European Journal of Pain最新文献_第7页

Peak alpha frequency differs between chronic back pain and chronic widespread pain 慢性背痛和慢性广泛性疼痛的阿尔法峰值频率不同。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-07 DOI: 10.1002/ejp.4737

Natalie McLain, Rocco Cavaleri, Jason Kutch

Background

Low peak alpha frequency (PAF) is an electroencephalography (EEG) outcome associated reliably with high acute pain sensitivity. However, existing research suggests that the relationship between PAF and chronic pain is more variable. This variability could be attributable to chronic pain groups typically being examined as homogenous populations, without consideration being given to potential diagnosis-specific differences. Indeed, while emerging work has compared individuals with chronic pain to healthy controls, no previous studies have examined differences in PAF between diagnoses or across chronic pain subtypes.

Methods

To address this gap, we reanalysed a dataset of resting state EEG previously used to demonstrate a lack of difference in PAF between individuals with chronic pain and healthy controls. In this new analysis, we separated patients by diagnosis before comparing PAF across three subgroups: chronic widespread pain (n = 30), chronic back pain (n = 38), and healthy controls (n = 87).

Results

We replicate the original finding of no significant difference between chronic pain groups and controls, but also find that individuals with widespread pain had significantly higher global average PAF values than those of people with chronic back pain [p = 0.028, β = 0.25 Hz] after controlling for age, sex, and depression.

Conclusions

These novel findings reveal PAF values in individuals with chronic pain may be diagnosis-specific and not uniformly shifted from the values of healthy controls. Future studies should account for diagnosis and be cautious with exploring homogenous ‘chronic pain’ classifications during investigations of PAF.

Significance

Our work suggests that, contrary to previous hypotheses, inter-individual differences in PAF reflect diagnosis-specific mechanisms rather than the general presence of chronic pain, and therefore may have important implications for future work regarding individually-tailored pain management strategies.

背景：低峰值α频率（PAF）是一种脑电图（EEG）结果，与急性疼痛敏感性高有可靠的联系。然而，现有研究表明，PAF 与慢性疼痛之间的关系变化较大。造成这种差异的原因可能是慢性疼痛群体通常被作为同质人群进行研究，而没有考虑潜在的特定诊断差异。事实上，虽然新近的研究将慢性疼痛患者与健康对照组进行了比较，但之前的研究并未对不同诊断或不同慢性疼痛亚型的 PAF 差异进行研究：为了填补这一空白，我们重新分析了静息状态脑电图数据集，该数据集曾用于证明慢性疼痛患者与健康对照组之间的 PAF 没有差异。在这项新的分析中，我们按照诊断将患者分开，然后比较三个亚组的 PAF：慢性广泛性疼痛（30 人）、慢性背痛（38 人）和健康对照组（87 人）：结果：我们重复了原来的发现，即慢性疼痛组与对照组之间无显著差异，但同时发现，在控制年龄、性别和抑郁后，广泛性疼痛患者的全球平均 PAF 值明显高于慢性背痛患者[p = 0.028，β = 0.25 Hz]：这些新发现揭示了慢性疼痛患者的 PAF 值可能具有诊断特异性，而且与健康对照组的 PAF 值偏移不一致。未来的研究应考虑诊断因素，并在调查 PAF 时谨慎探索同质化的 "慢性疼痛 "分类：我们的研究结果表明，与之前的假设相反，PAF 的个体间差异反映的是诊断特异性机制，而不是慢性疼痛的普遍存在。

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引用次数: 0

Navigating the light and shadow of scientific publishing faced with machine learning and generative AI 面对机器学习和生成式人工智能，在科学出版的光与影中航行。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-03 DOI: 10.1002/ejp.4736

Federico Palmisani, Daniel Segelcke, Jan Vollert

Background

The public release of ChatGPT in November 2022 sparked a boom and public interest in generative artificial intelligence (AI) that has led to journals and journal families hastily releasing generative AI policies, ranging from asking authors for acknowledgement or declaration to the outright banning of use.

Results

Here, we briefly discuss the basics of machine learning, generative AI, and how it will affect scientific publishing. We focus especially on potential risks and benefits to the scientific community as a whole and journals specifically.

Conclusion

While the concerns of editors, for example about manufactured studies, are valid, some recently implemented or suggested policies will not be sustainable in the long run. The quality of generated text and code is quickly becoming so high that it will not only be impossible to detect the use of generative AI but would also mean taking a powerful tool away from researchers that can make their life easier every day.

Significance

We discuss the history and current state of AI and highlight its relevance for medical publishing and pain research. We provide guidance on how to act now to increase good scientific practice in the world of ChatGPT and call for a task force focusing on improving publishing pain research with use of generative AI.

背景：2022年11月公开发布的ChatGPT引发了生成式人工智能（AI）的热潮和公众兴趣，导致期刊和期刊家族匆忙发布生成式人工智能政策，从要求作者致谢或声明到直接禁止使用不等：在此，我们简要讨论了机器学习、生成式人工智能的基本原理，以及它将如何影响科学出版。我们尤其关注它对整个科学界和期刊的潜在风险和益处：虽然编辑们的担忧是合理的，例如对人造研究的担忧，但最近实施或建议的一些政策从长远来看是不可持续的。生成文本和代码的质量正在迅速变得如此之高，以至于不仅不可能发现生成式人工智能的使用，而且还意味着从研究人员手中夺走了一个可以让他们每天的生活更轻松的强大工具：我们讨论了人工智能的历史和现状，并强调了其与医学出版业和疼痛研究的相关性。我们为现在如何采取行动以提高ChatGPT领域的良好科学实践提供了指导，并呼吁成立一个特别工作组，专注于利用生成式人工智能改进疼痛研究的出版工作。

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引用次数: 0

Neural correlates of pain acceptance and the role of the cerebellum: Functional connectivity and anatomical differences in individuals with headaches versus matched controls 接受疼痛的神经相关性和小脑的作用：头痛患者与匹配对照组的功能连接和解剖学差异。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-01 DOI: 10.1002/ejp.4734

Vasilis S. Vasiliou, Nikos Konstantinou, Yiolanda Christou, Savvas Papacostas, Fofi Constantinidou, Eleni Heracleous, Ioannis Seimenis, Maria Karekla

Background

Despite functional connectivity network dysfunction among individuals with headaches, no studies have examined functional connectivity neural correlates and anatomical differences in coping with headaches.

Methods

This study investigated inter-individual variability in whole-brain functional connectivity and anatomical differences among 37 individuals with primary headaches and 24 age- and gender-matched controls, and neural correlates of psychological flexibility (PF) that was previously found to contribute to headache adjustment. Participants (84% women; M headache severity = 4/10; M age = 43 years) underwent functional magnetic resonance imaging scans and completed questionnaires to examine global and subnetwork brain areas, and their relations with PF components, controlling for age, gender, education, and head-motion.

Results

Seed and voxel-based contrast analyses between groups showed atypical functional connectivity of regions involved in pain matrix and core resting-state networks. Pain acceptance was the sole PF component that correlated with the cerebellum (x, y, z: 28, −72, −34, p-false discovery rate <0.001), where individuals with headaches showed higher grey matter density compared to controls.

Conclusions

The cerebellum, recently implicated in modulating emotional and cognitive processes, was indicated to process information resembling what individuals do when practicing pain acceptance. Our findings establish for the first time this connection of the cerebellum and its role in pain acceptance. We propose that pain acceptance might be a behavioural biomarker target that could modulate problematic headache perceptions and brain networks abnormalities.

Significance

This study highlights the potential use of emerging behavioural biomarkers in headache management, such as pain acceptance, and their role in modifying the headache experience. Notably, grey matter reorganization in the cerebellum and other known brain pain networks, could indicate brain networks that can be modified from targeted behavioural interventions to help decode the nociplastic mechanisms that predominates in headaches.

背景：尽管头痛患者中存在功能连接网络功能障碍，但还没有研究对头痛应对的功能连接神经相关性和解剖差异进行研究：尽管头痛患者存在功能连接网络功能障碍，但还没有研究对应对头痛的功能连接神经相关性和解剖学差异进行研究：本研究调查了37名原发性头痛患者和24名年龄与性别匹配的对照组患者全脑功能连接的个体间变异性和解剖学差异，以及心理灵活性（PF）的神经相关性，心理灵活性曾被认为有助于头痛的适应。参与者（84%为女性；中位头痛严重程度=4/10；中位年龄=43岁）接受了功能磁共振成像扫描并填写了调查问卷，在控制年龄、性别、教育程度和头部运动的情况下，对整体和子网脑区及其与心理灵活性成分的关系进行了研究：结果：不同组间的种子分析和基于体素的对比分析显示，参与疼痛矩阵和核心静息态网络的区域存在非典型功能连接。疼痛接受是唯一与小脑相关的 PF 成分（x、y、z：28、-72、-34，P-误发现率结论）：小脑最近被认为与调节情绪和认知过程有关，它处理的信息与个人在练习接受疼痛时处理的信息相似。我们的研究结果首次证实了小脑的这种联系及其在疼痛接受中的作用。我们认为，疼痛接受可能是一种行为生物标记目标，可以调节头痛问题感知和大脑网络异常：本研究强调了新出现的行为生物标志物（如疼痛接受度）在头痛管理中的潜在用途及其在改变头痛体验中的作用。值得注意的是，小脑和其他已知脑痛网络的灰质重组可能表明，可以通过有针对性的行为干预来改变脑网络，从而帮助解码头痛中占主导地位的非可塑性机制。

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引用次数: 0

Persistence, not avoidance, is associated with low back pain—An observational cohort study 腰背痛与坚持而非逃避有关--一项观察性队列研究。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-09-30 DOI: 10.1002/ejp.4728

Sabina Hotz-Boendermaker, Ursula Surbeck, Rita Morf, Fabian Pfeiffer

Background

Low back pain (LBP) is increasingly understood as a long-lasting condition with a variable course. Avoidance and persistence behaviour have been described to mediate pain persistence by potentially linking psychosocial factors and biomechanics. The resulting maladaptive changes in musculoskeletal structures can result in movement control impairment (MCI). This investigation aimed to observe avoidance and persistence behaviour and MCI in participants with acute LBP over 1 year and explore their association with pain persistence.

Methods

In this observational cohort study, 165 participants were assessed at five time points: ≤ 1 month (baseline), 2, 3, 6, and 12 months after the onset of acute LBP. Simultaneously collected clinical data such as self-reported outcomes at baseline for avoidance and persistence and assessments of MCI were filled in linear mixed-effects regression models.

Results

The mixed-effects analysis revealed for the adjusted model that a one-point increase in persistence scores resulted in a 3.31-point increase in pain intensity while interacting with state anxiety over time (p = 0.05, 95% confidence interval 0.07–6.07). This effect was not found for avoidance behaviour at baseline (p = 0.21) and MCI.

Conclusions

The relationship between persistence and pain intensity throughout measurement suggests that continuing usual activities beyond pain, coupled with feelings of distress, may lead to persistent LBP. These results underscore the need for a therapeutic shift toward a multidimensional approach that considers the physical and psychological characteristics of persons with LBP. Screening for activity patterns in acute LBP is critical for providing tailored treatment and counselling.

Significance Statement

In acute low back pain (LBP), maintaining usual activities despite pain and distress can contribute to the continuation of LBP. Alongside a multidimensional approach that considers physical and psychological factors, attitudes toward daily activities are also important. Screening for both maladaptive and adaptive activity patterns in individuals with acute LBP is essential for effective LBP management, improving patient outcomes, and preventing persistent pain.

背景：腰背痛（LBP）被越来越多的人认为是一种病程长、病情多变的疾病。据描述，回避和持续行为可能将社会心理因素和生物力学联系起来，从而介导疼痛的持续。由此导致的肌肉骨骼结构适应性不良变化可导致运动控制障碍（MCI）。这项调查旨在观察急性枸杞痛患者一年内的回避和坚持行为以及MCI，并探讨它们与疼痛持续性之间的关系：在这项观察性队列研究中，165名参与者在五个时间点接受了评估：急性枸杞痛发病后≤1个月（基线）、2个月、3个月、6个月和12个月。在线性混合效应回归模型中填入了同时收集到的临床数据，如基线时对回避和持续性的自我报告结果以及对 MCI 的评估：混合效应分析显示，在调整模型中，持续性得分每增加一分，疼痛强度就会增加 3.31 分，同时随着时间的推移与状态焦虑相互作用（p = 0.05，95% 置信区间为 0.07-6.07）。基线时的回避行为（p = 0.21）和 MCI 均未发现这种效应：在整个测量过程中，持续性和疼痛强度之间的关系表明，在疼痛之外继续进行通常的活动，再加上痛苦的感觉，可能会导致持续性枸杞痛。这些结果表明，治疗方法需要向考虑枸杞多糖症患者生理和心理特点的多维方法转变。对急性腰背痛患者的活动模式进行筛查对于提供量身定制的治疗和咨询至关重要：在急性腰背痛（LBP）患者中，尽管有疼痛和痛苦，但仍保持平常的活动会导致腰背痛的持续。除了考虑生理和心理因素的多维方法外，对日常活动的态度也很重要。筛查急性腰痛患者的适应不良和适应性活动模式对于有效管理腰痛、改善患者预后和预防持续性疼痛至关重要。

{"title":"Persistence, not avoidance, is associated with low back pain—An observational cohort study","authors":"Sabina Hotz-Boendermaker, Ursula Surbeck, Rita Morf, Fabian Pfeiffer","doi":"10.1002/ejp.4728","DOIUrl":"10.1002/ejp.4728","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low back pain (LBP) is increasingly understood as a long-lasting condition with a variable course. Avoidance and persistence behaviour have been described to mediate pain persistence by potentially linking psychosocial factors and biomechanics. The resulting maladaptive changes in musculoskeletal structures can result in movement control impairment (MCI). This investigation aimed to observe avoidance and persistence behaviour and MCI in participants with acute LBP over 1 year and explore their association with pain persistence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this observational cohort study, 165 participants were assessed at five time points: ≤ 1 month (baseline), 2, 3, 6, and 12 months after the onset of acute LBP. Simultaneously collected clinical data such as self-reported outcomes at baseline for avoidance and persistence and assessments of MCI were filled in linear mixed-effects regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mixed-effects analysis revealed for the adjusted model that a one-point increase in persistence scores resulted in a 3.31-point increase in pain intensity while interacting with state anxiety over time (<i>p</i> = 0.05, 95% confidence interval 0.07–6.07). This effect was not found for avoidance behaviour at baseline (<i>p</i> = 0.21) and MCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The relationship between persistence and pain intensity throughout measurement suggests that continuing usual activities beyond pain, coupled with feelings of distress, may lead to persistent LBP. These results underscore the need for a therapeutic shift toward a multidimensional approach that considers the physical and psychological characteristics of persons with LBP. Screening for activity patterns in acute LBP is critical for providing tailored treatment and counselling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>In acute low back pain (LBP), maintaining usual activities despite pain and distress can contribute to the continuation of LBP. Alongside a multidimensional approach that considers physical and psychological factors, attitudes toward daily activities are also important. Screening for both maladaptive and adaptive activity patterns in individuals with acute LBP is essential for effective LBP management, improving patient outcomes, and preventing persistent pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Geographical disparities in fibromyalgia severity: An Italian study 纤维肌痛严重程度的地域差异：一项意大利研究。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-09-26 DOI: 10.1002/ejp.4735

Marco Di Carlo, Sonia Farah, Fabiola Atzeni, Alessandra Alciati, Manuela Di Franco, Cristina Iannuccelli, Laura Bazzichi, Gerolamo Bianchi, Massimo Giovale, Rosella Tirri, Serena Guiducci, Giuliana Guggino, Franco Franceschini, Rosario Foti, Alberto Lo Gullo, Giovanni Biasi, Elisa Gremese, Lorenzo Dagna, Enrico Tirri, Roberto Giacomelli, Alberto Batticiotto, Maurizio Cutolo, Piercarlo Sarzi-Puttini, Fausto Salaffi

Background

Geographic origin may represent a variable capable of influencing health status. This study aims to investigate the presence of differences of disease severity in Italian patients with fibromyalgia from different macro-regions.

Methods

This retrospective, cross-sectional study involved patients included in the Italian Fibromyalgia Registry. Three geographical macro-regions were identified, comprising patients from Northern Italy, Central Italy and Southern Italy. Clinical differences (evaluated through PolySymptomatic Distress Scale [PSD], revised Fibromyalgia Impact Questionnaire [FIQR] and modified Fibromyalgia Assessment Status [FASmod]) among the geographical macro-regions were studied using one-way analysis of variance (ANOVA) and the Scheffé's test.

Results

A total of 6095 patients (5719 females and 376 males) were included, with 1957 from Northern Italy, 2979 from Central Italy and 1159 from Southern Italy. All studied clinical indices showed a trend indicative of greater disease severity in Southern Italy, followed by Northern Italy and then Central Italy (mean values for PSD: 19.97 ± 6.20 in Northern Italy, 18.61 ± 7.12 in Central Italy, 23.01 ± 5.66 in Souther Italy). These differences were statistically significant for the overall scores of all studied indices, evaluated with ANOVA (all p < 0.001) and in the head to head comparisons, evaluted with Scheffé's test.

Conclusions

Geographic background is significantly associated with variations in the severity of fibromyalgia in Italian patients.

Significance Statement

This is the first study to demonstrate geographical origin-dependent intra-national differences in the severity of fibromyalgia. The results confirm the necessity of considering fibromyalgia within the context of the biopsychosocial model and of implementing healthcare policies targeted towards the most underserved regions.

背景：地域可能是影响健康状况的一个变量。本研究旨在调查来自不同大区的意大利纤维肌痛患者的疾病严重程度是否存在差异：这项回顾性横断面研究涉及意大利纤维肌痛登记处的患者。研究确定了三个地理大区，包括来自意大利北部、中部和南部的患者。研究采用单因素方差分析（ANOVA）和谢菲检验（Scheffé's test）对宏观地理区域之间的临床差异（通过多症状困扰量表（PSD）、修订版纤维肌痛影响问卷（FIQR）和修订版纤维肌痛评估状态（FASmod）进行评估）进行了研究：共纳入 6095 名患者（女性 5719 人，男性 376 人），其中 1957 人来自意大利北部，2979 人来自意大利中部，1159 人来自意大利南部。所有研究的临床指数都显示出一种趋势，即意大利南部的疾病严重程度更高，其次是意大利北部，然后是意大利中部（PSD 的平均值：意大利北部为 19.97 ± 6.20，意大利中部为 18.61 ± 7.12，意大利南部为 23.01 ± 5.66）。经方差分析评估，这些差异在所有研究指标的总分上都具有统计学意义（均为 p 结论）：地理背景与意大利患者纤维肌痛严重程度的差异有明显关联：本研究首次证明了纤维肌痛的严重程度在不同国家间存在着与地理背景相关的差异。研究结果证实，有必要在生物心理社会模式的背景下考虑纤维肌痛，并针对服务最不充分的地区实施医疗保健政策。

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引用次数: 0

Assessing signs of central sensitization: A critical review of physiological measures in experimentally induced secondary hyperalgesia 评估中枢敏化迹象：对实验诱导的继发性痛觉亢进的生理测量方法的重要回顾。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-09-24 DOI: 10.1002/ejp.4733

Caterina M. Leone, Cedric Lenoir, Emanuel N. van den Broeke

Background and Objectives

Central sensitization (CS) is believed to play a role in many chronic pain conditions. Direct non-invasive recording from single nociceptive neurons is not feasible in humans, complicating CS establishment. This review discusses how secondary hyperalgesia (SHA), considered a manifestation of CS, affects physiological measures in healthy individuals and if these measures could indicate CS. It addresses controversies about heat sensitivity changes, the role of tactile afferents in mechanical hypersensitivity and detecting SHA through electrical stimuli. Additionally, it reviews the potential of neurophysiological measures to indicate CS presence.

Databases and Data Treatment

Four databases, PubMed, ScienceDirect, Scopus and Cochrane Library, were searched using terms linked to ‘hyperalgesia’. The search was limited to research articles in English conducted in humans until 2023.

Results

Evidence for heat hyperalgesia in the SHA area is sparse and seems to depend on the experimental method used. Minimal or no involvement of tactile afferents in SHA was found. At the spinal level, the threshold of the nociceptive withdrawal reflex (RIII) is consistently reduced during experimentally induced SHA. The RIII area and the spinal somatosensory potential (N13-SEP) amplitude are modulated only with long-lasting nociceptive input. At the brain level, pinprick-evoked potentials within the SHA area are increased.

Conclusions

Mechanical pinprick hyperalgesia is the most reliable behavioural readout for SHA, while the RIII threshold is the most sensitive neurophysiological readout. Due to scarce data on reliability, sensitivity and specificity, none of the revised neurophysiological methods is currently suitable for CS identification at the individual level.

Significance

Gathering evidence for CS in humans is a crucial research focus, especially with the increasing interest in concepts such as ‘central sensitization-like pain’ or ‘nociplastic pain’. This review clarifies which readouts, among the different behavioural and neurophysiological proxies tested in experimental settings, can be used to infer the presence of CS in humans.

背景和目的：中枢敏化（CS）被认为在许多慢性疼痛病症中发挥作用。直接非侵入性记录单个痛觉神经元在人体中并不可行，这使 CS 的确定变得复杂。本综述讨论了继发性痛觉过敏（SHA）（被认为是 CS 的一种表现形式）如何影响健康人的生理指标，以及这些指标是否能表明 CS 的存在。文章探讨了有关热敏性变化、触觉传入在机械过敏中的作用以及通过电刺激检测继发性痛觉过敏的争议。此外，它还回顾了神经生理学测量方法在指示 CS 存在方面的潜力：使用与 "痛觉过敏 "相关的术语对 PubMed、ScienceDirect、Scopus 和 Cochrane Library 四个数据库进行了检索。搜索仅限于 2023 年之前以人类为研究对象的英文研究文章：SHA区域热过痛的证据很少，似乎取决于所使用的实验方法。研究发现，触觉传入在 SHA 中的参与极少或没有参与。在脊髓水平，实验诱导的 SHA 会持续降低痛觉退缩反射（RIII）的阈值。RIII区域和脊髓躯体感觉电位（N13-SEP）的振幅仅在长时间的痛觉输入时才会受到调节。在大脑层面，SHA区域内的针刺诱发电位会增加：结论：机械针刺痛是 SHA 最可靠的行为读数，而 RIII 阈值则是最敏感的神经生理学读数。由于可靠性、灵敏度和特异性方面的数据稀缺，目前没有一种经修订的神经生理学方法适合用于个体水平的 CS 鉴定：收集人类 CS 的证据是一项重要的研究重点，尤其是随着人们对 "中枢敏化样疼痛 "或 "非可塑性疼痛 "等概念的兴趣与日俱增。这篇综述阐明了在实验环境中测试的不同行为和神经生理学代用指标中，哪些读数可用于推断人类是否存在 CS。

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引用次数: 0

Increased behavioural inhibition and decreased behavioural activation in whiplash-associated disorders: Associations with health outcomes 鞭打相关疾病中行为抑制的增加和行为激活的减少：与健康结果的关系

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-09-22 DOI: 10.1002/ejp.4721

Ashley Smith, Susanne Becker

<div> <section> <h3> Background</h3> <p>Motivation can be investigated with the BIS (Behavioural Inhibition System)/BAS (Behavioural Activation System) scale. BAS regulates the motivation to approach goal-oriented outcomes, particularly rewarding stimuli and situations, while BIS regulates escape and avoidance of unpleasant outcomes. Chronic whiplash-associated disorders (WAD) is a heterogenous pain condition with known alterations in motivated behaviour. The study aimed (1) to investigate the relationship between BIS/BAS, and pain and disability with quality of life and psychological measures in chronic WAD; (2) to determine if BIS and/or BAS mediate the relationships between pain, disability, and psychological symptoms and quality of life.</p> </section> <section> <h3> Methods</h3> <p>254 chronic WAD patients participated in the study. Outcome measures were assessed using self-report questionnaires. BIS/BAS scores were compared to published normative data. Differences in health outcomes for participants within/outside normative 95% confidence intervals were compared and correlations with health measures tested. Mediation models explored bi-directional associations between stress, anxiety, depression, post-traumatic stress severity, pain catastrophizing, and quality of life with pain and disability.</p> </section> <section> <h3> Results</h3> <p>Participants who exceeded normative 95% confidence intervals for BIS demonstrated higher scores for pain interference, disability and all mental health measures. No mediating role of BIS/BAS on the relation between pain and disability with quality of life and health outcomes could be confirmed.</p> </section> <section> <h3> Conclusions</h3> <p>A comparatively large proportion of the sample exceeded the 95% confidence interval for BIS and BAS scores with associations of these scores with health outcomes, but altered motivation to approach goal-oriented outcomes appears to play only a subordinate role in chronic WAD.</p> </section> <section> <h3> Significance statement</h3> <p>In line with current theories, we found a large proportion (30%–50%) of patients with whiplash-associated disorders (WAD) showing signs of altered function in the Behavioural Inhibition System (BIS) and Behavioural Activation System (BAS) suggesting altered reward processing and motivation in these patients. While such altered functions showed associations with pain interference, disability and all mental health measures, reward process

背景：动机可通过行为抑制系统（BIS）/行为激活系统（BAS）量表进行调查。行为抑制系统（BAS）调节接近目标导向结果的动机，特别是奖励性刺激和情境，而行为激活系统（BIS）调节逃避和避免不愉快结果的动机。慢性鞭打相关障碍（WAD）是一种异质性疼痛，已知其动机行为会发生改变。该研究旨在：（1）调查 BIS/BAS、疼痛和残疾与慢性 WAD 患者的生活质量和心理测量之间的关系；（2）确定 BIS 和/或 BAS 是否介导疼痛、残疾、心理症状和生活质量之间的关系。采用自我报告问卷对结果进行评估。将 BIS/BAS 评分与已公布的标准数据进行比较。比较了标准 95% 置信区间内/外参与者的健康结果差异，并测试了与健康测量的相关性。中介模型探讨了压力、焦虑、抑郁、创伤后应激反应严重程度、疼痛灾难化以及疼痛和残疾生活质量之间的双向关联：结果：BIS值超过标准值95%置信区间的参与者在疼痛干扰、残疾和所有心理健康测量方面的得分都较高。BIS/BAS对疼痛和残疾与生活质量和健康结果之间的关系没有中介作用：很大一部分样本的 BIS 和 BAS 分数超过了 95% 的置信区间，这些分数与健康结果之间存在关联，但在慢性 WAD 中，以目标为导向的结果动机的改变似乎只起辅助作用：与目前的理论一致，我们发现很大一部分（30%-50%）鞭打相关障碍（WAD）患者的行为抑制系统（BIS）和行为激活系统（BAS）出现了功能改变的迹象，这表明这些患者的奖赏处理和动机发生了改变。虽然这些功能的改变与疼痛干扰、残疾和所有心理健康指标有关，但奖赏处理不能被证明是慢性腰椎间盘突出症患者的致病相关因素。

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引用次数: 0

Group dynamics and therapy outcome of multimodal pain therapies: A prospective observational trial 多模式疼痛疗法的群体动力与治疗效果：前瞻性观察试验。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-09-20 DOI: 10.1002/ejp.4731

Lorenz Leopold Mihatsch, Benjamin Luchting, Nannette Baumann, Isabel Kiesewetter, Hans Peter Richter

Background

For the treatment of chronic pain, interdisciplinary treatment programs are recommended. Despite continuous adaptation and optimization of this cost- and time-intensive and comprehensive form of therapy, it is not successful in some patients. As personality disorders have an important influence on social interaction and behaviour, the aim of our study was to identify the possible impact of patients with personality disorders on group dynamics and to analyse the influence of group dynamics on individual therapy outcomes.

Methods

We conducted a prospective observational study in patients with chronic pain (N = 104) who participated in a 5-week interdisciplinary treatment program. The main outcome parameters were psychological state and pain intensity before and after the program.

Results

In contrast to our clinical assumption, we found that neither the type nor the number of patients with personality accentuation or personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome.

Discussion

This trial analysed the connection between group dynamics and therapy outcome of multimodal pain therapies in chronic pain patients considering the factor of personality disorders. Our data demonstrated that neither the type nor the number of patients with personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome. Hence, clinicians should not be afraid to include patients with personality disorders in their treatment programs.

Significance Statement

The study emphasizes that clinicians may include patients with personality disorders in multimodal pain treatment programs and groups, provided that the maintenance of a close therapeutic bond with the patient and within the interdisciplinary team is given.

背景：为治疗慢性疼痛，建议采用跨学科治疗方案。尽管这种耗费大量成本和时间的综合治疗方式在不断调整和优化，但在一些患者身上并不成功。由于人格障碍会对社会交往和行为产生重要影响，我们的研究旨在确定人格障碍患者对群体动力学可能产生的影响，并分析群体动力学对个体治疗结果的影响：我们对参加为期 5 周的跨学科治疗项目的慢性疼痛患者（104 人）进行了前瞻性观察研究。主要结果参数为项目前后的心理状态和疼痛强度：结果：与我们的临床假设相反，我们发现人格突出或人格障碍患者的类型和数量都不会对小组动态产生临床影响，即使是消极的小组动态也不会对个体治疗结果产生负面影响：本试验分析了慢性疼痛患者多模式疼痛疗法的团体动力与治疗效果之间的联系，并考虑了人格障碍的因素。我们的数据表明，人格障碍患者的类型和数量都不会对小组动态产生临床影响，即使是消极的小组动态也不会对个体治疗效果产生负面影响。因此，临床医生不应害怕将人格障碍患者纳入治疗计划：本研究强调，临床医生可将人格障碍患者纳入多模式疼痛治疗项目和小组，但前提是必须与患者及跨学科小组保持密切的治疗联系。

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引用次数: 0

The burden of chronic pain in transgender and gender diverse populations: Evidence from a large US clinical database 变性和性别多元化人群的慢性疼痛负担：来自美国大型临床数据库的证据。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-09-20 DOI: 10.1002/ejp.4725

Tomasz Tabernacki, David Gilbert, Stephen Rhodes, Kyle Scarberry, Rachel Pope, Megan McNamara, Shubham Gupta, Swagata Banik, Kirtishri Mishra

<div> <section> <h3> Background</h3> <p>Chronic pain, affecting approximately 20% of the global population, is the leading cause of disability worldwide. Transgender individuals are disproportionately exposed to chronic pain risk factors compared with the cisgender population. This study compares the incidence of chronic pain between transgender and cisgender individuals and examines the impact of gender affirming hormone therapy, anxiety, and depression on chronic pain.</p> </section> <section> <h3> Methods</h3> <p>The study analysed medical records data of 56,470 transgender men and 41,882 transgender women in the TrinetX database. Six cohorts were created: transgender women either receiving oestrogen or no intervention, transgender men receiving testosterone or no intervention and cohorts of cisgender males and females. Unmatched age-adjusted incidence rates were calculated. Then cohorts were matched on 22 chronic pain-associated covariates and the rate of new chronic pain diagnoses was compared between those receiving hormone therapy and those without.</p> </section> <section> <h3> Results</h3> <p>We observed significantly higher rates of chronic pain among transgender individuals compared with cisgender counterparts. Transgender men on testosterone therapy and transgender women on oestrogen therapy exhibited an increased likelihood of chronic pain diagnoses compared with those not receiving hormone therapy. Individuals with anxiety and depression were more likely to be diagnosed with chronic pain.</p> </section> <section> <h3> Conclusion</h3> <p>This study demonstrates a significant burden of chronic pain in transgender individuals, with an increased risk among those receiving hormone therapy. Our study, the first to assess chronic pain in a large cohort of transgender patients, provides support for a potential association between hormone therapy and risk of chronic pain diagnosis. Further research is required to understand causal mechanisms and to develop improved screening and management of chronic pain in transgender populations.</p> </section> <section> <h3> Significance Statement</h3> <p>Our study, featuring the largest cohort of Transgender and Gender Diverse (TGD) individuals assembled to date, reveals critical disparities in chronic pain among TGD populations, notably those on hormone therapy, compared with the cisgender population. It highlights the urgent need for specialized screening and treatment for this vulnerable population, an

背景：慢性疼痛影响着全球约 20% 的人口，是导致全球残疾的主要原因。变性人与双性恋人群相比，面临的慢性疼痛风险因素不成比例。本研究比较了变性人和同性人的慢性疼痛发病率，并研究了性别肯定激素疗法、焦虑和抑郁对慢性疼痛的影响：研究分析了 TrinetX 数据库中 56,470 名变性男性和 41,882 名变性女性的医疗记录数据。研究建立了六个队列：接受雌激素或不接受干预的变性女性、接受睾酮或不接受干预的变性男性，以及顺性别男性和女性队列。计算未匹配的年龄调整发病率。然后根据 22 个与慢性疼痛相关的协变量对队列进行配对，并比较接受激素治疗者与未接受激素治疗者新诊断出慢性疼痛的比率：结果：我们观察到变性人的慢性疼痛发病率明显高于同性人。与未接受激素治疗的人相比，接受睾丸激素治疗的变性男性和接受雌激素治疗的变性女性被诊断为慢性疼痛的可能性更高。患有焦虑症和抑郁症的人更有可能被诊断为慢性疼痛：这项研究表明，变性人的慢性疼痛负担很重，接受激素治疗的变性人患慢性疼痛的风险更高。我们的研究是首次对变性人患者的慢性疼痛进行评估，为激素治疗与慢性疼痛诊断风险之间的潜在关联提供了支持。我们需要进一步研究，以了解其因果机制，并改进变性人慢性疼痛的筛查和管理：我们的研究汇集了迄今为止最大的变性和性别多元化（TGD）人群，揭示了变性和性别多元化人群（尤其是接受激素治疗的变性和性别多元化人群）与顺性别人群在慢性疼痛方面的严重差异。它强调了对这一弱势群体进行专门筛查和治疗以及研究激素治疗对疼痛的影响的迫切需要。这些见解旨在促进更有效、更个性化的医疗保健，提高 TGD 群体的福祉和生活质量。

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引用次数: 0

Slow depolarizing electrical stimuli reveal differential time courses of nociceptor recovery after prolonged topical capsaicin in human skin 缓慢的去极化电刺激揭示了人体皮肤局部长时间使用辣椒素后痛觉感受器恢复的不同时间过程

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-09-19 DOI: 10.1002/ejp.4726

Divya Tumbala Gutti, Richard Carr, Martin Schmelz, Roman Rukwied

Background

We examined de-functionalization and temporal functional recovery of C-nociceptor evoked pain after topical 8% capsaicin applied for 4 consecutive days.

Methods

Capsaicin and placebo patches were applied to human forearm skin (n = 14). Cold, warmth and heat pain thresholds, pain NRS to electrical and thermal (48°C, 5 s) stimuli and axon reflex flare were recorded weekly for 49 days. Mechanical and heat sensitive (‘polymodal’) nociceptors were activated by single electrical half-period sinusoidal pulses (0.5 s, 1 Hz). Mechanical and heat insensitive (‘silent’) nociceptors were activated by 4 Hz sinusoidal stimuli.

Results

Capsaicin abolished heat pain. Sensation to electrical sinusoidal stimulation was reduced but never abolished during the treatment. Pain to electrical 1 Hz ‘polymodal’ nociceptor stimulation took longer to recover than pain ratings to 4 Hz 2.5 s sinusoidal stimulation activating ‘polymodal’ and ‘silent’ nociceptors (35 vs. 21 days). Heat pain was indifferent to placebo from day 21–49. Axon reflex flare was abolished during capsaicin and only recovered to ~50% even after 49 days.

Conclusions

Capsaicin abolishes heat transduction at terminal nociceptive endings, whereas small-diameter axons sensitive to sinusoidal electrical stimulation can still be activated. 1 Hz depolarizing stimuli evoke burst discharges, as demonstrated before, and recover slower after capsaicin than single pulses induced by 4 Hz. The difference in recovery suggests differential time course of functional regeneration for C-nociceptor sub-types after capsaicin. All sensations recovered completely within 7 weeks in healthy subjects. Our findings contrast analgesia lasting for months in spontaneous neuropathic pain patients treated with 8% capsaicin.

Significance

Sinusoidal electrical stimulation can still activate small diameter axons desensitized to heat after 4 consecutive days of topical 8% capsaicin application and reveals differential temporal functional regeneration of C-nociceptor sub-types. Electrical sinusoidal stimulation may detect such axons that no longer respond to heat stimuli in neuropathic skin.

背景我们研究了连续 4 天局部使用 8% 的辣椒素后 C-神经感受器诱发疼痛的去功能化和时间功能恢复情况。方法在人体前臂皮肤上贴上辣椒素和安慰剂贴片（n = 14）。在 49 天内，每周记录一次冷、温、热痛阈值、电和热（48°C，5 秒）刺激下的疼痛 NRS 以及轴突反射耀斑。机械和热敏感（"多模态"）痛觉感受器由单次半周期正弦波脉冲（0.5 秒，1 赫兹）激活。机械和热不敏感（"无声"）痛觉感受器由 4 赫兹的正弦波刺激激活。在治疗过程中，对正弦波电刺激的感觉有所减弱，但从未消失。与激活 "多模态 "和 "无声 "痛觉感受器的 4 赫兹 2.5 秒正弦波刺激相比，1 赫兹 "多模态 "痛觉感受器电刺激的疼痛恢复时间更长（35 天对 21 天）。从第 21 天到第 49 天，热痛与安慰剂无关。结论辣椒素可取消末端痛觉末梢的热传导，而对正弦波电刺激敏感的小直径轴突仍可被激活。如前所述，1 赫兹去极化刺激可诱发猝发放电，但辣椒素后的恢复速度比 4 赫兹单脉冲刺激慢。这种恢复上的差异表明，辣椒素作用后，C-感觉器亚型的功能再生时间不同。健康受试者的所有感觉都在 7 周内完全恢复。我们的研究结果与自发性神经病理性疼痛患者接受 8%辣椒素治疗后持续数月的镇痛效果形成了鲜明对比。意义正弦波电刺激在连续 4 天局部应用 8%辣椒素后仍能激活对热脱敏的小直径轴突，并揭示了 C 感觉器亚型的不同时间功能再生过程。正弦波电刺激可检测到神经病理性皮肤中不再对热刺激有反应的轴突。

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