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Editorial: Acupuncture to treat pain in specific body regions 社论:针灸治疗特定身体区域的疼痛
Pub Date : 2024-06-07 DOI: 10.3389/fpain.2024.1421548
C. M. Giovanardi, Alessandra Poini, Gianni Allais
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引用次数: 0
The impact of an immersive digital therapeutic tool on experimental pain: a pilot randomized within-subject experiment with an active control condition 沉浸式数字治疗工具对实验性疼痛的影响:带有主动控制条件的试验性随机受试者内实验
Pub Date : 2024-06-06 DOI: 10.3389/fpain.2024.1366892
Sanoussy Diallo, Serge Marchand, A. Dumais, Stéphane Potvin
Pain is a complex and multifaced sensory and emotional experience. Virtual reality (VR) has shown promise in reducing experimental pain and chronic pain. This study examines an immersive VR environment initially designed for endometriosis patients, which demonstrated short-term analgesic effects. The research aims to determine the impact of the VR environment on experimental pain intensity and unpleasantness both during and after VR exposure (3D with binaural beats), while using an active control condition (2D with no binaural beats). Additionally, a secondary objective of the study was to identify the psychological and psychophysical factors that predict the analgesic effects of the immersive digital therapeutic tool.The study involved twenty-one healthy individuals and used a within-subject design, comparing a VR treatment with an active control condition. Continuous heat stimulation was applied to the left forearm with a Peltier thermode. Pain ratings were collected for immediate and short-term effects.In both the VR and Control conditions, there were no significant differences in pain intensity before, during, and after exposure. However, during VR exposure, there was a significant decrease in pain unpleasantness as compared to before exposure (p < 0.001), with a 27.2% pain reduction. In the Control condition, there were no significant differences in pain unpleasantness during and after exposure. Furthermore, no psychological and psychophysical factors predicted the analgesic effects.The study investigated how a VR environment affected experimentally induced pain in healthy volunteers. It showed that VR reduced pain unpleasantness during exposure but had no lasting impact. The VR environment mainly influenced the emotional aspect of pain, possibly due to its inclusion of binaural beats and natural stimuli. The study suggests that the VR environment should be tested in chronic pain population with high distress levels.Registration number (clinicaltrials.gov)NCT06130267.
疼痛是一种复杂而多面的感官和情绪体验。虚拟现实(VR)在减轻实验性疼痛和慢性疼痛方面显示出良好的前景。本研究考察了最初为子宫内膜异位症患者设计的沉浸式 VR 环境,该环境显示了短期镇痛效果。研究旨在确定 VR 环境对实验性疼痛强度和不快感的影响,包括在暴露于 VR 环境(带有双耳节拍的 3D 环境)期间和之后,同时使用主动对照条件(没有双耳节拍的 2D)。此外,该研究的次要目标是确定预测沉浸式数字治疗工具镇痛效果的心理和心理物理因素。该研究涉及 21 名健康人,采用受试者内设计,将 VR 治疗与主动对照条件进行比较。使用珀尔帖热电极对左前臂进行持续热刺激。在 VR 和对照组条件下,暴露前、暴露期间和暴露后的疼痛强度没有明显差异。然而,与暴露前相比,在 VR 暴露期间,疼痛的难受程度明显降低(p < 0.001),疼痛减轻了 27.2%。在对照组条件下,暴露期间和暴露后的疼痛不适感没有明显差异。该研究调查了 VR 环境如何影响健康志愿者的实验性疼痛。研究结果表明,VR 在暴露过程中会降低疼痛的不快感,但不会产生持久影响。VR 环境主要影响疼痛的情绪方面,这可能是由于它包含了双耳节拍和自然刺激。这项研究表明,VR 环境应该在慢性疼痛人群中进行测试,因为这些人群的痛苦程度较高。注册号(clinicaltrials.gov)为 NCT06130267。
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引用次数: 0
Mechanisms of complex regional pain syndrome 复杂区域疼痛综合征的发病机制
Pub Date : 2024-05-17 DOI: 10.3389/fpain.2024.1385889
Jagan Devarajan, Shayla Mena, Jianguo Cheng
Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder characterized by a diverse array of symptoms, including pain that is disproportionate to the initial triggering event, accompanied by autonomic, sensory, motor, and sudomotor disturbances. The primary pathology of both types of CRPS (Type I, also known as reflex sympathetic dystrophy, RSD; Type II, also known as causalgia) is featured by allodynia, edema, changes in skin color and temperature, and dystrophy, predominantly affecting extremities. Recent studies started to unravel the complex pathogenic mechanisms of CRPS, particularly from an autoimmune and neuroimmune interaction perspective. CRPS is now recognized as a systemic disease that stems from a complex interplay of inflammatory, immunologic, neurogenic, genetic, and psychologic factors. The relative contributions of these factors may vary among patients and even within a single patient over time. Key mechanisms underlying clinical manifestations include peripheral and central sensitization, sympathetic dysregulation, and alterations in somatosensory processing. Enhanced understanding of the mechanisms of CRPS is crucial for the development of effective therapeutic interventions. While our mechanistic understanding of CRPS remains incomplete, this article updates recent research advancements and sheds light on the etiology, pathogenesis, and molecular underpinnings of CRPS.
复杂性区域疼痛综合征(CRPS)是一种慢性疼痛疾病,其特点是症状多种多样,包括与最初诱发事件不相称的疼痛,并伴有自主神经、感觉、运动和渗出性运动障碍。这两种 CRPS(I 型,又称反射性交感神经营养不良,RSD;II 型,又称因果痛)的主要病理特征是异动症、水肿、皮肤颜色和温度的变化,以及主要影响四肢的营养不良。最近的研究开始揭示 CRPS 复杂的致病机制,尤其是从自身免疫和神经免疫相互作用的角度。CRPS 现在被认为是一种系统性疾病,源于炎症、免疫、神经源、遗传和心理因素的复杂相互作用。这些因素的相对作用可能因患者而异,甚至在同一患者体内也会随着时间的推移而变化。临床表现的关键机制包括外周和中枢敏化、交感神经失调和躯体感觉处理的改变。加强对 CRPS 机制的了解对于开发有效的治疗干预措施至关重要。虽然我们对 CRPS 的机理认识仍不全面,但本文更新了最新的研究进展,并阐明了 CRPS 的病因、发病机制和分子基础。
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引用次数: 0
Case Report: Nonverbal approaches in the treatment of a patient with fibromyalgia with anger rooted in adverse childhood experiences 病例报告:用非语言方法治疗一名因童年不良经历而愤怒的纤维肌痛患者
Pub Date : 2024-05-16 DOI: 10.3389/fpain.2024.1374324
Yuri Adachi, Masako Hosoi, Tomoe Nishihara, Naoki Hirabayashi, Takako Sawa, Tomoko Matsushita, K. Tatsushima, Kozo Anno, Mitsunao Tomioka, Nobuyuki Sudo
In psychotherapy, it is important to establish and deepen a therapeutic trusting relationship, but patients who have experienced extreme adversity in childhood tend to have difficulty in building such a relationship. This paper reports a case of fibromyalgia with adverse childhood experiences (ACEs) in which a nonverbal approach was successful in building a trusting relationship.The patient is a woman in her late 40s. She had strong anger rooted in ACEs, including neglect by her father, a feeling of unfair parenting by her mother compared to her younger brother, overcontrol of her life by her mother, and sexual abuse by her uncle. She was filled with strong interpersonal distrust and anger, and the experience of an unsuccessful surgery compounded her distrust of medical care. The therapist initially had severe difficulty in verbal interaction with the patient. When conducting “drawing” therapy, she ignored the therapist's comments and completely blacked out the drawing paper. However, the patient-therapist relationship gradually changed, and verbal interaction became possible through the use of nonverbal approaches such as framing her drawing paper and “Towel Baby Holding.”The therapist was able to understand the patient's emotions through these nonverbal approaches and to communicate with the patient that she understood her feelings. This approach was also successful in the patient’s understanding of her own pathology. The patient became able to honestly express her feelings in words, which eventually enabled her to be introduced to mindfulness therapy, leading to a favorable treatment course.For patients with ACEs, a nonverbal approach helps build a therapeutic relationship and plays an important role in understanding the patient.
在心理治疗中,建立和加深治疗信任关系非常重要,但童年经历过极端逆境的患者往往难以建立这种关系。本文报告了一例患有纤维肌痛并伴有童年逆境经历(ACEs)的患者,在该病例中,非语言疗法成功地建立了信任关系。她的愤怒源于 ACE,包括父亲对她的忽视、母亲对弟弟的不公平教育、母亲对她生活的过度控制以及叔叔对她的性虐待。她对人际关系充满了强烈的不信任和愤怒,而一次不成功的手术经历又加重了她对医疗服务的不信任。治疗师最初在与患者进行语言交流时遇到了严重困难。在进行 "绘画 "治疗时,她对治疗师的评论置若罔闻,并将画纸完全涂黑。然而,患者与治疗师的关系逐渐发生了变化,通过使用非语言方法,如将画纸装裱起来和 "抱毛巾宝宝",语言互动成为可能。这种方法也成功地让病人理解了自己的病理。患者开始能够用语言诚实地表达自己的感受,这最终使她能够接受正念疗法,从而获得了良好的治疗效果。对于 ACE 患者,非语言疗法有助于建立治疗关系,在理解患者方面发挥着重要作用。
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引用次数: 0
Terminology matters: is the International Association for the Study of Pain definition of pain fully satisfactory for fetuses, neonates, and infants? 术语问题:国际疼痛研究协会对疼痛的定义是否完全符合胎儿、新生儿和婴儿的需要?
Pub Date : 2024-05-16 DOI: 10.3389/fpain.2024.1369945
M. E. Canepa, L. Raffini, L. A. Ramenghi
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引用次数: 0
Cold-evoked potentials in Fabry disease and polyneuropathy 法布里病和多发性神经病的冷诱发电位
Pub Date : 2024-05-15 DOI: 10.3389/fpain.2024.1352711
D. Kersebaum, M. Sendel, J. Lassen, S. Fabig, J. Forstenpointner, M. Reimer, Sima Canaan-Kühl, Jens Gaedeke, S. Rehm, J. Gierthmühlen, Ralf Baron, P. Hüllemann
Fabry disease (FD) causes cold-evoked pain and impaired cold perception through small fiber damage, which also occurs in polyneuropathies (PNP) of other origins. The integrity of thinly myelinated fibers and the spinothalamic tract is assessable by cold-evoked potentials (CEPs). In this study, we aimed to assess the clinical value of CEP by investigating its associations with pain, autonomic measures, sensory loss, and neuropathic signs.CEPs were examined at the hand and foot dorsum of patients with FD (n = 16) and PNP (n = 21) and healthy controls (n = 23). Sensory phenotyping was performed using quantitative sensory testing (QST). The painDETECT questionnaire (PDQ), FabryScan, and measures for the autonomic nervous system were applied. Group comparisons and correlation analyses were performed.CEPs of 87.5% of the FD and 85.7% of the PNP patients were eligible for statistical analysis. In all patients combined, CEP data correlated significantly with cold detection loss, PDQ items, pain, and autonomic measures. Abnormal CEP latency in FD patients was associated with an abnormal heart frequency variability item (r = −0.684; adjusted p = 0.04). In PNP patients, CEP latency correlated significantly with PDQ items, and CEP amplitude correlated with autonomic measures (r = 0.688, adjusted p = 0.008; r = 0.619, adjusted p = 0.024). Furthermore, mechanical pain thresholds differed significantly between FD (gain range) and PNP patients (loss range) (p = 0.01).Abnormal CEPs were associated with current pain, neuropathic signs and symptoms, and an abnormal function of the autonomic nervous system. The latter has not been mirrored by QST parameters. Therefore, CEPs appear to deliver a wider spectrum of information on the sensory nervous system than QST alone.
法布里病(Fabry disease,FD)通过小纤维损伤导致冷诱发痛和冷觉受损,这也发生在其他原因引起的多发性神经病(PNP)中。冷诱发电位(CEPs)可评估薄髓鞘纤维和脊髓丘脑束的完整性。在这项研究中,我们旨在通过研究 CEP 与疼痛、自律神经措施、感觉缺失和神经病理性体征之间的关联来评估 CEP 的临床价值。使用定量感觉测试(QST)进行了感觉表型分析。此外,还采用了疼痛DETECT问卷(PDQ)、法布里扫描(FabryScan)和自律神经系统测量方法。87.5%的FD患者和85.7%的PNP患者的CEP符合统计分析条件。在所有患者中,CEP 数据与冷检测损失、PDQ 项目、疼痛和自律神经测量结果有显著相关性。FD患者的CEP潜伏期异常与心频变异性项目异常相关(r = -0.684;调整后p = 0.04)。在 PNP 患者中,CEP 潜伏期与 PDQ 项目显著相关,CEP 振幅与自律神经测量相关(r = 0.688,调整后 p = 0.008;r = 0.619,调整后 p = 0.024)。此外,FD(增益范围)和 PNP 患者(损耗范围)的机械痛阈值差异显著(p = 0.01)。自律神经系统功能异常与当前疼痛、神经病理性体征和症状以及自律神经系统功能异常有关,而后者并未反映在 QST 参数中。因此,与 QST 相比,CEPs 似乎能提供更广泛的感觉神经系统信息。
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引用次数: 0
Editorial: Non-invasive and minimally invasive vagus nerve stimulation for chronic pain 社论:无创和微创迷走神经刺激治疗慢性疼痛
Pub Date : 2024-05-15 DOI: 10.3389/fpain.2024.1402918
Anna Woodbury, Peter Staats
{"title":"Editorial: Non-invasive and minimally invasive vagus nerve stimulation for chronic pain","authors":"Anna Woodbury, Peter Staats","doi":"10.3389/fpain.2024.1402918","DOIUrl":"https://doi.org/10.3389/fpain.2024.1402918","url":null,"abstract":"","PeriodicalId":12641,"journal":{"name":"Frontiers in Pain Research","volume":"10 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140971884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Post-COVID-19 headache- NDPH phenotype: a systematic review of case reports COVID-19 后头痛--NDPH 表型:病例报告的系统回顾
Pub Date : 2024-05-14 DOI: 10.3389/fpain.2024.1376506
N. Dhiman, Deepika Joshi, Royana Singh, Vyom Gyanpuri, Anand Kumar
Post-acute COVID-19 syndrome or “long COVID” affects patients even after the recovery from Covid infection in various ways. Persistent headache or New Daily Persistent Headache (NDPH) is one of such symptoms. In this review, we will discuss about the case-reports of post covid-19 headache- NDPH phenotype both after and in the course of COVID-19 infection.Case reports/studies talked about patients having NDPH around the disease either immediately or late post COVID were included. Data was taken from the source and synthesised on a qualitative basis.Literature search showed 3,538 articles, out of which 12 were screened as per the eligibility criteria and finally, 4 case reports on NDPH and Covid-19 were chosen for analysis from the database and by human search. All case reports justify the criteria for acceptability in quality for this systematic review.NDPH in and around Covid 19 infection is something that is currently an ingenious debated topic in the scientific community. More case studies should be written and published on the same subject so that a large systematic review could be conducted.The review is registered in Prospero with no. Identifier (CRD42022354912).https://www.crd.york.ac.uk/, PROSPERO (CRD42022354912).
急性 COVID-19 后综合征或 "长 COVID "会以各种方式影响患者,甚至在 Covid 感染痊愈后也是如此。持续性头痛或新的每日持续性头痛(NDPH)就是此类症状之一。在这篇综述中,我们将讨论在感染 COVID-19 后和感染过程中出现 COVID-19 后头痛-NDPH 表型的病例报告。文献检索显示有 3,538 篇文章,其中 12 篇按照资格标准进行了筛选,最后从数据库和人工检索中选择了 4 篇关于 NDPH 和 Covid-19 的病例报告进行分析。所有病例报告都符合本系统综述的质量可接受性标准。应就同一主题撰写和发表更多的病例研究报告,以便进行大规模的系统综述。https://www.crd.york.ac.uk/, PROSPERO (CRD42022354912).
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引用次数: 0
Reappraising the psychosomatic approach in the study of “chronic orofacial pain”: looking for the essential nature of these intractable conditions 重新评估研究 "慢性口面部疼痛 "的心身医学方法:寻找这些顽症的本质属性
Pub Date : 2024-05-10 DOI: 10.3389/fpain.2024.1349847
Akira Toyofuku, H. Matsuoka, Yoshihiro Abiko
As burning mouth syndrome (BMS) and atypical odontalgia (AO) continue to remain complex in terms of pathophysiology and lack explicit treatment protocol, clinicians are left searching for appropriate solutions. Oversimplification solves nothing about what bothers us in clinical situations with BMS or AO. It is important to treat a complicated phenomenon as complex. We should keep careful observations and fact-finding based on a pragmatic approach toward drug selection and prescription with regular follow-up. We also need to assess the long-term prognosis of treatment with a meticulous selection of sample size and characteristics. Further investigation of BMS and AO from a psychosomatic perspective has the potential to provide new insight into the interface between brain function and “chronic orofacial pain.”
由于灼口综合征(BMS)和非典型牙周病(AO)的病理生理学仍然很复杂,而且缺乏明确的治疗方案,临床医生只能寻找适当的解决方案。在临床上,过度简化并不能解决 BMS 或 AO 的任何问题。重要的是,要将复杂的现象视为复杂。我们应该在务实的基础上,对药物选择和处方进行仔细观察和事实调查,并定期随访。我们还需要评估治疗的长期预后,精心选择样本量和特征。从心身医学的角度对BMS和AO进行进一步研究,有可能为了解大脑功能与 "慢性口面痛 "之间的关系提供新的视角。
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引用次数: 0
Trigeminal somatosensation in the temporomandibular joint and associated disorders 颞下颌关节的三叉神经体感及相关疾病
Pub Date : 2024-05-09 DOI: 10.3389/fpain.2024.1374929
Sienna K. Perry, J.J. Emrick
The temporomandibular joint (TMJ) consists of bone, cartilage, ligaments, and associated masticatory muscles and tendons that coordinate to enable mastication in mammals. The TMJ is innervated by the trigeminal nerve (CNV), containing axons of motor and somatosensory neurons. Somatosensation includes touch, temperature, proprioception, and pain that enables mammals to recognize and react to stimuli for survival. The somatosensory innervation of the TMJ remains poorly defined. Disorders of the TMJ (TMD) are of diverse etiology and presentation. Some known symptoms associated with TMD include facial, shoulder, or neck pain, jaw popping or clicking, headaches, toothaches, and tinnitus. Acute or chronic pain in TMD stems from the activation of somatosensory nociceptors. Treatment of TMD may involve over- the-counter and prescription medication, nonsurgical treatments, and surgical treatments. In many cases, treatment achieves only a temporary relief of symptoms including pain. We suggest that defining the sensory innervation of the temporomandibular joint and its associated tissues with a specific focus on the contribution of peripheral innervation to the development of chronic pain could provide insights into the origins of joint pain and facilitate the development of improved analgesics and treatments for TMD.
颞下颌关节(TMJ)由骨、软骨、韧带以及相关的咀嚼肌和肌腱组成,它们相互协调,使哺乳动物能够咀嚼。颞下颌关节由三叉神经(CNV)支配,其中包含运动神经元和体感神经元的轴突。躯体感觉包括触觉、温度觉、本体感觉和痛觉,这些感觉使哺乳动物能够识别刺激并做出反应,以维持生存。颞下颌关节的躯体感觉神经支配仍未明确。颞下颌关节疾病(TMD)的病因和表现多种多样。与 TMD 相关的一些已知症状包括面部、肩部或颈部疼痛、下颌弹响或咔嗒声、头痛、牙痛和耳鸣。TMD 中的急性或慢性疼痛源于躯体感觉过敏原的激活。TMD 的治疗方法包括非处方药和处方药、非手术治疗和手术治疗。在许多情况下,治疗只能暂时缓解包括疼痛在内的症状。我们认为,确定颞下颌关节及其相关组织的感觉神经支配,并特别关注外周神经支配对慢性疼痛发展的贡献,有助于深入了解关节疼痛的起源,并促进开发更好的镇痛剂和 TMD 治疗方法。
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引用次数: 1
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Frontiers in Pain Research
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