scholarly journals Complexity Assessment of Chronic Pain in Elderly Knee Osteoarthritis Based on Neuroimaging Recognition Techniques

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Xuemin Wu ◽  
Jingjing Liu ◽  
Min Liu ◽  
Tao Wu
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Knee Osteoarthritis ◽  
Near Infrared ◽  
Similarity Index ◽  
The Elderly ◽  
Inverse Transformation ◽  
Low Level ◽  
Reconstruction Performance ◽  
Neuroimaging Techniques

The chronic pain of knee osteoarthritis in the elderly is investigated in detail in this paper, as well as the complexity of chronic pain utilising neuroimaging recognition techniques. Chronic pain in knee osteoarthritis (KOA) has a major effect on patients’ quality of life and functional activities; therefore, understanding the causes of KOA pain and the analgesic advantages of different therapies is important. In recent years, neuroimaging techniques have become increasingly important in basic and clinical pain research. Thanks to the application and development of neuroimaging techniques in the study of chronic pain in KOA, researchers have found that chronic pain in KOA contains both injury-receptive and neuropathic pain components. The neuropathic pain mechanism that causes KOA pain is complicated, and it may be produced by peripheral or central sensitization, but it has not gotten enough attention in clinical practice, and there is no agreement on how to treat combination neuropathic pain KOA. As a result, using neuroimaging techniques such as magnetic resonance imaging (MRI), electroencephalography (EEG), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS), this review examines the changes in brain pathophysiology-related regions caused by KOA pain, compares the latest results in pain assessment and prediction, and clarifies the central brain analgesic mechanistic. The capsule network model is introduced in this paper from the perspective of deep learning network structure to construct an information-complete and reversible image low-level feature bridge using isotropic representation, predict the corresponding capsule features from MRI voxel responses, and then, complete the accurate reconstruction of simple images using inverse transformation. The proposed model improves the structural similarity index by about 10%, improves the reconstruction performance of low-level feature content in simple images by about 10%, and achieves feature interpretation and analysis of low-level visual cortical fMRI voxels by visualising capsule features, according to the experimental results.

scholarly journals Chronic Pain in the Elderly: The Case for New Therapeutic Strategies

2015 ◽  
Vol 5;18 (5;9) ◽  
pp. E863-E876
Author(s):  
Giustino Varrassi
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Immune System ◽  
Mast Cells ◽  
Elderly Patients ◽  
Elderly Population ◽  
Neuronal Cells ◽  
Neuronal Cell ◽  
The Elderly ◽  
Narrative Review

Background: Elderly patients in general exhibit a higher incidence of chronic and neuropathic pain conditions. This group poses a particular clinical challenge due to age-related pharmacokinetic and pharmacodynamic issues, comorbid conditions, and polypharmacy, as well as frailty and cognitive decline. Poor control of pain has consistently been identified as an issue for older people. The identification of safe and efficacious treatments for chronic pain remains a critical public health concern, especially considering the progressive increase of the world’s elderly population. Objectives: This narrative review deals with the principal alterations of the somatosensory system together with changes in non-neuronal cells in the course of aging. The possibility to control chronic pain based on an innovative strategy which addresses non-neuronal cell dysregulation control will also be discussed. Study Design: Narrative review. Results: Peripheral nerves display functional, structural, and biochemical changes with aging that mainly involve Aδ fibers. Alteration in the responses to heat pain in the middle insular cortex and primary somatosensory cortex are also observed in the elderly. In general, pain threshold increases with age while the threshold of pain tolerance remains unchanged or decreases. Additionally, other important modifications of the pain perception system in this age group consist in a clear reduction in the descending inhibitory capacity with an associated increase in central sensitization. Furthermore, different changes concern immune system cells, such as mast cells and microglia, that with age show an increase in their sensitivity to noxious stimuli and a decreased capability to be regulated by homeostatic endogenous systems. Since these cells are the primary interlocutors for pain neurons, their alterations lead to changes that promote persistent neuroinflammation, thereby impacting pain neuronal cell functionality. Limitation: This review is not an exhaustive review for the current evidence supporting the role of immune cells in influencing pain somatosensory neuron functions. It is also important to stress the small number of studies designed to determine the efficacy and safety of anti-pain therapies in elderly patients. Conclusion: Non-neuronal cells of immune system origin such as microglia and mast cells, along with astrocytes, are capable of influencing pain somatosensory neuron functions. These nervous system non-neuronal cells may thus be viewed as innovative targets for persistent pain control. Among therapies aiming at preserving the functionality of non-neuronal cells, palmitoylethanolamide, with its high efficacy/risk ratio, may be an excellent co-treatment for the ever-growing elderly population with chronic pain. Key words: Elderly, chronic and neuropathic pain, mast cells, glial cells, neuroinflammation, micronized and ultra-micronized palmitoylethanolamide

scholarly journals Evaluation of the efficacy of pregabalin in the therapy of chronic pain in patients with knee osteoarthritis

2017 ◽  
Vol 89 (12) ◽  
pp. 81-85 ◽  
Author(s):  
E S Filatova ◽  
E F Turovskaya ◽  
L I Alekseeva
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Combination Therapy ◽  
Knee Osteoarthritis ◽  
Anticonvulsant Drug ◽  
Pain Visual Analogue Scale ◽  
Womac Index ◽  
Inflammatory Drugs ◽  
To Receive ◽  
Positive Effect

Aim. To evaluate the efficacy of pregabalin in the therapy of chronic pain in patients with knee osteoarthritis (KOA). Subjects and methods. The study enrolled 60 patients with KOA and neuropathic pain component (NPC) (Douleur Neuropathique en 4 questions (DN4) questionnaire scores, >4) who were randomized into two groups to receive aceclofenac or aceclofenac + pregabalin for 5 weeks. All the patients underwent clinical and neurological examinations, assessment of the functional WOMAC index, pain intensity at rest and during movement, and diagnosis of neuropathic pain (NP) (DN4 and Pain DETECT questionnaires). Results. Both groups were observed to have positive changes in the studied parameters; however, combination therapy using an anticonvulsant drug (pregabalin) showed a more pronounced positive effect against not only NPC, but also the functional activity (WOMAC) and severity of pain (visual analogue scale). Conclusion. Combination therapy using pregabalin in KOA patients having the signs of NP is more effective than monotherapy with nonsteroidal anti-inflammatory drugs (aceclofenac).

scholarly journals Importance and challenges of neuropathic pain

2021 ◽  
Vol 64 (7) ◽  
pp. 456-459
Author(s):  
In Soo Joo
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Neurological Disorders ◽  
Social Relationship ◽  
Elderly Population ◽  
Pathological Condition ◽  
The Elderly ◽  
Subjective Symptom ◽  
Background Pain

Background: Pain is a complex and subjective symptom frequently encountered in many clinical fields. Acute pain is usually physiological, but chronic pain is a pathological condition that seriously affects the patientsʼ normal daily activities and quality of life. In addition, chronic pain has profoundly detrimental effects on their family and social relationship as well as a national healthcare system.Current Concepts: Neuropathic pain is accompanied by diverse neurological disorders in the central and peripheral nervous systems. Neuropathic pain is also a type of chronic pain and has mechanisms unresolved completely yet. Despite recent advances in basic and clinical researches of neuropathic pain including an individualized therapy, the treatment has not been satisfactory. Another problem is the increasing prevalence of neuropathic pain because of the rapid increase of the elderly population as in the case of Korea.Discussion and Conclusion: The clinician should be aware of a clinical entity of neuropathic pain to make an accurate diagnosis and to treat the patients more effectively.

Identification of Neuropathic Pain Component in Patients with Knee Osteoarthritis

TRAUMA ◽  
2016 ◽  
Vol 17 (3) ◽  
pp. 114
Author(s):  
V.V. Povorozniuk ◽  
U.I. Pryimych
Keyword(s):  
Neuropathic Pain ◽  
Knee Osteoarthritis

scholarly journals The effects of teaching methods of palliative care on life pattern of old women with chronic pain

2019 ◽  
Vol 29 (4) ◽  
Author(s):  
Elham Hesari ◽  
Zahra Sabzi ◽  
Shohreh Kolagari
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Teaching Methods ◽  
Social Life ◽  
Educational Program ◽  
Elderly Women ◽  
Intervention Group ◽  
The Elderly ◽  
Old People ◽  
Life Pattern

Chronic pain is among problems of old people and causes changes in their life pattern and processes. Teaching palliative care can help old people suffering from chronic pain to live an active life. The aim of this research was to determine effects of educating of palliative care on life pattern of elderly women with chronic pain. The present study was a Quasi-experimental design with pre-test and post test was conducted on 30 elderly women suffering from chronic pain in 2018 in Iran. The Questionnaire for evaluating the Pattern of Life with Pain in the elderly was filled before the intervention, group educating of palliative care was carried out using an educational package, and the questionnaire was completed again immediately and one and three months after. The data was analyzed using mean, standard deviations, Fisher’s F test, and Greenhouse-Geisser and Bonferroni post-hoc test by employing SPSS- 16. Mean changes before teaching palliative care significantly differed from those of immediately and one and three months after the educational program (p = 0.0), (p = 0.004). There were significant differences between the stages of immediately and one month after the educational program and that of three months after it (p = 0.001), (p = 0.002). Concerning the personal life patterns, there were statistically significant differences between the stage immediately after the educational program and those before the intervention and three months after it (p = 0.005), (p = 0.000). Regarding the social life pattern, only the stage of one month after the educational program significantly differed from that of three months (p = 0.005). Mean growth in life pattern of the old women suffering from chronic pain in the stages after the intervention indicated the importance of and the necessity for palliative care during old age. Moreover, the success of this education three months after the educational program as compared to immediately and one month after it indicates that allocation of sufficient time plays a very important role in transferring information and in teaching methods of palliative care to old people.

scholarly journals The Safety and Effect of Local Botulinumtoxin A Injections for Long-Term Management of Chronic Pain in Post-Herpetic Neuralgia: Literature Review and Cases Report Treated with Incobotulinumtoxin A

2021 ◽  
Vol 11 (8) ◽  
pp. 758
Author(s):  
Songjin Ri ◽  
Anatol Kivi ◽  
Jörg Wissel
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Adverse Events ◽  
Case Reports ◽  
Pain Reduction ◽  
Post Herpetic Neuralgia ◽  
Botulinumtoxin A ◽  
Incobotulinumtoxin A ◽  
Term Management

There are few reports on the safety and effectiveness of long-term botulinumtoxin A (BoNT A) therapy in severe chronic pain of post-herpetic neuralgia (PHN). The literature was searched with the term “neuropathic pain” and “botulinum” on PubMed (up to 29 February 2020). Pain was assessed with the Visual Analogue Scale (VAS) before and after BoNT A therapy. A total of 10 clinical trials and six case reports including 251 patients with PHN were presented. They showed that BoNT A therapy had significant pain reduction (up to 30–50%) and improvement in quality of life. The effect duration seems to be correlated with BoNT A doses injected per injection site. Intervals between BoNT A injections were 10–14 weeks. No adverse events were reported in cases and clinical studies, even in the two pregnant women, whose babies were healthy. The repeated (≥6 times) intra/subcutaneous injections of incobotulinumtoxin A (Xeomin®, Merz Pharmaceuticals, Germany) over the two years of our three cases showed marked pain reduction and no adverse events. Adjunctive local BoNT A injection is a promising option for severe PHN, as a safe and effective therapy in long-term management for chronic neuropathic pain. Its effect size and -duration seem to be depended on the dose of BoNT A injected per each point.

scholarly journals FRI0382 EFFECTS OF GENICULAR NERVE BLOCK IN PATIENTS WITH KNEE OSTEOARTHRITIS WHO HAVE NEUROPATHIC OR NOCICEPTIVE PAIN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 788.2-789
Author(s):  
B. Tas ◽  
P. Akpinar ◽  
I. Aktas ◽  
F. Unlu Ozkan ◽  
I. B. Kurucu
Keyword(s):  
Neuropathic Pain ◽  
Knee Osteoarthritis ◽  
Nerve Block ◽  
Intractable Pain ◽  
Ultrasound Guided ◽  
Lidocaine Group ◽  
Knee Oa ◽  
Significant Difference ◽  
Genicular Artery ◽  
Saline Solutions

Background:Genicular nerve block (GNB) is a safe and effective therapeutic procedure for intractable pain associated with chronic knee osteoarthritis (OA)(1). There is increasing support for the neuropathic component to the knee OA pain. Investigators proposed that targeting treatment to the underlying pain mechanism can improve pain management in knee OA (2). There is a debate on injectable solutions used in nerve blocks (3).Objectives:To investigate the analgesic and functional effects of USG-guided GNB in patients with chronic knee OA (with/without neuropathic pain) and to evaluate the efficacy of the anesthetic and non-anesthetic solutions used.Methods:Ninety patients with chronic knee OA between the ages of 50-80 were divided into two groups with and without neuropathic pain according to painDETECT questionnaire (4). The groups were randomized into three subgroups to either the lidocaine group (n=30) or dextrose group (n=29) or saline solutions (n=31). After the ultrasound-guided GNB, quadriceps isometric strengthening exercises and cryotherapy were recommended to the patients. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne-algofunctional Index were assessed at baseline and at 1 week, 1 and 3 months later after the procedure.Results:Statistically significant improvement was observed in all groups with or without neuropathic pain according to VAS values at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05). Statistically significant improvement was observed in all groups with neuropathic pain according to painDETECT values at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05). There was a statistically significant improvement in the groups without neuropathic pain which received dextrose and saline solutions, according to painDETECT values, but not in the group which received lidocain at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p>0.05). There was a statistically significant improvement in all groups with or without neuropathic pain according to WOMAC and Lequesne total scores at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05).Conclusion:We conclude that in patients with chronic knee OA (with/without neuropathic pain), the use of GNB with USG is an analgesic method which provides short to medium term analgesia and functional recovery and has no serious side effects. The lack of significant difference between the anesthetic and non-anesthetic solutions used in the GNB suggests that this may be a central effect rather than a symptom of peripheral nerve dysfunction. It suggests that injection may have an indirect effect through nociceptive processing and changes in neuroplastic mechanisms in the brain. In addition, we can say that regular exercise program contributes to improved physical function with the decrease in pain.References:[1]Kim DH et al. Ultrasound-guided genicular nerve block for knee osteoarthritis: a double-blind, randomized controlled trial of local anesthetic alone or in combination with corticosteroid. Pain Physician 2018;21:41-51.[2]Thakur M et.al. Osteoarthritis pain: nociceptive or neuropathic?. Nat Rev Rheumatol 2014:10(6):374.[3]Lam SKH et al. Transition from deep regional blocks toward deep nerve hydrodissection in the upper body and torso: method description and results from a retrospective chart review. BioMed Research International Volume 2017;7920438.[4]Hochman JR et al. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011 Jun;19(6):647-54.Fig. 1:Ultrasound- guided identification of GNB target sites. Doppler mode. White arrows indicate genicular arteries.A.Superior medial genicular artery.B.Inferior medial genicular artery.C.Superior lateral genicular artery.Disclosure of Interests:None declared

scholarly journals Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 630
Author(s):  
Satoshi Shimo ◽  
Yuta Sakamoto ◽  
Takashi Amari ◽  
Masaaki Chino ◽  
Rie Sakamoto ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Elderly People ◽  
Physical Disability ◽  
The Elderly ◽  
Daily Basis ◽  
Community Dwelling ◽  
Negative Effects ◽  
The Relationship ◽  
Elderly Healthcare ◽  
Disability Research

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

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