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Allogenic umbilical cord tissue for temporomandibular joint injuries. 同种异体脐带组织治疗颞下颌关节损伤。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-24 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1281277
Adarsh Aratikatla, Samir Ghandour, Nicola Maffulli, Manu Gupta, Ashim Gupta

The temporomandibular joint (TMJ) is crucial for functions of daily living such as mastication and articulation. Common TMJ issues include osteoarthritis, internal derangement, and myofascial pain dysfunction. Conservative methods such as physical therapy and medications are used, with surgical options such as arthroscopy and replacement for severe cases. Emerging regenerative medicine explores non-surgical treatments using human stem cells from umbilical cord derivatives, showing potential for tissue regeneration in TMJ disorders. A systematic search was conducted across PubMed, Embase, Scopus, and Web of Science databases, adhering to PRISMA guidelines, aiming to identify relevant articles published in English until August 2023. The search used specific terms to target in vitro, preclinical, and clinical studies on umbilical cord (UC)-derived tissue and mesenchymal stem cells (MSCs) for treating TMJ disorders. The search was extended to three clinical trial registries for on-going investigations related to UC tissue and MSCs for TMJ disorder management. The studies included in this article report the safety and efficacy profiles of allogenically acquired, umbilical cord-derived tissues and associated mesenchymal stem cells for temporomandibular joint ailments, future adequately powered, randomized controlled trials are warranted to conclusively justify the clinical use of this biologic therapy.

颞下颌关节(TMJ)对日常生活功能(如咀嚼和关节)至关重要。常见的TMJ问题包括骨关节炎、内部紊乱和肌筋膜疼痛功能障碍。使用物理治疗和药物治疗等保守方法,并可选择关节镜检查和严重病例的替代手术。新兴的再生医学探索了使用脐带衍生物的人类干细胞进行非手术治疗,显示出TMJ疾病组织再生的潜力。根据PRISMA指南,在PubMed、Embase、Scopus和Web of Science数据库中进行了系统搜索,旨在识别2023年8月之前以英语发表的相关文章。这项研究使用了特定的术语来靶向脐带(UC)衍生组织和间充质干细胞(MSC)治疗TMJ疾病的体外、临床前和临床研究。搜索范围扩大到三个临床试验注册中心,以进行与UC组织和MSCs有关的TMJ疾病管理的持续研究。本文中的研究报告了同种异体获得的脐带来源组织和相关间充质干细胞治疗颞下颌关节疾病的安全性和有效性,未来有必要进行充分的随机对照试验,以最终证明这种生物疗法的临床应用是合理的。
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引用次数: 0
Multidimensional visualization and analysis of chronic pain variables of patients who attended a chronic pain program. 参加慢性疼痛项目的患者的慢性疼痛变量的多维可视化和分析。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-24 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1125992
Yuelin Cindy Li, Eleni G Hapidou

Psychologically-based chronic pain variables measure multiple domains of the pain experience such as anxiety, depression, catastrophizing, acceptance and stages of change. These variables measure specific areas such as emotional and cognitive states towards chronic pain and its management, acceptance towards the chronic pain condition, and an individual's readiness to move towards self-management methods. Conceptually, these variables appear to be interrelated to each other, and also form groupings of similar underlying themes. Groupings that have been previously discussed for these variables include positive and negative affect, and improved and poor adjustment. Psychological experience of chronic pain as a whole is mostly understood through conceptually consolidating individual scores across different measures covering multiple domains. A map of these variables in relation to each other can offer an overview for further understanding and exploration. We hereby visualize highlights of relationships among 11 psychosocial chronic pain variables including measures examining physical and somatic aspects, using three-dimensional biplots. Variables roughly form two groupings, with one grouping consisting of items of negative affect, cognition, and physical state ratings, and the other grouping consisting of items of acceptance and the later three stages of change (contemplation, action, maintenance). Also, we follow up with canonical correlation as a complement to further identify key relationships between bimodal groupings. Key variables linking bimodal relationships consist of catastrophizing, depression and anxiety in one grouping and activity engagement in the other. Results are discussed in the context of existing literature.

基于心理学的慢性疼痛变量测量疼痛体验的多个领域,如焦虑、抑郁、灾难、接受和变化阶段。这些变量衡量特定领域,如对慢性疼痛及其管理的情绪和认知状态,对慢性疼痛状况的接受程度,以及个人走向自我管理方法的准备程度。从概念上讲,这些变量似乎是相互关联的,也形成了相似的基本主题的分组。之前讨论过的这些变量的分组包括积极和消极影响,以及改进和较差的调整。慢性疼痛的心理体验作为一个整体,主要是通过概念上整合涵盖多个领域的不同指标的个人得分来理解的。这些变量之间的关系图可以为进一步理解和探索提供概览。我们在此可视化11个心理社会慢性疼痛变量之间关系的亮点,包括使用三维双图检查身体和身体方面的测量。变量大致分为两组,一组由负面影响、认知和身体状态评分组成,另一组由接受和后三个变化阶段(沉思、行动、维持)组成。此外,我们将正则相关作为补充,以进一步确定双峰分组之间的关键关系。连接双峰关系的关键变量包括一组中的灾难性、抑郁和焦虑,另一组则包括活动参与。结果在现有文献的背景下进行了讨论。
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引用次数: 0
Editorial: Advancements in deep brain stimulation for chronic pain control. 社论:脑深部刺激治疗慢性疼痛的进展。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-23 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1293919
Michael D Staudt, Nasser K Yaghi, David J Mazur-Hart, Prasad Shirvalkar
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引用次数: 0
Physicians' perception about predictors of opioid abuse in patients with chronic non-cancer pain: a Delphi study. 医生对慢性非癌性疼痛患者阿片类药物滥用预测因素的认知:德尔菲研究。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-19 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1269018
Santiago Galán, Rocío de la Vega, Rosa Esteve, Alicia E López-Martínez, Mariano Fernández Baena, Carmen Ramírez-Maestre

Background: Opioids are being prescribed widely, and increasingly, for the treatment of chronic non-cancer pain (CNCP). However, several side effects are associated with mid- and long-term opioid use and, for certain patients, with the risk of problematic opioid use. The aim of this study is to know the perception of the physicians about which variables could be associated with increased risk of patients with CNCP developing a problem of abuse or misuse of the prescribed opioid medication.

Methods: Twenty-nine physicians with experience in CNCP pain management and opioids prescription participated in a two-round Delphi study focused on the risk factors for opioid misuse and abuse.

Results: The variables that reached consensus regarding their relationship with the increased risk of suffering a problem of opioid abuse or misuse were: (1) Experiencing pain on a daily basis, (2) previous use of high-dose opioids, (3) generalized anxiety, (4) hopelessness, (5) benzodiazepine intake, (6) use of opioids for reasons other than pain, (7) family problems, family instability or family breakdown, and (8) having access to several opioid prescribers. The only variable that reached consensus regarding it not being associated to a possible risk of abuse or misuse was having mild pain intensity (0-4 on a NRS-11).

Conclusions: This study provides useful information that could help make decisions about the use of opioids for CNCP treatment and prevent future difficulties. Prospective studies testing the relationship of the variables that reached consensus with the risk of opioid misuse and abuse are warranted.

Significance: This study shows the variables of CNCP that the professional must take into account in order to avoid possible problems when prescribing opioids.

背景:阿片类药物被广泛且越来越多地用于治疗慢性非癌性疼痛(CNCP)。然而,一些副作用与中长期阿片类药物使用有关,对某些患者来说,还与阿片类物质使用有问题的风险有关。本研究的目的是了解医生对哪些变量可能与CNCP患者出现滥用或滥用处方阿片类药物问题的风险增加有关的看法。方法:29名在CNCP疼痛管理和阿片类药物处方方面有经验的医生参与了一项两轮德尔菲研究,重点是阿片类物质滥用和滥用的风险因素。结果:就其与阿片类药物滥用或滥用问题风险增加的关系达成共识的变量是:(1)每天经历疼痛,(2)以前使用过高剂量阿片类,(3)普遍焦虑,(4)绝望,(5)苯二氮卓类药物摄入,(6)因疼痛以外的原因使用阿片类,家庭不稳定或家庭破裂,以及(8)接触到几位阿片类药物处方医生。唯一达成共识的与可能的滥用或误用风险无关的变量是轻度疼痛强度(NRS-11为0-4)。结论:这项研究提供了有用的信息,有助于决定使用阿片类药物治疗CNCP,并防止未来的困难。有必要进行前瞻性研究,测试达成共识的变量与阿片类药物滥用风险的关系。意义:本研究显示了专业人员在开具阿片类药物处方时必须考虑的CNCP变量,以避免可能出现的问题。
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引用次数: 0
Editorial: Computational methods for pain pharmacology. 社论:疼痛药理学的计算方法。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-19 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1298882
Jakub Mlost, Mateusz Kucharczyk
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引用次数: 0
Editorial: Emerging trends in headache. 社论:头痛的新趋势。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-19 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1288707
Luca Giani, Pınar Yalinay Dikmen
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引用次数: 0
A model for personalized diagnostics for non-specific low back pain: the role of the myofascial unit. 非特异性腰痛的个性化诊断模型:肌筋膜单位的作用。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-13 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1237802
Siddhartha Sikdar, John Srbely, Jay Shah, Yonathan Assefa, Antonio Stecco, Secili DeStefano, Marta Imamura, Lynn H Gerber

Low back pain (LBP) is the leading cause of disability worldwide. Most LBP is non-specific or idiopathic, which is defined as symptoms of unknown origin without a clear specific cause or pathology. Current guidelines for clinical evaluation are based on ruling out underlying serious medical conditions, but not on addressing underlying potential contributors to pain. Although efforts have been made to identify subgroups within this population based on response to treatment, a comprehensive framework to guide assessment is still lacking. In this paper, we propose a model for a personalized mechanism-based assessment based on the available evidence that seeks to identify the underlying pathologies that may initiate and perpetuate central sensitization associated with chronic non-specific low back pain (nsLBP). We propose that central sensitization can have downstream effects on the "myofascial unit", defined as an integrated anatomical and functional structure that includes muscle fibers, fascia (including endomysium, perimysium and epimysium) and its associated innervations (free nerve endings, muscle spindles), lymphatics, and blood vessels. The tissue-level abnormalities can be perpetuated through a vicious cycle of neurogenic inflammation, impaired fascial gliding, and interstitial inflammatory stasis that manifest as the clinical findings for nsLBP. We postulate that our proposed model offers biological plausibility for the complex spectrum of clinical findings, including tissue-level abnormalities, biomechanical dysfunction and postural asymmetry, ecological and psychosocial factors, associated with nsLBP. The model suggests a multi-domain evaluation that is personalized, feasible and helps rule out specific causes for back pain guiding clinically relevant management. It may also provide a roadmap for future research to elucidate mechanisms underlying this ubiquitous and complex problem.

腰痛(LBP)是全世界致残的主要原因。大多数LBP是非特异性或特发性的,其定义为来源不明的症状,没有明确的具体原因或病理。目前的临床评估指南是基于排除潜在的严重疾病,而不是解决潜在的疼痛因素。尽管已经努力根据对治疗的反应来确定这一人群中的亚组,但仍然缺乏指导评估的全面框架。在本文中,我们提出了一种基于现有证据的个性化机制评估模型,旨在确定可能引发和持续与慢性非特异性腰痛(nsLBP)相关的中枢敏化的潜在病理。我们提出,中枢增敏可能对“肌筋膜单元”产生下游影响,肌筋膜单元被定义为一个完整的解剖和功能结构,包括肌纤维、筋膜(包括肌内膜、肌周和肌外膜)及其相关神经支配(自由神经末梢、肌梭)、淋巴管和血管。组织水平的异常可以通过神经源性炎症、筋膜滑动受损和间质炎症停滞的恶性循环持续存在,这些表现为nsLBP的临床表现。我们假设,我们提出的模型为复杂的临床发现提供了生物学合理性,包括与nsLBP相关的组织水平异常、生物力学功能障碍和姿势不对称、生态和心理社会因素。该模型提出了一种个性化、可行的多领域评估,有助于排除背痛的具体原因,指导临床相关管理。它还可能为未来的研究提供一个路线图,以阐明这一普遍而复杂的问题背后的机制。
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引用次数: 0
Corrigendum: Effect of manual therapy on music students with playing-related musculoskeletal disorders: a prospective study. 勘误表:一项前瞻性研究:手工治疗对音乐系学生演奏相关肌肉骨骼疾病的影响。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-12 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1303660
Carolin Assel

[This corrects the article DOI: 10.3389/fpain.2023.1151886.].

[这更正了文章DOI:10.3389/fpain.2023.1151886.]。
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引用次数: 0
Role of mu opioid receptor (MOR) agonist efficacy as a determinant of opioid antinociception in a novel assay of pain-depressed behavior in female and male mice. μ阿片受体(MOR)激动剂作为阿片类镇痛感受的决定因素在一项新的雌性和雄性小鼠疼痛抑制行为测定中的作用。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-11 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1281698
S Stevens Negus, Hamid I Akbarali, Minho Kang, Young K Lee, Samuel A Marsh, Edna J Santos, Yan Zhang

Introduction: Intermediate efficacy mu opioid receptor (MOR) agonists have potential to retain analgesic effectiveness while improving safety, but the optimal MOR efficacy for effective and safe opioid analgesia is unknown. Preclinical assays of pain-depressed behavior can assess effects of opioids and other candidate analgesics on pain-related behavioral depression, which is a common manifestation of clinically relevant pain and target of pain treatment. Accordingly, the present study goal was to validate a novel assay of pain-depressed locomotor behavior in mice and evaluate the role of MOR efficacy as a determinant of opioid analgesic effects and related safety measures.

Methods: Male and female ICR mice were tested in a locomotor chamber consisting of 2 compartments connected by a doorway that contained a 1-inch-tall barrier. Dependent measures during 15-min behavioral sessions included crosses between compartments (which required vertical activity to surmount the barrier) and total movement counts (which required horizontal activity to break photobeams in each compartment).

Results and discussion: Intraperitoneal injection of lactic acid (IP acid) produced a concentration- and time-dependent depression of both endpoints. Optimal blockade of IP acid-induced behavioral depression with minimal motor impairment was achieved with intermediate-efficacy MOR treatments that also produced less gastrointestinal-transit inhibition and respiratory depression than the high-efficacy MOR agonist fentanyl. Sex differences in treatment effects were rare. Overall, these findings validate a novel procedure for evaluating opioids and other candidate analgesic effects on pain-related behavioral depression in mice and support continued research with intermediate-efficacy MOR agonists as a strategy to retain opioid analgesic effectiveness with improved safety.

引言:中效μ阿片受体(MOR)激动剂有可能在提高安全性的同时保持镇痛效果,但有效和安全的阿片镇痛的最佳MOR疗效尚不清楚。疼痛抑制行为的临床前分析可以评估阿片类药物和其他候选止痛药对疼痛相关行为抑郁的影响,疼痛相关行为抑郁症是临床相关疼痛的常见表现,也是疼痛治疗的目标。因此,本研究的目的是验证一种新的小鼠疼痛抑制运动行为的测定方法,并评估MOR疗效作为阿片类镇痛作用和相关安全措施的决定因素的作用。方法:雄性和雌性ICR小鼠在由2个隔间组成的运动室中进行测试,该隔间由一个1英寸高的门连接。在15分钟的行为训练中,依赖性测量包括隔室之间的交叉(需要垂直活动才能越过屏障)和总运动计数(需要水平活动才能打破每个隔室中的光束)。结果和讨论:腹膜内注射乳酸(IP酸)会产生浓度和时间依赖性的两者抑制端点。与高效MOR激动剂芬太尼相比,中等疗效的MOR治疗也产生较少的胃肠道转运抑制和呼吸抑制,从而实现了对IP酸诱导的行为抑郁的最佳阻断,并具有最小的运动损伤。治疗效果的性别差异是罕见的。总的来说,这些发现验证了一种评估阿片类药物和其他候选镇痛作用对小鼠疼痛相关行为抑郁的新方法,并支持使用中等疗效MOR激动剂作为一种策略来保持阿片类镇痛效果并提高安全性的持续研究。
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引用次数: 0
Medication-overuse headache-a review of different treatment strategies. 药物过度使用头痛——不同治疗策略综述。
Q2 CLINICAL NEUROLOGY Pub Date : 2023-10-10 eCollection Date: 2023-01-01 DOI: 10.3389/fpain.2023.1103497
Abouch Krymchantowski, Carla Jevoux, Ana Gabriela Krymchantowski, Luiza Barbosa Ramos, Jackeline S S Barbosa, Raimundo Pereira Silva-Neto

Medication-overuse headache (MOH) can develop from primary headaches. MOH is usually the result of overuse of symptomatic medications. It is a noteworthy personal and societal burden. The identification and treatment of patients at risk for MOH is an essential component of MOH management. Medication overuse can be modifiable and can advance from episodic to chronic migraine. Treatment for MOH is complex, and experts in the field have varied views on the most appropriate strategy for MOH treatment. The objective of this review is to give a comprehensive synopsis of the literature for the management of MOH. Treatment strategies, such as detoxification and prevention, are the debatable issues. Medication withdrawal is the foundation for management. The available literature suggested abrupt withdrawal with preventive approaches for early management. Bridging therapy could be useful to get relief from withdrawal symptoms. Multidisciplinary choices proved beneficial in supporting withdrawal and preventing relapse. Worldwide, the termination of overused medications has been observed as a standard treatment strategy; however, patient-specific approaches should be taken.

药物过度使用性头痛(MOH)可由原发性头痛发展而来。MOH通常是过度使用有症状的药物的结果。这是一个值得注意的个人和社会负担。识别和治疗有MOH风险的患者是MOH管理的重要组成部分。药物过度使用是可以改变的,可以从发作性偏头痛发展为慢性偏头痛。卫生部的治疗是复杂的,该领域的专家对卫生部最合适的治疗策略有不同的看法。本综述的目的是为卫生部的管理提供一个全面的文献概要。戒毒和预防等治疗策略是有争议的问题。停药是管理的基础。现有文献建议采用预防性方法进行早期管理。桥接疗法可能有助于缓解戒断症状。事实证明,多学科的选择对支持戒断和预防复发是有益的。在世界范围内,终止过度使用药物已被视为一种标准的治疗策略;然而,应该采取针对患者的方法。
{"title":"Medication-overuse headache-a review of different treatment strategies.","authors":"Abouch Krymchantowski,&nbsp;Carla Jevoux,&nbsp;Ana Gabriela Krymchantowski,&nbsp;Luiza Barbosa Ramos,&nbsp;Jackeline S S Barbosa,&nbsp;Raimundo Pereira Silva-Neto","doi":"10.3389/fpain.2023.1103497","DOIUrl":"10.3389/fpain.2023.1103497","url":null,"abstract":"<p><p>Medication-overuse headache (MOH) can develop from primary headaches. MOH is usually the result of overuse of symptomatic medications. It is a noteworthy personal and societal burden. The identification and treatment of patients at risk for MOH is an essential component of MOH management. Medication overuse can be modifiable and can advance from episodic to chronic migraine. Treatment for MOH is complex, and experts in the field have varied views on the most appropriate strategy for MOH treatment. The objective of this review is to give a comprehensive synopsis of the literature for the management of MOH. Treatment strategies, such as detoxification and prevention, are the debatable issues. Medication withdrawal is the foundation for management. The available literature suggested abrupt withdrawal with preventive approaches for early management. Bridging therapy could be useful to get relief from withdrawal symptoms. Multidisciplinary choices proved beneficial in supporting withdrawal and preventing relapse. Worldwide, the termination of overused medications has been observed as a standard treatment strategy; however, patient-specific approaches should be taken.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"4 ","pages":"1103497"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10597723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50163998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Frontiers in pain research (Lausanne, Switzerland)
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