Only Cervical Segments C0-C2, Not C3 Are Relevant for Subgrouping Migraine Patients According to Manual Palpation and Pain Provocation

Background and Aims: Subgrouping of migraine patients according to the pain response to manual palpation of the upper cervical spine has been recently described. Based on the neuroanatomy and the convergence of spinal and trigeminal nerves in the trigeminocervical complex, the cervical segments C1 to C3 are potentially relevant. To date it has not been investigated whether palpation results of all upper cervical segments are based on one underlying construct which allows combining the results of several tests.Methods: Seventy-one migraine patients with chronic or frequent episodic migraine diagnosed according to the IHS classification version 3 were examined by one physiotherapist. Manual palpation was performed on the upper three cervical segments unilaterally left and right. The results of the palpation according to the patients’ responses were combined using factor analysis to determine whether results from all three segments form one underlying construct. In addition, item response theory (IRT) was used to investigate the structure of the response pattern as well as item difficulty and discriminationFindings: Factor analysis (principal component) showed that the palpation of C3 loads less onto the underlying construct than the palpation of C1 and C2. Considering a cut-off value >1.0, the eigenvalues of all three segments do not represent one underlying construct. When excluding the results from C3, remaining items form one construct. The internal consistency of the pain response to palpation of C1 and C2 is acceptable with a Cronbach’s alpha of 0.69. IRT analysis showed that the rating scale model fits best to the pain response pattern. The discrimination value (1.24) was equal for all 4 items. Item difficulty showed a clear hierarchical structure between the palpation of C1 and C2, indicating that people with a higher impairment are more likely to respond with referred pain during palpation of the segment C2. Conclusion: Statistical analysis confirms that results from the palpation of the cervical segments C1 and C2 in migraine patients can be combined. IRT analysis confirmed the ordinal pattern of the pain response and showed the higher probability of a pain response during palpation of C2. Registration of main Study: German registry of clinical trials (DRKS00015995), Registered 20. December 2018, https://www.drks.de/drks_web/setLocale_EN.do

Anti-inflammatory iron chelator, DIBI, reduces leukocyte-endothelial adhesion and clinical symptoms of LPS-induced interstitial cystitis in mice

BACKGROUND: Interstitial cystitis (IC) is a prevalent and debilitating chronic inflammatory disease of the urinary bladder. Currently there are no fully effective therapeutic agents available, in part due to the still obscure pathogenesis of IC. Lipopolysaccharide (LPS) also known as endotoxin from Gram negative bacteria elicits IC in mice and has formed the basis of model systems for investigation. Excess free iron plays an important role in inflammation through generation of reactive oxygen species (ROS). The novel iron chelator DIBI has been shown to sequester excess free iron and dampen excess inflammatory responses to systemic LPS administration and also to Gram negative bacterial infections. OBJECTIVE: The overall objective of this study was to evaluate the effects of DIBI on LPS induced IC in mice. Leukocyte activation, endothelial adhesion and functional capillary density were assessed by intravital microscopy of the bladder microcirculation following a single intravesical LPS administration with or without intravesical DIBI treatment. Clinical IC symptoms were also assessed through behavioral and pain threshold force measurements. METHODS: Four groups of female BALB/c mice (n = 5–6/group) were randomized in this study: control group, IC group without therapy, IC group with DIBI therapy and control group with DIBI therapy. The groups were examined using intravital microscopy (IVM) of the bladder for leukocyte-endothelial interactions (adherent leukocytes, temporarily interacting leukocytes) and functional capillary density (FCD). A modified behavioral score by Boucher et al. and Von-Frey-Aesthesiometry were used to evaluate key behavioral indices related to pain and visceral pain perception. RESULTS: LPS introduced intravesically induced an early (≤2h) inflammation of the bladder evidenced by leukocyte activation and adhesion to bladder capillary walls. Intravesical DIBI therapy of mice 30min following LPS administration and assessed after 1.5h treatment showed a significant decrease in the number of adherent leukocytes compared to IC animals without DIBI treatment. DIBI treated mice showed a significantly lowered increase in behavioral distress scores compared to IC mice without therapy. Untreated IC mice exhibited a significantly decreased threshold force value for evoked pain response and DIBI treatment improved the threshold pain response. A significant inverse correlation was found for the two pain and suffering evaluation methods results. CONCLUSION: DIBI reduced inflammatory endothelial leukocyte adhesion and key indices related to pain and suffering over those observed in untreated IC mice. Our findings suggest a potential therapeutic role for DIBI for IC treatment.

Literature Review : Tentang Massage Effleurage Terhadap Respon Nyeri Pada Ibu Bersalin Kala I

Contraction during labour can be painful. The pain due to labour process can be reduced by performing non-pharmacological treatment of Effleurage. Effelurage is a serries of massage which is done in the abdominal area aiming to reduce pain that arises during the labour process. The purpose of this study was to find out whether Effleurage could reduce pain response of mothers in the first phase labour. The study was a literature review of three articles taken from Google Scholar with the keyword “Effleurage”, “labour pain” and “first phase” in the form of fulltext articles, published in 2019. The respondents of the thre articles 63 mothers who gave birth. The average value of pain response showed by the respondents before and after being treated with Effleurage decreased from 5.883 to 3.576. Therefore, it was concluded that effleurage could be given to mothers to reduce the pain response in the labour process. Moreover, health providers are expected to treat mothers with Effleurage to reduce their pain to the labour process.Keywords: First phase, labour pain, Massage effleurage AbstrakKontraksi selama persalinan dapat menimbulkan rasa nyeri. Rasa nyeri yang dirasakan pada proses persalinan tersebut dapat dikurangi dengan melakukan tindakan non-farmakologis salah satunya berupa pemberianmassage effleurage. Massage effleurage yang dilakukan di area perut untuk membantu mengurangi rasa nyeri yang muncul pada proses persalinan. Tujuan karya tulis ilmiah ini untuk mengetahui apakah massage effleurage dapat menurunkan respon nyeri pada ibu bersalin kala I berdasarkan literatur review. Desain karya tulis ilmiah berupa literatur review dengan jumlah artikel tiga yang diambil dari laman jurnal google scholar dengan kata kunci “massage effleurage”. “nyeri persalinan” dan “kala I” berupa artikel fulltext, terbit tahun 2019. Jumlah responden dari tiga artikel tersebut adalah 63 ibu bersalin. Nilai rata-rata respon nyeri sebelum dilakukan massage effleurage 5,883, dan nilai rata-rata respon nyeri setelah dilakukan massage effleurage 3,576. Simpulannya adalah tindakan massage effleurage dapat membantu menurunkan respon nyeri pada proses persalinan. Saran bagi pelayanan kesehatan agar dapat menerapkan teknik massage effleurage untuk mengurangi nyeri pada proses persalinan.Kata kunci: Massage effleurage,nyeri persalinan, kala I

Focused Ultrasound and RadioTHERapy for Non-Invasive Palliative Pain Treatment in Patients with Bone Metastasis: A Study Protocol for the Three Armed Randomized Controlled FURTHER-trial

Background Cancer Induced Bone Pain (CIBP), caused by bone metastases, is a common complication of cancer and strongly impairs quality of life (QoL). External Beam RadioTherapy (EBRT) is the current standard of care for treatment of CIBP. However, approximately 45% of patients have no adequate pain response after EBRT. Magnetic Resonance image guided High Intensity Focused Ultrasound (MR-HIFU) may improve pain palliation in this patient population. Methods/design: The FURTHER trial is an international multicenter, three-armed randomized controlled trial. A total of 216 patients with painful bone metastases will be randomized in a 1:1:1 ratio to receive EBRT only, MR-HIFU only, or combined treatment with EBRT followed by MR-HIFU. During a follow-up period of six months, patients will be contacted at eight time points to retrieve information about their level of pain, QoL and the occurrence of (serious) adverse events. The primary outcome of the trial is pain response at 14 days after completion of treatment. Secondary outcomes include pain response at 14 days after trial enrolment, pain scores (daily until the 21st day, weekly until the 6th week and monthly until the 6th month), toxicity, adverse events, QoL, and survival. Cost-effectiveness and cost-utility analysis will be conducted. Discussion The FURTHER trial aims to evaluate the effectiveness and cost-effectiveness of MR-HIFU – alone or in combination with EBRT – compared to EBRT to relieve CIBP. The trial will be performed in six hospitals in four European countries, all of which are partners in the FURTHER consortium. Trial registration: The FURTHER trial is registered under the Netherlands Trials Register number NL71303.041.19 and ClinicalTrials.gov registration number NCT04307914. Date of trial registration is 13-01-2020.

The effect of maternal exposure to titanium dioxide nanoparticles on the pain response in offspring mice using formalin test

This study was conducted to evaluate the effect of maternal exposure to TiO2 nanoparticles on the pain response in offspring mice. 30 female mice with a mean ± SD weight of 30 ± 5 g were randomly divided into three groups: the control group (group 1) received only the basal diet; the sham group (group 2) received saline plus as a carrier (100 μL/mice) subcutaneously on days 3, 7, 10, and 14 post-mating; and the test group (group 3) received 100 μL/mice TNPs subcutaneously on days 3, 7, 10, and 14 post-mating. Offspring were divided into 6 groups 21 days after birth and underwent formalin test. Blood samples were taken to evaluate possible oxidative changes in total antioxidant capacity (TAC) and malondialdehyde (MDA). Exposure to TNPs significantly ( p < 0.05) decreased pain perception. Except for a significant difference between the sham group and the control group, MDA and TAC were not significantly different among the studied groups. Injection of TNPs to pregnant mice would affect the pain perception in their offspring. This may be attributable to the ability of these particles to pass through the placenta to produce free radicals.