| 1. |
- Giesecke, T., et al.
(författare)
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Zentrale Schmerzverarbeitung bei chronischem Rückenschmerz : Hinweise auf verminderte Schmerzinhibition : Central pain processing in chronic low back pain : Evidence for reduced pain inhibition
- 2006
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Ingår i: Schmerz. - : Springer Science and Business Media LLC. - 0932-433X. ; 20:5, s. 411-417
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: A study of patients with low back pain (LBP) had revealed altered central pain processing. At an equal pain level LBP patients had considerably more neuronal activation in the somatosensory cortices than controls. In a new analysis of this dataset, we further investigated the differences in central pain processing between LBP patients and controls, looking for possible pathogenic mechanisms.METHODS: Central pain processing was studied by functional magnetic resonance imaging (fMRI), using equally painful pressure stimuli in a block paradigm. In this study, we reanalyzed the fMRI data to statistically compare pain-elicited neuronal activation of both groups.RESULTS: Equally painful pressure stimulation resulted in a significantly lower increase of regional cerebral blood flow (rCBF) in the periaqueductal gray (PAG) of the LBP patients. The analysis further revealed a significantly higher increase of rCBF in LBP than in HC in the primary and secondary somatosensory cortex and the lateral orbitofrontal cortex (LOFK), elicited by these same stimuli.CONCLUSIONS: These findings support a dysfunction of the inhibitory systems controlled by the PAG as a possible pathogenic mechanism in chronic low back pain.
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| 2. |
- Kundakci, Burak, et al.
(författare)
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International, multidisciplinary Delphi consensus recommendations on non-pharmacological interventions for fibromyalgia
- 2022
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Ingår i: Seminars in Arthritis & Rheumatism. - : Elsevier BV. - 0049-0172 .- 1532-866X. ; 57
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To develop evidence-based expert recommendations for non-pharmacological treatments for pain, fatigue, sleep problems, and depression in fibromyalgia.Methods: An international, multidisciplinary Delphi exercise was conducted. Authors of EULAR and the Canadian Fibromyalgia Guidelines Group, members of the American Pain Society and clinicians with expertise in fibromyalgia were invited. Participants were asked to select non-pharmacological interventions that could be offered for specific fibromyalgia symptoms and to classify them as either core or adjunctive treatments. An evidence summary was provided to aid the decision making. Items receiving >70% votes were accepted, those receiving <30% votes were rejected and those obtaining 30-70% votes were recirculated for up to two additional rounds.Results: Seventeen experts participated (Europe (n = 10), North America (n = 6), and Israel (n = 1)) in the Delphi exercise and completed all three rounds. Aerobic exercise, education, sleep hygiene and cognitive behavioural therapy were recommended as core treatments for all symptoms. Mind-body exercises were recommended as core interventions for pain, fatigue and sleep problems. Mindfulness was voted core treatment for depression, and adjunctive treatment for other symptoms. Other interventions, namely music, relaxation, hot bath, and local heat were voted as adjunctive treatments, varying between symptoms.Conclusions: This study provided evidence-based expert consensus recommendations on non-pharmacological treatments for fibromyalgia that may be used to individualise treatments in clinical practice targeting the diverse symptoms associated with fibromyalgia.
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| 3. |
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| 4. |
- Nijs, Jo, et al.
(författare)
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Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine
- 2021
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Ingår i: Lancet Rheumatology. - : Elsevier BV. - 2665-9913. ; 3:5
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Tidskriftsartikel (refereegranskat)abstract
- Chronic pain is a leading cause of disability globally and associated with enormous health-care costs. The discrepancy between the extent of tissue damage and the magnitude of pain, disability, and associated symptoms represents a diagnostic challenge for rheumatology specialists. Central sensitisation, defined as an amplification of neural signalling within the CNS that elicits pain hypersensitivity, has been investigated as a reason for this discrepancy. Features of central sensitisation have been documented in various pain conditions common in rheumatology practice, including fibromyalgia, osteoarthritis, rheumatoid arthritis, Ehlers-Danlos syndrome, upper extremity tendinopathies, headache, and spinal pain. Within individual pain conditions, there is substantial variation among patients in terms of presence and magnitude of central sensitisation, stressing the importance of individual assessment. Central sensitisation predicts poor treatment outcomes in multiple patient populations. The available evidence supports various pharmacological and non-pharmacological strategies to reduce central sensitisation and to improve patient outcomes in several conditions commonly seen in rheumatology practice. These data open up new treatment perspectives, with the possibility for precision pain medicine treatment according to pain phenotyping as a logical next step. With this view, studies suggest the possibility of matching non-pharmacological approaches, or medications, or both to the central sensitisation pain
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| 5. |
- Giesecke, T., et al.
(författare)
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Evidence of augmented central pain processing in idiopathic chronic low back pain
- 2004
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Ingår i: Arthritis Rheum. - : Wiley. - 0004-3591. ; 50:2, s. 613-23
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: For many individuals with chronic low back pain (CLBP), there is no identifiable cause. In other idiopathic chronic pain conditions, sensory testing and functional magnetic resonance imaging (fMRI) have identified the occurrence of generalized increased pain sensitivity, hyperalgesia, and altered brain processing, suggesting central augmentation of pain processing in such conditions. We compared the results of both of these methods as applied to patients with idiopathic CLBP (n = 11), patients with widespread pain (fibromyalgia; n = 16), and healthy control subjects (n = 11). METHODS: Patients with CLBP had low back pain persisting for at least 12 months that was unexplained by MRI/radiographic changes. Experimental pain testing was performed at a neutral site (thumbnail) to assess the pressure-pain threshold in all subjects. For fMRI studies, stimuli of equal pressure (2 kg) and of equal subjective pain intensity (slightly intense pain) were applied to this same site. RESULTS: Despite low numbers of tender points in the CLBP group, experimental pain testing revealed hyperalgesia in this group as well as in the fibromyalgia group; the pressure required to produce slightly intense pain was significantly higher in the controls (5.6 kg) than in the patients with CLBP (3.9 kg) (P = 0.03) or the patients with fibromyalgia (3.5 kg) (P = 0.006). When equal amounts of pressure were applied to the 3 groups, fMRI detected 5 common regions of neuronal activation in pain-related cortical areas in the CLBP and fibromyalgia groups (in the contralateral primary and secondary [S2] somatosensory cortices, inferior parietal lobule, cerebellum, and ipsilateral S2). This same stimulus resulted in only a single activation in controls (in the contralateral S2 somatosensory cortex). When subjects in the 3 groups received stimuli that evoked subjectively equal pain, fMRI revealed common neuronal activations in all 3 groups. CONCLUSION: At equal levels of pressure, patients with CLBP or fibromyalgia experienced significantly more pain and showed more extensive, common patterns of neuronal activation in pain-related cortical areas. When stimuli that elicited equally painful responses were applied (requiring significantly lower pressure in both patient groups as compared with the control group), neuronal activations were similar among the 3 groups. These findings are consistent with the occurrence of augmented central pain processing in patients with idiopathic CLBP.
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| 6. |
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| 7. |
- Foerster, B R, et al.
(författare)
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Cerebral Blood Flow Alterations in Pain-Processing Regions of Patients with Fibromyalgia Using Perfusion MR Imaging.
- 2011
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Ingår i: AJNR. American journal of neuroradiology. - 1936-959X. ; 32, s. 1873-1878
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Widespread pain sensitivity in patients with FM suggests a CNS processing problem. The purpose of this study was to assess alterations in perfusion as measured by DSC in a number of brain regions implicated in pain processing between patients with FM and healthy controls. MATERIALS AND METHODS: Twenty-one patients with FM and 27 healthy controls underwent conventional MR imaging and DSC. For DSC, 12 regions of interest were placed in brain regions previously implicated in pain processing. rCBF values were calculated for each region of interest. Subjects answered mood/pain coping questionnaires and underwent clinical/experimental pain assessment. RESULTS: There were significant correlations between the thalamic rCBF values and the pain-control beliefs of FM subjects. The strength of the relationship between clinical pain measures and thalamic rCBF values increased after adjusting for pain-control beliefs. There was a significantly different distribution pattern of rCBF values across various brain regions between the FM group and the healthy controls. There was a lower degree of correlation in the FM group between the thalamic rCBF values and the other brain regions relative to the healthy controls. CONCLUSIONS: Significant correlations were found between thalamic rCBF values and pain belief values. These data suggest that there are baseline alterations of brain perfusion in patients with FM. rCBF values of the thalami exhibited lower correlations with respect to other brain regions thought to be involved in pain processing compared with those in healthy controls.
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| 8. |
- Gerstner, G. E., et al.
(författare)
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Posterior Insular Molecular Changes in Myofascial Pain
- 2012
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Ingår i: Journal of Dental Research. - : SAGE Publications. - 0022-0345 .- 1544-0591. ; 91:5, s. 485-490
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Tidskriftsartikel (refereegranskat)abstract
- Temporomandibular disorders (TMD) include craniocervical pain conditions with unclear etiologies. Central changes are suspected; however, few neuroimaging studies of TMD exist. Single-voxel proton magnetic resonance spectroscopy (H-1-MRS) was used before and after pressure-pain testing to assess glutamate (Glu), glutamine (Gln), N-acetylaspartate (NAA), and choline (Cho) levels in the right and left posterior insulae of 11 individuals with myofascial TMD and 11 matched control individuals. Glu levels were significantly lower in all individuals after pain testing. Among those with TMD, left-insular Gln levels were related to reported pain, left posterior insular NAA and Cho levels were significantly higher at baseline than in control individuals, and NAA levels were significantly correlated with pain-symptom duration, suggesting adaptive changes. The results suggest that significant central cellular and molecular changes can occur in individuals with TMD.
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| 9. |
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| 10. |
- Kosek, Eva, et al.
(författare)
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Reply to Cohen
- 2022
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Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 1872-6623 .- 0304-3959. ; 163:4
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 11. |
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