJECTIVE: To determine the benefits of vestibular rehabilitation involving virtual reality by comparing pre intervention and post intervention assessments in individuals with hereditary spastic paraplegia. METHODS: In this randomized controlled clinical trial from the Rebec platform RBR-3jmx67 in which allocation concealment was performed and the evaluators be blinded will be included. The participants will include 40 patients diagnosed with hereditary spastic paraplegia. The interventions will include vestibular rehabilitation with virtual reality using the Wii® console, Wii-Remote and Wii Balance Board (Nintendo), and the studies will include pre- and post intervention assessments. Group I will include twenty volunteers who performed balance games. Group II will include twenty volunteers who performed balance games and muscle strength games. The games lasted from 30 minutes to an hour, and the sessions were performed twice a week for 10 weeks (total: 20 sessions). RESULTS: This study provides a definitive assessment of the effectiveness of a virtual reality vestibular rehabilitation program in halting the progression of hereditary spastic paraplegia, and this treatment can be personalized and affordable. CONCLUSION: The study will determine whether a vestibular rehabilitation program with the Nintendo Wii® involving virtual reality can reduce the progressive effect of hereditary spastic paraplegia and serve as an alternative treatment option that is accessible and inexpensive. Rebec platform trial: RBR-3JMX67.
Sujet(s)
Traitement par les exercices physiques , Équilibre postural/génétique , Paraplégie spasmodique héréditaire/rééducation et réadaptation , Moelle spinale/anatomopathologie , Adolescent , Adulte , Brésil , Dysfonctionnement cognitif/physiopathologie , Dysfonctionnement cognitif/rééducation et réadaptation , Femelle , Jeux récréatifs , Humains , Mâle , Adulte d'âge moyen , Force musculaire/physiologie , Douleur/physiopathologie , Douleur/prévention et contrôle , Qualité de vie , Paraplégie spasmodique héréditaire/génétique , Paraplégie spasmodique héréditaire/physiopathologie , Résultat thérapeutique , Réalité de synthèse , Jeune adulteRÉSUMÉ
OBJECTIVE: The aim was to analyze the effect of one session and three sessions of strength training (ST) on pain in women with fibromyalgia (FM). METHOD: Twenty-three women with FM performed three sessions of ST for a week. Each training session worked the main muscle groups and lasted 60 min. Three sets of 12 repetitions were performed with 1 min intervals in between. The load was increased based on the perception of subjective effort of each patient. Pain intensity was evaluated immediately after the first and third sessions using a Fischer digital algometer. RESULTS: After the first ST session, pain reduction was observed. No significant differences were found in pain thresholds on the baseline versus the third session. The analysis of MBI demonstrated that the ST does not worsen patients' pain, indicating a 52.2% trivial effect and a 39.1% beneficial effect. CONCLUSION: Our results suggest that there is no harmful effect on the pain of women with FM after an acute session of ST. We emphasize that despite the promising results, more studies on the subject are needed to help understand pain in patients with FM.
Sujet(s)
Fibromyalgie/thérapie , Gestion de la douleur/méthodes , Douleur/physiopathologie , Entraînement en résistance/méthodes , Femelle , Fibromyalgie/physiopathologie , Humains , Adulte d'âge moyen , Mesure de la douleur , Seuil nociceptif/physiologie , Résultat thérapeutiqueRÉSUMÉ
Lumbar disc herniation (LDH) is a relatively common pathology usually presenting with unilateral radiculopathy ipsilateral to the disc herniation. Some patients can present with contralateral radicular symptoms. The objective of this article is to review the current literature on lumbar disc herniations with contralateral radiculopathy regarding its pathophysiology and surgical strategies. A systematic review of the literature on LDH with contralateral radiculopathy was performed using MEDLINE (via PubMed) using MeSH terms. This review was done following recommendations of PRISMA statement and PICOT strategy of search. Initial electronic search identified 126 papers. Finally, 18 articles were reviewed. None of the included papers was described as comparative. Pathophysiological processes underlying contralateral pain may include prominent spondylotic changes and the accompanying stenosis; hypertrophic yellow ligament; dural attachments along the posterior longitudinal ligament; nerve root traction forces; and friction radiculitis, migrated epidural fat, nerve root anomaly, and venous congestion inside the vertebral canal. In our pooled analysis, 11 patients reported were treated by bilateral approach with 100% of clinical success and no complications. Eight patients were treated by unilateral approach ipsilateral to pain with 100% of clinical success and no complications. Forty-eight patients were treated by unilateral approach ipsilateral to herniation with 100% of clinical success and no complications. Pathophysiology underlying contralateral pain in LDH is probably multifactorial. There is not enough scientific evidence to define the best surgical approach for patients with LDH and contralateral pain.
Sujet(s)
Déplacement de disque intervertébral/physiopathologie , Déplacement de disque intervertébral/chirurgie , Vertèbres lombales/chirurgie , Procédures de neurochirurgie/méthodes , Radiculopathie/physiopathologie , Radiculopathie/chirurgie , Femelle , Humains , Dégénérescence de disque intervertébral/épidémiologie , Dégénérescence de disque intervertébral/physiopathologie , Dégénérescence de disque intervertébral/chirurgie , Déplacement de disque intervertébral/épidémiologie , Mâle , Procédures de neurochirurgie/tendances , Études observationnelles comme sujet/méthodes , Douleur/épidémiologie , Douleur/physiopathologie , Douleur/chirurgie , Radiculopathie/épidémiologieRÉSUMÉ
OBJECTIVE: Considering the osteoarthritis (OA) model that integrates the biological, mechanical, and structural components of the disease, the present study aimed to investigate the association between urinary C-Telopeptide fragments of type II collagen (uCTX-II), knee joint moments, pain, and physical function in individuals with medial knee OA. METHODS: Twenty-five subjects radiographically diagnosed with knee OA were recruited. Participants were evaluated through three-dimensional gait analysis, uCTX-II level, the WOMAC pain and physical function scores, and the 40m walk test. The association between these variables was investigated using Pearson's product-moment correlation, followed by a hierarchical linear regression, controlled by OA severity and body mass index (BMI). RESULTS: No relationship was found between uCTX-II level and knee moments. A significant correlation between uCTX-II level and pain, physical function, and the 40m walk test was found. The hierarchical linear regression controlling for OA severity and BMI showed that uCTX-II level explained 9% of the WOMAC pain score, 27% of the WOMAC physical function score, and 7% of the 40m walk test. CONCLUSION: Greater uCTX-II level is associated with higher pain and reduced physical function and 40m walk test performance in individuals with medial knee OA.
Sujet(s)
Collagène de type II/composition chimique , Collagène de type I/composition chimique , Articulation du genou/physiopathologie , Gonarthrose/physiopathologie , Douleur/physiopathologie , Peptides/composition chimique , Marqueurs biologiques , Collagène de type I/urine , Humains , Peptides/urineRÉSUMÉ
OBJECTIVE: To compare the performance, reliability, and validity of functional tests between women with and without patellofemoral pain. METHODS: Twenty women with a diagnosis of patellofemoral pain between 18 and 40 years of age and 20 age-matched pain-free controls participated in the study. All participants performed a set of five function tests: sitting-rising test, sit-to-stand in 30 seconds, stair-climb test, stair descent test, and six-minute step test. To investigate reliability, participants were assessed on two different days, seven days apart, by two independent investigators blinded to the results of the other investigator. Validity was evaluated through associations with the results on the Anterior Knee Pain Scale. RESULTS: Performance in the tests was worse in women with patellofemoral pain than in the control group for the sit-to-stand in 30 seconds (mean difference [MD] 3.4reps; 95%CI: 0.4, 6.4), stair-climb test (MD: 0.36s; 95%CI: 0.1, 0.63), and six-minute step test (MD: 45reps; 95%CI: 20, 70). No differences were observed for the sitting-rising and stair descent tests. All tests in both groups showed moderate to excellent intra- and inter-rater reliability (intraclass correlation coefficients: 0.61 to 0.91 and 0.72 to 0.96, respectively). Finally, only the results on the sit-to-stand in 30 seconds test correlated with the Anterior Knee Pain Scale (r=0.44, p=0.047) in the patellofemoral pain group. CONCLUSION: Women with patellofemoral pain present lower performance on some functional tests. Functional tests are reliable in patients with patellofemoral pain, although they are not associated with the results on the Anterior Knee Pain Scale self-questionnaire.