scholarly journals Pain Treatment for Patients With Osteoarthritis and Central Sensitization

2013 ◽  
Vol 93 (6) ◽  
pp. 842-851 ◽  
Author(s):  
Enrique Lluch Girbés ◽  
Jo Nijs ◽  
Rafael Torres-Cueco ◽  
Carlos López Cubas
Keyword(s):  
Central Sensitization ◽  
Pain Treatment ◽  
Behavioral Therapy ◽  
Modern Society ◽  
Descending Inhibition ◽  
Osteoarthritis Pain ◽  
Descending Facilitation ◽  
Neuroscience Education ◽  
New Treatment ◽  
Central Pain Processing

Osteoarthritis is one of the most frequent, disabling, and costly pathologies of modern society. Among the main aims of osteoarthritis management are pain control and functional ability improvement. The exact cause of osteoarthritis pain remains unclear. In addition to the pathological changes in articular structures, changes in central pain processing or central sensitization appear to be involved in osteoarthritis pain. The latter calls for a broader approach to the management of patients with osteoarthritis. Yet, the scientific literature offers scant information addressing the treatment of central sensitization, specifically in patients with osteoarthritis. Interventions such as cognitive-behavioral therapy and neuroscience education potentially target cognitive-emotional sensitization (and descending facilitation), and centrally acting drugs and exercise therapy can improve endogenous analgesia (descending inhibition) in patients with osteoarthritis. Future studies should assess these new treatment avenues.

scholarly journals Pain in Patients with Chronic Fatigue Syndrome: Time for Specific Pain Treatment?

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. E677-E686
Author(s):  
Jo Nijs
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioral Therapy ◽  
Central Sensitization ◽  
Pain Treatment ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Chronic Fatigue ◽  
Cognitive Behavioral ◽  
Fatigue Syndrome ◽  
Endogenous Analgesia

Background: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers. Objectives: To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as other CFS symptoms? Second, it is examined whether effective treatments for pain from CFS are currently available. Study Design: Narrative review covering the scientific literature up through December 2011. Setting: Several universities. Results: From the available literature, it is concluded that musculoskeletal factors are unlikely to account for pain from CFS. Pain seems to be one out of many symptoms related to central sensitization from CFS. This idea is supported by the findings of generalized hyperalgesia (including widespread increased responsiveness to painful stimuli) and dysfunctional endogenous analgesia in response to noxious thermal stimuli. Pain catastrophizing and depression partly account for pain from CFS. Pain increases during exercise is probably due to the lack of endogenous analgesia and activation of several genes in response to exercise in CFS. There is currently no evidence in support for the efficacy of complementary medicine in the treatment of pain from CFS. Intensive education about the biology of pain from CFS (within the framework of central sensitization) has positive short-term effects for patients with CFS, and fatigue-targeting cognitive behavioral therapy appears to be effective for pain from CFS as well. Limitations: The role of the deficient hypothalamus-pituitary-adrenal axis in relation to pain from CFS, as well as the interactions with immune (dys)functioning require further study. Conclusion: Recent research has increased our understanding of pain from CFS, including its treatment. It is advocated to optimize current CFS treatment protocols by targeting the underlying mechanism for those patients having severe pain. Key words: Chronic pain, chronic fatigue syndrome, fibromyalgia, central sensitization, catastrophizing, exercise, cognitive behavioral therapy.

scholarly journals Assessment of diagnostic criteria for the identification of central sensitization in patients with osteoarthritis pain

Medicine ◽  
2020 ◽  
Vol 99 (52) ◽  
pp. e23470
Author(s):  
Christian Dürsteler ◽  
Carlos Cordero-García ◽  
Carlos Ignacio García Fernández ◽  
Juan V. Peralta Molero ◽  
Ignacio Morón Merchante
Keyword(s):  
Diagnostic Criteria ◽  
Central Sensitization ◽  
Osteoarthritis Pain

scholarly journals Monoaminergic and Opioidergic Modulation of Brainstem Circuits: New Insights Into the Clinical Challenges of Pain Treatment?

2021 ◽  
Vol 2 ◽  
Author(s):  
Isaura Tavares ◽  
José Tiago Costa-Pereira ◽  
Isabel Martins
Keyword(s):  
Neuropathic Pain ◽  
Pain Control ◽  
Pain Treatment ◽  
Reticular Nucleus ◽  
Serotoninergic System ◽  
High Plasticity ◽  
Descending Facilitation ◽  
Pain Models ◽  
Dual Action ◽  
Control Circuits

The treatment of neuropathic pain remains a clinical challenge. Analgesic drugs and antidepressants are frequently ineffective, and opioids may induce side effects, including hyperalgesia. Recent results on brainstem pain modulatory circuits may explain those clinical challenges. The dual action of noradrenergic (NA) modulation was demonstrated in animal models of neuropathic pain. Besides the well-established antinociception due to spinal effects, the NA system may induce pronociception by directly acting on brainstem pain modulatory circuits, namely, at the locus coeruleus (LC) and medullary dorsal reticular nucleus (DRt). The serotoninergic system also has a dual action depending on the targeted spinal receptor, with an exacerbated activity of the excitatory 5-hydroxytryptamine 3 (5-HT3) receptors in neuropathic pain models. Opioids are involved in the modulation of descending modulatory circuits. During neuropathic pain, the opioidergic modulation of brainstem pain control areas is altered, with the release of enhanced local opioids along with reduced expression and desensitization of μ-opioid receptors (MOR). In the DRt, the installation of neuropathic pain increases the levels of enkephalins (ENKs) and induces desensitization of MOR, which may enhance descending facilitation (DF) from the DRt and impact the efficacy of exogenous opioids. On the whole, the data discussed in this review indicate the high plasticity of brainstem pain control circuits involving monoaminergic and opioidergic control. The data from studies of these neurochemical systems in neuropathic models indicate the importance of designing drugs that target multiple neurochemical systems, namely, maximizing the antinociceptive effects of antidepressants that inhibit the reuptake of serotonin and noradrenaline and preventing desensitization and tolerance of MOR at the brainstem.

Central Sensitization and Altered Central Pain Processing in Chronic Low Back Pain

2013 ◽  
Vol 29 (7) ◽  
pp. 625-638 ◽  
Author(s):  
Nathalie A. Roussel ◽  
Jo Nijs ◽  
Mira Meeus ◽  
Veit Mylius ◽  
Cécile Fayt ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Central Sensitization ◽  
Pain Processing ◽  
Central Pain ◽  
Low Back ◽  
Central Pain Processing

scholarly journals Efficacy of Preemptive Analgesia with Pregabalin in Orthognathic Surgery-A Systematic Review

2021 ◽  
pp. 334-340
Author(s):  
Subhashini Ramasubbu ◽  
Abdul Wahab
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Central Sensitization ◽  
Orthognathic Surgery ◽  
Pain Treatment ◽  
Oral Surgery ◽  
Preemptive Analgesia ◽  
Surgical Trauma ◽  
Acute Postoperative Pain ◽  
Manual Search

Background: Orthognathic surgery is a treatment approach that is used for correcting the congenital or developmental anomalies of maxilla and mandible as well as secondary deformities of trauma. During these procedure saws, chisels, separators, and plate screw systems are used. Postoperative pain is an acute pain that is accompanied by the inflammatory process that occurs as a result of surgical trauma, and gradually decreases with tissue recovery. The analgesic prevents the establishment of the central sensitization due to incisional injury (only covers the surgical period) and prevents the establishment of the central sensitization (covering the surgical and early postoperative periods). Pregabalin is a structural gama-aminobutyric acid (GABA) analogue. It has been shown in recent studies that pregabalin, which is involved in chronical pain treatment, can also be involved in acute postoperative pain treatment. Objectives: The aim of this systematic review is to assess the efficacy of preemptive analgesia with pregabalin on postoperative pain in orthognathic surgery. Materials and Methods: The Data Bases of PubMed, Cochrane and Google scholar were searched for the related topics along with a complimentary manual search of all oral surgery journals till September 2019. Articles were selected based on the inclusion criteria, which included all RCTs. Results: From this systematic review it is concluded that pre-emptive analgesia with pregabalin is effective in lowering acute postoperative pain in the patients who have undergone orthognathic surgery. Conclusion: In this systematic review we have concluded that, on average, a single dose of pregabalin was shown to decrease post-operative pain. More studies have to be done to evaluate the efficacy of the drug.   

scholarly journals The Case of "Hiro": Treating Tourette Syndrome by Comprehensive Behavioral Intervention for Tics (CBIT)

2017 ◽  
Vol 13 (1) ◽  
pp. 1
Author(s):  
Jeremy D. Lichtman
Keyword(s):  
Tourette Syndrome ◽  
Behavioral Intervention ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
Case Formulation ◽  
Efficacious Treatment ◽  
Treatment Considerations ◽  
New Treatment

Cognitive-behavioral therapy (CBT) with Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment for Tourette Syndrome (TS), with a manualized version available for guiding practitioners through treatment. However, CBIT is still a fairly new treatment for TS and rigorous training in its application is sparse. Additionally, potential treatment considerations are not thoroughly described in the manual. This dissertation presents a systematic case study that specifically analyzes the use of the manual with 10-year-old "Hiro," a South Asian Indian boy with TS who also had attention deficit hyperactivity disorder (ADHD), which is a confounding factor in the treatment of TS. To do this meant applying flexibility and an "hypothesizing-then-testing" mentality. The creation of an individualized case formulation and an associated treatment plan for Hiro were very valuable components in his treatment. The case study chronicles Hiro's successful treatment and explores how and when adherence to the manual was effective as well as how and when greater flexibility was required. Furthermore, the case study explores factors in the clinician/client relationship and how that relationship can prove a powerful tool in treatment. Options for how to maintain treatment goals after termination are also examined.

Sign in / Sign up

Export Citation Format

Share Document