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This study explores the biomechanics underlying the sit-to-stand (STS) functional maneuver in chronic LBP patients to understand how different spinal disorders and levels of pain severity relate to unique compensatory biomechanical behaviors. This work stands to further our understanding of the relationship between spinal loading and symptoms in LBP patients.
Learn More >Behavioral symptoms, including mood disorders, substantially impact the quality of life of patients with inflammatory bowel disease (IBD), even when clinical remission is achieved. Here, we used multimodal magnetic resonance imaging (MRI) to determine if IBD is associated with changes in the structure and function of deep gray matter brain regions that regulate and integrate emotional, cognitive, and stress responses.
Learn More >The real-world use of triptans in the treatment of migraine is disappointing. Only 12% of the Danish migraine population purchased a triptan between 2014 and 2019, and only 43% repurchased a triptan after first prescription. The aim of the present study was to assess whether physicians and patients adhere to the therapeutic guideline on acute migraine treatment. We interviewed 299 triptan experienced participants with migraine and 101 triptan naïve participants with migraine from the Danish Migraine Population Cohort, using a semi-structured questionnaire. Descriptive statistical analyses were used to study the association with triptan use and the assessed factors. Among triptan naïve participants with migraine, 64% had consulted their general practitioner about their migraine, of whom only 23% received information about the possibility of triptan treatment. Among triptan experienced participants, 77% had only tried one type of triptan. Only 12% could recall they had been informed by their general practitioner to try each triptan three times before giving up. Twenty percent were informed to try three different triptans in total, if the first did not work. In disagreement with the guideline, participants who reported a low pain reduction by a triptan had only tried one type of triptan. Our study shows a low adherence to therapeutic guideline for the attack treatment of migraine. There is a need for better education of general practitioners regarding treatment of migraine. Future campaigns should aim to inform both the public and the general practitioner about antimigraine treatments.
Learn More >Multisensory sensitivity (MSS) to non-painful stimuli has been identified as a risk factor for the presence of coexisting chronic pain conditions (COPCs). However, it remains unclear whether MSS can differentiate pain phenotypes involving different levels of central sensitivity. Both pain-free and those with chronic pain, particularly fibromyalgia (FM), migraine or low back pain (LBP) were recruited, with pain co-morbidities assessed. MSS was highest in FM, followed by migraine, then LBP, and lowest in pain-free individuals (adjusted between condition Cohen's d = 0.32 – 1.2, p ≤ 0.0007). However, when secondly grouping patients by total number of pain comorbidities reported, those with a single pain condition (but not FM) did not have significantly elevated MSS versus pain-free individuals (adj d= 0.17, p = 0.18). Elevated MSS scores produced increased odds of having 2 or more pain comorbidities; OR [95%CI] =2.0 [1.15, 3.42] without, and 5.6 [2.74, 11.28], with FM (p ≤ 0.0001). Further, those with low MSS levels were 55% – 87% less likely to have ≥ 2 pain comorbidities with or without FM (OR 0.45 [0.22, 0.88] to 0.13 [0.05, 0.39]; p ≤ 0.0001). Our findings support that MSS can differentiate between pain phenotypes with different degrees of expected central mechanism involvement, and also serves as a risk and resilience marker for total COPCs. This supports the use of MSS as a marker of heightened central nervous system processing, and thus may serve as a clinically feasible assessment to better profile pain phenotypes with the goal of improving personalized treatment.
Learn More >The aim of this work was to explore the expression of miR-320a level in fibromyalgia patients in comparison to healthy controls, and to clarify its impact on the severity of symptoms and the cerebral processing of pain assessed by middle latency somatosensory evoked potentials (SSEPs).
Learn More >Autonomic nervous system dysfunction has been implicated in chronic whiplash-associated disorder (WAD). However, the relationship between autonomic variables (e.g., resting heart rate and blood pressure) and clinical factors in chronic WAD is not well understood. This study sought to examine the associations between resting heart rate, resting blood pressure, pain processing and psychological variables in chronic WAD and in pain-free controls.
Learn More >Individuals experience chronic pain differently, not only based on different clinical diagnosis, but also on differing degrees of influence by biopsychosocial pain modulators. We aimed to cluster chronic pain patients into distinct subgroups based on psychosocial characteristics and pain intensity, and subsequently examined group differences in pain-related interference approximately one year later.
Learn More >Opioids are often the mainstay of postoperative pain management, despite strong evidence of their ill effects and potential for long-term addiction. The goal of this study was to quantify opioid use and contrast pain management strategies of multiple international institutions performing fibula free flap reconstruction. A retrospective multicenter cohort study was designed, including five international centers. For inclusion, the patients had to have undergone a primary fibula free flap reconstruction of the mandible. A total of 185 patients were included. The median opioid use across all centers at 72 hours was 133 oral morphine equivalents. The highest utilization was in the USA (P < 0.001), which was approximately six times that of Italy, four times that of Argentina, and twice that of India, despite all centers performing a similar procedure. Based on this study there are clear differences in prescribing practices and ideologies among surgeons from different countries.
Learn More >The aim of this study was to investigate alterations of the glymphatic system function in patients with cluster headache.
Learn More >Polymerization of deoxygenated hemoglobin S (HbS) underlies the pathophysiology of sickle cell disease (SCD). In activating red blood cell pyruvate kinase and glycolysis, mitapivat (AG-348) increases adenosine triphosphate (ATP) levels and decreases the 2,3-diphosphoglycerate (2,3-DPG) concentration, an upstream precursor in glycolysis. Both changes have therapeutic potential for patients with SCD. Here, we evaluated the safety and tolerability of multiple ascending doses of mitapivat in adults with SCD (HbSS) with no recent blood transfusions or changes in hydroxyurea (HU) or L-glutamine therapy. Seventeen subjects were enrolled, 1 subject was withdrawn shortly after starting the study. Sixteen subjects completed 3 ascending dose levels of mitapivat (5 mg, 20 mg and 50 mg, twice daily (BID)) for 2 weeks each; following a protocol amendment, the dose was escalated to 100 mg BID in 9 subjects. Mitapivat was well-tolerated at all dose levels, with the most common treatment-emergent adverse events (AEs) being insomnia, headache, and hypertension. Six serious AEs (SAEs) included 4 vaso-occlusive crises (VOCs), non-VOC-related shoulder pain, and a pre-existing pulmonary embolism. Two VOCs occurred during drug taper and were possibly drug-related; no other SAEs were drug-related. Mean hemoglobin increase at the 50 mg BID dose level was 1.2 g/dL, with 9/16 (56.3%) patients achieving a hemoglobin response of ≥ 1 g/dL increase compared to baseline. Mean reductions in hemolytic markers and dose-dependent decreases in 2,3-DPG and increases in ATP were also observed. This study provides proof of concept that mitapivat has disease-modifying potential in patients with SCD. (Investigator-sponsor; ClinicalTrials.gov NCT04000165).
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