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1.
J Headache Pain ; 20(1): 115, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842742

RESUMO

BACKGROUND: Many single nucleotide polymorphisms (SNPs) have been reported to be associated with migraine susceptibility. However, evidences for their associations with migraine endophenotypes or subtypes are scarce. We aimed to investigate the associations of pre-identified migraine susceptibility loci in Taiwanese with migraine endophenotypes or subtypes, including chronic migraine and allodynia. METHODS: The associations of six SNPs identified from our previous study, including TRPM8 rs10166942, LRP1 rs1172113, DLG2 rs655484, GFRA1 rs3781545, UPP2 rs7565931, and GPR39 rs10803531, and migraine endophenotypes, including chronic migraine and allodynia were tested. Significant associations in the discovery cohort were validated in the replication cohort. The adjusted odds ratios (aOR) were calculated after controlling for confounders. RESULTS: In total, 1904 patients (mean age 37.5 ± 12.2 years old, female ratio: 77.7%) including 1077 in the discovery cohort and 827 in the replication cohort were recruited. Of them, 584 (30.7%) had chronic migraine. Of the 6 investigated SNPs, TRPM8 rs10166942 T allele-carrying patients were more likely to have chronic migraine than non-T allele carriers in both discovery and replication cohorts and combined samples (33.7% vs. 25.8%, p = 0.004, aOR = 1.62). In addition, T allele carriers reported more allodynic symptoms than non-T allele carriers (3.5 ± 3.7 vs. 2.6 ± 2.8, p < 0.001). However, allodynia severity did not differ between episodic and chronic migraine patients. No further correlations between genetic variants and endophenotypes were noted for the other SNPs. CONCLUSIONS: TRPM8 may contribute to the pathogenesis of chronic migraine. However, our study did not support allodynia as a link between them. The underlying mechanisms deserve further investigations.


Assuntos
Variação Genética/genética , Estudo de Associação Genômica Ampla/métodos , Hiperalgesia/genética , Transtornos de Enxaqueca/genética , Polimorfismo de Nucleotídeo Único/genética , Canais de Cátion TRPM/genética , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Predisposição Genética para Doença/epidemiologia , Predisposição Genética para Doença/genética , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Taiwan/epidemiologia
2.
Eur J Pharmacol ; 862: 172631, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31472119

RESUMO

This study assessed the participation of spinal TWIK-related acid-sensitive K+ channels 1 and 3 (TASK-1 and TASK-3) in inflammatory (formalin test) and neuropathic (spinal nerve ligation, SNL) pain in rats. Intrathecal pre-treatment (-10 min) with the TASK-1 blocker ML365 or TASK-3 blocker PK-THPP, but not vehicle, enhanced in a dose-dependent manner 1% formalin-induced acute and long-lasting secondary mechanical allodynia and mechanical hyperalgesia in rats. In contrast, intrathecal pre-treatment with terbinafine, an activator of TASK-3, reduced formalin-induced flinching and allodynia/hyperalgesia. Both blockers and terbinafine had similar effects on female and male rats. In addition, intrathecal injection of ML365 or PK-THPP blocked the terbinafine-induced antiallodynic effect in neuropathic rats, but they did not modify baseline withdrawal threshold in naïve or sham-operated rats. TASK-1 and TASK-3 mRNA and protein were expressed in L4 and L5 dorsal root ganglia (DRG) and dorsal and ventral spinal cord of naïve animals. Interestingly, formalin injection increased TASK-1 expression in ipsilateral L5 DRG, but not in the spinal cord. Moreover, formalin injection transiently enhanced TASK-3 expression in ipsilateral L5 DRG and dorsal spinal cord. In contrast, SNL down-regulated TASK-3 expression in the ipsilateral L4 and L5 DRG but not in dorsal or ventral spinal cord, while SNL did not modify TASK-1 expression at any tissue. The pharmacological and molecular results suggest that TASK-1 and TASK-3 have a relevant antinociceptive role in inflammatory and neuropathic pain.


Assuntos
Hiperalgesia/patologia , Inflamação/patologia , Neuralgia/patologia , Canais de Potássio de Domínios Poros em Tandem/metabolismo , Animais , Modelos Animais de Doenças , Regulação para Baixo , Feminino , Formaldeído/administração & dosagem , Gânglios Espinais/patologia , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/etiologia , Inflamação/induzido quimicamente , Inflamação/complicações , Injeções Espinhais , Ligadura/efeitos adversos , Masculino , Neuralgia/diagnóstico , Neuralgia/etiologia , Medição da Dor , Canais de Potássio de Domínios Poros em Tandem/agonistas , Canais de Potássio de Domínios Poros em Tandem/antagonistas & inibidores , Ratos , Ratos Sprague-Dawley , Medula Espinal/cirurgia , Terbinafina/administração & dosagem
3.
Pain Pract ; 19(8): 811-820, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31231923

RESUMO

INTRODUCTION: Topical capsaicin is commonly employed to experimentally induce central sensitization (CS) in humans. While previous studies have investigated the effect of skin preheating on the sensitizing effect of capsaicin, no studies have compared the synergistic effect of skin preheating on the magnitude of sensitization via topical capsaicin within the first 30 minutes of application. We tested the hypothesis that skin preheating potentiates the sensitizing effect of topical capsaicin by evoking a larger region of secondary hyperalgesia vs. topical capsaicin alone. METHODS: Twenty young, healthy subjects each received topical capsaicin (Zostrix HP 0.075%) only (CAP), topical capsaicin with preheating (CAP + HEAT), and topical nonsensitizing placebo cream (CON) in a crossover design. Capsaicin and placebo creams were applied to a 50 cm2 area of the dorsal forearm. The CAP + HEAT session also included a 10-minute preheating session. Regions of secondary hyperalgesia were assessed using mechanical brush allodynia testing, and skin temperature was assessed via infrared thermography. Outcomes were normalized to baseline and compared at 10, 20, and 30 minutes after cream application. RESULTS: The CAP + HEAT session led to a significantly larger area of secondary hyperalgesia compared to the CAP session as measured by brush allodynia (CON: 0 ± 0 cm; CAP: 2.08 ± 0.45 cm; CAP + HEAT: 3.70 ± 0.46 cm; P < 0.05) and skin temperature (CON: -2.92% ± 0.03%; CAP: -0.63% ± 0.09%; CAP + HEAT: 2.50% ± 0.11%; ( of baseline) P < 0.05). CONCLUSION: Preheating amplifies the sensitizing effect of topical capsaicin within 30 minutes of application. The heat-capsaicin technique may be employed to assess differing magnitudes of CS induction and enables future studies investigating the development and progression of CS in humans.


Assuntos
Capsaicina/toxicidade , Sensibilização do Sistema Nervoso Central/efeitos dos fármacos , Temperatura Alta/efeitos adversos , Hiperalgesia/induzido quimicamente , Medição da Dor/métodos , Pele/efeitos dos fármacos , Adulto , Sensibilização do Sistema Nervoso Central/fisiologia , Estudos Cross-Over , Feminino , Voluntários Saudáveis , Humanos , Hiperalgesia/diagnóstico , Masculino , Adulto Jovem
4.
Musculoskelet Sci Pract ; 41: 55-63, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010570

RESUMO

PURPOSE: Cold hyperalgesia is an indicator of widespread pain sensitivity and is associated with poor clinical outcomes. Menthol activates TRPM8, a cold-sensing receptor channel. This research evaluated topical menthol as a potential stimulus to be used in the clinical evaluation of cold hyperalgesia. METHODS: Participants were 59 pain free volunteers (17 male: 42 female). A blinded, repeated measures design was used. Participants received applications of menthol at different concentrations in a liquid (study 1) or gel (study 2) formulation with a 24-h interval between each application. Each menthol concentration was applied for 15 min and participants were asked to rate the sensation produced using a series of visual analogue scales and by selecting words from a descriptor list derived from the McGill pain questionnaire (MPQ). The menthol was applied to a site on the volar forearm. Participants also had their cold pain thresholds (CPT) evaluated at the same site using a contact thermode. RESULTS: There were significant concentration-dependent effects for intensity of cold, unpleasantness and pain VAS: cold F(2,62) = 8.67, p < 0.001; unpleasantness χ2(2) = 14.14, p < 0.001; χ2(2) = 11.74, p = 0.003, with moderate effect sizes for unpleasantness and pain. There were also significant concentration dependent effects for descriptor indices, pain rating index (PRI) F(2,62) = 26.33, p < 0.001; number of words chosen (NWC) F(2,62) = 19.62, p < 0.001, with large effect sizes for 10-20% and 10-30% comparisons. Significant correlations were seen between measures of unpleasantness, pain, PRI, NWC and CPT dependent on menthol concentration. CONCLUSION: Topical menthol has potential as a stimulus to evaluate cold hyperalgesia.


Assuntos
Hiperalgesia/diagnóstico , Mentol/administração & dosagem , Medição da Dor/métodos , Limiar da Dor/efeitos dos fármacos , Células Receptoras Sensoriais/efeitos dos fármacos , Adulto , Idoso , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Pain ; 160 Suppl 1: S53-S58, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31008850

RESUMO

Mechanical allodynia is pain caused by normally innocuous mechanical stimuli and is a cardinal and intractable symptom of neuropathic pain. Roles of low-threshold mechanoreceptors (LTMRs), including Aß fibers, in mechanical allodynia have previously been proposed, but the necessity and sufficiency of LTMRs in allodynia have not been fully determined. Recent technological advances have made it possible to achieve subpopulation-specific ablation, silencing or stimulation, and to dissect and elucidate complex neuronal circuitry. Recent studies using an optogenetic approach have shown that activation of LTMRs, including Aß fibers that genetically express channelrhodopsin-2, by illuminating blue light to the skin elicit morphine-resistant withdrawal behaviors after nerve damage. Whole-cell recording has revealed that optical Aß stimulation after nerve injury causes excitation of lamina I dorsal horn neurons, which are normally silent by this stimulation. Moreover, Aß stimulation after nerve injury results in activation of central amygdaloid neurons and produces aversive behaviors. In summary, these findings indicate that optogenetics is a powerful approach for investigating LTMR-derived pain (resembling mechanical allodynia) with sensory and emotional features after nerve injury and for discovering novel and effective drugs to treat neuropathic pain.


Assuntos
Hiperalgesia/diagnóstico , Hiperalgesia/genética , Neuralgia/diagnóstico , Neuralgia/genética , Optogenética/tendências , Medição da Dor/métodos , Animais , Humanos , Hiperalgesia/metabolismo , Neuralgia/metabolismo , Optogenética/métodos , Limiar da Dor/fisiologia
6.
BMC Infect Dis ; 19(1): 37, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-30626351

RESUMO

BACKGROUND: Cystic echinococcosis (CE) is a worldwide zoonosis and the liver is the most commonly affected organ. Clinical manifestations range from completely asymptomatic cysts to a potential lethal cyst rupture and anaphylaxis. CASE PRESENTATION: Severe chest allodynia was an unusual clinical presentation of hepatic cyst rupture in the retroperitoneal space, without any other specific symptoms. CE diagnosis was confirmed by computed tomography scan and magnetic resonance. The patient underwent hepatectomy with complete resolution of the neuropathic pain. CONCLUSIONS: Retroperitoneal hydatid cyst rupture is a rare event and its clinical manifestation may mimic other chest neuropathies.


Assuntos
Equinococose Hepática/complicações , Equinococose , Hiperalgesia , Tórax , Equinococose/diagnóstico , Equinococose/parasitologia , Hepatectomia , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/parasitologia , Fígado/parasitologia , Fígado/cirurgia , Tórax/parasitologia , Tórax/patologia
7.
Disabil Rehabil ; 41(8): 991-993, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29216768

RESUMO

PURPOSE: To describe the clinical manifestation and the treatment of complex regional pain syndrome type II in childhood. METHODS: Using information on the symptoms, diagnosis, rehabilitation and outcome of a young patient with complex regional pain syndrome type II. RESULTS: A 9-year -old girl had severe pain in the region of the left foot, signs of a common fibular nerve entrapment, hyperalgesia not limited to the distribution of the injured nerve, weakness and temperature asymmetry unknown origin. She consulted few doctor's before she was given the right diagnosis of complex regional pain syndrome type II. Following the diagnosis the treatment started, it included intensive physiotherapy, electrical therapy and also supportive psychological therapy. Half a year later, the patient was free of the daily pain and returned to all physical activity without any restrictions. CONCLUSIONS: The case report illustrates that peripheral nerve compression or injuries specifically, complex regional pain syndrome type II, should be taken into consideration when evaluating children with weakness and pain of the lower or upper limb. Implication of rehabilitation Raising the awareness of complex regional pain syndrome in the childhood is essential for an early diagnosis and appropriate treatment. The treatment options include early and adequate pain management inclusive electrical therapy and physiotherapy. Psychological therapy helps to avoid psychological stress reaction and the disease negative impact on the child's education and sports and the family social life.


Assuntos
Síndromes da Dor Regional Complexa , Terapia por Estimulação Elétrica/métodos , , Modalidades de Fisioterapia , Técnicas Psicológicas , Criança , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/fisiopatologia , Síndromes da Dor Regional Complexa/psicologia , Síndromes da Dor Regional Complexa/reabilitação , Exercício Físico , Feminino , Pé/inervação , Pé/fisiopatologia , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/etiologia , Hiperalgesia/terapia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/terapia , Medição da Dor/métodos , Resultado do Tratamento
8.
J Cardiothorac Vasc Anesth ; 33(3): 808-816, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30064852

RESUMO

Opioids have played in a key role in cardiac anesthesia and analgesia since the early years of cardiac surgery. Today, opioids continue to be the primary mode for analgesia in cardiac surgery, yet there is considerable variability in the choice, dose and route of used. A history of the use of opioids in cardiothoracic anesthesia is presented, followed by an examination of the differences among current opioids in use and of outcome variables important in cardiac anesthesia, such as postoperative analgesia, extubation times, fast-track cardiac anesthesia, chronic neuropathic pain, and cardioprotection. Topical issues such as the role of perioperative opioid use in the global opioid crisis, opioid-sparing techniques and novel opioids in development are also discussed.


Assuntos
Analgesia/métodos , Analgésicos Opioides/administração & dosagem , Anestesia/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Adulto , Analgesia/tendências , Analgésicos Opioides/efeitos adversos , Anestesia/tendências , Procedimentos Cirúrgicos Cardíacos/tendências , Humanos , Hiperalgesia/induzido quimicamente , Hiperalgesia/diagnóstico , Hiperalgesia/epidemiologia , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor/métodos , Manejo da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle
9.
Am J Ther ; 26(3): e397-e405, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29726847

RESUMO

BACKGROUND: Opioid-induced hyperalgesia (OIH) is a phenomenon that causes an increased pain sensitization and perception of pain to noxious stimuli secondary to opioid exposure. While this clinical effect has been described in the surgical setting, it is unclear if OIH occurs in the nonsurgical setting. STUDY QUESTION: To review the available literature which evaluated OIH in nonsurgical settings. DATA SOURCES: A comprehensive literature search was performed using PubMed (January 1946-July 2017) using a variety of keywords for OIH. This review included randomized controlled trials with objectives to identify OIH in the nonsurgical setting. The clinical outcomes of interest were identification of OIH, adverse events, and impact of OIH on opioid consumption. RESULTS: The search identified 8 studies that fulfilled the criteria. Six studies enrolled healthy male volunteers, 1 study used chronic low-back patients, and another used heroin-dependent treatment-seeking adults. Studies used various opioids and dosages, including remifentanil, alfentanil, fentanyl, morphine, methadone, and buprenorphine. Three primary experimental pain induction models were used to evaluate for OIH. Measured outcomes included hyperalgesia area, pain threshold, and pain tolerance. All 5 studies that used the electrical stimulation model identified OIH as a significant outcome. However, only 2 of 5 studies using the cold pressor model and 1 of 3 studies using the heat pressor model identified OIH. None of the trials explored clinical outcomes, such as effects on opioid consumption. CONCLUSIONS: Most included studies identified OIH as a significant outcome within the nonsurgical setting. However, due to conflicting conclusions and various limitations, the clinical impact of OIH could not be assessed. Clinicians should monitor for effects of OIH in the nonoperative setting because there is insufficient evidence from the available literature to conclude that OIH is consistently observed in this setting.


Assuntos
Analgésicos Opioides/efeitos adversos , Hiperalgesia/induzido quimicamente , Manejo da Dor/efeitos adversos , Limiar da Dor/efeitos dos fármacos , Dor/tratamento farmacológico , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/fisiopatologia , Manejo da Dor/métodos
10.
J Oral Facial Pain Headache ; 32(4): 400-408, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30365576

RESUMO

AIMS: To investigate the test-retest reliability of mechanical sensitivity mapping in the masseter and temporomandibular joint (TMJ) regions between sessions, days, and examiners with a fixed and standardized pressure stimulus, as well as to compare mechanical sensitivity between sides and sites. METHODS: A total of 20 healthy young volunteers participated. Pressure stimulation was applied to 15 sites in the masseter region with a Palpeter device of 1.0-kg force and to 9 sites in the TMJ region with a Palpeter of 0.5-kg force. All participants were tested twice in two separate sessions on the same day by Examiner 1 with an interval of 3 hours between tests. After 1 week, the protocol was repeated in the same manner in two separate sessions by Examiner 1 and Examiner 2 (one session each). RESULTS: Analysis of variance (ANOVA) of numeric rating scale (NRS) scores and center of gravity (COG) values in both regions showed no significant main effects of examiner, day, or session (P ≥ .167). The test-retest reliability of data implied excellent agreement (intra-class correlation coefficients all > 0.75) between different examiners, days, and sessions. In addition, the ANOVA of the mean NRS scores in both regions showed significant main effects of site (P = .001). CONCLUSION: This feasible and reliable technique may provide a new tool for comprehensive evaluation of mechanical allodynia and hyperalgesia in the orofacial region, which are common features related to temporomandibular disorders and other chronic craniofacial pain conditions.


Assuntos
Dor Facial/diagnóstico , Hiperalgesia/diagnóstico , Músculo Masseter/fisiologia , Estimulação Física/métodos , Pressão , Transtornos da Articulação Temporomandibular/diagnóstico , Articulação Temporomandibular/fisiologia , Adulto , Grupo com Ancestrais do Continente Asiático , Dor Facial/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Hiperalgesia/fisiopatologia , Masculino , Músculo Masseter/fisiopatologia , Reprodutibilidade dos Testes , Limiar Sensorial , Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto Jovem
11.
Curr Osteoporos Rep ; 16(6): 763-771, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30370434

RESUMO

PURPOSE OF REVIEW: The goal of this review is to provide a broad overview of the current understanding of mechanisms underlying bone and joint pain. RECENT FINDINGS: Bone or joint pathology is generally accompanied by local release of pro-inflammatory cytokines, growth factors, and neurotransmitters that activate and sensitize sensory nerves resulting in an amplified pain signal. Modulation of the pain signal within the spinal cord and brain that result in net increased facilitation is proposed to contribute to the development of chronic pain. Great strides have been made in our understanding of mechanisms underlying bone and joint pain that will guide development of improved therapeutic options for these patients. Continued research is required for improved understanding of mechanistic differences driving different components of bone and/or joint pain such as movement related pain compared to persistent background pain. Advances will guide development of more individualized and comprehensive therapeutic options.


Assuntos
Artralgia/etiologia , Hiperalgesia/complicações , Articulações/inervação , Nociceptividade/fisiologia , Medição da Dor/métodos , Artralgia/diagnóstico , Artralgia/fisiopatologia , Osso e Ossos/fisiopatologia , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/fisiopatologia , Articulações/fisiopatologia
12.
Brain Inj ; 32(13-14): 1866-1878, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30346868

RESUMO

Blast-induced traumatic brain injury (blast-TBI) is associated with vestibulomotor dysfunction, persistent post-traumatic headaches and post-traumatic stress disorder, requiring extensive treatments and reducing quality-of-life. Treatment and prevention of these devastating outcomes require an understanding of their underlying pathophysiology through studies that take advantage of animal models. Here, we report that cranium-directed blast-TBI in rats results in signs of pain that last at least 8 weeks after injury. These occur without significantly elevated behavioural markers of anxiety-like conditions and are not associated with glial up-regulation in sensory thalamic nuclei. These injuries also produce transient vestibulomotor abnormalities that resolve within 3 weeks of injury. Thus, blast-TBI in rats recapitulates aspects of the human condition.


Assuntos
Lesões Encefálicas/complicações , Dor Facial/etiologia , Reflexo Vestíbulo-Ocular/fisiologia , Transtornos das Sensações/etiologia , Análise de Variância , Animais , Traumatismos por Explosões/complicações , Lesões Encefálicas/etiologia , Adaptação à Escuridão/fisiologia , Modelos Animais de Doenças , Comportamento Exploratório/fisiologia , Hiperalgesia/diagnóstico , Hiperalgesia/etiologia , Masculino , Aprendizagem em Labirinto , Neuroglia/metabolismo , Neuroglia/patologia , Medição da Dor , Limiar da Dor/fisiologia , Estimulação Física/efeitos adversos , Equilíbrio Postural , Ratos , Ratos Long-Evans , Teste de Desempenho do Rota-Rod , Tálamo/patologia , Fatores de Tempo
13.
Sci Rep ; 8(1): 14002, 2018 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-30228362

RESUMO

Detection of cold allodynia is a very important aspect in the study of pain behavior. An effective and concise device for detecting cold pain has always been the hope of many researchers. Here, an easily produced and operated cold plate device is presented for the assessment of cold allodynia in mice. The device used to detect cold allodynia has two components: a chamber consists of a cylinder for animal experiment and a cube box around the chamber for holding ice to keep temperature stable. In the testing chamber, a mouse was placed on the circular plexiglass plate steady at 4 °C above ice for five minutes. The tested mouse will lift its paw when exposed to the cold plate. The number of lifts will present animal's response to the degree of cold stimulation. To evaluate this approach, three commonly used pain models of mice were tested: formalin test, bone cancer pain (BCP), and chronic constriction injury (CCI). As is reported in other literatures, these three pain mice models showed increased sensitivity to cold stimulation. The new device is indeed suitable for detecting cold allodynia behavior in mice. Comparisons with existing devices of detecting cold allodynia, such as the cold plate in the market (UGO, Panlab, Columbus, etc.), the new device has the advantages of low cost, simple operation and easy popularization and can detect cold allodynia behavior of mice very well. This is a very practical and economical device to detect cold allodynia behavior.


Assuntos
Dor do Câncer/complicações , Carcinoma Pulmonar de Lewis/fisiopatologia , Temperatura Baixa , Constrição Patológica/complicações , Modelos Animais de Doenças , Hiperalgesia/diagnóstico , Medição da Dor/instrumentação , Animais , Comportamento Animal , Hiperalgesia/etiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Medição da Dor/métodos
14.
Br J Dermatol ; 179(5): 1157-1162, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30113701

RESUMO

BACKGROUND: Sensitive skin syndrome (SSS) is defined as the occurrence of unpleasant sensations (itch, pain, burning, prickling) in response to stimuli that should not normally cause such sensations. Previous studies show that SSS could be a small fibre neuropathy, but quantitative sensory testing (QST) is lacking. OBJECTIVES: Using QST, to determine the presence or absence of tactile sensitivity disorder, mainly heat pain threshold (HPT), in patients with SSS. METHODS: This monocentric case-control study included 21 patients with SSS and 21 controls. The patients underwent QST. Neuropathic pain was assessed by two questionnaires: the Douleur Neuropathique 4 (DN4) and the Neuropathic Pain Symptom Inventory (NPSI). RESULTS: Forty-two patients were included in the study. The HPT was significantly lower in the cases (14·5 ± 2·8) than in the controls (17·8 ± 2·5) (P < 0·001). Intermediate pain (HPT 5·0) was also significantly decreased in patients with SSS. The DN4 and NPSI scores were significantly higher in the cases than in the controls. CONCLUSIONS: The decrease in HPT in patients with SSS compared with controls suggests the presence of hyperalgesia, probably due to the damage of C-fibres. These findings, as well as the increased DN4 and NPSI scores, strengthen the neuronal hypothesis of SSS and are new arguments for consideration of SSS as small fibre neuropathy.


Assuntos
Hiperalgesia/diagnóstico , Neuralgia/diagnóstico , Pele/inervação , Neuropatia de Pequenas Fibras/diagnóstico , Adulto , Estudos de Casos e Controles , Temperatura Baixa/efeitos adversos , Feminino , Humanos , Hiperalgesia/etiologia , Pessoa de Meia-Idade , Neuralgia/etiologia , Medição da Dor , Limiar da Dor , Neuropatia de Pequenas Fibras/etiologia , Inquéritos e Questionários/estatística & dados numéricos , Síndrome , Vibração/efeitos adversos , Adulto Jovem
15.
J Neurosci Methods ; 308: 192-196, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30102954

RESUMO

BACKGROUND: Preclinical studies measure withdrawal responses to evoking thermal and mechanical stimuli instead of the more clinically important spontaneous pain. NEW METHOD: Therefore, we studied the effect of peripheral inflammation induced by intraplantar administration of complete Freund's adjuvant (CFA) in mice on the variability of temperature and bioimpedance as an index of pain produced by inflammation. To this end, we initially determined mathematical scores based on changes in temperature and bioimpedance (STB) for animals with an inflamed paw and compared these scores with commonly used measures of inflammatory pain. We then pharmacologically validated the tool using dexamethasone. RESULTS: The STB analysis resembled the response found in the von Frey Hair (vFH) test. The CFA-induced increase in STB and vFH tests were reversed by intraperitoneal administration of dexamethasone. The correlation between the STB and vFH measurements showed a high correlation coefficient (R2 = 0.911, p < 0.001). COMPARISON WITH EXISTING METHOD: Our results also demonstrated that CFA paw injection induced mechanical hyperalgesia in mice and remained virtually unaltered during all time-points tested for 5 days, as measured with vFHs. The administration of CFA into the paw induced a large increase in paw volume that was apparent 1 and 5 days after the injection. The CFA injection resulted in a significant (p < 0.05) decrease in the response latency to the heat stimulus, as evaluated on day 4 post-CFA injection. CONCLUSIONS: The data presented here suggest that STB may provide a novel non-invasive approach for inflammatory pain detection.


Assuntos
Analgesia/métodos , Anti-Inflamatórios/administração & dosagem , Hiperalgesia/diagnóstico , Inflamação/complicações , Medição da Dor/métodos , Animais , Dexametasona/administração & dosagem , Adjuvante de Freund/administração & dosagem , Temperatura Alta , Hiperalgesia/etiologia , Inflamação/induzido quimicamente , Masculino , Camundongos , Nociceptividade/fisiologia
16.
BMC Musculoskelet Disord ; 19(1): 307, 2018 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-30144797

RESUMO

BACKGROUND: Pain in osteoarthritis (OA) remains poorly understood. Different types of somatosensory alterations exist in OA including hyperesthesia and increased sensitivity to painful stimuli as well as those of decreased sensitivity to cutaneous stimuli including vibratory perception threshold. The relationship between these different somatosensory measures has not been previously evaluated in OA. In this observational study, we evaluated relationships between vibratory perception (VPT), pressure pain detection thresholds (PPT), allodynia and subjective pain in knee OA. METHODS: Forty-two persons with moderate to severe knee OA and 12 controls without OA were evaluated. VPT was measured using a biothesiometer. Allodynia was measured by application of a 60 g Von Frey monofilament repeatedly to predetermined sites. PPTs were measured using a pressure algometer. RESULTS: Increased vibratory acuity was associated with lower PPTs and presence of allodynia. Allodynia was more common in OA than controls (54.8% vs 16.6%, p = 0.024 in the ipsilateral knee, and 42.9% vs 0%, p = 0.005 in the contralateral knee). OA participants with allodynia had lower PPTs than those without allodynia. In those with OA, spontaneous knee pain was associated with lower PPTs and with allodynia. CONCLUSION: This study confirms the presence of somatosensory alterations in OA. Sensory alterations (vibratory perception) were shown to be related to nociceptive alterations (sensitization) in OA, showing a general increased sensitivity to cutaneous mechanical stimulation. Understanding these relationships is an important step in delineating the complicated pathophysiology of pain processing in OA.


Assuntos
Hiperalgesia/diagnóstico , Osteoartrite do Joelho/diagnóstico , Medição da Dor/métodos , Dor/diagnóstico , Vibração , Feminino , Humanos , Hiperalgesia/epidemiologia , Hiperalgesia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/fisiopatologia , Dor/epidemiologia , Dor/fisiopatologia , Distúrbios Somatossensoriais/diagnóstico , Distúrbios Somatossensoriais/epidemiologia , Distúrbios Somatossensoriais/fisiopatologia
17.
PLoS One ; 13(8): e0201354, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30091986

RESUMO

OBJECTIVE: Complex Regional Pain Syndrome (CRPS), a chronic pain condition, develops mainly after limb trauma and severely inhibits function. While early diagnosis is essential, factors for CRPS onset are elusive. Therefore, identifying those at risk is crucial. Sensory modulation dysfunction (SMD), affects the capacity to regulate responses to sensory input in a graded and adaptive manner and was found associated with hyperalgesia in otherwise healthy individuals, suggestive of altered pain processing. AIM: To test SMD as a potential risk factor for CRPS. METHODS: In this cross-sectional study, forty-four individuals with CRPS (29.9±11 years, 27 men) and 204 healthy controls (27.4±3.7 years, 105 men) completed the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS). A physician conducted the CRPS Severity Score (CSS), testing individuals with CRPS. RESULTS: Thirty-four percent of the individuals with CRPS and twelve percent of the healthy individuals were identified to have SMD (χ2 (1) = 11.95; p<0.001). Logistic regression modeling revealed that the risk of CRPS is 2.68 and 8.21 times higher in individuals with sensory over- and sensory under-responsiveness, respectively, compared to non-SMD individuals (p = 0.03 and p = 0.01, respectively). CONCLUSIONS: SMD, particularly sensory under-responsiveness, might serve as a potential risk factor for CRPS and therefore screening for SMD is recommended. This study provides the risk index probability clinical tool a simple evaluation to be applied by clinicians in order to identify those at risk for CRPS immediately after injury. Further research is needed.


Assuntos
Traumatismos do Braço/complicações , Síndromes da Dor Regional Complexa/epidemiologia , Hiperalgesia/epidemiologia , Traumatismos da Perna/complicações , Transtornos das Sensações/epidemiologia , Adulto , Doença Crônica/epidemiologia , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/etiologia , Síndromes da Dor Regional Complexa/prevenção & controle , Estudos Transversais , Feminino , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/etiologia , Hiperalgesia/prevenção & controle , Masculino , Medição da Dor , Fatores de Risco , Transtornos das Sensações/complicações , Transtornos das Sensações/diagnóstico , Índice de Gravidade de Doença , Distúrbios Somatossensoriais , Adulto Jovem
18.
Pain ; 159(11): 2375-2382, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30015708

RESUMO

Enhanced sensitivity to light (photophobia) and patterns is common in migraine and can be regarded as visual allodynia. We aimed to develop and validate a questionnaire to easily quantify sensitivity to light and patterns in large populations, and to assess and compare visual allodynia across different migraine subtypes and states. We developed the Leiden Visual Sensitivity Scale (L-VISS), a 9-item scale (score range 0-36 points), based on literature and patient interviews, and examined its construct validity. Furthermore, we assessed ictal and interictal visual sensitivity in episodic migraine with (n = 67) and without (n = 66) aura and chronic migraine with (n = 20) and without (n = 19) aura, and in healthy controls (n = 86). Differences between migraine subtypes and states were tested using a linear mixed model with 3 fixed factors (episodic/chronic, with/without aura, and ictal/interictal). Test-retest reliability and construct validity of L-VISS were good. Leiden Visual Sensitivity Scale scores correlated in the expected direction with light discomfort (Kendall's τ = -0.25) and pattern glare tests (τ = 0.35). Known-group comparisons confirmed its construct validity. Within migraine subtypes, L-VISS scores were higher in migraine with aura versus without aura and in chronic versus episodic migraine. The linear mixed model showed all factors affected the outcome (P < 0.001). The L-VISS is an easy-to-use scale to quantify and monitor the burden of bothersome visual sensitivity to light and patterns in large populations. There are remarkable ictal and interictal differences in visual allodynia across migraine subtypes, possibly reflecting dynamic differences in cortical excitability.


Assuntos
Hiperalgesia/diagnóstico , Hiperalgesia/etiologia , Transtornos de Enxaqueca/classificação , Transtornos de Enxaqueca/fisiopatologia , Estimulação Luminosa/efeitos adversos , Percepção Visual/fisiologia , Adulto , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários
19.
Pain Physician ; 21(3): E247-E256, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29871380

RESUMO

BACKGROUND: Hypersensitivity of the central nervous system to environmental and chemical stimuli is a clinical feature of central sensitization mechanisms that can be assessed with the central sensitization inventory (CSI). OBJECTIVE: The aim was to determine prevalence rate of this feature and explore the treatment-, patient-, pain-, and psychosocial-related variables associated with the degree of self-reported signs of central sensitization, assessed with the CSI (0-100), in breast cancer survivors at long-term. STUDY DESIGN: Cross-sectional study. SETTING: University Hospitals, Leuven, Belgium. METHODS: One hundred and forty-six women with persistent pain, more than one year after breast cancer surgery, were included. The following factors were analyzed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy, and trastuzumab); 2) patient's related variables (age and body mass index); 3) pain-related variables (pain intensity, pain quality, primary hyperalgesia, and index of widespread pain); and 4) psychosocial variables (the degree of pain catastrophizing and vigilance and awareness to pain). The dependent variable was degree of central sensitization measured with the CSI. Additionally, a stepwise regression was performed. RESULTS: Fifty-five (38%) patients reported signs of central sensitization measured with the CSI (i.e., > 40/100). From multivariable analysis, it appears that more severe pain quality and higher levels of pain catastrophizing contribute to a higher degree of central sensitization. The stepwise regression revealed that up to 24% of variance of the CSI can be explained by these factors. LIMITATIONS: A selection bias may be present since patients were all recruited from a larger cohort participating in clinical trials on the effectiveness of physical therapy after breast cancer treatment. CONCLUSION: Signs of central sensitization cannot be neglected in breast cancer survivors at long term. More severe pain quality and pain catastrophizing contribute to higher levels of central sensitization in this population. KEY WORDS: Breast neoplasm, pain, central sensitization mechanisms, central sensitization inventory.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Sensibilização do Sistema Nervoso Central , Hiperalgesia/epidemiologia , Adulto , Idoso , Neoplasias da Mama/cirurgia , Catastrofização , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Hiperalgesia/diagnóstico , Pessoa de Meia-Idade , Prevalência , Autorrelato , Extremidade Superior
20.
Curr Opin Gastroenterol ; 34(4): 258-265, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29846258

RESUMO

PURPOSE OF REVIEW: In 2016, the Rome IV process and criteria were published. They provide a system to standardize patient diagnostic requirements for clinical studies and pharmaceutical trials on functional gastrointestinal disorders (FGIDs), which are now called disorders of gut-brain interaction (DGBI). Although the Rome criteria have limitations in clinical practice, an understanding of the criteria can help clinicians to manage symptoms in patients with DGBI, and with organic diseases as well. RECENT FINDINGS: In this report, the Rome IV criteria for esophageal DGBI, the updated algorithms for esophageal symptoms, and the multidimensional clinical profile (MDCP) are reviewed. SUMMARY: The esophageal DGBI comprise functional esophageal chest pain, functional heartburn, globus, functional dysphagia, and the newly introduced reflux hypersensitivity. They are characterized by the presence of chronic symptoms attributed to the esophagus without evidence of esophageal structural, inflammatory, or motility abnormalities. Also, Rome IV suggests for the first time the possibility that functional heartburn or reflux hypersensitivity might overlap with gastroesophageal reflux disease. Accordingly, testing with endoscopy and biopsies, esophageal pH ±â€Šimpedance monitoring and high-resolution esophageal manometry are necessary to establish esophageal DGBI diagnoses. Algorithms aid in this diagnostic process, and the MDCP that captures the full dimension of each patient's presentation is helpful in planning personalized treatment regimens.


Assuntos
Doenças do Esôfago/diagnóstico , Esôfago/fisiopatologia , Medicina de Precisão , Algoritmos , Dor no Peito/diagnóstico , Transtornos de Deglutição/diagnóstico , Doenças do Esôfago/fisiopatologia , Refluxo Gastroesofágico/diagnóstico , Azia/diagnóstico , Humanos , Hiperalgesia/diagnóstico , Guias de Prática Clínica como Assunto
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