scholarly journals Altered Interoceptive Perception and the Effects of Interoceptive Analgesia in Musculoskeletal, Primary, and Neuropathic Chronic Pain Conditions

2020 ◽  
Vol 10 (4) ◽  
pp. 201
Author(s):  
Daniele Di Lernia ◽  
Marco Lacerenza ◽  
Vivien Ainley ◽  
Giuseppe Riva
Keyword(s):  
Chronic Pain ◽  
Tactile Stimulation ◽  
The Body ◽  
Pain Severity ◽  
Anxiety And Depression ◽  
Novel Method ◽  
Chronic Pain Conditions ◽  
Interoceptive Accuracy ◽  
Tactile System ◽  
Single Blind

Chronic pain (CP) severely disrupts the daily life of millions. Interoception (i.e., sensing the physiological condition of the body) plays a pivotal role in the aetiology and maintenance of CP. As pain is inherently an interoceptive signal, interoceptive frameworks provide important, but underutilized, approaches to this condition. Here we first investigated three facets of interoceptive perception in CP, compared with pain-free controls. We then introduce a novel interoceptive treatment and demonstrate its capacity to reduce pain severity in CP, potentially providing complementary analgesic treatments. Study 1 measured interoceptive accuracy, confidence and sensibility in patients (N = 60) with primary, secondary musculoskeletal, and neuropathic CP. Compared with matched controls, CP participants exhibited significantly lower interoceptive accuracy and interoceptive confidence. Pain severity was predicted positively by interoceptive accuracy, anxiety and depression, and negatively by interoceptive confidence. Study 2 tested a promising new interoceptive treatment for CP, in a single-blind between-subjects design (N = 51) with primary, secondary musculoskeletal, and neuropathic CP patients. The treatment specifically activates the C-Tactile system, by means of controlled stimulation of interoceptive unmyelinated afferents, at 3 cm/s with a force of 2.5 mN. This treatment led to significant pain reduction (mean 23%) in the CP treatment group after only 11 min, while CP controls who received comparable but non-interoceptive stimulation reported no change in pain intensity. These studies highlight the importance of interoceptive approaches to CP and demonstrate the potential of this novel method of C-Tactile stimulation to provide complementary analgesic treatments.

scholarly journals Altered interoceptive perception and the effects of interoceptive analgesia in musculoskeletal, primary, and neuropathic chronic pain conditions.

2020 ◽  
Author(s):  
Daniele Di Lernia ◽  
Marco Lacerenza ◽  
Vivien Ainley ◽  
Giuseppe Riva
Keyword(s):  
Chronic Pain ◽  
Physiological Condition ◽  
The Body ◽  
Pain Severity ◽  
Anxiety And Depression ◽  
Novel Method ◽  
Chronic Pain Conditions ◽  
Interoceptive Accuracy ◽  
Tactile System ◽  
Single Blind

Chronic pain (CP) severely disrupts the daily life of millions. Interoception (i.e., the sensing of the physiological condition of the body) plays a pivotal role in the aetiology and maintenance of CP. Given that pain is inherently an interoceptive signal, interoceptive frameworks provide important, but currently under-utilised, approaches to this condition. Here we first investigated three facets of interoceptive perception in CP, compared with pain-free healthy controls. We then introduce a novel interoceptive treatment and demonstrate its capacity to reduce pain severity in CP, thus potentially providing effective complementary analgesic treatments. Study 1 measured ‘interoceptive accuracy’, ‘interoceptive confidence’ and ‘interoceptive sensibility’ in patients (N=60) with primary, secondary musculoskeletal, and neuropathic CP. Compared with matched pain-free controls, CP participants exhibited significantly lower interoceptive accuracy and interoceptive confidence. Pain severity was positively predicted by interoceptive accuracy, anxiety and depression, but negatively predicted by interoceptive confidence. In Study 2 we tested a promising new interoceptive treatment for CP, in a single-blind between-subjects design (N=51) with primary, secondary musculoskeletal, and neuropathic CP patients. The treatment specifically activates the C-Tactile system, by means of controlled stimulation of interoceptive unmyelinated afferents, at 3cm/s with a force of 2.5mN. This treatment led to significant pain reduction (mean 23%) in the CP treatment group, while CP controls who received comparable but non-interoceptive stimulation reported no change in pain intensity. Together, these two studies highlight the importance of interoceptive approaches to CP and demonstrate the potential of this novel method of C-Tactile fibre stimulation to reduce pain severity.

scholarly journals Experimentally induced pain does not influence updating of peripersonal space and body representations following tool-use

2018 ◽  
Author(s):  
Axel Davies Vittersø ◽  
Monika Halicka ◽  
Gavin Buckingham ◽  
Michael J Proulx ◽  
Mark Wilson ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Tool Use ◽  
Experimental Pain ◽  
Peripersonal Space ◽  
The Body ◽  
Body Representations ◽  
Tactile Target ◽  
The Difference ◽  
Chronic Pain Conditions ◽  
Crossmodal Congruency

Representations of the body and peripersonal space can be distorted for people with some chronic pain conditions. Experimental pain induction can give rise to similar, but transient distortions in healthy individuals. However, spatial and bodily representations are dynamic, and constantly update as we interact with objects in our environment. It is unclear whether induced pain disrupts the mechanisms involved in updating these representations. In the present study, we sought to investigate the effect of induced pain on the updating of peripersonal space and body representations during and following tool-use. We compared performance under three conditions (pain, active placebo, neutral) on a visuotactile crossmodal congruency task and a tactile distance judgement task to measure updating of peripersonal space and body representations, respectively. We induced pain by applying 1% capsaicin cream to the arm, and for placebo we used a gel that induced non-painful warming. Consistent with previous findings, the difference in crossmodal interference from visual distractors in the same compared to opposite visual field to the tactile target was less when tools were crossed than uncrossed. This suggests an extension of peripersonal space to incorporate the tips of the tools. Also consistent with previous findings, estimates of the felt distance between two points (tactile distance judgements) decreased after active tool-use. In contrast to our predictions, however, we found no evidence that pain interfered with performance on either task when compared to the control conditions. This suggests that the updating of peripersonal space and body representations is not disrupted by induced pain. Therefore, acute pain does not account for the distorted representations of the body and peripersonal space that can endure in people with chronic pain conditions.

scholarly journals Pathogenic Role of iNOs+ M1 Effector Macrophages in Fibromyalgia

2020 ◽  
Author(s):  
Vishwas Tripathi ◽  
Amaresh Mishra ◽  
Yamini Pathak ◽  
Aklank Jain ◽  
Hridayesh Prakash
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Neurodegenerative Disorder ◽  
Specific Treatment ◽  
The Body ◽  
World Population ◽  
Pain Models ◽  
Chronic Pain Conditions ◽  
Inflammatory Macrophages ◽  
The Impact

Fibromyalgia (FM) or Fibromyalgia Syndrome (FMS) is a neurodegenerative disorder causing musculoskeletal pain, tenderness, stiffness, fatigue, and sleep disorder in the body. It is one of the most common chronic pain conditions, affecting about 6% of the world population. Being refractory, till date, no specific treatment of this disease is available. Accumulating evidences over the last few decades indicate that proinflammatory macrophages, cytokines, & chemokines as the key players in this disease. Recent findings suggest activation of Microglial cells and associated pro-inflammatory signals as one of the major causes of chronic pain in patients suffering from fibromyalgia. Increased density of iNOs/CD68+ M1 effector macrophages has been associated with neuropathic pain models. In light of this, depletion of these pro-inflammatory macrophages has been shown to reduce sensitivity to neuropathic pain. On the other hand, modulating pattern of AGEs (Advanced Glycation End-Products) can also contribute to inactivation of macrophages. These findings strongly suggest that macrophages are critical in both inflammatory and neuropathic pain. Therefore, this chapter highlights the impact of macrophage plasticity in various immunopathological aspects of fibromyalgia.

Severity of chronic pain and its relationship to quality of life in multiple sclerosis

2005 ◽  
Vol 11 (3) ◽  
pp. 322-327 ◽  
Author(s):  
Lorraine V Kalia ◽  
Paul W OConnor
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Chronic Pain ◽  
Short Form ◽  
Depression Scale ◽  
Pain Severity ◽  
Anxiety And Depression ◽  
Mcgill Pain Questionnaire ◽  
Neurogenic Pain

Introduction: This study used reliable and validated instruments to compare pain severity in multiple sclerosis (MS) to that in other chronic painful conditions, and to examine relationships between chronic pain in MS and health-related quality of life (HRQOL). Methods: Ninety-nine MS patients completed a self-administered survey comprised of the Medical Outcomes 36-Item Short-Form Health Survey, the Short-Form McGill Pain Questionnaire, and the Hospital Anxiety and Depression Scale. Results: Pain severity was not different between MS patients with pain and rheumatoid arthritis (P=0.77) or osteoarthritis (P=0.98) patients. Chronic pain in MS was less often neurogenic than non-neurogenic, although severity of neurogenic pain was greater than that of non-neurogenic pain (P=0.048). Chronic pain in MS was found to have no significant relationship to age, disease duration or disease course. Instead, we found that pain was correlated with aspects of HRQOL, particularly mental health (r=0.44, P<0.0001) versus physical functioning (r=0.19, P>0.05). Chronic pain was significantly related to anxiety and depression for females but not for males with MS. Conclusions: Chronic pain in MS is as severe as pain in arthritic conditions and is associated with reduced HRQOL. Thus, pain can be a significant symptom for MS patients and the need for treatment may be underestimated.

To What Extent Do Anxiety and Depression Interact with Chronic Pain?

1993 ◽  
Vol 38 (1) ◽  
pp. 36-38 ◽  
Author(s):  
Klaus Kuch ◽  
Brian Cox ◽  
Ramon J. Evans ◽  
Peter C. Watson ◽  
Constantine Bubela
Keyword(s):  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Depressed Mood ◽  
Pain Severity ◽  
Anxiety And Depression ◽  
Pain Frequency

In 61 patients with generalized musculoskeletal pain, severity of anxiety and depression correlated significantly with self-reported impact of illness and physician-rated disability. Depression was significantly associated with pain-frequency, whereas anxiety was unrelated. Depressed mood was more closely tied to patients’ ability to function than to their experience of pain.

Fibromyalgia

2019 ◽  
Author(s):  
Daniel Joseph Clauw
Keyword(s):  
Chronic Pain ◽  
Gastrointestinal Disorder ◽  
The Body ◽  
Volume Control ◽  
Vulvar Vestibulitis ◽  
Peripheral Tissues ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Underlying Mechanisms ◽  
Chronic Pain Conditions

Clinicians often encounter individuals who present with pain that they cannot adequately explain based on the degree of damage or inflammation noted in peripheral tissues. This typically prompts an evaluation looking for a cause of the pain. If no cause is found, these individuals are often given a diagnostic label that merely connotes that the patient has chronic pain in a region of the body, without an underlying mechanistic cause. Fibromyalgia (FM) is merely the current term for widespread musculoskeletal pain for which no alternative cause can be identified. This review covers the epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and complications and prognosis of FM. Figures show underlying mechanisms that can cause chronic pain; an individual’s “set point” or “volume control setting” for pain as set by a variety of factors, including the levels of neurotransmitters that either facilitate pain or reduce pain transmission; the 2011 Fibromyalgia Survey Criteria; symptoms and syndromes frequently seen in individuals with FM; the distribution of the 2011 Fibromyalgia Survey scores in a large cohort of individuals undergoing joint replacement surgery; and an algorithm showing the importance of dually focused treatment for FM and other chronic pain conditions. Tables list clinical characteristics of centralized pain, pharmacologic therapies for FM, and nonpharmacologic therapies for FM. This review contains 6 figures, 9 tables, and 78 references. Keywords: Fibromyalgia, chronic low back pain, headache, temporomandibular joint disorder, gastrointestinal disorder, irritable bowel syndrome (IBS), nonulcer dyspepsia, or esophageal dysmotility,  interstitial cystitis, chronic prostatitis, vulvodynia, vulvar vestibulitis, and endometriosis

Fibromyalgia

2019 ◽  
Author(s):  
Daniel Joseph Clauw
Keyword(s):  
Chronic Pain ◽  
Gastrointestinal Disorder ◽  
The Body ◽  
Volume Control ◽  
Vulvar Vestibulitis ◽  
Peripheral Tissues ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Underlying Mechanisms ◽  
Chronic Pain Conditions

Clinicians often encounter individuals who present with pain that they cannot adequately explain based on the degree of damage or inflammation noted in peripheral tissues. This typically prompts an evaluation looking for a cause of the pain. If no cause is found, these individuals are often given a diagnostic label that merely connotes that the patient has chronic pain in a region of the body, without an underlying mechanistic cause. Fibromyalgia (FM) is merely the current term for widespread musculoskeletal pain for which no alternative cause can be identified. This review covers the epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and complications and prognosis of FM. Figures show underlying mechanisms that can cause chronic pain; an individual’s “set point” or “volume control setting” for pain as set by a variety of factors, including the levels of neurotransmitters that either facilitate pain or reduce pain transmission; the 2011 Fibromyalgia Survey Criteria; symptoms and syndromes frequently seen in individuals with FM; the distribution of the 2011 Fibromyalgia Survey scores in a large cohort of individuals undergoing joint replacement surgery; and an algorithm showing the importance of dually focused treatment for FM and other chronic pain conditions. Tables list clinical characteristics of centralized pain, pharmacologic therapies for FM, and nonpharmacologic therapies for FM. This review contains 6 figures, 9 tables, and 78 references. Keywords: Fibromyalgia, chronic low back pain, headache, temporomandibular joint disorder, gastrointestinal disorder, irritable bowel syndrome (IBS), nonulcer dyspepsia, or esophageal dysmotility,  interstitial cystitis, chronic prostatitis, vulvodynia, vulvar vestibulitis, and endometriosis

Fibromyalgia

2019 ◽  
Author(s):  
Daniel Joseph Clauw
Keyword(s):  
Chronic Pain ◽  
Gastrointestinal Disorder ◽  
The Body ◽  
Volume Control ◽  
Vulvar Vestibulitis ◽  
Peripheral Tissues ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Underlying Mechanisms ◽  
Chronic Pain Conditions

Clinicians often encounter individuals who present with pain that they cannot adequately explain based on the degree of damage or inflammation noted in peripheral tissues. This typically prompts an evaluation looking for a cause of the pain. If no cause is found, these individuals are often given a diagnostic label that merely connotes that the patient has chronic pain in a region of the body, without an underlying mechanistic cause. Fibromyalgia (FM) is merely the current term for widespread musculoskeletal pain for which no alternative cause can be identified. This review covers the epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and complications and prognosis of FM. Figures show underlying mechanisms that can cause chronic pain; an individual’s “set point” or “volume control setting” for pain as set by a variety of factors, including the levels of neurotransmitters that either facilitate pain or reduce pain transmission; the 2011 Fibromyalgia Survey Criteria; symptoms and syndromes frequently seen in individuals with FM; the distribution of the 2011 Fibromyalgia Survey scores in a large cohort of individuals undergoing joint replacement surgery; and an algorithm showing the importance of dually focused treatment for FM and other chronic pain conditions. Tables list clinical characteristics of centralized pain, pharmacologic therapies for FM, and nonpharmacologic therapies for FM. This review contains 6 figures, 9 tables, and 78 references. Keywords: Fibromyalgia, chronic low back pain, headache, temporomandibular joint disorder, gastrointestinal disorder, irritable bowel syndrome (IBS), nonulcer dyspepsia, or esophageal dysmotility,  interstitial cystitis, chronic prostatitis, vulvodynia, vulvar vestibulitis, and endometriosis

Patients selected to participate in multimodal pain rehabilitation programmes in primary care−a multivariate cross-sectional study focusing on gender and sick leave

2020 ◽  
Vol 20 (3) ◽  
pp. 511-524
Author(s):  
Gunilla Stenberg ◽  
Paul Enthoven ◽  
Peter Molander ◽  
Björn Gerdle ◽  
Britt-Marie Stålnacke
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Chronic Pain ◽  
Sick Leave ◽  
Partial Least Square ◽  
Anxiety And Depression ◽  
Data Set ◽  
Work Related ◽  
Chronic Pain Conditions

AbstractBackground and aimsA multimodal rehabilitation programme (MMRP) is an evidence-based treatment of chronic pain conditions. The complexity involved in chronic pain needs to be identified and evaluated in order to adapt the rehabilitation to patients’ needs. The aim was to investigate the multivariate relationships between self-reported variables in patients with chronic pain before taking part in MMRP in primary care, with a special focus on gender and degree of sick leave.MethodsPrior to MMRP, 397 patients (339 women and 58 men) filled in a questionnaire about pain, healthcare aspects, health-related quality of life, anxiety and depression, coping, physical function, and work-related variables e.g. sick leave. Data were analysed by principal component analysis (PCA) and partial least square analysis.ResultsThe PCA identified four components that explained 47% of the variation in the investigated data set. The first component showed the largest variation and was primarily explained by anxiety and depression, quality of life, acceptance (activity engagement), and pain-related disability. Gender differences were only seen in one component with the pain variables having the highest loadings. Degree of sick leave was not well explained by the variables in the questionnaire.ConclusionsThe questionnaire filled out by the patients prior to participation in MMRP in primary care identified much of the complexity of chronic pain conditions but there is room for improvement, e.g. regarding explanation of work-related factors. In the multivariate analysis, gender did not fall out as an important factor for how most patients answered the questions.ImplicationsThere are not many studies that describe patients who undergo MMRP in primary care since previously such patients were treated mostly in specialist care. More knowledge is needed about these patients in order to improve rehabilitation plans and interventions. The results suggest that the questionnaire identifies the complexity among chronic pain patients in primary care. The identified components could improve assessment before MMRP and contribute to better tailored programmes.

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