scholarly journals Chronic Pain in Inflammatory Arthritis: Mechanisms, Metrology, and Emerging Targets—A Focus on the JAK-STAT Pathway

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Fausto Salaffi ◽  
Giovanni Giacobazzi ◽  
Marco Di Carlo
Keyword(s):  
Central Nervous System ◽  
Chronic Pain ◽  
Inflammatory Arthritis ◽  
Inflammatory Process ◽  
Pain Processing ◽  
Central Pain ◽  
The Central Nervous System ◽  
Central Pain Processing ◽  
Processing Mechanisms ◽  
Stat Pathway

Chronic pain is nowadays considered not only the mainstay symptom of rheumatic diseases but also “a disease itself.” Pain is a multidimensional phenomenon, and in inflammatory arthritis, it derives from multiple mechanisms, involving both synovitis (release of a great number of cytokines) and peripheral and central pain-processing mechanisms (sensitization). In the last years, the JAK-STAT pathway has been recognized as a pivotal component both in the inflammatory process and in pain amplification in the central nervous system. This paper provides a summary on pain in inflammatory arthritis, from pathogenesis to clinimetric instruments and treatment, with a focus on the JAK-STAT pathway.

Stress and tension-type headache mechanisms

Cephalalgia ◽  
2010 ◽  
Vol 30 (10) ◽  
pp. 1250-1267 ◽  
Author(s):  
Stuart Cathcart ◽  
Anthony H Winefield ◽  
Kurt Lushington ◽  
Paul Rolan
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Tension Type Headache ◽  
Pain Processing ◽  
Central Pain ◽  
Comprehensive Review ◽  
Healthy Humans ◽  
The Central Nervous System ◽  
Type Headache ◽  
The Relationship

Stress is widely demonstrated as a contributing factor in tension-type headache (TTH). The mechanisms underlying this remain unclear at present. Recent research indicates the importance of central pain processes in tension-type headache (TTH) pathophysiology. Concurrently, research with animals and healthy humans has begun to elucidate the relationship between stress and pain processing in the central nervous system, including central pain processes putatively dysfunctional in TTH. Combined, these two fields of research present new insights and hypotheses into possible mechanisms by which stress may contribute to TTH. To date, however, there has been no comprehensive review of this literature. The present paper provides such a review, which may be valuable in facilitating a broader understanding of the central mechanisms by which stress may contribute to TTH.

The development of a novel questionnaire assessing alterations in central pain processing in people with and without chronic pain

2020 ◽  
Vol 20 (2) ◽  
pp. 407-417
Author(s):  
Philip D. Austin ◽  
Ali Asghari ◽  
Daniel S.J. Costa ◽  
Philip J. Siddall
Keyword(s):  
Chronic Pain ◽  
Factor Analysis ◽  
Exploratory Factor Analysis ◽  
Pain Modulation ◽  
Self Report ◽  
Pain Processing ◽  
Central Pain ◽  
Item Questionnaire ◽  
Excellent Internal Consistency ◽  
Central Pain Processing

AbstractBackground and aimsThe purpose of this study was to (a) develop and (b) conduct exploratory factor analysis on a novel self-report instrument for symptoms associated with altered central pain processing.MethodsWe first developed a 25-item questionnaire based on previous literature identifying symptoms and behaviours that may reflect altered spinal and supraspinal pain processing. We then administered this questionnaire to 183 people with chronic pain (n = 99) and healthy individuals (n = 84). Exploratory factor analysis was conducted to identify the factor structure of the questionnaire.ResultsOur results support a two-factor solution for the 25-item questionnaire that accounted for 57.2% of the total variance of responses in people with and without chronic pain. Factor one (11 items) included items related to alterations in sensation of pain, while factor two (seven items) included items associated with emotional and fatigue symptoms. Seven items showed weak factor loadings and were eliminated. Reliability was excellent, while both factors showed strong correlations with previously-validated self-report Instruments: (pain catastrophising, mood, vigilance, pain self-efficacy) and conditioned pain modulation, providing evidence for their validity.ConclusionsWe have developed a questionnaire containing two factors that appear to be related to two different symptom clusters, one of which is specifically related to pain and one of which contains other health-related symptoms related to mood and fatigue. These factors show excellent internal consistency and validity. This questionnaire may be a quick, easy and reliable instrument to assess central pain processing in clinical settings.

Analgesics, opioids, and NSAIDs

2020 ◽  
pp. 331-338
Author(s):  
Mark D. Russell ◽  
Nidhi Sofat
Keyword(s):  
Immune Cells ◽  
Peripheral Nerves ◽  
Scientific Basis ◽  
Pain Processing ◽  
Central Pain ◽  
Calcitonin Gene ◽  
The Central Nervous System ◽  
Inflammatory Drugs ◽  
Nociceptive Input ◽  
Central Pain Processing

In this chapter, we discuss nociceptive treatment targets for pain in rheumatoid arthritis (RA), including non-steroidal anti-inflammatory drugs (NSAIDs). Sustained nociceptive input, as found in RA, can lead to changes in central pain processing. Nociceptive input is increased following local sensitization of peripheral nerves within the joint. Coupled with inflammation, it is known that major mediators of pain include neuropeptides (e.g. calcitonin gene-related peptide, CGRP) and neurotrophins such as nerve growth factor (NGF), each of which can also sensitize peripheral nerves. Immune cells within the central nervous system (CNS) directly contribute to developing central sensitization through the generation of cytokines such as IL-1. Interest has therefore grown in analgesics for RA pain that may target the CNS, including opiates and centrally acting analgesics. In this chapter, we discuss the scientific basis of pain in RA, followed by treatments currently widely used in clinical practice, including NSAIDs, opioids, and centrally acting analgesics.

scholarly journals Altered central pain processing in fibromyalgia – a multimodal neuroimaging case-control study using arterial spin labelling

2020 ◽  
Author(s):  
Monika Müller ◽  
Florian Wüthrich ◽  
Andrea Federspiel ◽  
Roland Wiest ◽  
Niklaus Egloff ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Resting State ◽  
Case Control Study ◽  
Case Control ◽  
Pain Processing ◽  
Central Pain ◽  
Brain Areas ◽  
Structural Alterations ◽  
Central Pain Processing ◽  
Control Study

AbstractFibromyalgia is characterized by chronic pain and a striking discrepancy between objective signs of tissue damage and severity of pain. Function and structural alterations in brain areas involved in pain processing may explain this feature. Previous case-control studies in fibromyalgia focused on acute pain processing using experimentally-evoked pain paradigms. Yet, these studies do not allow conclusions about chronic, stimulus-independent pain. Resting-state cerebral blood flow (rsCBF) acquired by arterial spin labelling (ASL) may be a more accurate marker for chronic pain. The objective was to integrate four different functional and structural neuroimaging markers to evaluate the neural correlate of chronic, stimulus-independent pain using a resting-state paradigm. In line with the pathophysiological concept of enhanced central pain processing we hypothesized that rsCBF is increased in fibromyalgia in areas involved in processing of acute pain.We performed an age matched case-control study of 32 female fibromyalgia patients and 32 pain-free controls and calculated group-differences in rsCBF, resting state functional connectivity, grey matter density and cortical thickness using whole-brain and region of interest analyses. We adjusted all analyses for depression and anxiety. As centrally acting drugs are likely to interfere with neuroimaging markers, we performed a subgroup analysis limited to patients not taking such drugs.We found no differences between cases and control in rsCBF of the thalamus, the basal ganglia, the insula, the somatosensory cortex, the prefrontal cortex, the anterior cingulum and supplementary motor area as brain previously identified to be involved in acute processing in fibromyalgia. The results remained robust across all four neuroimaging markers and when limiting the study population to patients not taking centrally acting drugs and matched controls.In conclusion, we found no evidence for functional or structural alterations in brain areas involved in pain processing in fibromyalgia that could reflect neural correlates of chronic stimulus-independent pain.

Treatment response and central pain processing in Anterior Cutaneous Nerve Entrapment Syndrome: An explorative study

2017 ◽  
Vol 14 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Dagmar C. van Rijckevorsel ◽  
Oliver B. Boelens ◽  
Rudi M. Roumen ◽  
Oliver H. Wilder-Smith ◽  
Harry van Goor
Keyword(s):  
Abdominal Wall ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Diagnosis And Treatment ◽  
Pain Processing ◽  
Central Pain ◽  
Pain Thresholds ◽  
Generalized Hyperalgesia ◽  
Central Pain Processing ◽  
Nerve Entrapment Syndrome

AbstractBackground10–30% of chronic abdominal pain originates in the abdominal wall. A common cause for chronic abdominal wall pain is the Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), in which an intercostal nerve branch is entrapped in the abdominal rectus sheath. Treatment consists of local anaesthetics and neurectomy, and is ineffective in 25% of cases for yet unknown reasons.In some conditions, chronic pain is the result of altered pain processing. This so-called sensitization can manifest as segmental or even generalized hyperalgesia, and is generally difficult to treat.ObjectiveThe aim of this study was to assess pain processing in ACNES patients responsive and refractory to treatment by using Quantitative Sensory Testing, in order to explore whether signs of altered central pain processing are present in ACNES and are a possible explanation for poor treatment outcomes.Methods50 patients treated for ACNES with locally orientated treatment were included. They were allocated to a responsive or refractory group based on their response to treatment. Patients showing an improvement of the Visual Analogue Scale (VAS) pain score combined with a current absolute VAS of <40 mm were scored as responsive.Sensation and pain thresholds to pressure and electric skin stimulation were determined in the paravertebral bilateral ACNES dermatomes and at four control areas on the non-dominant side of the body, i.e. the musculus trapezius pars medialis, musculus rectus femoris, musculus abductor hallucis and the thenar. The ACNES dermatomes were chosen to signal segmental hyperalgesia and the sum of the control areas together as a reflection of generalized hyperalgesia. Lower thresholds were interpreted as signs of sensitized pain processing. To test for alterations in endogenous pain inhibition, a conditioned pain modulation (CPM) response to a cold pressor task was determined. Also, patients filled in three pain-related questionnaires, to evaluate possible influence of psychological characteristics on the experienced pain.ResultsPatients refractory to treatment showed significantly lower pressure pain thresholds in the ACNES dermatomes and for the sum of as well as in two individual control areas. No differences were found between groups for electric thresholds or CPM response. Duration of complaints before diagnosis and treatment was significantly longer in the refractory compared to the responsive group, and refractory patients scored higher on the pain-related psychological surveys.Conclusion and ImplicationsIn this hypothesis-generating exploratory study, ACNES patients refractory to treatment showed more signs of sensitized segmental and central pain processing. A longer duration of complaints before diagnosis and treatment may be related to these alterations in pain processing, and both findings could be associated with less effective locally orientated treatment. In order to validate these hypotheses further research is needed.Registration numberNCT01920880 (Clinical Trials Register; http://www.clinicaltrials.gov).

Pain outcome after pancreatic surgery for pain of chronic pancreatitis: Relation to altered central pain processing

Pancreatology ◽  
2013 ◽  
Vol 13 (2) ◽  
pp. e7
Author(s):  
S.A.W. Bouwense ◽  
U.A. Ali ◽  
R.P.G. ten Broek ◽  
Y. Issa ◽  
C.H. van Eijck ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Surgery ◽  
Pain Processing ◽  
Central Pain ◽  
Pain Outcome ◽  
Central Pain Processing
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