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1.
Nat Commun ; 11(1): 3948, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769984

RESUMO

Thalamocortical dysrhythmia is a key pathology of chronic neuropathic pain, but few studies have investigated thalamocortical networks in chronic low back pain (cLBP) given its non-specific etiology and complexity. Using fMRI, we propose an analytical pipeline to identify abnormal thalamocortical network dynamics in cLBP patients and validate the findings in two independent cohorts. We first identify two reoccurring dynamic connectivity states and their associations with chronic and temporary pain. Further analyses show that cLBP patients have abnormal connectivity between the ventral lateral/posterolateral nucleus (VL/VPL) and postcentral gyrus (PoCG) and between the dorsal/ventral medial nucleus and insula in the less frequent connectivity state, and temporary pain exacerbation alters connectivity between the VL/VPL and PoCG and the default mode network in the more frequent connectivity state. These results extend current findings on thalamocortical dysfunction and dysrhythmia in chronic pain and demonstrate that cLBP pathophysiology and clinical pain intensity are associated with distinct thalamocortical network dynamics.


Assuntos
Córtex Cerebral/fisiopatologia , Dor Crônica/fisiopatologia , Núcleos Laterais do Tálamo/fisiopatologia , Dor Lombar/fisiopatologia , Núcleos Ventrais do Tálamo/fisiopatologia , Adulto , Mapeamento Encefálico , Estudos de Casos e Controles , Córtex Cerebral/diagnóstico por imagem , Dor Crônica/diagnóstico , Conjuntos de Dados como Assunto , Feminino , Humanos , Núcleos Laterais do Tálamo/diagnóstico por imagem , Dor Lombar/diagnóstico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiopatologia , Medição da Dor , Núcleos Ventrais do Tálamo/diagnóstico por imagem , Adulto Jovem
2.
Science ; 369(6505): 842-846, 2020 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-32792398

RESUMO

How is neuropathic pain regulated in peripheral sensory neurons? Importins are key regulators of nucleocytoplasmic transport. In this study, we found that importin α3 (also known as karyopherin subunit alpha 4) can control pain responsiveness in peripheral sensory neurons in mice. Importin α3 knockout or sensory neuron-specific knockdown in mice reduced responsiveness to diverse noxious stimuli and increased tolerance to neuropathic pain. Importin α3-bound c-Fos and importin α3-deficient neurons were impaired in c-Fos nuclear import. Knockdown or dominant-negative inhibition of c-Fos or c-Jun in sensory neurons reduced neuropathic pain. In silico screens identified drugs that mimic importin α3 deficiency. These drugs attenuated neuropathic pain and reduced c-Fos nuclear localization. Thus, perturbing c-Fos nuclear import by importin α3 in peripheral neurons can promote analgesia.


Assuntos
Dor Crônica/fisiopatologia , Neuralgia/fisiopatologia , Células Receptoras Sensoriais/fisiologia , alfa Carioferinas/fisiologia , Transporte Ativo do Núcleo Celular , Animais , Benzofenonas/farmacologia , Dor Crônica/genética , Perfilação da Expressão Gênica , Técnicas de Silenciamento de Genes , Isoxazóis/farmacologia , Camundongos , Camundongos Endogâmicos C57BL , Neuralgia/genética , Proteínas Proto-Oncogênicas c-fos/antagonistas & inibidores , Proteínas Proto-Oncogênicas c-fos/metabolismo , Fator de Transcrição AP-1/metabolismo , alfa Carioferinas/genética
3.
Medicine (Baltimore) ; 99(31): e21378, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756127

RESUMO

BACKGROUND: A number of studies have used regional homogeneity (ReHo) to depict local functional connectivity in chronic pain (CP). However, the findings from these studies were mixed and inconsistent. METHODS: A computerized literature search will be performed in PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), WanFang, and SinoMed databases until June 15, 2019 and updated on March 20, 2020. This protocol will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). The Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) software will be used for this voxel-wise meta-analysis. RESULTS: This meta-analysis will identify the most consistent ReHo alterations in CP. CONCLUSIONS: To our knowledge, this will be the first voxel-wise meta-analysis that integrates ReHo findings in CP. This meta-analysis will offer the quantitative evidence of ReHo alterations that characterize brain local functional connectivity of CP. PROSPERO REGISTRATION NUMBER: CRD42019148523.


Assuntos
Encéfalo/diagnóstico por imagem , Dor Crônica/fisiopatologia , Imagem por Ressonância Magnética , Mapeamento Encefálico/métodos , Dor Crônica/diagnóstico por imagem , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
4.
PLoS One ; 15(7): e0236734, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716976

RESUMO

OBJECTIVES: Health and wellness coaching (HWC) interventions have been reported to improve health outcomes for individuals with chronic diseases such as diabetes, cardiovascular disease, or cancer. However, HWC also holds potential as an effective intervention within a biopsychosocial chronic pain management framework. The aim of the present study was to evaluate the effects of HWC on individuals with chronic pain. METHODS: Participants were referred by their primary care provider or insurance company to a comprehensive telephonic 12-month pain management HWC program. Relationships between pain outcomes and physical and psychological factors were retrospectively analyzed. Mixed linear-effects modeling explored whether physical and psychological variables were associated with pain outcomes over time. RESULTS: Four hundred nineteen participants (female, 58.9%; mean age, 54.8) enrolled in the program and 181 completed the intervention. After 12 months in the program, statistically and clinically significant reductions were observed for pain intensity (Hedges' g = 1.00) and pain-related interference (Hedges' g = 1.13). Linear mixed-effects modeling indicated that improvements in physical functioning and psychological factors were associated with improvements in pain intensity. DISCUSSION: Our results provide a novel analysis on the effects of HWC on chronic pain and pain-related interference. HWC appears to be a promising intervention to improve pain-related outcomes in a population with chronic pain. Further investigation of HWC as an intervention for chronic pain is warranted.


Assuntos
Dor Crônica/terapia , Pessoal de Saúde/estatística & dados numéricos , Promoção da Saúde , Tutoria/métodos , Manejo da Dor/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Prognóstico , Estudos Retrospectivos , Inquéritos e Questionários
7.
PLoS One ; 15(6): e0235419, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589694

RESUMO

BACKGROUND: Physical inactivity and chronic pain are both major public health concerns worldwide. Although the health benefits of regular physical exercise are well-documented, few large epidemiological studies have investigated the association between specific domains of physical exercise and chronic pain in young adults. We sought to investigate the association between frequency, intensity and duration of physical exercise, and chronic pain. METHODS: Data stem from the SHoT2018-study, a national health survey for higher education in Norway, in which 36,625 fulltime students aged 18-35 years completed all relevant questionnaires. Chronic pain, defined according to the International Classification of Diseases 11th Revision (ICD-11), was assessed with a newly developed hierarchical digital instrument for reporting both distribution and characteristics of pain in predefined body regions. Physical exercise was assessed using three sets of questions, measuring the number of times exercising each week, and the average intensity and the number of hours each time. RESULTS: The majority (54%) of the students reported chronic pain in at least one location, and the prevalence was especially high among women. The overall pattern was an inverse dose-response association between exercise and chronic pain: the more frequent, harder or longer the physical exercise, the lower the risk of chronic pain. Similar findings were generally also observed for the number of pain locations: frequent exercise was associated with fewer pain locations. Adjusting for demographical, lifestyle factors and depression had little effect on the magnitude of the associations. CONCLUSION: Given the many health benefits of regular exercise, there is much to be gained in facilitating college and university students to be more physically active, ideally, thru a joint responsibility between political and educational institutions. Due to the cross-sectional nature of the study, one should be careful to draw a firm conclusion about the direction of causality.


Assuntos
Dor Crônica/fisiopatologia , Exercício Físico , Estudantes/estatística & dados numéricos , Universidades/estatística & dados numéricos , Adulto , Dor Crônica/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
8.
Ann Thorac Cardiovasc Surg ; 26(4): 196-201, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32493872

RESUMO

OBJECTIVE: To evaluate the effect of music therapy on the chronic pain and midterm quality of life of patients after mechanical valve replacement. METHODS: Patients were divided into two groups according to whether or not they received music therapy. The patients in the music group received 30 minutes of music therapy every day for 6 months after the operation. The patients in the control group received standard treatment and had 30 minutes of quiet rest time every day in the same period. The short-form of McGill Pain Questionnaire (SF-MPQ) was used to evaluate the degree of postoperative chronic pain, and the SF-36 was used to evaluate the midterm quality of life of patients. RESULTS: In terms of the degree of postoperative chronic pain, the score of the pain rating index (PRI) emotional item in the music group was significantly lower than that in the control group. In the evaluation of the postoperative midterm quality of life using the SF-36, the emotional function score in the music group was significantly higher than that in the control group. CONCLUSION: This study preliminarily showed that music therapy can effectively reduce chronic pain and improve midterm quality of life after surgery.


Assuntos
Valva Aórtica/cirurgia , Dor Crônica/terapia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/cirurgia , Musicoterapia , Dor Pós-Operatória/terapia , Qualidade de Vida , China , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Percepção da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/psicologia , Fatores de Tempo , Resultado do Tratamento
9.
J Headache Pain ; 21(1): 78, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32560622

RESUMO

Chronic pain surrounding the temporomandibular joints and masticatory muscles is often the primary chief complaint of patients with temporomandibular disorders (TMD) seeking treatment. Yet, the neuro-pathophysiological basis underlying it remains to be clarified. Neuroimaging techniques have provided a deeper understanding of what happens to brain structure and function in TMD patients with chronic pain. Therefore, we performed a systematic review of magnetic resonance imaging (MRI) studies investigating structural and functional brain alterations in TMD patients to further unravel the neurobiological underpinnings of TMD-related pain. Online databases (PubMed, EMBASE, and Web of Science) were searched up to August 3, 2019, as complemented by a hand search in reference lists. A total of 622 papers were initially identified after duplicates removed and 25 studies met inclusion criteria for this review. Notably, the variations of MRI techniques used and study design among included studies preclude a meta-analysis and we discussed the findings qualitatively according to the specific neural system or network the brain regions were involved in. Brain changes were found in pathways responsible for abnormal pain perception, including the classic trigemino-thalamo-cortical system and the lateral and medial pain systems. Dysfunction and maladaptive changes were also identified in the default mode network, the top-down antinociceptive periaqueductal gray-raphe magnus pathway, as well as the motor system. TMD patients displayed altered brain activations in response to both innocuous and painful stimuli compared with healthy controls. Additionally, evidence indicates that splint therapy can alleviate TMD-related symptoms by inducing functional brain changes. In summary, MRI research provides important novel insights into the altered neural manifestations underlying chronic pain in TMD.


Assuntos
Encéfalo/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Dor Facial/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Encéfalo/fisiopatologia , Dor Crônica/epidemiologia , Dor Crônica/fisiopatologia , Dor Facial/epidemiologia , Dor Facial/fisiopatologia , Feminino , Humanos , Masculino , Neuroimagem/métodos , Transtornos da Articulação Temporomandibular/epidemiologia , Transtornos da Articulação Temporomandibular/fisiopatologia
10.
Rev Med Suisse ; 16(692): 885-889, 2020 May 06.
Artigo em Francês | MEDLINE | ID: mdl-32374530

RESUMO

The International Association for the Study of Pain (IASP) proposed the current diagnostic description of complex regional pain syndrome (CRPS) for the distinct and complex chronic pain condition in 1994. Since this classification, studies on the syndrome have led to a better understanding of the underlying pathophysiological mechanisms, epidemiology and therapeutic approaches. F. Luthi of SUVA Care reviewed CRPS in detail in 2014 and 2019 issues of the Revue médicale suisse. The purpose of this article is to provide an update of results on the neural mechanisms involved in this syndrome and how this helps management of CRPS, in particular bringing awareness to physicians of all specialties of the first symptoms with practical advice for investigations and treatment.


Assuntos
Encéfalo/fisiopatologia , Síndromes da Dor Regional Complexa/fisiopatologia , Síndromes da Dor Regional Complexa/terapia , Manejo da Dor , Dor Crônica/epidemiologia , Dor Crônica/fisiopatologia , Dor Crônica/terapia , Síndromes da Dor Regional Complexa/epidemiologia , Humanos
11.
Nurs Outlook ; 68(4): 440-448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32402394

RESUMO

BACKGROUND: Long-term use of prescription opioids for pain results in negative health outcomes. Overweight and pain are related, and adults with either condition commonly report poor sleep quality, high levels of depression, low levels of self-efficacy, and high pain interference and intensity. Insufficient research exists regarding how weight may influence pain outcomes in the context of common symptoms. PURPOSE: To investigate how body mass index (BMI) influences relationships between health factors and pain outcomes among adults with pain prescribed opioids. METHODS: The sample included 226 adults. Linear regression models tested relationships among variables and outcomes of pain intensity and pain interference. FINDINGS: BMI significantly strengthened relationships between health factors and pain interference but not pain intensity. DISCUSSION: Adults with persistent pain suffer worsened pain interference in the context of increased weight status. Nurses should consider addressing BMI as part of a holistic pain management care plan.


Assuntos
Analgésicos Opioides/uso terapêutico , Índice de Massa Corporal , Dor Crônica/tratamento farmacológico , Dor Crônica/fisiopatologia , Obesidade/complicações , Manejo da Dor/métodos , Avaliação de Sintomas/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Pain Res Manag ; 2020: 3204720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32399125

RESUMO

Chronic pain is a serious public health problem that has grown exponentially in recent years, which is why it has received the attention of numerous researchers. Most of the studies in the field of chronic pain have focused on care as a mediating variable on the perception of painful stimuli and emotions. Nevertheless, there are very few studies that have gone in the opposite direction. This study's aim is therefore to analyse the impact of emotional variables (anxiety and depression), the rating of pain, and age on vigilance processes in a sample of patients with chronic pain. To do so, the attentional performance of a cohort of 52 patients with chronic pain was measured through the use of a modified dot-probe task. Furthermore, all the participants were evaluated using the following self-report measures: Beck's Depression Inventory-II (BDI-II), the McGill Pain Questionnaire, and the Pain Anxiety Symptoms Scale-20 (PASS-20). Stepwise multiple linear regression analysis revealed a significant negative correlation between the pain rating index and the number of mistakes the participants made during the attention test. There was also a positive and significant correlation with age and another negative and significant correlation with cognitive anxiety regarding the overall performance times during the undertaking of the experimental task. These results point to the importance of a more in-depth understanding of the impact that the emotional variables and other variables such as age have on attentional processes and the rating of pain. Finally, the discussion focuses on the implications these results could have for clinical practice or for future research studies in this field.


Assuntos
Fatores Etários , Ansiedade/psicologia , Atenção/fisiologia , Dor Crônica/psicologia , Depressão/psicologia , Adulto , Idoso , Ansiedade/complicações , Dor Crônica/fisiopatologia , Estudos de Coortes , Depressão/complicações , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos
13.
Pain Res Manag ; 2020: 1876862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32454918

RESUMO

Purified from the roots of the plant Sinomenium acutum, sinomenine is traditionally used in China and Japan for treating rheumatism and arthritis. Previously, we have demonstrated that sinomenine possessed a broad analgesic spectrum in various chronic pain animal models and repeated administration of sinomenine did not generate tolerance. In this review article, we discussed sinomenine's analgesic mechanism with focus on its role on immune regulation and neuroimmune interaction. Sinomenine has distinct immunoregulative properties, in which glutamate, adenosine triphosphate, nitric oxide, and proinflammatory cytokines are thought to be involved. Sinomenine may alter the unbalanced neuroimmune interaction and inhibit neuroinflammation, oxidative stress, and central sensitization in chronic pain states. In conclusion, sinomenine has promising potential for chronic pain management in different clinical settings.


Assuntos
Analgésicos/farmacologia , Dor Crônica , Morfinanos/farmacologia , Neuroimunomodulação/efeitos dos fármacos , Animais , Dor Crônica/tratamento farmacológico , Dor Crônica/fisiopatologia , Humanos
15.
PLoS One ; 15(4): e0230933, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240225

RESUMO

Insomnia is a major comorbid symptom of chronic pain and is likely to affect caregiver burden. This cross-sectional study investigated the association between insomnia in chronic pain patients and family caregiver burden. Participants were 60 patients with chronic pain of ≥3 months duration. Demographic and clinical information were collected using the Athens Insomnia Scale (AIS), the Pain Disability Assessment Scale (PDAS), the Hospital Anxiety and Depression Scale (HADS), and a pain intensity numerical rating scale (NRS). Family members who accompanied chronic pain patients to hospital completed the Zarit Burden Interview (ZBI). Univariate regression analysis and multiple regression analysis were conducted to clarify the associations between ZBI scores and total/subscale AIS scores. Covariates were age; sex; pain duration; and scores on the PDAS, HADS anxiety subscale, HADS depression subscale, and NRS. Insomnia was independently associated with ZBI scores [ß: 0.27, 95% confidence interval (CI): 0.07-0.52, p = 0.001]. Scores on the AIS subscale of physical and mental functioning during the day were significantly associated with ZBI scores (ß: 0.32, 95% CI: 0.05-0.59, p = 0.007). In conclusion, the findings suggest that in chronic pain patients, comorbid insomnia and physical and mental daytime functioning is associated with family caregiver burden independently of pain duration, pain-related disability, and pain intensity.


Assuntos
Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Adaptação Psicológica/fisiologia , Idoso , Ansiedade/psicologia , Efeitos Psicossociais da Doença , Estudos Transversais , Depressão/psicologia , Avaliação da Deficiência , Pessoas com Deficiência/psicologia , Família/psicologia , Feminino , Humanos , Masculino , Medição da Dor/estatística & dados numéricos , Qualidade de Vida/psicologia , Inquéritos e Questionários
16.
Medicine (Baltimore) ; 99(15): e19621, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282709

RESUMO

Although lumbopelvic stability exercise improves lumbopelvic motor control function in patients with chronic low back pain (CLBP), the difference in lumbopelvic motor control function between the patients with CLBP and the healthy controls is unclear. The purpose of this study was to compare lumbopelvic motor control function between patients with CLBP and healthy controls and to determine the prevalence of CLBP according to core stability function.For this study, 278 participants were recruited, including patients with CLBP (n = 137) and healthy controls (n = 141). The participants performed a core stability function test and were classified to either the low or high core stability function group according to their core stability function for CLBP prevalence analysis.Lumbopelvic motor control was significantly higher in the healthy controls than in patients with CLBP. Of the patients in the low lumbopelvic motor control function group, 65.9% had CLBP, whereas 36.8% of the patients in the high lumbopelvic motor control function group had CLBP. Lumbopelvic motor control function demonstrated a significant difference between the patients with CLBP and the healthy controls. The lumbopelvic motor control function test was demonstrated to be an effective diagnostic tool for distinguishing CLBP. This information can be applied in assessments and interventions for CLBP in clinical settings.


Assuntos
Dor Crônica/fisiopatologia , Dor Lombar/fisiopatologia , Músculo Esquelético/fisiopatologia , Equilíbrio Postural , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Arch Phys Med Rehabil ; 101(8): 1304-1312, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32325162

RESUMO

OBJECTIVE: To assess the effectiveness of an individualized comprehensive rehabilitation program (ICPR) on impaired postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain. DESIGN: Randomized controlled trial. SETTING: Women with chronic pelvic pain were recruited from the Gynecology Department of the University Hospital San Cecilio in Granada, Spain. PARTICIPANTS: Participants (N=38) who were randomly divided into 2 groups. INTERVENTIONS: The intervention group received an 8-week ICRP, and the control group received a leaflet with ergonomic information. MAIN OUTCOME MEASURES: The main outcomes included were postural control (Mini Balance Evaluation Systems [Mini BESTest] and timed Up and Go [TUG]), pain (Brief Pain Inventory), self-perceived health status (EuroQol 5 dimensions [EQ-5D]), and functionality (Oswestry Disability Index [ODI]). RESULTS: Significant differences were found between groups in the Mini BESTest and TUG scores with large effect sizes. The Brief Pain Inventory, EQ-5D, and ODI also presented significant differences in the between-groups analysis, with better scores in the intervention group after treatment. In the follow-up analysis, significant differences were found between groups in the Mini BESTest (P<.001), the cognitive TUG subscale (P=.032), interference of pain (P<.001), anxiety and depression (P=.001), and visual analog scale EQ-5D (P=.026) subscales, as well as the ODI (P<.001). CONCLUSIONS: Our results show significant improvements on postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain who received an 8-week ICRP.


Assuntos
Dor Crônica/reabilitação , Dor Pélvica/reabilitação , Modalidades de Fisioterapia , Equilíbrio Postural , Adulto , Dor Crônica/fisiopatologia , Avaliação da Deficiência , Teste de Esforço , Feminino , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Dor Pélvica/fisiopatologia , Desempenho Físico Funcional , Método Simples-Cego
18.
Proc Natl Acad Sci U S A ; 117(18): 10015-10023, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312809

RESUMO

Chronic pain is a highly prevalent disease with poorly understood pathophysiology. In particular, the brain mechanisms mediating the transition from acute to chronic pain remain largely unknown. Here, we identify a subcortical signature of back pain. Specifically, subacute back pain patients who are at risk for developing chronic pain exhibit a smaller nucleus accumbens volume, which persists in the chronic phase, compared to healthy controls. The smaller accumbens volume was also observed in a separate cohort of chronic low-back pain patients and was associated with dynamic changes in functional connectivity. At baseline, subacute back pain patients showed altered local nucleus accumbens connectivity between putative shell and core, irrespective of the risk of transition to chronic pain. At follow-up, connectivity changes were observed between nucleus accumbens and rostral anterior cingulate cortex in the patients with persistent pain. Analysis of the power spectral density of nucleus accumbens resting-state activity in the subacute and chronic back pain patients revealed loss of power in the slow-5 frequency band (0.01 to 0.027 Hz) which developed only in the chronic phase of pain. This loss of power was reproducible across two cohorts of chronic low-back pain patients obtained from different sites and accurately classified chronic low-back pain patients in two additional independent datasets. Our results provide evidence that lower nucleus accumbens volume confers risk for developing chronic pain and altered nucleus accumbens activity is a signature of the state of chronic pain.


Assuntos
Dor nas Costas/fisiopatologia , Dor Crônica/fisiopatologia , Giro do Cíngulo/fisiopatologia , Núcleo Accumbens/fisiopatologia , Adulto , Dor nas Costas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Dor Crônica/diagnóstico por imagem , Feminino , Giro do Cíngulo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/fisiopatologia , Vias Neurais/fisiopatologia , Núcleo Accumbens/diagnóstico por imagem , Fatores de Risco
20.
Am J Obstet Gynecol ; 223(3): 350-371, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32151612

RESUMO

OBJECTIVE: The objective of the study was to synthesize the epidemiological findings for the associations between dysmenorrhea, including primary dysmenorrhea and endometriosis-associated dysmenorrhea and any chronic pain conditions, including chronic pelvic pain, and chronic nonpelvic pain. DATA SOURCES: The data sources included PubMed, Embase, and CINAHL from inception to December 2019. STUDY ELIGIBILITY CRITERIA: The study criteria included observational population-based studies in which the relationship between dysmenorrhea and the presence or severity of chronic pain was examined. STUDY APPRAISAL AND SYNTHESIS METHODS: Each study was double coded and evaluated for bias based on the modified Newcastle and Ottawa Scale. Random-effect meta-analyses were conducted to quantify the associations between dysmenorrhea and the presence of chronic pelvic and nonpelvic pain. RESULTS: Out of 9452 records, 32 studies were included, with 14 reporting associations between dysmenorrhea and chronic pelvic pain, and 20 for dysmenorrhea and chronic nonpelvic pain. Primary dysmenorrhea and endometriosis-associated dysmenorrhea were examined in 7 studies, respectively. More than 30% of the studies were categorized as poor quality, 56% as moderate, and 12.5% as high. Dysmenorrhea was positively associated with both the presence and severity of chronic pelvic and nonpelvic pain conditions. Based on 6689 women from 8 studies, those with chronic pelvic pain had 2.43 (95% confidence interval, 1.98-2.99, I2, 42%) times the odds of having dysmenorrhea compared with those without. Based on 3750 women from 11 studies, those with chronic nonpelvic pain had 2.62 (95% confidence interval, 1.84-3.72, I2, 72%) times the odds of having dysmenorrhea compared with those without. Overall, dysmenorrhea was associated with 2.50 (95% confidence interval, 2.02-3.10) times the odds of chronic pain, which did not differ by chronic pelvic vs chronic nonpelvic pain, community vs clinical populations, or different geographical regions. CONCLUSIONS: Dysmenorrhea may be a general risk factor for chronic pain, although whether primary dysmenorrhea increases the risk for chronic pain is unclear. Given that adolescence is a sensitive period for neurodevelopment, elucidating the role of primary dysmenorrhea in pain chronicity in future longitudinal studies is important for preventing both chronic pelvic and nonpelvic pain.


Assuntos
Dor Crônica/epidemiologia , Dismenorreia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/fisiopatologia , Dismenorreia/fisiopatologia , Endometriose/complicações , Endometriose/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Dor Pélvica/epidemiologia , PubMed , Adulto Jovem
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