European Journal of Pain最新文献_第6页

Neural correlates of pain acceptance and the role of the cerebellum: Comment 接受疼痛的神经相关性和小脑的作用：评论。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-03 DOI: 10.1002/ejp.4751

Hinpetch Daungsupawong, Viroj Wiwanitkit

引用次数: 0

Prescription time trends in patients with high-impact chronic pain: A National Patient Registry Study 影响较大的慢性疼痛患者的处方时间趋势：全国患者登记研究。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-28 DOI: 10.1002/ejp.4746

Karin D. Bruun, Caroline T. Thorarinsson, Henrik B. Vaegter, Floor D. Zegers, Bente M. Nørgård, Mette Wod

Background

High-impact chronic pain (HICP), defined as chronic pain with a significant impact on daily function, affects approximately 8% of the Western population. In Denmark, HICP still remains to be described at the population level. Some patients with HICP are referred to the Danish pain centres, where they are registered with a procedural code. We conducted a nationwide registry-based study of all Danish patients registered with a visit to a pain centre from January 2005 to March 2022, to explore time trends in the prescription of analgesics and sedatives in this HICP subpopulation. Furthermore, data on socioeconomics and hospital diagnoses are reported.

Methods

We used data from the Central Person Registry, the Danish National Patient Registry, the Danish National Prescription Registry, combined with data on socioeconomic information from Statistics Denmark. Data was collected on prescriptions 3 months before the first visit to a pain centre. Prescriptions were stratified into five calendar periods: before 2011, 2011–2013, 2014–2016, 2017–2019, and 2020–2022.

Results

We identified 66,577 patients referred to a pain centre. Over 15 years, prescriptions before referral declined for opioids (from 53.2% to 31.7%), NSAIDs (from 28.3% to 23.5%), antidepressants (from 20.5% to 16.8%), anxiolytics (from 12.3% to 3.2%), and sleep medication (from 15.8% to 7.6%). In contrast, prescriptions increased for paracetamol (from 31.1% to 48.9%) and gabapentinoids (from 19.2% to 27.7%).

Conclusions

In patients with HICP visiting Danish pain centres, prescriptions before referral decreased for opioids over 15 years, with a simultaneously increased prescription of gabapentinoids (gabapentin and pregabalin).

Significance Statement

This nationwide study of 66,577 Danish patients with high-impact chronic pain reveals a significant decrease in filled opioid prescriptions over the past 15 years, with a simultaneous rise in gabapentinoid use before referral to pain centres. These findings suggest a shift in clinical practice towards alternative pain management strategies. The study underscores the need for continued research into the long-term effects of these changes and their impact on patient outcomes.

背景：高影响慢性疼痛（HICP）是指对日常功能有重大影响的慢性疼痛，约占西方人口的 8%。在丹麦，HICP 仍未在人口层面上得到描述。一些 HICP 患者会被转诊到丹麦疼痛中心，并在那里进行程序代码登记。我们对 2005 年 1 月至 2022 年 3 月期间在疼痛中心登记就诊的所有丹麦患者进行了一项全国范围的登记研究，以探讨 HICP 亚群中镇痛剂和镇静剂处方的时间趋势。此外，我们还报告了有关社会经济学和医院诊断的数据：我们使用了来自中央人员登记处、丹麦全国患者登记处和丹麦全国处方登记处的数据，以及丹麦统计局提供的社会经济信息数据。我们收集了首次到疼痛中心就诊前 3 个月的处方数据。处方被分为五个日历期：2011 年前、2011-2013 年、2014-2016 年、2017-2019 年和 2020-2022 年：结果：我们确定了 66577 名转诊至疼痛中心的患者。15年间，转诊前阿片类药物（从53.2%降至31.7%）、非甾体抗炎药（从28.3%降至23.5%）、抗抑郁药（从20.5%降至16.8%）、抗焦虑药（从12.3%降至3.2%）和睡眠药物（从15.8%降至7.6%）的处方量均有所下降。相比之下，扑热息痛（从31.1%增至48.9%）和加巴喷丁类药物（从19.2%增至27.7%）的处方量有所增加：结论：在丹麦疼痛中心就诊的 HICP 患者中，阿片类药物在转诊前的处方量在 15 年内有所减少，而加巴喷丁类药物（加巴喷丁和普瑞巴林）的处方量同时有所增加：这项针对 66577 名丹麦高影响慢性疼痛患者的全国性研究显示，在过去 15 年中，阿片类药物的处方大幅减少，与此同时，在转诊至疼痛中心之前使用加巴喷丁类药物的情况有所增加。这些发现表明，临床实践正在向替代性疼痛管理策略转变。该研究强调，有必要继续研究这些变化的长期效果及其对患者预后的影响。

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引用次数: 0

The effect of stretching intensity on pain sensitivity: A randomized crossover study on healthy adults 拉伸强度对疼痛敏感性的影响：一项针对健康成年人的随机交叉研究。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-26 DOI: 10.1002/ejp.4750

Morten Pallisgaard Støve, Line Ørum Hansen, Kristian Kloppenborg Elmbæk, Stig Peter Magnusson, Janus Laust Thomsen, Allan Riis

Background

Stretching exercises have effects on local and widespread pain sensitivity. A dose–response relationship may exist between the analgesic effect and the intensity of stretching, such that a higher intensity of stretching may generate a larger reduction in analgesic response, but this remains to be studied. This study aimed to examine the dose–response relationship between stretching intensity and the analgesic effect.

Methods

A randomized, repeated-measures crossover study was performed to examine the effect of stretching to the first point of pain onset and stretching to the point of a sensation of stretching (discomfort). The primary outcome was regional and distant pressure pain thresholds.

Results

Thirty-one participants (n = 24 female) were available for analysis. We observed a 22.2% increase in regional pressure pain thresholds (93.2 kPa, p = 0.001) and a 15.0% increase in distant pressure pain thresholds (50.9 kPa, p = 0.012) following stretching to the point of stretch. We observed a 20.0% increase in regional pressure pain thresholds (90.3 kPa, p = 0.001) and a 15.1% increase in distant pressure pain thresholds (52.1 kPa, p = 0.004) following stretching to the point of pain.

Conclusions

The results showed that local and widespread pain sensitivity decreased following acute stretching, regardless of stretching intensity. No differences in pain sensitivity were found between stretching to the point of stretch or stretching to the first onset of pain. Thus, the results showed no evidence of a dose–response relationship between stretching intensity and the analgesic effect.

Significance

The study showed a significant acute hypoalgesic effect of stretching exercises regardless of stretching intensity. This may have appropriate clinical implications for patients with musculoskeletal and nociplastic pain.

背景：拉伸运动对局部和广泛的疼痛敏感性都有影响。镇痛效果与拉伸强度之间可能存在剂量-反应关系，即拉伸强度越高，镇痛反应的减弱程度越大，但这一点仍有待研究。本研究旨在探讨拉伸强度与镇痛效果之间的剂量反应关系：进行了一项随机、重复测量交叉研究，以检验拉伸至第一疼痛点和拉伸至有拉伸感（不适）点的效果。主要结果是区域和远处压力痛阈值：31名参与者（女性24人）可用于分析。我们观察到，在拉伸至拉伸点后，区域压力痛阈值（93.2 千帕，p = 0.001）增加了 22.2%，远处压力痛阈值（50.9 千帕，p = 0.012）增加了 15.0%。我们观察到，在拉伸至疼痛点后，局部压力痛阈值（90.3 kPa，p = 0.001）增加了 20.0%，远处压力痛阈值（52.1 kPa，p = 0.004）增加了 15.1%：结论：研究结果表明，无论拉伸强度如何，急性拉伸后局部和广泛的疼痛敏感性都会降低。拉伸至疼痛点与拉伸至首次出现疼痛之间的疼痛敏感性没有差异。因此，研究结果没有显示拉伸强度与镇痛效果之间存在剂量反应关系：研究表明，无论拉伸强度如何，拉伸运动都具有明显的急性低镇痛效果。这可能对肌肉骨骼和神经痛患者有适当的临床意义。

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引用次数: 0

Post-injury use of opioid analgesics in patients with traumatic injury: A registry-based study 外伤患者伤后使用阿片类镇痛药的情况：一项基于登记册的研究。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-25 DOI: 10.1002/ejp.4743

Henrik A. Torp, Svetlana O. Skurtveit, Ingebjørg Gustavsen, Jon M. Gran, Leiv A. Rosseland

Background

Opioid analgesics are commonly used to treat acute and chronic pain following traumatic injury. Psychiatric comorbidity has been reported to be associated with increased pain and persistent opioid use. Our aims were to determine the extent of post-injury opioid use and assess whether pre-injury antidepressant, benzodiazepine, and z-hypnotic drug use is associated with increased post-injury opioid use.

Methods

Data on trauma patients aged 15 years and older included in the Oslo University Hospital Trauma Registry between 2005 and 2014 was linked to data from the Norwegian Prescription Database. We identified opioid dispensing within the first 90 and 365 days following trauma and determined subsequent persistent use. Multivariable logistic regression was applied to examine associations between pre- and post-injury drug use.

Results

3912 of 11,057 patients (35.4%) had opioids dispensed within 90 days after trauma, and 4644 (42.0%) within 365 days. Among 9800 previously opioid-naïve, the proportions were 33.0% and 39.0%, respectively. One year after the first post-injury opioid dispensing, 9.6% of all opioid users and 4.5% of new users were defined as persistent users. Pre-injury benzodiazepine use and z-hypnotic use was associated with new persistent opioid use (adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.47–3.45, and aOR 2.04; 95% CI 1.33–3.13, respectively), whereas pre-injury antidepressant use was not (aOR 1.49; 95% CI 0.97–2.30).

Conclusions

Opioid use after trauma is widespread. Development of persistent use is limited, particularly in previously opioid-naïve patients. Pre-injury benzodiazepine or z-hypnotic use seem to increase odds of new persistent use.

Significance statement

This large registry-based study adds to the body of knowledge on opioid use beyond in-hospital care in patients having sustained traumatic injury, a field which is scarcely investigated and not yet fully understood. It suggests that both previous drug therapy and the nature of opioid treatment initiation may affect outcome. This will help guide clinicians in selecting the appropriate pain management in this patient group.

背景：阿片类镇痛药常用于治疗外伤后的急性和慢性疼痛。据报道，精神疾病合并症与疼痛加剧和持续使用阿片类药物有关。我们的目的是确定受伤后阿片类药物的使用程度，并评估受伤前使用抗抑郁药、苯二氮卓类药物和z-催眠药是否与受伤后阿片类药物使用增加有关：将奥斯陆大学医院创伤登记处 2005 年至 2014 年期间收录的 15 岁及以上创伤患者数据与挪威处方数据库的数据进行链接。我们确定了创伤后最初 90 天和 365 天内阿片类药物的发放情况，并确定了随后的持续使用情况。我们采用多变量逻辑回归法研究了受伤前和受伤后药物使用之间的关联：在 11,057 名患者中，有 3912 人（35.4%）在创伤后 90 天内使用过阿片类药物，有 4644 人（42.0%）在创伤后 365 天内使用过阿片类药物。在 9800 名之前未使用过阿片类药物的患者中，这一比例分别为 33.0% 和 39.0%。在受伤后首次发放阿片类药物一年后，9.6%的阿片类药物使用者和4.5%的新使用者被定义为持续使用者。受伤前苯二氮卓类药物和z-催眠药的使用与新的阿片类药物的持续使用有关（调整后的几率比[aOR]分别为2.25；95%置信区间[CI]为1.47-3.45和aOR为2.04；95%置信区间[CI]为1.33-3.13），而受伤前抗抑郁药物的使用与之无关（aOR为1.49；95%置信区间[CI]为0.97-2.30）：结论：创伤后阿片类药物的使用非常普遍。结论：外伤后阿片类药物的使用非常普遍，但持续使用的情况有限，尤其是以前未使用过阿片类药物的患者。受伤前使用苯二氮卓或z-催眠药似乎会增加新的持续使用几率：这项以登记为基础的大型研究进一步丰富了有关创伤患者在院内护理之外使用阿片类药物的知识。研究表明，既往的药物治疗和开始阿片类药物治疗的性质可能会影响治疗效果。这将有助于指导临床医生为这一患者群体选择适当的疼痛治疗方法。

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引用次数: 0

Effect of limb position change on capsaicin-evoked pain: Evidence of interplays between the vascular and nociceptive systems? 肢体位置变化对辣椒素诱发疼痛的影响：血管系统与痛觉系统相互作用的证据？

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-24 DOI: 10.1002/ejp.4742

Arthur S. Courtin, Clara Knaepen, André Mouraux, Sabien Geraldine Antonia van Neerven

Background

This experiment aimed at confirming our incidental observation that, when capsaicin is applied on the volar forearm, raising the arm to a vertical position leads to a dramatic increase in capsaicin-evoked pain and to explore possible underlying mechanisms.

Methods

Twenty healthy volunteers received a 2% capsaicin patch on one forearm and a vehicle patch on the other. Patches were kept in place for 60 min. The perception caused by the patch was assessed repeatedly before, during and after patch application, both with the arm in horizontal resting position and raised vertically. In addition, capsaicin-induced secondary hyperalgesia was assessed using mechanical pinprick stimuli. Half of the participants were seated upright while the other half were lying supine, to assess whether the effect of limb position on capsaicin-evoked pain was due to gravity.

Results

After a few minutes of patch application, raising the capsaicin-treated arm (but not the vehicle-treated arm) led to a strong increase of the pain experienced at the patch. This effect of raising the arm did not differ between participants in the supine and seated groups and is therefore likely related to the position of the arm relative to the ground rather than to the body. Mechanical secondary hyperalgesia and the arm raising effect were strongly decorrelated at the last time point after patch removal, indicating different underlying mechanisms.

Conclusion

Our results indicate that capsaicin-evoked pain can be strongly modulated by limb posture and that this effect may be caused by an interplay between vascular and nociceptive systems.

Significance Statement

Capsaicin-evoked pain can be strongly modulated by limb posture and this effect may be caused by an interplay between vascular and nociceptive systems.

实验背景本实验旨在证实我们的偶然观察结果，即在前臂外侧涂抹辣椒素后，将手臂抬高至垂直位置会导致辣椒素诱发的疼痛剧增，并探索可能的潜在机制：方法：20 名健康志愿者的一只前臂上贴有 2% 的辣椒素贴片，另一只前臂上贴有载体贴片。贴片放置 60 分钟。在贴敷前、贴敷中和贴敷后，在手臂处于水平静止位置和垂直抬起的情况下，对贴敷引起的感觉进行反复评估。此外，还使用机械针刺刺激评估了辣椒素诱发的继发性痛觉减退。一半受试者直立坐着，另一半受试者仰卧，以评估肢体位置对辣椒素诱发疼痛的影响是否是由于重力造成的：结果：贴上贴片几分钟后，抬起经过辣椒素处理的手臂（而不是经过载体处理的手臂）会导致贴片处的疼痛感强烈增加。仰卧组和坐位组的参与者抬起手臂的效果没有差异，因此可能与手臂相对于地面而不是身体的位置有关。在去除贴片后的最后一个时间点，机械性继发性痛觉减退和手臂抬高效应具有很强的相关性，这表明其潜在机制是不同的：我们的研究结果表明，辣椒素诱发的疼痛可受到肢体姿势的强烈调节，这种效应可能是由血管系统和痛觉系统之间的相互作用引起的：辣椒素诱发的疼痛可受到肢体姿势的强烈调节，这种效应可能是由血管系统和痛觉系统之间的相互作用引起的。

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引用次数: 0

Pain intensity and comorbid depressive symptoms in the general population: An analysis of the German Health Update Study (GEDA 2019/2020-EHIS) 普通人群的疼痛强度和合并抑郁症状：德国健康更新研究（GEDA 2019/2020-EHIS）分析。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-23 DOI: 10.1002/ejp.4745

Jan Niklas Ahrend, Kathrin Jobski, Carsten Bantel, Falk Hoffmann

Background

Pain and depressive symptoms often co-occur, but the influence of pain intensity remains unclear. This study analyses the association between pain intensity and depressive symptoms in the general adult German population.

Methods

Data was obtained from the cross-sectional German Health Update Study (GEDA 2019/2020-EHIS). Pain intensity in the last 4 weeks was categorized into no pain, mild, moderate, and severe. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire (PHQ-8). The prevalence of depressive symptoms was analysed including a 95% confidence interval (95% CI). A multivariable logistic regression analysed associated factors with depressive symptoms by odds ratio (OR).

Results

Of 22,708 participants (51.0% women, 35.1% aged 45–64 years), 41.2% reported no pain, 32.1% mild, 15.3% moderate, and 11.5% severe pain. Depressive symptoms were present in 8.3% overall (women 9.1%, men 7.5%). Participants with no pain, mild, moderate, and severe pain reported depressive symptoms in 2.5%, 6.5%, 14.4%, and 27.1%, respectively. In the multivariable analysis, higher pain intensity was associated with a higher risk of depressive symptoms (mild pain OR 1.8, 95% CI 1.3–2.4; moderate pain OR 2.8, 95% CI 2.0–4.0; severe pain OR 4.0, 95% CI 2.8–5.6). Depressive symptoms were further associated with a Body Mass Index (BMI) under 18.5 kg m⁻² (OR 2.4; 95% CI 1.4–4.1), but not with sex (OR 1.1; 95% CI 0.9–1.3).

Conclusions

Higher pain intensity increases the risk of depressive symptoms. We suggest regular assessment of pain and further assessment of depressive symptoms in patients with moderate or severe pain.

Significance Statement

Our study found a clear association between higher pain intensity and depressive symptoms in the general population across all types of pain. Further, being underweight was linked to depressive symptoms overall and the highest prevalence of depressive symptoms was found in underweight persons with severe pain. These findings highlight the importance of assessing depressive symptoms in patients with higher pain intensity, especially in underweight patients.

背景：疼痛和抑郁症状经常同时出现，但疼痛强度的影响仍不明确。本研究分析了德国成年普通人群中疼痛强度与抑郁症状之间的关联：数据来自横断面德国健康更新研究（GEDA 2019/2020-EHIS）。最近4周的疼痛强度分为无痛、轻度、中度和重度。抑郁症状采用 8 项患者健康问卷（PHQ-8）进行评估。抑郁症状发生率的分析包括 95% 置信区间 (95% CI)。多变量逻辑回归通过几率比（OR）分析了与抑郁症状相关的因素：在 22 708 名参与者（51.0% 为女性，35.1% 年龄在 45-64 岁之间）中，41.2% 报告无疼痛，32.1% 报告轻度疼痛，15.3% 报告中度疼痛，11.5% 报告重度疼痛。有抑郁症状的人占总人数的 8.3%（女性占 9.1%，男性占 7.5%）。无疼痛、轻度、中度和重度疼痛的参与者中，分别有 2.5%、6.5%、14.4% 和 27.1% 出现抑郁症状。在多变量分析中，疼痛强度越高，出现抑郁症状的风险越高（轻度疼痛 OR 1.8，95% CI 1.3-2.4；中度疼痛 OR 2.8，95% CI 2.0-4.0；重度疼痛 OR 4.0，95% CI 2.8-5.6）。抑郁症状还与体重指数（BMI）低于 18.5 kg m-2 有关（OR 2.4；95% CI 1.4-4.1），但与性别无关（OR 1.1；95% CI 0.9-1.3）：结论：疼痛强度越高，抑郁症状的风险越大。我们建议中度或重度疼痛患者定期进行疼痛评估，并进一步评估抑郁症状：我们的研究发现，在所有类型的疼痛中，疼痛强度越高，抑郁症状越明显。此外，体重不足与抑郁症状总体相关，而体重不足的重度疼痛患者抑郁症状发生率最高。这些发现强调了对疼痛强度较高的患者，尤其是体重不足的患者进行抑郁症状评估的重要性。

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引用次数: 0

A randomized clinical trial of emotional freedom techniques for chronic pain: Live versus self-paced delivery with 6-month follow-up 情绪自由技术治疗慢性疼痛的随机临床试验：现场授课与自学授课，6 个月随访。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-18 DOI: 10.1002/ejp.4740

Peta Stapleton, Clara Wilson, Nicola Uechtritz, Michele Stewart, Michelle McCosker, Tom O'Keefe, Matthew Blanchard

Background

Chronic pain represents a major global healthcare crisis, and current treatments are limited in effectiveness and safety. Emotional freedom techniques (EFTs) show promise as a potential psychological treatment.

Methods

The current study investigated the effect of a randomized clinical trial of EFT for chronic pain in a sample of 147 adult chronic pain sufferers (89.9% female; mean 54.63 years). Participants engaged in a 6-week EFT programme (either online self-paced or in-person).

Results

The per-protocol analysis indicated pain severity and interference scores were significantly lower at the end of treatment for the EFT group compared to waitlist, and these were sustained at follow-up. There were no differences between the in-person or self-paced programmes at follow-up for pain severity and interference. Somatic symptoms were significantly lower after EFT, although no further differences at follow-up. Quality of life scores were significantly higher after EFT, which were sustained at follow-up, and no differences between two styles of programme. No significant effects were found for anxiety, depression, happiness or satisfaction with life across the 6-week programmes for either style of delivery or at follow-up. These are discussed in terms of clinical score meanings. Intent-to-treat analysis was consistent with the per-protocol analyses. Limitations of the study are identified and future directions are discussed.

Conclusions

Findings offer early promise for EFT as a potentially effective pain management strategy, as well as support for online intervention without compromising treatment outcomes.

Significance Statement

An emerging body-based intervention for chronic pain may be a possible solution for remote clients who cannot attend in-person sessions. In this clinical trial Emotional Freedom Techniques (EFT) significantly reduced chronic pain severity and interference, and there were no differences between and online self-paced program toan online in-person EFT intervention. Both were equally effective, also enhancing quality of life without compromising outcomes. The results were significant at 6-month follow-up/. These findings highlight a body-based approach as a promising, accessible pain management strategy, and highlights that online programs may be part of the solution for chronic pain patients.

背景：慢性疼痛是全球医疗保健的一大危机，而目前的治疗方法在有效性和安全性方面都很有限。情绪自由技术（EFT）作为一种潜在的心理治疗方法前景广阔：本研究调查了在 147 名成年慢性疼痛患者（89.9% 为女性，平均 54.63 岁）中开展的 EFT 治疗慢性疼痛随机临床试验的效果。参与者参加了为期 6 周的 EFT 计划（在线自学或面对面学习）：结果：按协议分析表明，在治疗结束时，EFT组的疼痛严重程度和干扰评分明显低于候补名单组，并且在随访中保持不变。在随访中，面对面或自定进度方案在疼痛严重程度和干扰方面没有差异。EFT 治疗后，躯体症状明显减轻，但在随访时没有进一步的差异。经 EFT 治疗后，生活质量得分明显提高，并在随访中保持不变，两种治疗方式之间没有差异。对于焦虑、抑郁、幸福感或对生活的满意度，无论是哪种方式的 6 周课程或随访都没有发现明显的效果。我们将从临床评分的角度对这些影响进行讨论。意向治疗分析与按协议分析一致。本文指出了研究的局限性，并讨论了未来的研究方向：研究结果为 EFT 作为一种潜在有效的疼痛管理策略提供了早期希望，并支持在不影响治疗效果的情况下进行在线干预：一种新出现的以身体为基础的慢性疼痛干预方法可能会成为无法参加现场治疗的远程客户的一种解决方案。在这项临床试验中，情绪自由技术（EFT）显著降低了慢性疼痛的严重程度和干扰，在线自定进度程序与在线面对面 EFT 干预之间没有差异。两种方法同样有效，都能在不影响治疗效果的情况下提高生活质量。在6个月的随访中，效果显著。这些研究结果表明，以身体为基础的方法是一种很有前景的、易于接受的疼痛管理策略，并强调在线项目可能是慢性疼痛患者解决方案的一部分。

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引用次数: 0

Signs of hyperpathia in chronic peripheral neuropathic pain 慢性外周神经性疼痛中的过度紧张征兆

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-17 DOI: 10.1002/ejp.4739

Malin Erika Carmland, Melissa Dall Kreutzfeldt, Peter Kolind Brask-Thomsen, Troels Staehelin Jensen, Flemming Winther Bach, Søren Hein Sindrup, Nanna Brix Finnerup

Background

Neuropathic pain is pain due to a disease or lesion of the somatosensory system, and can be either spontaneous, evoked or both. Hyperpathia is a type of evoked pain defined by IASP as ‘a painful syndrome characterized by an abnormally painful reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold’. The literature is sparse, and definitions are unclear and inconsistent.

Methods

The aim of this study was to examine for the presence of mechanical hyperpathia in a heterogeneous group of patients with peripheral neuropathic pain and correlate signs of hyperpathia with other sensory signs. Patients were examined with graded pinprick stimuli to obtain a stimulus–response curve and repetitive pinprick stimuli to assess increase in pain over time and aftersensations. Then, patients were grouped based on the likelihood of having mechanical hyperpathia with either a steep stimulus–response curve or a steep curve on the repetitive pinprick test and results were correlated to mechanical detection and pain thresholds and other outcomes from a full quantitative sensory testing.

Results

We included 124 patients with documented peripheral neuropathic pain. Patients with a steep stimulus–response curve did not overlap with patients with a steep curve on the repetitive pinprick test and both groups more often had decreased rather than increased detection and pain thresholds.

Conclusions

Our study questions the concept of hyperpathia and suggests that more studies are needed to identify which symptoms and signs group together and might form a syndrome.

Significance Statement

Hyperpathia is a syndrome of evoked pain. It is poorly defined and little is known about its clinical presentation. Since it is part of pain symptomatology it is important to have a clear definition and understand the pathophysiology behind. This study explored signs of hyperpathia in a heterogeneous group of patients with peripheral neuropathic pain. We used stimulus–response function and repetitive pinprick stimulation to group patients based on the IASP definition. More studies are needed to understand how symptoms and signs coincide.

背景：神经病理性疼痛是由于躯体感觉系统的疾病或病变引起的疼痛，可以是自发的，也可以是诱发的或两者兼有。超病理性疼痛是诱发性疼痛的一种类型，国际疼痛学会（IASP）将其定义为 "一种疼痛综合征，其特征是对刺激（尤其是重复性刺激）的异常疼痛反应以及阈值升高"。相关文献较少，定义不明确且不一致：本研究的目的是检查不同类型的周围神经痛患者是否存在机械性过度紧张，并将过度紧张的迹象与其他感觉迹象联系起来。对患者进行分级针刺刺激检查，以获得刺激-反应曲线，并进行重复针刺刺激检查，以评估疼痛随时间推移而增加的情况和后遗症状。然后，根据刺激-反应曲线陡峭或重复针刺试验曲线陡峭的机械性神经过敏的可能性对患者进行分组，并将结果与机械检测和疼痛阈值以及全面定量感觉测试的其他结果相关联：我们纳入了124名有外周神经病理性疼痛记录的患者。刺激-反应曲线陡峭的患者与重复针刺试验曲线陡峭的患者并不重叠，两组患者的检测和疼痛阈值通常都是降低而非升高：我们的研究对 "过度紧张症 "的概念提出了质疑，并建议需要进行更多的研究，以确定哪些症状和体征组合在一起可能会形成一种综合征：过度紧张症是一种诱发疼痛的综合征。其定义尚不明确，临床表现也鲜为人知。由于它是疼痛症状学的一部分，因此明确定义并了解其背后的病理生理学非常重要。本研究探讨了外周神经病理性疼痛异质性患者群体中的过度紧张迹象。我们使用刺激-反应功能和重复针刺刺激，根据 IASP 定义对患者进行分组。要了解症状和体征是如何重合的，还需要更多的研究。

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引用次数: 0

Lower thresholds and stronger adaptation to pain in musicians reflect occupational-specific adaptations to contact heat stimulation 音乐家较低的疼痛阈值和较强的疼痛适应能力反映了接触热刺激的职业特异性适应。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-11 DOI: 10.1002/ejp.4738

Rebecca Divarco, Fabian Sternkopf, Matthias Karst, Eckart Altenmüller, Perianen Ramasawmy, Andrea Antal, André Lee

Background

Extensive audio-motor training and psychological stress can cause professional musicians acute overstrain-injury and chronic pain, resulting in damaged careers and diminished quality of life. It has also been previously shown that musicians might perceive pain differently than non-musicians. Therefore, the aim of our study was to quantify differences between musicians and non-musicians regarding their subjective responses to painful contact heat stimuli and assess how emotional traits might influence these responses.

Methods

Upon completing the StateTrait-Anxiety-Depression Inventory, 15 healthy musicians and 15 healthy non-musicians from German universities received 15 noxious contact heat stimuli at the dorsal side of each hand and foot. After each stimulation, participants were asked to provide a pain rating from 0 to 10.

Results

Musicians not only reported significantly higher pain ratings after the first stimulation but also showed a significantly higher degree of habituation compared to non-musicians. Additionally, musicians showed a significantly less pronounced difference regarding the pain rating of the hands compared to the feet than non-musicians. Trait anxiety and trait depression scores had no effect on the pain rating or the habituation.

Conclusion

The more pronounced habituation of musicians might hint at a neuroplastic nociceptive alteration in musicians. The lack of significance between the psychological traits and their effect on the pain ratings is surprising but could be a result of both participant groups having stressful careers.

Significance

The findings of this report justify musicians' repetitive sensorimotor training as an important model for plasticity and contribute to a better understanding of pain perception in musicians.

背景：大量的音频运动训练和心理压力会导致职业音乐家急性过度劳损和慢性疼痛，从而损害其职业生涯并降低其生活质量。此前也有研究表明，音乐家对疼痛的感知可能与非音乐家不同。因此，我们的研究旨在量化音乐家与非音乐家对疼痛接触热刺激的主观反应差异，并评估情绪特征如何影响这些反应：来自德国大学的 15 名健康音乐家和 15 名健康非音乐家在完成状态特质-焦虑-抑郁量表后，分别在手背和脚背接受了 15 次有害接触热刺激。每次刺激后，受试者都要给出 0 到 10 分的疼痛评分：结果：与非音乐家相比，音乐家不仅在第一次刺激后的疼痛评分明显更高，而且习惯程度也明显更高。此外，与非音乐家相比，音乐家手部与脚部的疼痛评分差异明显较小。特质焦虑和特质抑郁得分对疼痛评级和习惯化没有影响：结论：音乐家更明显的习惯化可能暗示了音乐家神经可塑性痛觉改变。心理特征及其对疼痛评级的影响之间缺乏显著性令人惊讶，但这可能是两个参与者群体的职业压力所致：本报告的研究结果证明，音乐家的重复感觉运动训练是一种重要的可塑性模型，有助于更好地理解音乐家的痛觉。

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引用次数: 0

Pain profiles and variability in temporal summation of pain and conditioned pain modulation in pain-free individuals and patients with low back pain, osteoarthritis, and fibromyalgia 无痛者和腰背痛、骨关节炎和纤维肌痛患者的疼痛特征以及疼痛和条件性疼痛调节的时间总和的变异性。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-10 DOI: 10.1002/ejp.4741

Kristian Kjær-Staal Petersen, Søren O'Neill, Morten Rune Blichfeldt-Eckhardt, Casper Nim, Lars Arendt-Nielsen, Henrik Bjarke Vægter

<div> <section> <h3> Background</h3> <p>Pain profiles (e.g. pro- and anti-nociceptive) can be developed using quantitative sensory testing (QST) but substantial variability exists. This study describes the variability in temporal summation of pain (TSP) and conditioned pain modulation (CPM) in chronic musculoskeletal pain patients, proposes cut-off values, and explores the association with clinical pain intensity.</p> </section> <section> <h3> Methods</h3> <p>This is a secondary analysis in which TSP and CPM were assessed using cuff algometry in pain-free subjects (<i>n</i> = 69), and patients with chronic low back pain (cLBP, <i>n</i> = 267), osteoarthritis (<i>n</i> = 134), and fibromyalgia (<i>n</i> = 101). Using TSP and CPM from the pain-free subjects as a reference, four distinct pain profiles TSP (low/high) and CPM (low/high) were created, and differences in clinical pain between pain profiles were explored.</p> </section> <section> <h3> Results</h3> <p>Individual data revealed large inter-person variability. High TSP and low CPM were found in fibromyalgia (<i>p</i> < 0.01) and osteoarthritis (<i>p</i> < 0.01) but not cLBP when compared to pain-free subjects. The proportion of patients classified into the distinct pain profiles was significantly different (<i>p</i> < 0.001) with the largest proportion in the high TSP and low CPM group in fibromyalgia (52.5%) and osteoarthritis (41.4%). Clinical pain was not significantly different comparing the pain profiles, and no significant correlations were observed between clinical pain and TSP or CPM.</p> </section> <section> <h3> Conclusion</h3> <p>These results demonstrated substantial inter-person variability in TSP and CPM in patients with different chronic pain conditions and pain-free subjects. The proportion of patients with a pro-nociceptive profile appears larger in fibromyalgia and osteoarthritis, but we found no association to clinical pain.</p> </section> <section> <h3> Significant Statement</h3> <p>This analysis shows that there is variability when assessing TSP and CPM in both pain-free subjects and patients with chronic pain. A cut-off for determining when a person is pain-sensitive is proposed, and data based on this cut-off approach suggest that significantly more patients with osteoarthritis and fibromyalgia are pain-sensitive (i.e. higher TSP and lower CPM) compared to pain-free subjects. This analysis does not find an association between pain sensitivity and clinical pain.<

背景：定量感觉测试（QST）可得出疼痛特征（如促痛和抗痛），但存在很大的变异性。本研究描述了慢性肌肉骨骼疼痛患者疼痛时间总和（TSP）和条件性疼痛调节（CPM）的变异性，提出了临界值，并探讨了与临床疼痛强度的关联：这是一项二次分析，在无痛受试者（n = 69）和慢性腰背痛（cLBP，n = 267）、骨关节炎（n = 134）和纤维肌痛（n = 101）患者中使用袖带算法评估 TSP 和 CPM。以无痛受试者的 TSP 和 CPM 为参照，建立了四种不同的疼痛特征 TSP（低/高）和 CPM（低/高），并探讨了不同疼痛特征之间临床疼痛的差异：结果：个体数据显示，人与人之间的差异很大。结果：个体数据显示，人与人之间的差异很大，纤维肌痛患者的 TSP 高，CPM 低（p 结论：这些结果表明，人与人之间的疼痛差异很大：这些结果表明，不同慢性疼痛患者和无痛受试者的 TSP 和 CPM 存在很大的个体差异。纤维肌痛和骨关节炎患者中具有亲痛觉特征的比例似乎更大，但我们没有发现这与临床疼痛有关：该分析表明，在评估无痛受试者和慢性疼痛患者的 TSP 和 CPM 时存在差异。我们提出了确定一个人何时对疼痛敏感的临界值，根据这种临界值方法得出的数据表明，与无疼痛的受试者相比，骨关节炎和纤维肌痛患者对疼痛敏感的人数要多得多（即 TSP 较高，CPM 较低）。本分析未发现疼痛敏感度与临床疼痛之间存在关联。

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引用次数: 0