| 1. |
- Alfvén, Gösta, et al.
(författare)
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Barn med stressutlöst smärta hade kraftigare startle-reflex
- 2017
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Återkommande stressutlöst smärta är ett närmast vardagligt fenomen. Avsaknaden av enkla test inom sjukvården för att diagnostisera stressutlöst smärta medför diagnostiska svårigheter och därmed svårigheter med handläggning. Ett grundläggande problem är att förståelse för den patofysiologiska processen bakom långvarig stressutlöst smärta saknas.Tidigare studier från samma forskare har visat att barn och tonåringar med långvarig stressutlöst smärta diagnostiserad enligt fastställda kriterier utvecklar ett karakteristiskt mönster av ömma punkter (tender points) i muskler på platser för bland annat huvudvärk, skuldersmärtor och buksmärtor nära naveln. Dessa muskler ingår i startle-reflexen, en neuromuskulär försvarsreaktion som utlöses från en kärna i hjärnstammen. Startle-reflexen startar med en blinkreflex och följs på mindre än en tiondels sekund av framåtböjning av huvudet och en nedstigande böjningsreaktion av kroppen, som sträcker sig ned till benen. Stress kan bland annat via amygdala leda till förstärkt och lättare utlöst startle-reflex.Vår hypotes var att startle-reflexen hos individer med stressutlöst smärta är mer lättutlöst och ger ett högre svar än hos friska. I en kontrollerad studie ingick 19 individer i åldern 10–17 år som hade stressutlöst återkommande smärta enligt fastställda kriterier. Gruppen jämfördes med 23 friska i jämförbar ålder, av motsvarande kön och utan smärtbesvär. Under likvärdiga, lugna förhållanden utlöstes startle-reflex vid upprepade starka auditiva signaler på 105 dB via hörlurar, och EMG registrerades från ögonblinkningsmuskeln (orbicularis oculi), tinningmuskel (temporalis), nacknära skuldermuskel (trapezius), stora bröstmuskeln (pectoralis major), bukmuskel (rectus abdominis) samt ryggmuskel (lumbala erector spinae).I smärtgruppen var muskelspänningen signifikant förhöjd i ovan nämnda muskler. Startle-reflexen utlöstes också lättare och tidigare, var kraftigare och varade längre. Muskelaktivitetsgraden efter ljudstimuli visade i smärtgruppen signifikant högre medelamplitud än i kontrollgruppen för alla sex muskler och de åtta upprepade startle-responserna sammantagna. Aktuell forskning om möjliga muskulära och centralnervösa smärtmekanismer presenteras i artikeln.För första gången har ökad muskelspänning och förstärkt startle-reaktion påvisats med EMG hos barn/ungdomar med återkommande stressutlöst smärta i ett mönster som sammanfaller med mönstret av ömma punkter och smärtlokalisation. Vår förhoppning är att dessa fynd ska stimulera till fortsatt forskning och förbättra klinisk praxis.Alfvén, G, Grillner, S, Andersson E. Eur J Pain. Epub 4 maj 2017. doi: 10.1002/ejp.1057
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| 2. |
- Alfvén, G, et al.
(författare)
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Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction.
- 2017
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 21:9, s. 1561-1570
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Children with recurrent pain of negative chronic stress origin from different locations have a characteristic pattern of tender points in the temporal, trapezoid, great pectoral and abdominal muscles. We tested the hypothesis that the startle reaction is activated in these children and that some of the startle-activated muscles are related to the tender point pattern and the recurrent pain.METHODS: In children/adolescents, aged 10-17 years, 19 with recurrent psychosomatic pain (PAIN) and 23 controls (CON) we measured and analysed resting activity and acoustic startle response with electromyography (EMG) for the muscles involved in the pattern of tender points and also the lumbar erector spinae.RESULTS: The PAIN group showed higher resting activity and higher acoustic startle response values than the CON group for all six muscles together regarding the mean amplitude in the initial 200 ms, and during the burst of activity, and longer burst duration and shorter burst latency. For PAIN versus CON, all separate muscles showed generally higher values of EMG amplitudes and burst durations, and shorter latencies for the burst onset in all measures; with significance or strong trends for several parameters and muscles.CONCLUSION: For the first time in children with recurrent psychosomatic pain, increased resting activity and potentiated startle response were demonstrated in the muscles involved in the stress tender point pattern.SIGNIFICANCE: This study demonstrates in adolescents how recurrent pain of negative stress origin from the head, stomach, back and chest is related to increased startle reaction and increased muscular tension in these regions. This study contributes to the understanding of the mechanisms underlying the global burden of recurrent pain.
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| 3. |
- Alfvén, Gösta, et al.
(författare)
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Increased muscle activity response during startle in children and adolescents with pain in the head, neck and abdomen due to stress
- 2020
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Konferensbidrag (refereegranskat)abstract
- Background: Headache of stress etiology is a common, worldwide medical problem with high sick leave and large economic consequences. There is a need to improve the understanding of underlying neurobiological processes. Research show that headache of stress etiology often is one symptom in a complex of multiple pains and augmented widespread muscular tension with a specific pattern of tender points (1). Objective and Method: We will present in children with recurrent stress related pain, some hormonal changes and electromyography (EMG) data, showing a novel and a missing link, regarding central and peripheral neurophysiological changes of significant importance for better understanding recurrent multiple pain including headache. Results: During high acoustic signals, the startle reaction was shown, via EMG, to be potentiated, more easily and more often elicited in several muscles related to the pain, in 19 children with recurrent stress related pain in the head, neck and abdomen, diagnosed according to strict defined criteria (2), and compared to 21 matched controls. Also, higher resting muscle activity was found in these children as well as increased cortisol and decreased oxytocin. Conclusion. Stressors evoke stress response for example in the amygdala, which can trigger and potentiate the startle reaction with amplified muscle excitability and tonus. These reactions and the increased cortisol and decreased oxytocin in those children are in accordance with findings of the right dominance of stress in the bi-cameral brain (3). These neurophysiological facts can be of importance for the understanding of clinical manifestation of headache and other pain and must be heeded in the treatment of patients with pain related to stress. 1.Alfven G, Grillner S, Andersson E. Review of childhood pain highlights the role of negative stress. Acta Paediatr.2019;Jun4.doi:10.1111/apa.14884.2.Alfvén G, Grillner S, Andersson E. Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction. Eur J Pain.2017;21:1561-1570.3.Strigo IA, Craig AD. Interoception, homeostatic emotions and sympathovagal balance. Philos Trans R Soc Lond B Biol Sci.2016;Nov19;371(1708).
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| 4. |
- Alfvén, Gösta, et al.
(författare)
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New Understanding of Psychosomatic Pain
- 2021
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Ingår i: Journal of Pain Management & Medicine. - : Walsh Medical Media. - 2684-1320. ; 7:3, s. 1-4
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Tidskriftsartikel (refereegranskat)abstract
- For better understanding and better care of psychosomatic pain valid and reliable diagnostic criteria is a prerequisite. The startle reflex is of importance for the understanding of the stress induced pain and the increased excitability in several muscles. The pattern of increased muscle tension and tenderness that can be found in these patterns can be of valuable diagnostic support. Decreased oxytocin and increased cortisol is a sign of right brain dominance in stress and indicate psuchosomatic pain. The omega-3 and omega-6 changes are in indication metabolic pain mechanism of interest for future study. Treatment is reccomended to be guided by the knowledge here described.
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| 5. |
- Alfven, Gösta, et al.
(författare)
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Review of childhood pain highlights the role of negative stress.
- 2019
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Ingår i: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 108:12, s. 2148-2156
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Forskningsöversikt (refereegranskat)abstract
- AIM: Recurrent pain of unknown origin is a major problem in children. The aim of the present review was to examine the hypothesis of negative stress as an aetiology of recurrent pain from different aspects.METHODS AND RESULTS: Epidemiological studies, clinical experience and hormonal data give support for such a hypothesis. Negative stress as a tentative aetiology for recurrent pain is reviewed. Stress, muscular tension, the startle reaction and its tentative relation to pain is illuminated. Deviations of hormonal secretion supporting a stress aetiology is mentioned. The role of central sensitization for recurrent pain is discussed. Possible aetiological implications of recurrent pain as a local symptom or a general disorder are presented. Brain changes due to stress is shortly reviewed. Stress and pain in the clinic are highlighted. The importance of biological, psychological and social factors, as well as genetic elements, are-Ddiscussed.CONCLUSION: Stress elicits neurobiological mechanisms. They may lead to many neurophysiological deviances. Increase of muscle tension and neuromuscular excitability and enhanced startle reaction may be of importance for recurring pain. The identification of stress as a primary cause of recurrent pain can have huge implications for understanding signs and treatment in clinical practice. This article is protected by copyright. All rights reserved.
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| 6. |
- Alfvén, Gösta, et al.
(författare)
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Stress and recurrent abdominal pain.
- 2023
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 112:11, s. 2312-2316
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Tidskriftsartikel (refereegranskat)abstract
- We discuss the aetiology of recurrent abdominal pain of non-organic origin, according to the Rome Criteria for Functional Gastrointestinal Disorders and a psychogenic hypothesis. Stress activates the brain-gut axis, which is important for local gut symptoms, such as abdominal pain, but it also causes pain in other areas, including the head, back and chest. Our research has indicated that the startle reflex plays a dominant role in this stress-induced pain pattern, which is manifested in the whole body. Localised abdominal pain can be part of a general negative stress reaction that causes multiple pains in other areas of the body.
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| 7. |
- Alfvén, G, et al.
(författare)
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The Dangerous Staircase of Stress
- 2021
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Ingår i: Anesthesia & Pain Research. - : SciVision Publishers. - 2639-846X. ; 5:2, s. 1-6
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Chronic negative stress may be the start of a progress of illness, that may end in serious troubles for the affected. In this Perspective we highlight the steps in such a progress, what we call a staircase of stress. This underlines the importance of recognition, understanding and therapeutic measures at an early stage of the stress disorders.
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| 8. |
- Alfvén, Gösta, et al.
(författare)
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Understanding pain of stress etiology, comprising changes in muscle excitability, hormones and the nervous system.
- 2020
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Konferensbidrag (refereegranskat)abstract
- G. Alfvén1, E. Andersson2, 31. Clintec, Karolinska Institute, Stockholm, Sweden. 2. The Department of Neuroscience, Karolinska institute, Stockholm, Sweden. 3. The Swedish School of Sport and Health Sciences, Stockholm, Sweden.Corresponding author: G Alfvén (gosta.alfven@slmk.org) Karolinska Institute, SwedenABSTRACT Background: Recurrent pain of stress etiology is a common, worldwide problem with impaired quality of life and decreased school attendance. Research show that pain of stress etiology, often called psychosomatic pain, often is a complex of multiple pains, other symptoms and augmented widespread muscular tension with a specific pattern of tender points (1). Objective and Method: We will in a clinical context present electromyography (EMG) data, showing a novel and a missing link, regarding central and peripheral neurophysiological changes of significant importance for better understanding recurrent multiple pain. Results: During high acoustic signals, the startle reaction was shown, via EMG, to be potentiated, more easily and more often elicited in several muscles related to the pain, in 19 children with recurrent stress related pain in the head, neck and abdomen, diagnosed according to strict defined criteria (2), and compared to 23 matched controls. Also, higher resting muscle activity was shown. We will also present data showing increased cortisol and decreased oxytocin and increased risk for developing fibromyalgia in children with psychosomatic pain. Conclusion. Stressors potentiated the startle reaction with increased muscle activity in rest and increased excitability. These reactions and increased cortisol and decreased oxytocin in those children are in accordance with findings of the right dominance of stress in the bi-cameral brain (3). These neurophysiological facts can be of importance for the understanding of clinical manifestation of recurrent pain and must be heeded in the treatment of patients with pain related to stress. 1. Alfven G, Grillner S, Andersson E. Review of childhood pain highlights the role of negative stress. Acta Paediatr.2019; Jun4.doi:10.1111/apa.14884.2. Alfvén G, Grillner S, Andersson E. Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction. Eur J Pain.2017;21:1561-1570.3. Strigo IA, Craig AD. Interoception, homeostatic emotions and sympathovagal balance. Philos Trans R Soc Lond B Biol Sci.2016;Nov19;371(1708).
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| 9. |
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| 10. |
- Alfvén, Gösta, et al.
(författare)
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Understanding stress comprising changes in muscle excitability, hormones and the nervous system.
- 2020
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Konferensbidrag (refereegranskat)abstract
- G. Alfvén1, E. Andersson2, 31. Clintec, Karolinska Institute 2. Department of Neuroscience, Karolinska institute, 3. Swedish School of Sport and Health Sciences, -all Stockholm, Sweden.Corresponding author: G Alfvén (gosta.alfven@slmk.org) ABSTRACT Background: Negative stress is very common, always affecting brain and body resulting in different symptoms often called psychosomatic. To better understand stress, it is important to overcome the mind-body dichotomy and explore how they are connected. Objective and Method: We will present in children with recurrent stress related pain, some hormonal changes and electromyography (EMG) data, showing a novel and a missing link, regarding central and peripheral neurophysiological changes of significant importance for better understanding recurrent multiple psychosomatic pain (1). Results: During high acoustic signals, the startle reaction was shown, via EMG, to be potentiated, more easily and more often elicited in several muscles related to the pain, in 19 children with recurrent stress related pain in the head, neck and abdomen, diagnosed according to strict defined criteria (2), and compared to 21 matched controls. Also, higher resting muscle activity was found in these children as well as increased cortisol and decreased oxytocin. Conclusion. Stressors evoke stress response for example in the amygdala, which can trigger and potentiate the startle reaction with amplified muscle excitability and tonus. These reactions and the increased cortisol and decreased oxytocin in those children are in accordance with findings of the right dominance of stress in the bi-cameral brain (3). These neurophysiological facts can be of importance for the understanding of clinical manifestation of psychosomatic pain and must be heeded in the treatment of patients with pain related to stress. 1.Alfven G, Grillner S, Andersson E. Review of childhood pain highlights the role of negative stress. Acta Paediatr.2019;Jun4.doi:10.1111/apa.14884.2.Alfvén G, Grillner S, Andersson E. Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction. Eur J Pain.2017;21:1561-1570.3.Strigo IA, Craig AD. Interoception, homeostatic emotions and sympathovagal balance. Philos Trans R Soc Lond B Biol Sci.2016;Nov19;371(1708).
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