(478) Effect of high and low frequency TENS on central pain processing in patients with knee osteoarthritis and healthy controls

Abstract Objectives To assess the immediate and three days postintervention effect of one dry needling session compared to one sham needling session on pain, central pain processing, muscle co-contraction and spatiotemporal parameters during gait in knee osteoarthritis patients. Methods A double-blind randomized controlled trial was conducted. Sixty-one knee osteoarthritis patients were randomly assigned to the dry needling or sham needling group. Primary outcomes were pain and central pain processing. Secondary outcomes included muscle co-contraction and spatiotemporal parameters during gait. Patients were assessed at baseline and 15 min after the intervention, and pain also three days after the intervention. Linear mixed models were used to examine between- and within-group differences. Results No significant between-group differences for pain were found, but within-group scores showed a significant decrease 15 min after sham needling and three days after dry needling. The mean conditioned pain modulation effect measured at the m. Trapezius worsened significantly 15 min after sham needling compared to after dry needling (between-group difference). However, individual conditioned pain modulation percentage scores remained stable over time. Various significant within-group differences were found 15 min after sham needling: a decrease of conditioned pain modulation measured at m. Quadriceps and m. Trapezius and stride- and step-time scores, and an increase in step length and widespread pain pressure threshold. A significant decrease in muscle co-contraction index of the m. Vastus Medialis and Semitendinosus was found as within-group difference 15 min after dry needling. Conclusions Dry needling has no larger effect on pain, central pain processing, muscle co-contraction and gait pattern 15 min and three days postintervention compared to sham needling. Mean conditioned pain modulation scores worsened after sham needling compared to after dry needling. Further research remains necessary.

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Does Acetaminophen Activate Endogenous Pain Inhibition in Chronic Fatigue Syndrome/ Fibromyalgia and Rheumatoid Arthritis? A DoubleBlind Randomized Controlled Cross-over Trial

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/e61 ◽

2013 ◽

Vol 2;16 (2;3) ◽

pp. E61-E70 ◽

Cited By ~ 2

Author(s):

Mira Meeus

Keyword(s):

Temporal Summation ◽

Chronic Fatigue ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Pain Processing ◽

Central Pain ◽

Healthy Controls ◽

Fatigue Syndrome ◽

Central Pain Processing ◽

Pain Inhibition

Background: Although enhanced temporal summation (TS) and conditioned pain modulation (CPM), as characteristic for central sensitization, has been proved to be impaired in different chronic pain populations, the exact nature is still unknown. Objectives: We examined differences in TS and CPM in 2 chronic pain populations, patients with both chronic fatigue syndrome (CFS) and comorbid fibromyalgia (FM) and patients with rheumatoid arthritis (RA), and in sedentary, healthy controls, and evaluated whether activation of serotonergic descending pathways by acetaminophen improves central pain processing. Study Design: Double-blind randomized controlled trial with cross-over design. Methods: Fifty-three women (19 CFS/FM patients, 16 RA patients, and 18 healthy women) were randomly allocated to the experimental group (1 g acetaminophen) or the placebo group (1 g dextrose). Participants underwent an assessment of endogenous pain inhibition, consisting of an evaluation of temporal summation with and without conditioned pain modulation (CPM). Seven days later groups were crossed-over. Patients and assessors were blinded for the allocation. Results: After intake of acetaminophen, pain thresholds increased slightly in CFS/FM patients, and decreased in the RA and the control group. Temporal summation was reduced in the 3 groups and CPM at the shoulder was better overall, however only statistically significant for the RA group. Healthy controls showed improved CPM for both finger and shoulder after acetaminophen, although not significant. Limitations: The influence of acetaminophen on pain processing is inconsistent, especially in the patient groups examined. Conclusion: This is the first study comparing the influence of acetaminophen on central pain processing in healthy controls and patients with CFS/FM and RA. It seems that CFS/ FM patients present more central pain processing abnormalities than RA patients, and that acetaminophen may have a limited positive effect on central pain inhibition, but other contributors have to be identified and evaluated. Key words: Chronic pain, sensitization, acetaminophen, conditioned pain modulation, temporal summation, chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis

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Functional connectivity of the anterior cingulate cortex with pain-related regions in children with post-traumatic headache

Cephalalgia Reports ◽

10.1177/25158163211009477 ◽

2021 ◽

Vol 4 ◽

pp. 251581632110094

Author(s):

Zahra Ofoghi ◽

Christiane S Rohr ◽

Deborah Dewey ◽

Signe Bray ◽

Keith Owen Yeates ◽

...

Keyword(s):

Functional Connectivity ◽

Anterior Cingulate Cortex ◽

Resting State ◽

Anterior Cingulate ◽

Pain Processing ◽

Central Pain ◽

Healthy Controls ◽

Post Traumatic ◽

The Right ◽

Central Pain Processing

Introduction: Post-traumatic headaches (PTH) are common following mild traumatic brain injury (mTBI). There is evidence of altered central pain processing in adult PTH; however, little is known about how children with PTH process pain. The anterior cingulate cortex (ACC) plays a critical role in descending central pain modulation. In this study, we explored whether the functional connectivity (FC) of the ACC is altered in children with PTH. Methods: In this case-control study, we investigated resting-state FC of 5 ACC seeds (caudal, dorsal, rostral, perigenual, and subgenual) in children with PTH ( n = 73) and without PTH ( n = 29) following mTBI, and healthy controls ( n = 27). Post-concussion symptoms were assessed using the Post-Concussion Symptom Inventory and the Child Health Questionnaire. Resting-state functional Magnetic Resonance Imaging (fMRI) data were used to generate maps of ACC FC. Group-level comparisons were performed within a target mask comprised of pain-related regions using FSL Randomise. Results: We found decreased FC between the right perigenual ACC and the left cerebellum, and increased FC between the right subgenual ACC and the left dorsolateral prefrontal cortex in children with PTH compared to healthy controls. The ACC FC in children without PTH following mTBI did not differ from the group with PTH or healthy controls. FC between rostral and perigenual ACC seeds and the cerebellum was increased in children with PTH with pre-injury headaches compared to those with PTH without pre-injury headaches. There was a positive relationship between PTH severity and rostral ACC FC with the bilateral thalamus, right hippocampus and periaqueductal gray. Conclusions: Central pain processing is altered in children with PTH. Pre-existing headaches help to drive this process. Trial registration: The PlayGame Trial was registered in ClinicalTrials.gov database ( ClinicalTrials.gov Identifier: NCT01874847).

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

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.09.014 ◽

2017 ◽

Vol 14 (1) ◽

pp. 53-59 ◽

Cited By ~ 2

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).

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

Pancreatology ◽

10.1016/j.pan.2012.12.078 ◽

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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Association of Dysregulated Central Pain Processing and Response to Disease–Modifying Antirheumatic Drug Therapy in Rheumatoid Arthritis

Arthritis & Rheumatology ◽

10.1002/art.41440 ◽

2020 ◽

Vol 72 (12) ◽

pp. 2017-2024

Author(s):

Andrew C. Heisler ◽

Jing Song ◽

Lutfiyya N. Muhammad ◽

Alyssa Wohlfahrt ◽

Wendy Marder ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Drug Therapy ◽

Antirheumatic Drug ◽

Pain Processing ◽

Central Pain ◽

Disease Modifying ◽

Central Pain Processing ◽

Antirheumatic Drug Therapy ◽

Disease Modifying Antirheumatic Drug

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Central pain processing does not differ between first episode and recurrent acute low back pain

Physiotherapy Practice and Research ◽

10.3233/ppr-190143 ◽

2020 ◽

Vol 41 (1) ◽

pp. 35-42

Author(s):

Wei-Ju Chang ◽

Valentina Buscemi ◽

Matthew B. Liston ◽

James H. McAuley ◽

Siobhan M. Schabrun

Keyword(s):

Low Back Pain ◽

Back Pain ◽

First Episode ◽

Pain Processing ◽

Central Pain ◽

Low Back ◽

Acute Low Back Pain ◽

Central Pain Processing

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

Pain Research and Management ◽

10.1155/2018/8564215 ◽

2018 ◽

Vol 2018 ◽

pp. 1-14 ◽

Cited By ~ 22

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.

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