scholarly journals Hormones in pain modulation and their clinical implications for pain control: a critical review

HORMONES ◽  
2016 ◽  
Vol 15 (3) ◽  
pp. 313-320 ◽  
Author(s):  
Xueyin Chen ◽  
Jinyuan Zhang ◽  
Xiangrui Wang
Keyword(s):  
Critical Review ◽  
Pain Control ◽  
Pain Modulation ◽  
Clinical Implications

Experimental evidence for weaker endogenous inhibition of trigeminal pain than extra-trigeminal pain in healthy individuals

Cephalalgia ◽  
2017 ◽  
Vol 38 (7) ◽  
pp. 1307-1315 ◽  
Author(s):  
Dan Levy ◽  
Lorin Abdian ◽  
Michal Dekel-Steinkeller ◽  
Ruth Defrin
Keyword(s):  
Pain Control ◽  
Pain Modulation ◽  
Primary Headaches ◽  
Healthy Individuals ◽  
Trigeminal Pain ◽  
Pain Syndromes ◽  
Body Regions ◽  
Endogenous Pain Modulation ◽  
High Prevalence ◽  
Pain Inhibition

Background and objectives The prevalence of pain syndromes that affect the territories innervated by the trigeminal nerve, such as headaches, is one of the highest and ranks second only to low back pain. A potential mechanism underlying this high prevalence may be a relatively weak endogenous pain modulation of trigeminal pain. Here, we sought to systematically compare endogenous pain modulation capabilities in the trigeminal region to those of extra-trigeminal regions in healthy subjects. Methods Healthy, pain free subjects (n = 17) underwent a battery of quantitative sensory testing to assess endogenous pain inhibition and pain enhancement efficiencies within and outside the trigeminal innervated region. Measurements included conditioned pain modulation (CPM), temporal summation of pain (TSP) and spatial summation of pain (SSP). Results Testing configurations that included trigeminal-innervated body regions displayed significantly weaker CPM when compared to extra-trigeminal innervated areas. SSP magnitude was smaller in the ophthalmic trigeminal innervation when compared to other body regions. TSP magnitude was not different between the different body regions tested. Conclusions Our findings point to regional differences in endogenous pain inhibition and suggest that in otherwise healthy individuals, the trigeminal innervation is subjected to a weaker inhibitory pain control than other body regions. Such weaker endogenous pain control could play, at least in part, a role in mediating the high prevalence of trigeminal-related pain syndromes, including primary headaches and TMD pain.

scholarly journals Treatment for Pediatric Aphasia: A Critical Review

2020 ◽  
Author(s):  
K. L. Cox ◽  
L. O. Froeschke ◽  
R. E. Schumacher ◽  
Brenda Gorman
Keyword(s):  
Critical Review ◽  
Observational Studies ◽  
Language Intervention ◽  
Clinical Implications ◽  
Functional Communication ◽  
Language Outcomes ◽  
Adequate Description ◽  
Current State ◽  
Rising Incidence ◽  
Aphasia Recovery

Objective: The primary aim of this study was to summarize the current state-of-science for principles and practices of intervention in acquired pediatric aphasia (APA). A secondary aim was to identify gaps in research regarding interventional frameworks, and to identify key areas of future inquiry to optimize language outcomes. Conclusions: Although epidemiologic data indicate rising incidence in  APA, limited research on recovery and intervention exists. Results suggest that language intervention supports aphasia recovery; however, available data lack adequate description of methodologies to make crosscomparisons and dosage recommendations possible. Evidence from observational studies suggests that a) pediatric recovery is not necessarily more rapid nor complete than adult recovery; b) principles of neuroplasticity may be applied to pediatric aphasia; however prognostication may be affected by developmental stage and presence of immature language networks; and, c) aphasia symptoms related to literacy may extend into adulthood, even after functional communication has been established. Clinical implications as well as recommendations for research are discussed in light of evidence.

Reliability of conditioned pain modulation for the assessment of endogenous pain control pathways

2016 ◽  
Vol 22 (3-4) ◽  
pp. 155-161 ◽  
Author(s):  
Tanja Bossmann ◽  
Torsten Brauner ◽  
Heiko Lowak ◽  
Fernand Anton ◽  
Clemens Forster ◽  
...  
Keyword(s):  
Pain Control ◽  
Pain Modulation ◽  
Conditioned Pain Modulation

scholarly journals The association between pain-induced autonomic reactivity and descending pain control is mediated by the periaqueductal grey

2020 ◽  
Author(s):  
Elena Makovac ◽  
Alessandra Venezia ◽  
David Hohenschurz-Schmidt ◽  
Ottavia Dipasquale ◽  
Jade B Jackson ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Functional Connectivity ◽  
Pain Control ◽  
Brain Regions ◽  
Pain Modulation ◽  
Autonomic Reactivity ◽  
Pain Mechanisms ◽  
Cold Pain ◽  
Periaqueductal Grey ◽  
Descending Pain Modulation

AbstractThere is a strict interaction between the autonomic nervous system (ANS) and pain, which might involve descending pain modulatory mechanisms. The periaqueductal grey (PAG) is involved both in descending pain modulation and ANS, but its role in mediating this relationship has not yet been explored.Here, we sought to determine brain regions mediating ANS and descending pain control associations. 30 participants underwent Conditioned Pain Modulation (CPM) assessments, in which they rated painful pressure stimuli applied to their thumbnail, either alone or with a painful cold contralateral stimulation. Differences in pain ratings between ‘pressure-only’ and ‘pressure+cold’ stimuli provided a measure of descending pain control. In 18 of the 30 participants, structural scans and two functional MRI assessments, one pain-free and one during cold-pain, were acquired. Heart Rate Variability (HRV) was simultaneously recorded.Low frequency HRV (LF-HRV) and the CPM score were negatively correlated; individuals with higher LF-HRV during pain reported reductions in pain during CPM. PAG-frontal medial cortex (FMC) and PAG-rostral ventro-medial medulla (RVM) functional connectivity correlated negatively with the CPM. Importantly, PAG-FMC functional connectivity mediated the strength of HRV-CPM association. CPM response magnitude was also negatively associated with PAG and positively associated with FMC grey matter volumes.Our multi-modal approach, using behavioral, physiological and MRI measures, provides important new evidence of interactions between ANS and descending pain mechanisms. ANS dysregulation and dysfunctional descending pain modulation are characteristics of chronic pain. We suggest that further investigation of body-brain interactions in chronic pain patients may catalyse the development of new treatments.

scholarly journals Current understanding of thalamic structure and function in migraine

Cephalalgia ◽  
2018 ◽  
Vol 39 (13) ◽  
pp. 1675-1682 ◽  
Author(s):  
Samaira Younis ◽  
Anders Hougaard ◽  
Rodrigo Noseda ◽  
Messoud Ashina
Keyword(s):  
Drug Target ◽  
Critical Role ◽  
Structure And Function ◽  
Pain Modulation ◽  
Clinical Implications ◽  
Important Position ◽  
Cortical Regions ◽  
And Function ◽  
Thalamic Structure

Objective To review and discuss the literature on the role of thalamic structure and function in migraine. Discussion The thalamus holds an important position in our understanding of allodynia, central sensitization and photophobia in migraine. Structural and functional findings suggest abnormal functional connectivity between the thalamus and various cortical regions pointing towards an altered pain processing in migraine. Pharmacological nociceptive modulation suggests that the thalamus is a potential drug target. Conclusion A critical role for the thalamus in migraine-related allodynia and photophobia is well established. Additionally, the thalamus is most likely involved in the dysfunctional pain modulation and processing in migraine, but further research is needed to clarify the exact clinical implications of these findings.

Endogenous opioids in the CNS

2018 ◽  
Author(s):  
Tony Dickenson
Keyword(s):  
Pain Control ◽  
Pain Modulation ◽  
Endogenous Opioids ◽  
Inhibitory Effects ◽  
Endogenous Opioid ◽  
Subsequent Work ◽  
Multiple Receptors ◽  
Opioid Drugs ◽  
The Central Nervous System ◽  
Opiate Binding

This short and concise paper was the first to unequivocally reveal that there were endogenous opioids in the central nervous system (CNS), identify their peptide nature and sequence, and show that they exerted physiological inhibitory effects. The idea that there were natural opioids fitted with concurrent reports of opiate-binding sites, and this led to the description of multiple receptors with their own families of peptide transmitters. No truly novel opioid drugs have emerged since, and attempts to protect and manipulate the enkephalins for pain control have yet to be successful. This does not detract from this key study, which made us think about pain modulation in a different way, and subsequent work has clearly shown how endogenous opioid signalling is critical in CNS function, perhaps most importantly in endogenous pain control, such as that harnessed by placebo analgesia.

scholarly journals Optimised transcranial direct current stimulation (tDCS) for fibromyalgia—targeting the endogenous pain control system: a randomised, double-blind, factorial clinical trial protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032710 ◽  
Author(s):  
Luis Castelo-Branco ◽  
Elif Uygur Kucukseymen ◽  
Dante Duarte ◽  
Mirret M El-Hagrassy ◽  
Camila Bonin Pinto ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Control System ◽  
Aerobic Exercise ◽  
Clinical Outcomes ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Pain Control ◽  
Pain Modulation ◽  
Double Blind ◽  
Direct Current Stimulation

IntroductionFibromyalgia (FM) is a common debilitating condition with limited therapeutic options. Medications have low efficacy and are often associated with adverse effects. Given that FM is associated with a defective endogenous pain control system and central sensitisation, combining interventions such as transcranial direct current stimulation (tDCS) and aerobic exercise (AE) to modulate pain-processing circuits may enhance pain control.Methods and analysisA prospective, randomised (1:1:1:1), placebo-controlled, double-blind, factorial clinical trial will test the hypothesis that optimised tDCS (16 anodal tDCS sessions combined with AE) can restore of the pain endogenous control system. Participants with FM (n=148) will undergo a conditioning exercise period and be randomly allocated to one of four groups: (1) active tDCS and AE, (2) sham tDCS and AE, (3) active tDCS and non-aerobic exercise (nAE) or (4) sham tDCS and nAE. Pain inhibitory activity will be assessed using conditioned pain modulation (CPM) and temporal slow pain summation (TSPS)—primary outcomes. Secondary outcomes will include the following assessments: Transcranial magnetic stimulation and electroencephalography as cortical markers of pain inhibitory control and thalamocortical circuits; secondary clinical outcomes on pain, FM, quality of life, sleep and depression. Finally, the relationship between the two main mechanistic targets in this study—CPM and TSPS—and changes in secondary clinical outcomes will be tested. The change in the primary efficacy endpoint, CPM and TSPS, from baseline to week 4 of stimulation will be tested with a mixed linear model and adjusted for important demographic variables.Ethics and disseminationThis study obeys the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of Partners Healthcare under the protocol number 2017P002524. Informed consent will be obtained from participants. Study findings will be reported in conferences and peer-reviewed journal publications.Trial registration numberNCT03371225.

scholarly journals Embodied Semantics in a Second Language: Critical Review and Clinical Implications

2019 ◽  
Vol 13 ◽  
Author(s):  
Elisa Monaco ◽  
Lea B. Jost ◽  
Pascal M. Gygax ◽  
Jean-Marie Annoni
Keyword(s):  
Second Language ◽  
Critical Review ◽  
Clinical Implications

scholarly journals Central Hyperexcitability in Chronic Musculoskeletal Pain: A Conceptual Breakthrough with Multiple Clinical Implications

2002 ◽  
Vol 7 (2) ◽  
pp. 81-92 ◽  
Author(s):  
Jan Lidbeck
Keyword(s):  
Musculoskeletal Pain ◽  
Myofascial Pain ◽  
Pain Modulation ◽  
Chronic Musculoskeletal Pain ◽  
Individual Treatment ◽  
Clinical Implications ◽  
Pain Processing ◽  
Central Pain ◽  
Myofascial Pain Syndromes ◽  
Pain Syndromes

Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

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