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Finding an effective preventive agent for the individual migraineur is often long and frustrating. An individual-specific, efficacy-predicting tool, would be invaluable in directing, shortening, and improving this process. As the serotonin norepinephrine reuptake inhibitors (SNRI) duloxetine is a pain modulator, we hypothesized that pro-nociceptivity will directly predict drug efficacy, so that the more pro-nociceptive the patient is, the more efficacious the drug. Therefore, we used psychophysical pain measures to predict duloxetine efficacy in migraine prevention.
Learn More >Imaging of the living human brain is a powerful tool to probe the interactions between brain, gut and microbiome in health and in disorders of brain-gut interactions, in particular IBS. While altered signals from the viscera contribute to clinical symptoms, the brain integrates these interoceptive signals with emotional, cognitive and memory related inputs in a non-linear fashion to produce symptoms. Tremendous progress has occurred in the development of new imaging techniques that look at structural, functional and metabolic properties of brain regions and networks. Standardisation in image acquisition and advances in computational approaches has made it possible to study large data sets of imaging studies, identify network properties and integrate them with non-imaging data. These approaches are beginning to generate brain signatures in IBS that share some features with those obtained in other often overlapping chronic pain disorders such as urological pelvic pain syndromes and vulvodynia, suggesting shared mechanisms. Despite this progress, the identification of preclinical vulnerability factors and outcome predictors has been slow. To overcome current obstacles, the creation of consortia and the generation of standardised multisite repositories for brain imaging and metadata from multisite studies are required.
Learn More >As a complex multidimensional construct, fatigue may play an important role in the physical and psychosocial functioning of youth with chronic pain. Based on a model previously tested in adults, the current study similarly utilized Patient-Reported Outcomes Measurement System (PROMIS) to examine how fatigue contributes to functional outcomes for youth with chronic pain. The model tested self-reported ratings of pain intensity, depressive symptoms, and sleep disturbance as predictors of outcomes (mobility, pain-related interference, and school functioning) as mediated by ratings of fatigue.
Learn More >Consultation-based reassurance for patients with low back pain (LBP) in primary care has been shown to be associated with patients' outcomes. Little is known about the role of reassurance in people with LBP consulting with orthopaedic spinal care teams. Reassurance may be important, especially in cases where surgery is not indicated and patients are discharged without treatment.
Learn More >Experimental and clinical studies suggest that the low-affinity N-methyl-d-aspartate (NMDA) receptor open-channel blockers Mg and memantine are effective in reducing trigeminal nociceptive activation. The aim of the present study was to investigate the apparent effectiveness of these channel blockers using a model of trigeminal activation in vivo. Rats were anesthetized before electrically stimulating the dura mater adjacent the middle meningeal artery. Neurons responding to stimulation were recorded extracellularly using electrophysiological methods while l-glutamate or NMDA and Mg , memantine, or sodium controls were applied locally using microiontophoresis. Microiontophoretic application of Mg or memantine into the trigeminocervical complex inhibited mechanically and electrically-stimulated craniovascular afferent, l-glutamate, or NMDA-evoked neuronal activity at the second order trigeminal synapse of craniovascular afferents. By contrast, intravenous administration of MgSO (100 mg/kg) or memantine (10 mg/kg) did not significantly affect electrically-stimulated afferent-evoked activity within the trigeminocervical complex. The Mg and memantine concentrations achieved after systemic administration may not effectively inhibit activation of the trigeminocervical complex, perhaps providing an explanation for the relatively poor efficacy of these NMDA receptor open-channel blockers for headache treatment in clinical studies. Nevertheless, the present results suggest blocking of NMDA-receptor open channels inhibits nociceptive activation of the trigeminocervical complex. Further exploration of such channel blockers as a therapeutic strategy for primary head pain is warranted. This article is protected by copyright. All rights reserved.
Learn More >Nocebo hyperalgesia (i.e., increased pain sensitivity based on expectations) can be induced by conditioning, but is supposed to be mediated by conscious expectation. Although recent evidence points to the feasibility of subliminal conditioning of nocebo hyperalgesia with masked faces, face processing might be a special case and the practical implications of subliminal conditioning remain questionable. This study aimed to implicitly condition nocebo hyperalgesia using supraliminal cues.
Learn More >As opioid abuse and addiction have developed into a major national health crisis, prescription of opioids for pain management has become more controversial. However, opioids do help some patients by providing pain relief and improving the quality of life. To better understand the addictive properties of opioids under chronic pain conditions, we used a conditioned place preference (CPP) paradigm to examine the rewarding properties of morphine in rats with persistent nociception.
Learn More >Calcitonin gene-related peptide has emerged as a therapeutic target in migraine. Monoclonal antibodies and small molecule receptor antagonists (gepants) directed against CGRP have been approved or are in Phase II or III clinical trials. For monitoring the long-term safety of these drugs, it is helpful to consider the role of CGRP in brain functioning.
Learn More >It is expected that the number of surgical procedures to diagnose, treat, and palliate cancers will increase in the near future. While many of those interventions can be performed with minimally invasive techniques, others require surgical large incisions and in some instances, they involve multiple areas of the body (i.e., tumor resections with flap reconstructions). Pain after major oncological procedures can be severe and many times difficult to treat as patients can present to the operating room with several conditions including preoperative pain (i.e., rapidly growing tumors and painful neuropathies), opioid tolerance, and contraindications to nonopioid analgesics or regional anesthesia. Inadequately treated postoperative pain is associated with activation of the sympathetic system, postoperative complications, large perioperative opioid use, and an increased risk of developing postoperative persistent pain. Furthermore, it has been theorized that poorly treated pain is associated with cancer recurrence and a reduced survival. Lastly, recent research questions the oncological safety of robotic surgery in gynecological procedures and indicates the need of open surgeries, which will be associated with an increased risk in moderate-to-severe postoperative pain. In conclusion, the management of acute postoperative pain in patients with cancer can be challenging.
Learn More >Cluster headache is the most severe primary headache disorder. A genetic basis has long been suggested by family and twin studies; however, little is understood about the genetic variants that contribute to cluster headache susceptibility.
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