Relationships Between Chronic Pain Stage, Cognition, Temporal Lobe Cortex, and Sociodemographic Variables

Background: Non-Hispanic black (NHB) individuals have increased risk of Alzheimer’s disease (AD) relative to non-Hispanic whites (NHW). Ethnicity/race can serve as a proxy sociodemographic variable for a complex representation of sociocultural and environmental factors. Chronic pain is a form of stress with high prevalence and sociodemographic disparities. Chronic pain is linked to lower cognition and accelerated biological aging. Objective: The purpose of this study is to seek understanding of potential cognitive and temporal lobe structural brain AD vulnerabilities based on chronic pain stage and ethnicity/race. Methods: Participants included 147 community dwelling NHB and NHW adults without dementia between 45–85 years old who had or were at risk of knee osteoarthritis. All participants received an MRI (3T Philips), the Montreal Cognitive Assessment (MoCA), and assessment of clinical knee pain stage. Results: There were ethnic/race group differences in MoCA scores but no relationships with chronic knee pain stage. Ethnicity/race moderated the relationship between AD-related temporal lobe thickness and chronic pain stage with quadratic patterns suggesting thinner cortex in high chronic pain stage NHB adults. Conclusion: There appear to be complex relationships between chronic knee pain stage, temporal lobe cortex, and sociodemographic variables. Specifically, NHB participants without dementia but with high chronic knee pain stage appeared to have thinner temporal cortex in areas associated with AD. Understanding the effects of sociocultural and socioeconomic factors on health outcomes is the first step to challenging the disparities in healthcare that now appear to link disease conditions to neurodegenerative processes.

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Towards a brain signature of chronic pain using cerebral blood flow spatial covariance analysis in people with chronic knee pain

10.1101/19008326 ◽

2019 ◽

Author(s):

Sarina J. Iwabuchi ◽

Yue Xing ◽

William J. Cottam ◽

Marianne M. Drabek ◽

Arman Tadjibaev ◽

...

Keyword(s):

Chronic Pain ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Knee Pain ◽

Current Evidence ◽

Spatial Covariance ◽

Default Mode ◽

Chronic Knee Pain ◽

Pain Sensitization ◽

Pain Patients

AbstractChronic musculoskeletal pain is a common problem globally. Current evidence suggests that maladaptive modulation of central pain pathways is associated with pain chronicity following e.g. chronic post-operative pain after knee replacement. Other factors such as low mood, anxiety and tendency to catastrophize seem to also be important contributors. We aimed to identify a chronic pain brain signature that discriminates chronic pain from pain-free conditions using cerebral blood flow (CBF) measures, and explore how this signature relates to the chronic pain experience. In 44 chronic knee pain patients and 29 pain-free controls, we acquired CBF data (using arterial spin labelling) and T1-weighted images. Participants completed a series of questionnaires related to affective processes, and pressure and cuff algometry to assess pain sensitization. Two factor scores were extracted from these scores representing negative affect and pain sensitization, respectively. A spatial covariance principal components analysis of CBF identified five components that significantly discriminated chronic pain patients from controls, with the unified network achieving 0.83 discriminatory accuracy (area under the curve). In chronic knee pain, significant patterns of relative hypo-perfusion were evident in anterior regions of the default mode and salience network hubs, while hyperperfusion was seen in posterior default mode regions, the thalamus, and sensory regions. One component was positively correlated to the pain sensitization score (r=.43, p=.006), suggesting that this CBF pattern reflects the neural activity changes encoding pain sensitization. Here, we report the first chronic knee pain-related brain signature, pointing to a brain signature underpinning the central aspects of pain sensitisation.

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A Systematic Review of the Effectiveness of Rehabilitation Therapy to Treat People with Chronic Knee Pain Following A Total Knee Replacement.

10.21203/rs.3.rs-70032/v1 ◽

2020 ◽

Author(s):

Nathan Adam Johns ◽

Justine Naylor ◽

Brinda Thirugnanam ◽

Dean Mckenzie ◽

Bernadette Brady ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Chronic Pain ◽

Total Knee Replacement ◽

Knee Pain ◽

Knee Replacement ◽

Chronic Knee Pain ◽

Total Knee ◽

Full Text Screening

Abstract Background:Chronic knee pain after a total knee replacement has been estimated to affect 10 to 30% of patients and is related to dissatisfaction with surgery, reduced function and reduced quality of life. Rehabilitation is often prescribed in the subacute period post-operatively, but it may offer benefit to the increasing numbers of patients with chronic pain after their knee replacement. The aim of this systematic review is to evaluate the effectiveness of rehabilitation to improve pain, function and quality of life in people with chronic knee pain persisting for more than 3 months following a total knee replacement.Methods: The systematic review was conducted following PRISMA guidelines with a search of the online databases Ovid Medline, Embase via Ovid, CINAHL Plus, PsycINFO, Ovid Emcare and Proquest from their earliest date to July 12, 2020. The search criteria included English language randomised controlled trials of rehabilitation strategies in any setting to treat people with chronic knee pain, defined as knee pain persisting for more than 3 months, following a total knee replacement. Rehabilitation programs included exercise therapy, patient education, cognitive and mind-body strategies and self-management and excluded medication trials, procedural techniques and complementary therapies. Results:There were 254 abstracts screened for eligibility with 13 remaining for full-text screening. Following full-text screening, there were no studies that met the eligibility criteria for evaluating rehabilitation therapy to treat chronic knee pain persisting for more than 3 months following a total knee replacement.Conclusion:Despite the high volume of knee replacement surgery and the high incidence of moderate to severe chronic pain ensuing, there is currently no evidence available that rehabilitation commencing three months after surgery can effectively treat chronic pain and disability following a total knee replacement.

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Vulnerable Dispositional Traits and Chronic Pain: Predisposing but not Predetermining

10.31234/osf.io/9m65c ◽

2021 ◽

Author(s):

Nicola Sambuco ◽

Angela M Mickle ◽

Cynthia Garvan ◽

Josue Cardoso ◽

Alisa Johnson ◽

...

Keyword(s):

Chronic Pain ◽

Knee Pain ◽

Psychosocial Functioning ◽

Community Dwelling ◽

Support Vector ◽

Affect Balance ◽

Clinical Pain ◽

Dispositional Trait ◽

Trait Groups ◽

Time Point

Introduction Dispositional traits can be protective or contribute to increased vulnerability in individuals with chronic pain. This study aims to evaluate the predictive utility of two dispositional trait measures, affect balance style and multi-domain trait groups specific to clinical pain, psychosocial functioning, experimental pain, and health outcomes at two years in individuals with chronic knee pain. MethodsThe study is a prospective analysis of 168 community dwelling individuals aged 45-85 years old with knee pain with or at risk for knee osteoarthritis. Affect balance style and multi-domain trait groups were developed and tested using regression analysis and machine learning (Support Vector Machine). ResultsAt baseline, affect balance style and multi-domain trait groups were predictive of psychosocial and clinical pain measures with the multi-domain trait groups showing a greater range of association with clinical measures. At the two-year time point, both the affect balance style groups and the multi-domain trait groups were predictive of physical and psychosocial functioning while the multi-domain trait groups were also predictive of all clinical pain measures. ConclusionThe multi-domain trait classification is a stronger predictor than the previously investigated affect balance style specific to clinical pain and pain-related functioning at two-years. Interestingly, in contrast to expectations, individuals in the vulnerable trait groups showed more variability in dispositional trait status at the two-year time point compared to those in the more protective trait groups. Findings reiterate that a vulnerable trait may be predisposing but is not predetermining regarding pain-related experiences.

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Genicular Nerve Radiofrequency Ablation and Dual Subsartorial Block for Chronic Knee Pain Post Total Knee Replacement: A Case Report

Journal of Anesthesiology and Clinical Research ◽

10.37275/jacr.v2i2.164 ◽

2022 ◽

Vol 2 (2) ◽

pp. 253-257

Author(s):

Aidyl Fitrisyah ◽

Stevanus Eliansyah Handrawan ◽

Nurlaili Maya Ramadhanty

Keyword(s):

Chronic Pain ◽

Radiofrequency Ablation ◽

Total Knee Replacement ◽

Knee Pain ◽

Knee Replacement ◽

Rating Scale ◽

Womac Score ◽

Assessment Tools ◽

Chronic Knee Pain ◽

Total Knee

Introduction. Chronic pain defines as pain persisting for three months or longer, chronic post-surgical pain can affect all dimensions of health-related quality of life, and is associated with functional limitations. treatment of chronic pain after total knee replacement is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristic. Genicular nerve block radiofrequency ablation is a safe and effective therapeutic procedure for pain associated with chronic pain due to knee osteoarthritis, and the evolution of newer regional analgesia techniques aids in reducing postoperative pain Dual Subsartorial Block (DSB) as a procedure specific, post total knee replacemet. historically there has been a reliance on using a pain-spesific assessment tools Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Case Presentation. A 55-year old woman admitted she had pain on bilateral knee, the knee pain had affected her daily living, she was diagnosed with chronic knee pain post TKR because of osteoarthritis genu bilateral, the patient was planning genicular nerve radiofrequency ablation and dual subsartorial block, from the examination we found that numeric rating scale was 6 (moderate pain) with WOMAC score 76, before the procedure the patients are examined through radiology for any deformity in the knee. The genicular nerve radiofrequency ablation under ultrasound guidance on bonylandmark, resulting anesthesia of the anterior compartment of the knee, and dual subsartorial block that cover almost all the innervations of pain generating component of the anterior and posterior knee joint involved in TKR surgery. After the procedure we reevaluated the pain score using NRS was 2 (mild pain), and with WOMAC Score 19. Conclusion. Treatment of chronic pain post total knee replacemet was challenging, targeted treatment may ameliorate the pain and prevent long term disability.

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Uncovering associations between data-driven learned qMRI biomarkers and chronic pain

Scientific Reports ◽

10.1038/s41598-021-01111-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Alejandro G. Morales ◽

Jinhee J. Lee ◽

Francesco Caliva ◽

Claudia Iriondo ◽

Felix Liu ◽

...

Keyword(s):

Chronic Pain ◽

Knee Pain ◽

Relaxation Times ◽

Magnetic Resonance Images ◽

Cartilage Thickness ◽

Imaging Biomarkers ◽

Lateral Side ◽

Ratio Test ◽

Medial Side ◽

Chronic Knee Pain

AbstractKnee pain is the most common and debilitating symptom of knee osteoarthritis (OA). While there is a perceived association between OA imaging biomarkers and pain, there are weak or conflicting findings for this relationship. This study uses Deep Learning (DL) models to elucidate associations between bone shape, cartilage thickness and T2 relaxation times extracted from Magnetic Resonance Images (MRI) and chronic knee pain. Class Activation Maps (Grad-CAM) applied on the trained chronic pain DL models are used to evaluate the locations of features associated with presence and absence of pain. For the cartilage thickness biomarker, the presence of features sensitive for pain presence were generally located in the medial side, while the features specific for pain absence were generally located in the anterior lateral side. This suggests that the association of cartilage thickness and pain varies, requiring a more personalized averaging strategy. We propose a novel DL-guided definition for cartilage thickness spatial averaging based on Grad-CAM weights. We showed a significant improvement modeling chronic knee pain with the inclusion of the novel biomarker definition: likelihood ratio test p-values of 7.01 × 10–33 and 1.93 × 10–14 for DL-guided cartilage thickness averaging for the femur and tibia, respectively, compared to the cartilage thickness compartment averaging.

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Chronic Pain and Risk of Injurious Falls in Community-Dwelling Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa249 ◽

2020 ◽

Author(s):

Yurun Cai ◽

Suzanne G Leveille ◽

Ling Shi ◽

Ping Chen ◽

Tongjian You

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Community Dwelling ◽

Pain Interference ◽

Fall Injuries ◽

Injurious Falls ◽

Increased Risk ◽

Falls In Older Adults ◽

Pain Characteristics

Abstract Background Fall injuries are a leading cause of death in older adults. The potential impact of chronic pain characteristics on risk for injurious falls is not well understood. This prospective cohort study examined the relationship between chronic pain and risk for injurious falls in older adults. Method The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older living in and around Boston, Massachusetts. Chronic pain characteristics, including pain severity, pain interference, and pain distribution, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Occurrence of falls and fall-related injuries were recorded using monthly fall calendar postcards and fall follow-up interviews during the 4-year follow-up period. Results Negative binomial regression models showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls adjusting for potential confounders. Participants in the highest third of pain interference scores had a 61% greater risk of injurious falls compared to those reporting little or no pain interference. Compared to no pain, multisite pain was associated with a 57% greater risk of injurious falls. Stratified by gender, the association was only significant in women. In the short term, moderate-to-severe pain in a given month was associated with increased risk of injurious falls in the subsequent month. Conclusions Global pain measures are associated with increased risk of injurious falls in older adults. Pain assessment should be incorporated into fall risk assessments. Interventions are needed to prevent fall injuries among elders with chronic pain.

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Long-Term Retrospective Assessment of Clinical Efficacy of Radiofrequency Ablation of the Knee Using a Cooled Radiofrequency System

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.489 ◽

2019 ◽

Vol 5 (22;5) ◽

pp. 489-489

Author(s):

Leonardo Kapural

Keyword(s):

Chronic Pain ◽

Radiofrequency Ablation ◽

Pain Relief ◽

Knee Pain ◽

Controlled Trial ◽

Real Life ◽

Clinical Effectiveness ◽

Opioid Use ◽

Chronic Knee Pain

Background: Cooled radiofrequency ablation (CRFA) in a randomized, prospective study demonstrated significantly greater improvements in pain, functional, and global outcome measures. Objectives: This large, real-life, retrospective study evaluated the long-term effectiveness of CRFA in the general chronic knee pain population. Study Design: Retrospective electronic chart review. Setting: Outpatient private practice. Methods: After institutional review board approval, we reviewed data of 275 consecutive patients who had undergone a geniculate nerve block at a single-site pain practice between July 1, 2014 and July 1, 2017. A total of 44 patients had a negative response to the geniculate block, and 11 patients had long-term pain relief from the block and declined CRFA. Eight patients underwent knee surgery after the block, and 7 never followed up for further treatment. Finally, 205 patients had undergone CRFA, and 183 (89%) of them returned to provide data. Results: The average age of the 183 patients was 61 (28-95) years, body mass index 34 (18.5- 57), and there were 105 women and 78 men. A total of 137 patients had unilateral knee pain, whereas 46 patients had bilateral knee pain. Eighty percent (146/183) reported at least one or more additional sources of chronic pain (back, shoulder, and others). The average opioid use at baseline was 50 mg morphine sulfate equivalents (median 30 mg). The average baseline pain scores were 8.5, which decreased to 2.2 after the geniculate local anesthetic block, and to 4.2 after CRFA. A total of 65% of the patients claimed > 50% pain relief, whereas 77% had 2 or more Visual Analog Scale points decrease, and 26 (14%) patients reported no pain at all after CRFA. The mean duration of > 50% pain relief after CRFA was 12.5 months (range 0-35 months). There was no significant decrease of opioid use. Patients who underwent a repeated procedure (n = 43) achieved a similar pain relief (P = 0.402). We could not find a statistical difference in geniculate CRFA outcomes between the group who had total knee arthroplasty (TKA; n = 21) and maintained chronic knee pain and patients who had no prior surgery (P = 0.542). Limitations: Retrospective nature of the study. Conclusions: This study demonstrates the clinical effectiveness of CRFA in the treatment of chronic knee pain from osteoarthritis, and even in those patients who maintained chronic knee pain after TKA. Our real-life data seems to agree with data previously published in a randomized controlled trial, despite the fact that this was quite a heterogenous patient population with various sources of chronic pain. Key words: Radiofrequency ablation, chronic knee pain, knee osteoarthritis

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