Measuring sensory and pain thresholds by Semmes-Weinstein monofilaments in patients with leg ulcers: a pilot study

2019 ◽  
Vol 28 (10) ◽  
pp. 647-655
Author(s):  
Mark MPM Jansen ◽  
Aukje ALM van de Ven ◽  
Pieter GM van der Valk ◽  
Oliver HG Wilder-Smith
Keyword(s):  
Pilot Study ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Pain Processing ◽  
Leg Ulcers ◽  
Sensory Thresholds ◽  
Protective Function ◽  
Pain Thresholds ◽  
Ulcer Margin ◽  
Mechanical Pain Thresholds

Objective: Pain is a common and disabling symptom in patients with leg ulcers. Clinical quantification of pain mostly depends on subjective pain reports, which do not reveal underlying mechanisms. The aim of this pilot study is to identify mechanisms underlying the pain in patients with leg ulcers by documenting alterations in pain processing using quantitative sensory testing. Methods: In nine ulcer patients the mechanical sensory thresholds and the mechanical pain thresholds were determined by Semmes-Weinstein monofilaments (SWM) at three different sites: on the contralateral (unaffected) leg, on the skin of the affected leg 10cm from the ulcer margin, and on the affected leg, close (1–2cm) to the ulcer margin. Besides the mechanical sensory thresholds and mechanical pain thresholds, pain at the site of the ulcer, using an 11-point numeric rating scale (NRS), was documented. Results: Mechanical sensory thresholds were increased in all subjects. Almost half (44%) of patients consistently showed allodynia at the unaffected site. The lowering of mechanical pain thresholds correlated with higher scores on the NRS. Conclusion: All patients showed diminished touch and/or protective sensation, which might have contributed to ulcer development via (partial) loss of protective function. The allodynia at the unaffected site suggests the presence of central sensitisation of pain processing.

A Pilot Study of the Government Pharmaceutical Organization (GPO) Cannabis Extract for Multiple Sclerosis (MS) Spasticity Treatment in Thailand

2021 ◽  
Vol 104 (3) ◽  
pp. 460-465
Keyword(s):  
Multiple Sclerosis ◽  
Pilot Study ◽  
Rating Scale ◽  
Final Analysis ◽  
Numeric Rating Scale ◽  
Secondary Outcome ◽  
Pharmaceutical Organization ◽  
Cannabis Extract ◽  
The Government ◽  
Numeric Rating

Background: The prevalence of spasticity in multiple sclerosis (MS) patients is nearly 90%. Most patients do not respond to current anti-spastic medications. Objective: To evaluate the efficacy and safety of Government Pharmaceutical Organization cannabis extract (GPOCE) in the treatment of spasticity in MS patients in Thailand. Materials and Methods: This prospective pilot study in patients diagnosed with MS whose spasticity was not relieved under current spasticity treatments, was performed between November 2019 and June 2020. The GPOCE formulation of THC:CBD 1:1 was administered to all patients. The treatment outcomes were determined at 12 weeks and compared with their baseline. Results: Seven patients participated in the present study. Among these, two patients withdrew after receiving only a small dose of GPOCE. Finally, five patients were included in the final analysis. The primary outcome was a reduction in the Modified Ashworth Score (MAS), which decreased among participants from a baseline of 15 (IQR 12 to 19) to 6 (IQR 1 to 12) (p=0.043). The key secondary outcome was a clinically relevant response (CRR), which was defined as a reduction of the spasticity Numeric Rating Scale (NRS) of more than thirty percent compared to baseline. Four patients (80%) achieved CRR. Moreover, the overall spasticity NRS decreased from a median of 6 (IQR5 to 7) to 2 (IQR2 to 3). A reduction of other NRS parameters, including fatigue, pain, tremor, sleep, spasm, anxiety, and depression, was also observed after treatment. Moreover, GPOCE was generally well tolerated. Conclusion: GPOCE is useful in treating spasticity in patients with MS. The safety profile is acceptable under the supervision of a health care provider. Keywords: Multiple sclerosis (MS), Cannabis extract, Spasticity

scholarly journals Preventiometer, a Novel Wellness Assessment Device, Used With Healthy Volunteers: A Phase 2 Study

2021 ◽  
Vol 10 ◽  
pp. 216495612110450
Author(s):  
Sanjeev Nanda ◽  
Tony Y. Chon ◽  
Saswati Mahapatra ◽  
Stephanie A. Lindeen ◽  
Karen M. Fischer ◽  
...  
Keyword(s):  
Pilot Study ◽  
Healthy Volunteers ◽  
Rating Scale ◽  
Assessment Tool ◽  
Numeric Rating Scale ◽  
Assessment Process ◽  
Sample Population ◽  
Participant Satisfaction ◽  
Assessment Tests ◽  
Academic Medical

Background We previously reported on a pilot study to assess the incorporation of a novel wellness assessment device, the Preventiometer (iPEx5 GmbH, Greifswald, Germany), into an academic medical practice. The present follow-up study expands on those data and evaluates the acceptability of the assessment process in a larger sample population. Objective The aim of this study was to evaluate participant satisfaction with the Preventiometer wellness assessment. Methods A total of 60 healthy volunteers participated. Each participant underwent a comprehensive wellness assessment with the Preventiometer and received data from more than 30 diagnostic tests. A 32-question survey (with a numeric rating scale from 0 to 10) was used to rate the wellness assessment tests and participants’ impressions of the wellness assessment. Results Each assessment had a significantly higher rating than 7 ( P < .001), and the majority of participants agreed or strongly agreed that they were satisfied (98.3%), and they strongly agreed that they were engaged the entire time (93.2%), and liked the instant test results feature of the Preventiometer device (93.2%). Conclusion This study confirms findings from our previous pilot study regarding the feasibility of the Preventiometer as a wellness assessment tool. The study further demonstrated that 98% of participants were satisfied with the assessment and that all of them would recommend it to others.

scholarly journals The Effect of a Perioperative Ketamine Infusion on the Incidence of Chronic Postsurgical Pain—A Pilot Study

2017 ◽  
Vol 45 (4) ◽  
pp. 459-465 ◽  
Author(s):  
P. J. Peyton ◽  
C. Wu ◽  
T. Jacobson ◽  
M. Hogg ◽  
F. Zia ◽  
...  
Keyword(s):  
Pilot Study ◽  
Rating Scale ◽  
Randomised Trial ◽  
Numeric Rating Scale ◽  
Major Surgery ◽  
Control Group ◽  
Postsurgical Pain ◽  
Quality Of Recovery ◽  
Chronic Postsurgical Pain ◽  
Average Pain

Chronic postsurgical pain (CPSP) is a common and debilitating complication of major surgery. We undertook a pilot study at three hospitals to assess the feasibility of a proposed large multicentre placebo-controlled randomised trial of intravenous perioperative ketamine to reduce the incidence of CPSP. Ketamine, 0.5 mg/kg pre-incision, 0.25 mg/kg/hour intraoperatively and 0.1 mg/kg/hour for 24 hours, or placebo, was administered to 80 patients, recruited over a 15-month period, undergoing abdominal or thoracic surgery under general anaesthesia. The primary endpoint was CPSP in the area of the surgery reported at six-month telephone follow-up using a structured questionnaire. Fourteen patients (17.5%) reported CPSP (relative risk [95% confidence interval] if received ketamine 1.18 [0.70 to 1.98], P=0.56). Four patients in the treatment group and three in the control group reported ongoing analgesic use to treat CPSP and two patients in each group reported their worst pain in the previous 24 hours at ≥3/10 at six months. There were no significant differences in adverse event rates, quality of recovery scores, or cumulative morphine equivalents consumption in the first 72 hours. Numeric Rating Scale pain scores (median [interquartile range]) for average pain in the previous 24 hours among those patients reporting CPSP were 17.5 [0 to 40] /100 with no difference between treatment groups. A large (n=4,000 to 5,000) adequately powered multicentre trial is feasible using this population and methodology.

Thermal and Mechanical Pain Thresholds of Women With Provoked Localized Vulvodynia: A Pilot Study

2019 ◽  
Vol 119 (3) ◽  
pp. 164 ◽  
Author(s):  
Maureen E. Basha ◽  
Susan Kellogg-Spadt ◽  
Lara J. Burrows ◽  
Monique S. Ruberu ◽  
Andrea S. Wallach ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pain Thresholds ◽  
Mechanical Pain Thresholds

scholarly journals A Pilot Study of the Correlation between the Numeric Rating Scale used to Evaluate "Geop" and Questionnaires on Pain Perception

2015 ◽  
Vol 28 (1) ◽  
pp. 32 ◽  
Author(s):  
Bon Sung Koo ◽  
Myung Jin Jung ◽  
Joon Ho Lee ◽  
Hee Cheol Jin ◽  
Jeong Seok Lee ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pain Perception ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Numeric Rating

The Headache-Inducing Effect of Cilostazol in Human Volunteers

Cephalalgia ◽  
2006 ◽  
Vol 26 (11) ◽  
pp. 1304-1309 ◽  
Author(s):  
S Birk ◽  
C Kruuse ◽  
KA Petersen ◽  
P Tfelt-Hansen ◽  
J Olesen
Keyword(s):  
Rating Scale ◽  
International Headache Society ◽  
Cyclic Adenosine Monophosphate ◽  
Adenosine Monophosphate ◽  
Cyclic Guanosine Monophosphate ◽  
Receptor Activation ◽  
Guanosine Monophosphate ◽  
Double Blind ◽  
Pain Thresholds ◽  
Mechanical Pain Thresholds

We have previously shown that nitric oxide (NO) and cyclic guanosine monophosphate (GMP) may cause headache and migraine. However, not all findings in previous studies can be explained by an activation of the NO-cGMP pathway. Calcitonin gene-related peptide (CGRP) causes headache and migraine in migraine patients, but CGRP receptor activation causes an increase in cyclic adenosine monophosphate (cAMP). In order to investigate the role of cAMP in vascular headache pathogenesis, we studied the effect of cilostazol, an inhibitor of cAMP degradation, in our human experimental headache model. Twelve healthy volunteers were included in a double-blind, randomized, crossover study. Placebo or cilostazol (200 mg p.o.) was administered on two separate study days. Headache was scored on a verbal rating scale (0-10) and mechanical pain thresholds were measured with von Frey hairs. The median peak headache score 0-16 h postdose was 0 (range 0-2) after placebo and 3.5 (range 0-7) after cilostazol ( P = 0.003). The median headache curve peaked at 6-9 h postdose. The headaches induced were usually bilateral and pulsating. Nausea occurred in two volunteers, photo- and phonophobia were not seen. Two volunteers had a headache that fulfilled International Headache Society criteria for migraine without aura after cilostazol. No change in mechanical pain thresholds in the forehead was seen ( P = 0.25). The headache after cilostazol was equal to or more severe than headache induced by glyceryl trinitrate in previous experiments. The present study thus indicates that increased levels of cAMP may play a role in headache and migraine pathogenesis.

scholarly journals Mouthpiece ventilation in the management of dyspnea: A single-arm pilot study

2020 ◽  
Vol 34 (9) ◽  
pp. 1274-1278
Author(s):  
Juho T Lehto ◽  
Sirpa Leivo-Korpela ◽  
Tarja Korhonen ◽  
Heidi A Rantala ◽  
Hanna Raunio ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pilot Study ◽  
Visual Analogue Scale ◽  
Adverse Events ◽  
Confidence Interval ◽  
Analogue Scale ◽  
Rating Scale ◽  
Advanced Disease ◽  
Numeric Rating Scale ◽  
Numeric Rating

Background: Noninvasive ventilation may relieve dyspnea in advanced diseases, but noninvasive ventilation through mouthpiece has not been tested in palliative care. Aim: To assess the feasibility of mouthpiece ventilation in relieving dyspnea among patients with advanced disease. Design: In this prospective single-arm pilot study, the change in dyspnea by mouthpiece ventilation was measured with numeric rating scale (0–10) and 100-mm visual analogue scale. Overall, benefit and adverse events of the therapy were also assessed. Setting/participants: Twenty-two patients with an advanced disease and dyspnea from the Tampere University Hospital or Pirkanmaa Hospice were treated with mouthpiece ventilation. The patients used mouthpiece ventilation as long as they preferred, but for a minimum of 5 min. Results: After the treatment period lasting a median of 13.5 min, mean decrease in dyspnea was −1.1 (95 % confidence interval = −2.2 to −0.1, p = 0.034) on numeric rating scale and −11.8 mm (95 % confidence interval = −19.9 to −3.7, p = 0.006) on visual analogue scale. Nonetheless, there was a high variability in this effect between individual patients. About half of the patients found mouthpiece ventilation beneficial. No serious adverse events occurred, but dry mouth was the most common adverse event. Anxiety did not increase with mouthpiece ventilation. Conclusion: Mouthpiece ventilation is feasible and may relieve dyspnea in some patients with an advanced disease. Further studies are needed, and these might concentrate on stable patients in early palliative care. Before initiation, this study was registered at clinicaltrials.gov (study no. NCT03012737).

scholarly journals Reversal of hyperactive subthalamic circuits differentially mitigates pain hypersensitivity phenotypes in parkinsonian mice

2020 ◽  
Vol 117 (18) ◽  
pp. 10045-10054 ◽  
Author(s):  
Yiwen Luan ◽  
Dongliang Tang ◽  
Haichuan Wu ◽  
Weixin Gu ◽  
Yuqing Wu ◽  
...  
Keyword(s):  
Substantia Nigra ◽  
Critical Role ◽  
Pain Processing ◽  
Pain Thresholds ◽  
Pain Hypersensitivity ◽  
Thermal Pain ◽  
Nonmotor Symptom ◽  
Underlying Mechanisms ◽  
Central Pain Processing ◽  
Mechanical Pain Thresholds

Although pain is a prevalent nonmotor symptom in Parkinson’s disease (PD), it is undertreated, in part because of our limited understanding of the underlying mechanisms. Considering that the basal ganglia are implicated in pain sensation, and that their synaptic outputs are controlled by the subthalamic nucleus (STN), we hypothesized that the STN might play a critical role in parkinsonian pain hypersensitivity. To test this hypothesis, we established a unilateral parkinsonian mouse model with moderate lesions of dopaminergic neurons in the substantia nigra. The mice displayed pain hypersensitivity and neuronal hyperactivity in the ipsilesional STN and in central pain-processing nuclei. Optogenetic inhibition of STN neurons reversed pain hypersensitivity phenotypes in parkinsonian mice, while hyperactivity in the STN was sufficient to induce pain hypersensitivity in control mice. We further demonstrated that the STN differentially regulates thermal and mechanical pain thresholds through its projections to the substantia nigra pars reticulata (SNr) and the internal segment of the globus pallidus (GPi)/ventral pallidum (VP), respectively. Interestingly, optogenetic inhibition of STN-GPi/STN-VP and STN-SNr projections differentially elevated mechanical and thermal pain thresholds in parkinsonian mice. In summary, our results support the hypothesis that the STN and its divergent projections play critical roles in modulating pain processing under both physiological and parkinsonian conditions, and suggest that inhibition of individual STN projections may be a therapeutic strategy to relieve distinct pain phenotypes in PD.

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