The incidence of neuropathic pain symptoms in patients with knee osteoarthritis

Introduction. Pain is the most common symptom of knee osteoarthritis. Until recently, this pain was referred to as nociceptive pain. However, the difficulties of pain management in knee osteoarthritis indicate the possible presence of a neuropathic component. The objective of this study was to determine how often neuropathic component is part of chronic pain in knee osteoarthritis. Material and Methods. The study included 417 patients with knee osteoarthritis. The patients were tested using the Neuropathic Pain (Douleur Neuropathique) 4 Questions and a Numeric Pain Rating Scale. Patients were divided into 2 groups. The first group included patients with a Neuropathic Pain 4 Questions score ? 4, and the second group with a score < 4. Results. The majority of patients included in this study were females (301, 72.2%), and most of the patients scored less than 4 in the questionnaire (231, 55.4%). Among the patients with a score ? 4, 144 (77.4%) were female, which is significantly higher compared to the group of patients who scored < 4, 157 (68%) (p = 0.037). There was no statistically significant difference in age between the two groups (p = 0.231). The current pain intensity, average pain, and maximum pain during the last 4 weeks were significantly higher in the group with a score ? 4 (p < 0.001). Conclusion. A significant number of patients with knee osteoarthritis had a neuropathic component of pain. There were significantly more women in the group with score ? 4, and this group also reported significantly higher current, as well as average and maximum pain during last 4 weeks than the other group.

Download Full-text

Tetrodotoxin for Chemotherapy-Induced Neuropathic Pain: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Dose Finding Trial

Toxins ◽

10.3390/toxins13040235 ◽

2021 ◽

Vol 13 (4) ◽

pp. 235

Author(s):

Samuel A. Goldlust ◽

Mojgan Kavoosi ◽

Jennifer Nezzer ◽

Mehran Kavoosi ◽

Walter Korz ◽

...

Keyword(s):

Neuropathic Pain ◽

Rating Scale ◽

Primary Outcome Measure ◽

Dose Finding ◽

Double Blind ◽

Significant Difference ◽

Patient Reported ◽

Finding Study ◽

Average Patient ◽

Numeric Pain Rating Scale

Tetrodotoxin (TTX) has emerged as a potentially efficacious agent for chemotherapy-induced neuropathic pain (CINP), a prevalent, debilitating condition often resistant to analgesics. This randomized, double-blind, dose-finding study was undertaken to explore safety and trends in efficacy of four TTX doses and to identify a dose for further study. One hundred and twenty-five patients with taxane- or platinum-related CINP received subcutaneous placebo or TTX (7.5 µg twice daily (BID), 15 µg BID, 30 µg once daily (QD), 30 µg BID) for four consecutive days. Primary outcome measure was average patient-reported Numeric Pain Rating Scale (NPRS) score during Days 21–28 post-treatment. Changes in mean NPRS score were not statistically different between cohorts, due to small trial size and influence of a few robust placebo responders. Cumulative responder analysis showed significant difference from placebo with 30 µg BID cohort using the maximum response at any timepoint (p = 0.072), 5-day (p = 0.059), 10-day (p = 0.027), and 20-day (p = 0.071) rolling averages. In secondary quality of life (QOL) outcomes, 30 µg BID cohort also differed significantly from placebo in a number of SF-36 and CIPN20 subscales. Most adverse events (AE) were mild or moderate with oral paresthesia (29.6%) and oral hypoesthesia (24.8%) as most common.

Download Full-text

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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4628 ◽

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

Download Full-text

Evaluation of emotional arousal level and depression severity using voice-derived sound pressure change acceleration

Scientific Reports ◽

10.1038/s41598-021-92982-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shuji Shinohara ◽

Hiroyuki Toda ◽

Mitsuteru Nakamura ◽

Yasuhiro Omiya ◽

Masakazu Higuchi ◽

...

Keyword(s):

Sound Pressure ◽

Rating Scale ◽

Characteristic Curve ◽

Emotional Arousal ◽

Pressure Change ◽

Arousal Level ◽

Depression Severity ◽

Number Of Patients ◽

National Defense Medical College ◽

Significant Difference

AbstractIn this research, we propose a new index of emotional arousal level using sound pressure change acceleration, called the emotional arousal level voice index (EALVI), and investigate the relationship between this index and depression severity. First, EALVI values were calculated from various speech recordings in the interactive emotional dyadic motion capture database, and the correlation with the emotional arousal level of each voice was examined. The resulting correlation coefficient was 0.52 (n = 10,039, p < 2.2 × 10−16). We collected a total of 178 datasets comprising 10 speech phrases and the Hamilton Rating Scale for Depression (HAM-D) score of outpatients with major depression at the Ginza Taimei Clinic (GTC) and the National Defense Medical College (NDMC) Hospital. The correlation coefficients between the EALVI and HAM-D scores were − 0.33 (n = 88, p = 1.8 × 10−3) and − 0.43 (n = 90, p = 2.2 × 10−5) at the GTC and NDMC, respectively. Next, the dataset was divided into “no depression” (HAM-D < 8) and “depression” groups (HAM-D ≥ 8) according to the HAM-D score. The number of patients in the “no depression” and “depression” groups were 10 and 78 in the GTC data, and 65 and 25 in the NDMC data, respectively. There was a significant difference in the mean EALVI values between the two groups in both the GTC and NDMC data (p = 8.9 × 10−3, Cliff’s delta = 0.51 and p = 1.6 × 10−3; Cliff’s delta = 0.43, respectively). The area under the curve of the receiver operating characteristic curve when discriminating both groups by EALVI was 0.76 in GTC data and 0.72 in NDMC data. Indirectly, the data suggest that there is some relationship between emotional arousal level and depression severity.

Download Full-text

The Effect of Caudal Epidural Pulsed Radiofrequency Stimulation in Patients with Refractory Chronic Idiopathic Axonal Polyneuropathy

January 2018 - Pain Physician ◽

10.36076/ppj.2018.1.e57 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E57-E62

Author(s):

Min Cheol Chang

Keyword(s):

Neuropathic Pain ◽

Repeated Measures ◽

Rating Scale ◽

Axonal Neuropathy ◽

Pulsed Radiofrequency ◽

Oral Medications ◽

Axonal Polyneuropathy ◽

Number Of Patients ◽

Good Score ◽

Caudal Epidural

Background: Many patients with chronic idiopathic axonal polyneuropathy (CIAP) suffer from neuropathic pain, which is managed using several oral medications and modalities. However, despite these treatments, pain persists in some patients. Objective: In the clinical field, clinicians frequently meet patients with neuropathic pain caused by CIAP. The authors investigated the effect of caudal epidural pulsed radiofrequency (PRF) for the management of CIAP-induced refractory neuropathic pain. Study Design: This is a prospective study. Setting: The outpatient clinic of a single academic medical center in Korea Methods: Twenty patients with neuropathic pain and a diagnosis of refractory CIAP were recruited. For PRF stimulation, a 22-gauge cannula was inserted into the epidural space through the sacral hiatus under fluoroscopic guidance. PRF stimulation was administered once at 5 Hz with a 5-ms pulse width for 600 seconds at 55 V. The effect of stimulation was evaluated using a numeric rating scale (NRS) at 2 weeks and 1, 2, and 3 months after the procedure. Successful pain relief was defined as a reduction in the NRS score of ≥ 50% as compared with the score prior to treatment. In addition, at 3 months after treatment, patient satisfaction levels were examined; patients that reported “very good” (score = 7) or “good” (score = 6) results were considered to be satisfied with the procedure. Results: Neuropathic pain was significantly reduced at 2 weeks and at 1, 2, and 3 months followup after PRF (P < 0.001, repeated measures one-factor analysis). In addition, at 3 months post-PRF, half of the patients achieved a successful response (≥ 50% pain reduction) and were satisfied with treatment results. Limitations: A small number of patients were recruited, and we did not perform long-term follow-up. Conclusion: Caudal epidural PRF may be a good treatment option for managing neuropathic pain induced by CIAP, especially when pain is unresponsive to oral medications. Key words: Pulsed radiofrequency, chronic idiopathic axonal neuropathy, caudal epidural stimulation, neuropathic pain chronic pain, refractory pain

Download Full-text

Long-Term Results of a Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Refractory Neuropathic Pain

Translational Neuroscience and Clinics ◽

10.18679/cn11-6030_r.2017.002 ◽

2017 ◽

Vol 3 (1) ◽

pp. 4-15

Author(s):

Byung-chul Son ◽

Jin-gyu Choi ◽

Sang-woo Ha ◽

Deog-ryeong Kim

Keyword(s):

Neuropathic Pain ◽

Pain Relief ◽

Motor Cortex ◽

Success Rate ◽

Rating Scale ◽

Long Term Results ◽

Motor Cortex Stimulation ◽

Significant Difference ◽

Deep Brain

Objective Although deep brain stimulation (DBS) and motor cortex stimulation (MCS) are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis (Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results Of the 11 patients implanted with both DBS and MCS electrodes, nine (81.8%) had successful trials. Seven of these nine patients (77.8%) responded to MCS, and two (18.2%) responded to Vc DBS. With long-term follow-up (56 ± 27.5 months), the mean numerical rating scale decreased significantly (P < 0.05). The degree of percentage pain relief in the chronic MCS (n = 7) and chronic DBS (n = 2) groups were 34.1% ± 18.2% and 37.5%, respectively, and there was no significant difference (P = 0.807). Five out of the seven MCS patients (71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.

Download Full-text

Influence of Physical Therapy Modalities on Pain in Osteoporosis Patients: initial results of the treatment with physical therapy

Macedonian Medical Review ◽

10.1515/mmr-2016-0004 ◽

2016 ◽

Vol 70 (1) ◽

pp. 19-23

Author(s):

Valentina Koevska ◽

Snezana Perchinkova-Mishevska ◽

Erieta Nikolik-Dimitrova ◽

Biljana Mitrevska

Keyword(s):

Physical Therapy ◽

Pain Intensity ◽

Rating Scale ◽

Chronic Back Pain ◽

Low Frequency ◽

Physical Therapy Modalities ◽

Number Of Patients ◽

Therapeutic Exercises ◽

Significant Difference ◽

A Prospective Study

Abstract Introduction. Osteoporosis causes chronic back pain leading to restriction of functional capacity and quality of life. The aim of this study was to examine the influence of physical therapy modalities on pain in patients with osteoporosis. Methods. This is a prospective study of patients with osteoporosis, randomly chosen and followed for three months in the Institute of Physical Medicine and Rehabilitation (IPMR). Physical therapy consisted of physical modalities and therapeutic exercises. Physical therapy modalities included interferential currents and pulsed low-frequency electromagnetic field conducted each day with weekend breaks, 21 in total. Patients had therapeutic exercises 3 times a week during the entire follow-up period. Patients were assigned into two groups. The first group consisted of nine patients who underwent physical procedures and the second group consisted of nine patients who did not receive physical therapy modalities. Two check-ups were made on day 21 and at the end of the third month. Assessment of pain intensity was made by the use of a numeric pain rating scale. Results. No significant difference between the groups was observed regarding mean age of patients (p<0.21). The first check-up showed a significantly higher pain score in the second group of patients (p=0.0003). There was no significant difference in pain intensity between both groups of patients in the three-month period of investigation (p<0.63). Conclusion. Physical therapy modalities influence on pain in patients with osteoporosis. Our investigation included a small number of patients and hence further studies are necessary.

Download Full-text

Prevalence of Metabolic Syndrome and Related Factors in Patients with Non-alcoholic Fatty Liver

Jundishapur Journal of Chronic Disease Care ◽

10.5812/jjcdc.114541 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Mehrnoosh Zakerkish ◽

Abolghasem Assarzadeh ◽

Seyed Saeed Seyedian ◽

Alireza Jahanshahi

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Waist Circumference ◽

Fatty Liver ◽

Significant Relationship ◽

Common Symptom ◽

Related Factors ◽

Alcoholic Fatty Liver ◽

Number Of Patients ◽

Significant Difference

Objectives: This study was designed to investigate the prevalence of metabolic syndrome in patients diagnosed with non-alcoholic fatty liver disease (NAFLD) referring to the gastrointestinal and endocrinology clinics of Golestan and Imam Khomeini Hospitals, Ahvaz. Methods: The current cross-sectional study was performed on patients with NAFLD referring to the gastroenterology and endocrinology clinics of Golestan and Emam Khomeini hospitals, Ahvaz in the second half of 2020. Demographic information included age, gender, lumbar posture (while standing and the waist be in the upper edge of the iliac crest at the end of a normal exhalation using a non-elastic meter), grading fatty liver evidenced by ultrasound, and blood pressure and laboratory parameters, including triglyceride (TG), fasting blood sugar (FBS), and high-density lipoprotein (HDL) was recorded in the checklist. Data analysis was performed using SPSS 26.0 software. Results: This study was performed on 130 patients with an average age of 46.22 ± 14.27 years. Patients comprised 42 men (32.8%) and 88 women (67.2/%). Also, 63.84% of the patients with NAFLD had metabolic syndrome, and 56.2, 69.6, and 81.8% with grades 1, 2, and 3 of fatty liver, respectively had metabolic syndrome. There was a significant difference in terms of mean height and weight in both gender. There was a significant relationship between age and FBS, so that the levels of FBS increased statistically significantly with age (P < 0.05). Gender had a statistically significant relationship with HDL and waist circumference (P = 0.038). There was no statistically significant relationship between blood pressure, TG, HDL, FBS, and waist circumference, and different grades of fatty liver (P > 0.05). Conclusions: The current study showed a significant number of patients with NAFLD had metabolic syndrome, so that the most common symptom of metabolic syndrome was low HDL levels, followed by high FBS levels, blood pressure, and TG levels and waist circumference size. Nevertheless, it was not probable to assess whether NAFLD precedes the progress of metabolic syndrome.

Download Full-text

Treatment of post-herpetic pain with scrambler therapy, a patient-specific neuro-cutaneous electrical stimulation device.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19564 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19564-e19564

Author(s):

Thomas J. Smith ◽

Giuseppe Marineo

Keyword(s):

Neuropathic Pain ◽

Hematologic Malignancy ◽

Primary Diagnosis ◽

Patient Specific ◽

Treatment Results ◽

Before And After ◽

Maximum Pain ◽

Average Pain ◽

Average Pain Score ◽

Scrambler Therapy

e19564^ Background: Post herpetic neuropathy (PHN) is common in cancer and hematologic malignancy patients. It can be debilitating and difficulty to treat effectively. Scrambler therapy, a patient-specific neurocutaneous stimulation device, can be effective in treating chemotherapy induced neuropathy (JPSM 2010) and other neuropathic pain (JPSM 2012). Methods: We treated ten patients, 2 with cancer as their primary diagnosis, with refractory PHN Scrambler therapy at two institutions. Scrambler therapy was given as 30 minute sessions daily for 10 days. Pain was recorded before and after treatment. Results: The patient mean age was 54 ± SD 13 years, 6 men and 4 women, with a mean duration of PHN for 15.6 months (range 2.5 to 48 months) without satisfactory relief despite conventional drugs. The average pain score rapidly diminished from 7.64 ± 1.46 at baseline to 0.42 ± 0.89 at one month, a 95% reduction, with continued relief at 2 and 3 months. Patients achieved maximum pain relief with less than 5 treatments. Conclusions: Scrambler therapy appears to have a promising effect on PHN, with prompt and continued relief and no side effects. Further research is warranted. [Table: see text]

Download Full-text

Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

BioMed Research International ◽

10.1155/2017/7920438 ◽

2017 ◽

Vol 2017 ◽

pp. 1-17 ◽

Cited By ~ 6

Author(s):

Stanley K. H. Lam ◽

Kenneth Dean Reeves ◽

An-Lin Cheng

Keyword(s):

Neuropathic Pain ◽

Analgesic Effect ◽

Rating Scale ◽

Stellate Ganglion ◽

Upper Body ◽

Pain Rating ◽

Perineural Injection ◽

Numeric Pain Rating Scale ◽

The Mean ◽

Pain Rating Scale

Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain. The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described. Here we describe ultrasound-guided methods for hydrodissection of deep nerve structures in the upper torso, including the stellate ganglion, brachial plexus, cervical nerve roots, and paravertebral spaces. We retrospectively reviewed the outcomes of 100 hydrodissection treatments in 26 consecutive cases with a neuropathic pain duration of 16±12.2 months and the mean Numeric Pain Rating Scale (NPRS) 0–10 pain level of 8.3±1.3. The mean percentage of analgesia during each treatment session involving D5W injection without anesthetic was 88.1% ± 9.8%. The pretreatment Numeric Pain Rating Scale score of 8.3±1.3 improved to 1.9±0.9 at 2 months after the last treatment. Patients received 3.8±2.6 treatments over 9.7±7.8 months from the first treatment to the 2-month posttreatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half. Our results confirm the analgesic effect of D5W injection and suggest that hydrodissection using D5W provides cumulative pain reduction.

Download Full-text

Prevalence of Persistent Pain after Total Knee Arthroplasty and the Impact of Neuropathic Pain

The Journal of Knee Surgery ◽

10.1055/s-0038-1675415 ◽

2018 ◽

Vol 32 (10) ◽

pp. 1020-1023 ◽

Cited By ~ 1

Author(s):

Masahiro Hasegawa ◽

Shine Tone ◽

Yohei Naito ◽

Hiroki Wakabayashi ◽

Akihiro Sudo

Keyword(s):

Total Knee Arthroplasty ◽

Neuropathic Pain ◽

Knee Arthroplasty ◽

Severe Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Number Of Patients ◽

Numerical Rating ◽

Total Knee ◽

The Impact

AbstractThe present study aimed to define the prevalence of pain persisting after total knee arthroplasty (TKA) and determine the impact of neuropathic pain. Knee pain after TKA was evaluated in 154 patients (222 knees with osteoarthritis) using a numerical rating scale (NRS) and followed up for a mean of 4.7 years. The patients were classified according to whether they had no or mild pain (NRS ≤ 3), or moderate-to-severe pain (NRS > 3), and then assigned to groups with nociceptive, unclear, or neuropathic pain based on responses to painDETECT questionnaires. Risk factors for these types of pain were determined. The ratio of patients with moderate-to-severe pain was 28% (62 knees). Thirteen patients (21 knees; 9%) experienced unclear pain. Patients with moderate-to-severe or unclear pain had malalignment and lower Knee Society knee scores. In conclusion, a significant number of patients experienced moderate-to-severe and unclear pain after TKA. Moderate-to-severe pain was associated with unclear pain.

Download Full-text