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Pain catastrophizing is linked to a range of negative health and treatment outcomes, although debate continues about how best to define and treat it, since most interventions produce only modest benefit. This study aimed to contribute to theory-driven development of these treatments by exploring the role of perseverative thinking in pain catastrophizing, along with the higher order beliefs, called metacognitions, that might shape it.
Learn More >Pain is the most frequently occurring complication of sickle cell disease (SCD) and the leading cause of hospitalizations for affected individuals. Acute pain episodes are also an independent predictor of mortality in individuals with SCD. The pathophysiology of pain in SCD is complex and has been attributed to several biologic factors, including oxidative stress, vaso-occlusion, ischemia-reperfusion injury and inflammation. In spite of this complex biology, painful events requiring hospitalization are simplistically referred to as "acute vaso-occlusive pain episodes" by the hematology community, and subgroups of pain in SCD have not been formally classified. Neuropathic pain is an emerging unique SCD pain phenotype that could be a result of these biologic drivers in SCD. Neuropathic pain is caused by a lesion or disease of the somatosensory nervous system and has been estimated to occur in approximately 25-40% of adolescents and adults with SCD. Diagnostic modalities for neuropathic pain, including validated questionnaires incorporating pain descriptors, quantitative sensory testing and functional neuroimaging, have been evaluated in small to medium-sized cross-sectional studies of adolescents and adults with SCD. However, these diagnostic tests are not currently used in the routine care of individuals with SCD. Age, female gender and hydroxyurea use have been reported to be positively associated with neuropathic pain in SCD, although modifiable risk factors for the prevention of neuropathic pain in this population have not been identified. A few early phase studies have begun to investigate neuropathic pain-specific medications in individuals with SCD. However, evidence-based strategies to target neuropathic pain in SCD are lacking, and the existing literature suggests that neuropathic pain-specific medications are highly underutilized in individuals with SCD. We will review the epidemiology, underlying biology and therapeutic interventions for diagnosis and treatment of neuropathic pain in SCD. We will also highlight opportunities to address critical gaps in knowledge that remain for this under-recognized cause of SCD morbidity.
Learn More >Chronic inflammatory demyelinating polyneuropathy (CIDP) causes weakness which adversely impacts function and quality of life (QOL). CIDP often requires long-term management with intravenous or subcutaneous immunoglobulin. The Polyneuropathy and Treatment with Hizentra (PATH) study showed subcutaneous immunoglobulin (SCIG) was efficacious in CIDP maintenance. Here, we assess patient-reported outcomes in patients on SCIG.
Learn More >Interdisciplinary pain rehabilitation programs are an evidence-based biopsychosocial treatment approach for chronic pain. The purpose of the current study is to assess outcomes for a 10-week interdisciplinary, Acceptance and Commitment Therapy (ACT)-based, outpatient treatment model and to evaluate the relationship between psychological process variables (i.e., pain catastrophizing, pain acceptance, pain self-efficacy) and treatment outcomes.
Learn More >Chronic itch is a highly debilitating symptom among patients with inflammatory skin diseases. Recent studies have revealed that gastrin-releasing peptide (GRP) and its receptor (gastrin-releasing peptide receptor [GRPR]) in the spinal dorsal horn (SDH) play a central role in itch transmission.
Learn More >Injuries typically result in the development of neuropathic pain, which decreases in parallel with wound healing. However, the pain may remain after the injury appears to have healed, which is generally associated with an ongoing underlying pro-inflammatory state. Injury induces many cells to release factors that contribute to the development of a pro-inflammatory state, which is considered an essential first step towards wound healing. However, pain elimination requires a transition of the injury site from pro- to anti-inflammatory. Therefore, developing techniques that eliminate chronic pain require an understanding of the cells resident at and recruited to injury sites, the factors they release, that promote a pro-inflammatory state, and promote the subsequent transition of that site to be anti-inflammatory. Although a relatively large number of cells, factors, and gene expression changes are involved in these processes, it may be possible to control a relatively small number of them leading to the reduction and elimination of chronic neuropathic pain. This first of two papers examines the roles of the most salient cells and mediators associated with the development and maintenance of chronic neuropathic pain. The following paper examines the cells and mediators involved in reducing and eliminating chronic neuropathic pain.
Learn More >To determine preliminary outcomes of a treatment for refractory pediatric migraine that integrates outpatient dihydroergotamine (DHE) infusion with interdisciplinary adjunctive care.
Learn More >Systematic review with meta-analysis and meta-regression.
Learn More >Oral sucrose is commonly used to provide analgesia to neonates during painful procedures, such as venepuncture. The additional benefits of reducing pain during venepuncture when oral sucrose is combined with nonpharmacological strategies have not been extensively studied. This randomized controlled trial compared the efficacy of oral sucrose with nonnutritive sucking vs. oral sucrose with nonnutritive sucking plus "holding-cuddling" for pain management during venepuncture in term infants from birth to 3 months of life. Seventy-eight infants were equally randomized to receive 24% oral sucrose with nonnutritive sucking (control group) or 24% oral sucrose with nonnutritive sucking plus "holding-cuddling" (being held in a secure, cuddling position; experimental group) before venepuncture. Behavioral response to pain was measured by the 0-10 ranking scale "acute pain for neonates (APN)" at 30 and 60 s after venepuncture. Within the study sample, APN scores were ≥ 2 for 32/68 (47%) infants. "Holding-cuddling" did not significantly reduce mean APN scores at 30 and 60 s, but the rate of infants experiencing a high pain score (APN ≥ 8) at 60 s after the venepuncture was significantly lower in the experimental group compared to controls [4/34 vs. 12/34 ( = 0.04)]. Venepuncture is a painful procedure in newborn and young infants. The implementation of behavioral strategies in association with oral sucrose may mitigate pain during this procedure. This trial was registered at http://clinicaltrials.gov/ (NCT number 02803723).
Learn More >Migraine is a chronic dysfunction characterized by recurrent pain, but its pathogenesis is still unclear. As a result, more and more methods have been focused on the study of migraine in recent years, including functional magnetic resonance imaging (fMRI), which is a mainstream technique for exploring the neural mechanisms of migraine. In this paper, we systematically investigated the fMRI functional connectivities (FCs) between large-scale brain networks in migraine patients from the perspective of multi-channel hierarchy, including static and dynamic FCs of group and individual levels, where the brain networks were obtained using group independent component analysis. Meanwhile, the corresponding topology properties of static and dynamic FCs networks in migraine patients were statistically compared with those in healthy controls. Furthermore, a graph metrics based method was used to detect the potential brain functional connectivity states in dynamic FCs at individual and group levels, and the corresponding topology properties and specificity of these brain functional connectivity states in migraine patients were explored compared with these in healthy controls. The results showed that the dynamic FCs and corresponding global topology properties among nine large-scale brain networks involved in this study have significant differences between migraine patients and healthy controls, while local topological properties and dynamic fluctuations were easily affected by window-widths. Moreover, the implicit dynamic functional connectivity patterns in migraine patients presented specificity and consistency under different window-widths, which suggested that the dynamic changes in FCs and topology structure between them played a key role in the brain functional activity of migraine. Therefore, it may be provided a new perspective for the clinical diagnosis of migraine.
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