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The search for an ideal biomarker for migraine has persisted for a long time. There is plentiful evidence of potential biomarkers for migraine found in cerebrospinal fluid, blood and saliva.
Learn More >Chronic pain is a highly prevalent and debilitating condition, and there is a pressing need to find safe, effective and affordable treatments to tackle this public health issue. This pilot study aimed to assess whether therapeutic exercises supplemented by transcutaneous electrical nerve stimulation induces a greater hypoalgesic effect than therapeutic exercises supplemented by sham transcutaneous electrical nerve stimulation, in an elderly population suffering from chronic pain. Eighteen elderly participants suffering from chronic pain completed a therapeutic exercise program consisting of 45-min group sessions administered twice a week for 4 weeks. Half of the participants received real transcutaneous electrical nerve stimulation during the exercise sessions, while the others received sham transcutaneous electrical nerve stimulation. Participants completed pain questionnaires (McGill Pain Questionnaire, Brief Pain Inventory, Beck Depression Index) before and after the intervention, and recorded their pain levels on an 11-point numerical rating scale before and after each session (Clinical Trial.Gov ID: NCT02445677). Our results suggest that supplementing exercise sessions with transcutaneous electrical nerve stimulation does not improve the long-term outcomes of elderly patients suffering from chronic pain, but does induce short-term hypoalgesia during exercise sessions. Our study also offers valuable guidelines for the implementation of a future and adequately powered study looking at this research question.Implications for rehabilitationThe application of transcutaneous electrical nerve stimulation during exercises is well tolerated by elderly individuals suffering from chronic pain.Supplementing exercises with transcutaneous electrical nerve stimulation does not seem to improve general outcome in elderly suffering from chronic pain.Notwithstanding, the addition of transcutaneous electrical nerve stimulation tends to produce a marked hypoalgesic effect during the exercise sessions, an effect that could prompt indirect benefits for pain patients.
Learn More >Although pain is among the most common symptoms reported by patients, primary care practitioners (PCPs) face substantial challenges identifying and assessing pain.
Learn More >The hypothalamus has been suggested to be important in the initiation cascade of migraine attacks based on clinical and biochemical observations. Previous imaging studies could not disentangle the changes due to the attack and those due to the trigger compound. With a novel approach, we assessed hypothalamic neuronal activity in early premonitory phases of glyceryl-trinitrate (GTN)-induced and spontaneous migraine attacks. We measured the hypothalamic blood oxygen level-dependent (BOLD) response to oral glucose ingestion with 3T-functional MRI in 33 women, 16 with migraine without aura and 11 controls group-matched for age and BMI, on one day without prior GTN-administration, and on a second day after GTN-administration (to coincide with the premonitory phase of an induced attack). Interestingly, subgroups of patients with and without GTN-triggered attacks could be compared. Additionally, five migraineurs were investigated in a spontaneous premonitory phase. Linear mixed models were used to study between- and within-group effects. Without prior GTN-infusion, the BOLD-response to glucose was similar in migraine participants and controls (P = 0.41). After prior GTN-infusion, recovery occurred steeper and faster in migraineurs (versus day 1; P < 0.0001) and in those who developed an attack versus those who did not (P < 0.0001). Prior GTN-infusion did not alter the glucose-induced response in controls (versus baseline; P = 0.71). Just before spontaneous attacks, the BOLD-response recovery was also faster (P < 0.0001). In this study, we found new and direct evidence of altered hypothalamic neuronal function in the immediate preclinical phase of both GTN-provoked and spontaneous migraine attacks.
Learn More >Isolated injuries to the lateral cutaneous nerve (LCNC) branch of the common peroneal nerve can cause obscure chronic posterolateral knee and upper calf pain and sensory symptoms. Routine examination and electrodiagnostic testing do not detect them because the LCNC has no motor distribution and it is not interrogated by typical peroneal nerve conduction study. There are only about 10 prior cases-thus scant physician awareness-so most LCNC injuries remain misdiagnosed or undiagnosed, hindering care.
Learn More >Endometriosis is a disease of reproductive age characterized by chronic pelvic pain and infertility. Its pathogenesis is complex and still partially unexplained. However, there is increasing evidence of the role of chronic inflammation, immune system dysregulation, and oxidative stress in its development and progression. The latter appears to be involved in multiple aspects of the disease. Indeed, disease progression sustained by a hyperproliferative phenotype can be related to reactive oxygen species (ROS) imbalance, as numerous experiments using drugs to counteract hyperproliferation have shown in recent years. Chronic pelvic pain is also associated with cell function dysregulation favoring chronic inflammation and oxidative stress, specifically involving macrophages and mast cell activation. Moreover, there is increasing evidence of a role for ROS and impaired mitochondrial function not only as deleterious effectors of the ovarian reserve in patients with endometriomas but also in terms of oocyte quality and, hence, embryo development impairment. Targeting oxidative stress looks to be a promising strategy to both curb endometriotic lesion progression and alleviate endometriosis-associated symptoms of chronic pain and infertility. More investigations are nevertheless needed to develop effective therapeutic strategies for clinical application.
Learn More >Chronic orofacial pain conditions can be particularly difficult to diagnose and treat because of their complexity and limited understanding of the mechanisms underlying their aetiology and pathogenesis. Furthermore, there is considerable variability between individuals in their susceptibility to risk factors predisposing them to the development and maintenance of chronic pain as well as in their expression of chronic pain features such as allodynia, hyperalgesia and extraterritorial sensory spread. The variability suggests that genetic as well as environmental factors may contribute to the development and maintenance of chronic orofacial pain. This article reviews these features of chronic orofacial pain, and outlines findings from studies in animal models of the behavioural characteristics and underlying mechanisms related to the development and maintenance of chronic orofacial pain and trigeminal neuropathic pain in particular. The review also considers the role of environmental and especially genetic factors in these models, focussing on findings of differences between animal strains in the features and underlying mechanisms of chronic pain. These findings are not only relevant to understanding underlying mechanisms and the variability between patients in the development, expression and maintenance of chronic orofacial pain, but also underscore the importance for considering the strain of the animal to model and explore chronic orofacial pain processes.
Learn More >In 2016, the Center for Disease Control and Prevention released an opioid prescribing guideline for primary care in response to opioid overdose deaths. Despite efforts to encourage safer prescribing practices, experts and federal agencies suspect prescribing guidelines may be misapplied in clinical practice, resulting in abrupt tapering from opioid therapy. Although state laws likely influence prescriber behavior, little is known about state tapering laws. Thus, we examined the scope and variation of state tapering laws compared with federal opioid guidelines.
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