Neuropathic Pain Intensity Research Articles

The potential effects of untreated sleep-related breathing disorders on neuropathic pain, spasticity, and cardiovascular dysfunction following spinal cord injury: A cross-sectional prospective study protocol.

Sleep-related breathing disorders (SRBDs), neuropathic pain, spasticity and cardiovascular autonomic dysfunction are common after spinal cord injury (SCI). Prior studies suggest that systemic inflammation following SCI may be implicated in the development of neuropathic pain, spasticity and cardiovascular dysfunction. Given that SRBDs also cause a systemic inflammatory response, we hypothesized that individuals with SCI who develop more severe SRBDs would experience more intense neuropathic pain, more severe spasticity and more significant cardiovascular autonomic dysfunction. This cross-sectional prospective study will explore the previously understudied hypothesis that SRBDs are associated with increased neuropathic pain, spasticity, and cardiovascular autonomic dysfunction in adult individuals with low-cervical/high-thoracic (injury level at C5 to T6), complete/incomplete (ASIA Impairment Scale A, B, C or D) SCI. To our knowledge, no prior study has addressed this clinically relevant question on whether the degree of SRBDs affects the intensity of neuropathic pain, spasticity, and cardiovascular autonomic dysfunction in individuals with SCI. We anticipate that the results of this original study will provide key information for a future clinical trial on the use of continuous positive airway pressure (CPAP) therapy for moderate-to-severe SRBDs, which may better control neuropathic pain, spasticity, and cardiovascular autonomic dysfunction among individuals with SCI. The research protocol for this study was registered in the ClinicalTrials.gov website (NCT05687097). https://clinicaltrials.gov/ct2/show/NCT05687097.

Effects of Radiofrequency Diathermy Plus Therapeutic Exercises on Pain and Functionality of Patients with Patellofemoral Pain Syndrome: A Randomized Controlled Trial

Although consensus has been reached about the use of therapeutic exercise in patellofemoral pain syndrome, several techniques used worldwide such as radiofrequency diathermy could be useful as complementary therapy. The objective of this randomized controlled trial was to compare the effects of adding radiofrequency diathermy to therapeutic exercises in patients with patellofemoral pain syndrome. Fifty-six participants were randomly assigned either to radiofrequency diathermy plus therapeutic exercises group (n = 29) or therapeutic exercises group (n = 27). Both groups received the same therapeutic exercises, and the diathermy group additionally received monopolar dielectric diathermy for three weeks (5-3-2 weekly sessions). Data related to intensity of pain, probability of neuropathic pain, functionality, and range of movement of the knee were measured at baseline and three weeks after the intervention. Comparing pre-treatment and values obtained at the third week, significant improvements were found in intensity of pain, neuropathic pain, functionality, and range of motion in both groups (p < 0.05). The diathermy plus exercises group had significantly better intensity of pain than the control group at the end of the three weeks (p < 0.01). The addition of diathermy by emission of radiofrequency to the therapeutic knee exercise protocol is more effective than a therapeutic exercise protocol alone in the relief of intensity of pain in patients with patellofemoral pain in the immediate post-treatment follow-up compared with baseline scores.

Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.

Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.

Efficacy and safety of botulinumA toxin for the treatment of chronic peripheral neuropathic pain: A systematic review of randomized controlled trials and meta-analysis.

Botulinum toxin type A (BTX-A)is a recently developed treatment for the management of peripheral neuropathic pain. The objective of this study was to provide a synthesis of the evidence concerning the efficacy and safety of subcutaneous botulinum toxin type A injections. We searched the MEDLINE, EMBASE, LILACS, Cochrane, and Clinical Trial Register databases for randomized controlled trials comparingsubcutaneousBTX-A to placebo injections for treating chronic peripheral neuropathic pain. The primary endpoint was the assessment of pain 1month after the injection. The secondary outcomes were the assessment of pain at 3months, neuropathic pain intensity andquality of lifeat 1 and 3months, and adverse effects. A random-effect meta-analysis was performed on the combined data. Evidence quality was rated by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) method. Ten randomized controlled trials including 505 patients were included in this review (registration number CRD42021239108). At 1 and 3months after injection,theBTX-A groups had a lower mean difference (MD) in pain score (MD -1.87 (confidence intervals [CIs] -2.91; -0.83) and -1.38 (CI -1.95; -0.81), respectively).Subgroup analysis showed greater efficacy for diabetic polyneuropathy (MD -2.48, [-3.22; -1.74]).We found no impact ofBTX-A onquality of life and no difference in adverse effect betweenBTX-A andplacebo.The evidencewasconsideredof moderate quality. The pooled data suggest that subcutaneousBTX-A injections have aclinicallysignificant effect, decreasing pain for threemonths after the injection, but nobenefit in terms of quality of life has yet been demonstrated. We found that botulinum toxin is efficient and safe for the treatment of neuropathic pain, especially for diabetic polyneuropathy. Botulinum toxin type A, used for years in neurology, rehabilitation and physical medicine, has proved innocuous and effective, and should be considered as a serious alternative for pain treatment.

Effect of B complex vitamins on life quality and neuropathic pain intensity in patients undergoing hemodialysis

Background: Neuropathic pain (NP) is characterized by chronic pain with a generally strong intensity that leads to limitations regarding activities of daily living. Aims and Objectives: The aim of the study was to investigate the effect of B complex vitamins on NP intensity and life quality in patients undergoing hemodialysis. Materials and Methods: A randomized controlled double-blind clinical trial was conducted among hemodialysis patients with clinical diagnosis of NP randomly allocated to two groups: A (gabapentin) and B (B vitamins). DN4, visual analog scale, and Kidney Disease Quality of Life-Short Form questionnaire were used to identify NP, measure pain intensity, and assess quality of life, respectively. Results: A significant reduction in pain occurred after treatment with gabapentin (P=0.003). In the B group, the reduction of pain went from a mean of 7.27 to 5.09 after treatment (P=0.056). In the A group, a significantly poorer quality of life was reported after treatment in the social relations domain (P=0.010). A significant improvement in quality of life and environment domains (P=0.025 and 0.049, respectively) was reported after use of B vitamins. Conclusion: These findings demonstrate that B complex vitamins for the treatment of NP in hemodialysis patients should be investigated further, as this form of treatment contributed to a reduction in pain intensity and suffering with no side effects and at low cost.

Ipidacrine efficacy in diabetic polyneuropathy complex treatment: A review

Diabetic polyneuropathy (DPN) is a common neurological complication of diabetes mellitus. The most common DPN type is distal symmetric, predominantly sensory, polyneuropathy (DSPN), often accompanied by pain syndrome. This article is aimed to evaluate of ipidacrine (Ipigrix) efficacy in complex DSPN therapy. The dynamics of clinical and neurophysiological manifestations of DPN in the form of the appearance of previously absent tendon reflexes, a decrease in the area and severity of sensory disturbances, the intensity of neuropathic pain, an increase in the amplitude of motor and sensory responses in response to stimulation of peripheral nerves indicates the activation of reinnervation processes against the background of therapy using ipidacrine. Assessing the positive effect on the restoration of the structure and function of peripheral nerves, good tolerability and safety of ipidacrine (Ipigrix), it is possible to recommend the drug in patients with DSPN.

Transcutaneous Electrical Nerve Stimulation in Rodent Models of Neuropathic Pain: A Meta-Analysis.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive therapeutic intervention that is typically used for many years to treat chronic pain in patients who are refractory to pain medications. However, evidence of the efficacy of TENS treatment for neuropathic pain is lacking in humans. To further understand the efficacy of TENS under various intervention conditions and illuminate the current circumstance and future research directions, we systematically reviewed animal studies investigating the efficacy of TENS in relieving pain in neuropathic pain rodent models. We searched the Cochrane Library, EMBASE, MEDLINE (via PubMed), and Web of Science and identified 11 studies. Two meta-analyses were performed. The first meta-analysis showed that a single TENS treatment was capable of temporarily ameliorating neuropathic pain when compared to control groups with a significant effect (standardized mean difference: 1.54; 95% CI: 0.65, 2.42; p = 0.0007; I2 = 58%). Significant temporary alleviation in neuropathic pain intensity was also observed in the meta-analysis of repetitive TENS (standardized mean difference: 0.85; 95% CI: 0.31, 1.40; p = 0.002; I2 = 75%). Subgroup analysis showed no effect of the timing of the application of TENS (test for subgroup difference, p = 0.47). Leave-one-out sensitivity analyses suggested that no single study had an outsized effect on the pooled estimates, which may partly prove the robustness of these findings. Other stratified analyses were prevented by the insufficient number of included studies. Overall, current data suggest that TENS might be a promising therapy to ameliorate neuropathic pain. However, the high risk of bias in the included studies suggests that cautions must be considered when interpreting these findings and it is not reasonable to directly generalize the results obtained from animal studies to clinical practice. Future studies should pay more attention to improving the quality of study design and reporting, thereby facilitating the understanding of mechanisms underlying TENS treatment, reducing more potentially unsuccessful clinical trials, and optimizing the efficacy of TENS for people with neuropathic pain.

Effect of amitriptyline and pregabalin on heart rate variability and electrolytes in neurotrophic pain in diabetic patients

Background: The data regarding effects of amitriptyline and pregabalin on heart rate variability in patients with neuropathic pain in diabetic patients are poorly understood in India. The present study was conducted to evaluate the effect of amitriptyline and pregabalin on heart rate variability in diabetic patients with neuropathic pain and their effect on serum electrolyte (sodium and potassium).Methods: The patients include 60 diabetic patients of either sex aged 18-65 years diagnosed with neuropathic pain and divided into two groups. The study was prospective open label and observational study. Group 1 was treated with amitriptyline 10 mg once a day while group 2 with pregabalin 75 mg once a day and HRV, serum sodium and serum potassium levels and pain score were recorded; and data of post-treatment at 2 and 4 weeks were compared with pretreatment values (control). All the statistical analysis was performed by using SPSS 20.0 software.Results: Both the drugs have increased HRV and reduced neuropathic pain intensity after 2 and 4 weeks treatment. The sodium and potassium level were not altered by these drugs. No correlation was observed between HRV and neuropathic pain.Conclusions: In conclusion, both the amitriptyline and pregabalin have significantly increased HRV and reduced the neuropathic pain intensity; but no correlation was observed between increased HRV and reduced neuropathic pain intensity.

A Scoping Review of the Diurnal Variation in the Intensity of Neuropathic Pain.

Recent studies have suggested that neuropathic pain exhibits a daily diurnal pattern, with peak levels usually occurring in the late afternoon to evening and the trough in the morning hours, although literature on this topic has been sparse. This scoping review examines current evidence on the chronobiology of neuropathic pain both in animal models and in humans with neuropathic pain. A literature search was conducted in major medical databases for relevant articles on the chronobiology of neuropathic pain both in animal models and in humans with neuropathic pain. Data extracted included details of specific animal models or specific neuropathic pain conditions in humans, methods and timing of assessing pain severity, and specific findings of diurnal variation in pain intensity or its surrogate markers. Thirteen animal and eight human studies published between 1976 and 2020 were included in the analysis. Seven of the 13 animal studies reported specific diurnal variation in pain intensity, with five of the seven studies reporting a trend toward increased sensitivity to mechanical allodynia or thermal hyperalgesia in the late light to dark phase. All eight studies in human subjects reported a diurnal variation in the intensity of neuropathic pain, where there was an increase in pain intensity through the day with peaks in the late evening and early night hours. Studies included in this review demonstrated a diurnal variation in the pattern of neuropathic pain that is distinct from the pattern for nociceptive pain. These findings have implications for potential therapeutic strategies for neuropathic pain.

Identifying Discomplete Spinal Lesions: New Evidence from Pain-Autonomic Interaction in Spinal Cord Injury.

The clinical evaluation of spinal afferents is an important diagnostic and prognostic marker for neurological and functional recovery after spinal cord injury (SCI). Particularly important regarding neuropathic pain following SCI is the function of the spinothalamic tract (STT) conveying nociceptive and temperature information. Here, we investigated the added value of neurophysiological methods revealing discomplete STT lesions; that is, residual axonal sparing in clinically complete STT lesions. Specifically, clinical pinprick testing and thermal thresholds were compared with objective contact heat-evoked potentials (CHEPs) and a novel measure of pain-autonomic interaction employing heat-induced sympathetic skin responses (SSR). The test stimuli (i.e., contact heat, pinprick) were applied below the lesion level in 32 subjects with thoracic SCI while corresponding heat-evoked responses (i.e., CHEPs and SSR) were recorded above the lesion (i.e., scalp and hand, respectively). Readouts of STT function were related to neuropathic pain characteristics. In subjects with abolished pinprick sensation, measures of thermosensation (10%), CHEPs (33%), and SSR (48%) revealed residual STT function. Importantly, SSRs can be used as an objective readout and when abolished, no other proxy indicated residual STT function. No relationship was found between STT function readouts and spontaneous neuropathic pain intensity and extent. However, subjects with clinically preserved STT function presented more often with allodynia (54%) than subjects with discomplete (13%) or complete STT lesions (18%). In individuals with absent pinprick sensation, discomplete STT lesions can be revealed employing pain-autonomic measures. The improved sensitivity to discerning STT lesion completeness might support the investigation of its association with neuropathic pain following SCI.

Neuropathic pain as a predictor of neurological disorders regression in patients with spinal cord traumatic injury

Background. Neuropathic pain is one of the principal secondary complications of spinal cord injury. The biological role of neuropathic pain has not been established yet. This type of pain is formed directly in the area of the spinal cord injury; therefore, it can be assumed that its intensity may characterize both degenerative and reparative processes. The aim of this work is to assess the possible relationship between the intensity of neuropathic pain in patients with spinal cord injury at cervical subaxial spine and the dynamics of neurological disorder regression. Materials and methods. We have performed a retrospective analysis of patients referred to outpatient department of the Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine in the period from 2010 to 2020 after a surgical treatment of subaxial cervical spine traumatic injury. The extent of neurological disorders and the intensity of neuropathic pain were assessed within 5–7 and 11–13 months after surgery. Results. All 102 patients selected for analysis were divided into three groups depending on the intensity of the registered pain sensations: 1) absence of constant pain sensations — 19.6 % of subjects, 2)moderate pain— 56.9 %, 3) severe neuropathic pain — 23.5 %. In the first group, the regression of neurological disorders was 3.5 (95% confidence interval (CI) 2.15–6.15), in the second — 25.0 (95% CI 24.14–29.58), in the third — 13.0 (95% CI 10.87–16.55). The differences are statistically significant (χ2 = 60.4, df = 2, p &lt; 0.0001). In patients with severe neurological disorders, the dynamics of recovery did not correlate with the pain intensity. With ASIA B, the dynamics of group 1 was 8.5 (95% CI 10.56–27.56), of group 2— 15.0 (95% CI 13.41–18.41), of group 3 — 10.5 (95% CI 7.45–14.89). With ASIA C functional class, the difference is even more pronounced: in group 1, the median was 8.0 (95% CI 0.83–20.83), in group 2 — 32.0 (95% CI 25.41–36.86), in group 3 — 15.5 (95% CI 10.27–27.4). With ASIA D, a similar trend was observed. Conclusions. The worst regression of neurological disorders is observed in patients without clinically significant pain, the best results of neurological dysfunction recovery are found in patients with mode rate neuropathic pain.

Possible Neuropathic Pain in Patients with Osteoarthritis of the Knee Before and After Total Knee Arthroplasty.

PurposeAlthough the pain of osteoarthritis (OA) is traditionally considered to be nociceptive, some patients also have neuropathic pain. The objective of this study was to evaluate the presence of neuropathic pain in the knees of OA patients using the painDETECT questionnaire (PDQ).MethodsA total of 180 knees in 158 consecutive patients who underwent total knee arthroplasty (TKA) were enrolled prospectively. The prevalence of neuropathic pain, unclear pain, and nociceptive pain in the knee was determined before and after TKA using a numerical rating scale (NRS). All patients were evaluated preoperatively and 6 months postoperatively. Neuropathic pain and unclear pain were grouped together as possible neuropathic pain. The relationship between possible neuropathic pain and pain intensity was evaluated.ResultsBefore TKA, neuropathic pain and unclear pain were found in 10 and 30 knees, respectively. The remaining 140 knees were categorized as nociceptive pain. After TKA, the numbers of knees with neuropathic and unclear pain decreased to one and five, respectively. The prevalence of possible neuropathic pain decreased significantly from 22.2% to 3.3% after surgery. Among the six knees with possible neuropathic pain postoperatively, four had possible neuropathic pain preoperatively as well, while the remaining two patients had been classified as nociceptive pain preoperatively. Knees with possible neuropathic pain postoperatively had higher postoperative NRS scores than those with nociceptive pain.ConclusionAlthough the prevalence of possible neuropathic pain decreased significantly after TKA, the preoperative presence of possible neuropathic pain might be associated with the development of persistent postoperative pain following TKA.

Clinical and laboratory markers of early diagnosis of diabetic polyneuropathy

Objective. To study the content of the brain-derived neurotrophic factor (BDNF) and tropomyosin receptor of type B kinase (TrkB) in patients at an early stage of diabetic polyneuropathy. Late diagnosis of diabetic polyneuropathy (DPN) is largely due to the presence of a subclinical stage, at which damage to the nervous system develops in the absence of complaints from the patient.&#x0D; Materials and methods. 64 patients with type 2 diabetes mellitus and 11 persons of the control group were examined with an assessment of the pain status and the degree of peripheral neuropathy using PainDetect, TSS, NSS, NDS scales. Disturbance of nerve conduction along the nerves of the lower extremities was studied using electroneuromyography (ENMG). The study of the quantitative content of BDNF and TrkB in the serum was carried out with enzyme immunoassay.&#x0D; Results. The increased serum concentrations of BDNF (p = 0.001) and TrkB (p = 0.007) were found with the development of clinically evident DPN as compared to patients without DPN. In patients with diabetes mellitus with subclinical DPN, there was established a statistically significant increase in serum BDNF expression (2.97 [2.44; 3.37] ng/ml in comparison with the values both in the control group (p = 0.022) and in diabetic patients without DPN (p = 0.017). The mean TrkB level in this group was 4.29 [3.48; 5.62] ng/ml, that is also higher than the corresponding values for patients without DPN (p = 0.032) and the control group (p = 0.025). The serum BDNF level correlates with the duration of diabetes mellitus (R = 0.524; p = 0.02), the intensity of neuropathic pain (R = 0.402; p = 0.001), the degree of axonal damage according to ENMG data (R = -0.242; p = 0.03). Correlations between the serum TrkB content and the severity of diabetes mellitus course (R = 0.482; p = 0.01), pain intensity (R = 0.383; p = 0.001), and impaired nerve conduction (R = 0.359; p = 0.003) were found.&#x0D; Conclusions. The elevated expression and increased serum concentrations of BDNF and TrkB occur at the initial stage of the damage of peripheral nerve fibers and correlate with the degree of compensation for carbohydrate metabolism, the duration of diabetes and the severity of neural conduction disorders. The data obtained allow us to consider the increased serum levels of BDNF and TrkB as the markers of subclinical stage of diabetic polyneuropathy.

Neuropathic pain

Background Chronic neuropathic pain is a common occurrence, its prevalence ranges from 7 to 10% of the total population. Currently, the only official document that includes neuropathic pain is the International Classification of Headaches Disorders (ICHD-3), in which this type of pain is associated with traumatic brain injury and neuralgia. Until now, there has been no generally accepted terminology and classification of chronic neuropathic pain.Objective To provide the current terminology, classification and additional characteristics of neuropathic chronic pain.Results The review of modern terminology and classification of neuropathic chronic pain describes the terms included in the concept of chronic peripheral and central neuropathic pain, identifies pain subtypes, as well as its additional characteristics such as the intensity of neuropathic pain, the severity of suffering and disability.Conclusions Thus, the presented recent classification of chronic neuropathic pain is an exhaustive list of the most common neuropathic pain syndromes. The inclusion of classification into clinical practice will help to draw attention to the problem of treatment of chronic neuropathic pain by WHO members, carrying out epidemiological studies and making a correct diagnosis, and therefore the appointment of adequate treatment methods.

Supraspinal nociceptive networks in neuropathic pain after spinal cord injury.

Neuropathic pain following spinal cord injury involves plastic changes along the whole neuroaxis. Current neuroimaging studies have identified grey matter volume (GMV) and resting‐state functional connectivity changes of pain processing regions related to neuropathic pain intensity in spinal cord injury subjects. However, the relationship between the underlying neural processes and pain extent, a complementary characteristic of neuropathic pain, is unknown. We therefore aimed to reveal the neural markers of widespread neuropathic pain in spinal cord injury subjects and hypothesized that those with greater pain extent will show higher GMV and stronger connectivity within pain related regions. Thus, 29 chronic paraplegic subjects and 25 healthy controls underwent clinical and electrophysiological examinations combined with neuroimaging. Paraplegics were demarcated based on neuropathic pain and were thoroughly matched demographically. Our findings indicate that (a) spinal cord injury subjects with neuropathic pain display stronger connectivity between prefrontal cortices and regions involved with sensory integration and multimodal processing, (b) greater neuropathic pain extent, is associated with stronger connectivity between the posterior insular cortex and thalamic sub‐regions which partake in the lateral pain system and (c) greater intensity of neuropathic pain is related to stronger connectivity of regions involved with multimodal integration and the affective‐motivational component of pain. Overall, this study provides neuroimaging evidence that the pain phenotype of spinal cord injury subjects is related to the underlying function of their resting brain.

Exponential correlations among neuropathic components, pain intensity, and catastrophic thoughts in patients with musculoskeletal pain disorder

Background Neuropathic components and catastrophic thoughts contribute to the quality of life impairments in patients with chronic pain. This retrospective cross-sectional observational study examined the extent to which neuropathic components affect pain intensity and catastrophic thoughts using a mathematical model. Methods Participants with chronic pain with spinal or joint disorders were rated for pain intensity using a numerical rating scale (NRS), painDETECT questionnaire (PDQ), and pain catastrophizing scale (PCS). We plotted to scatter plots between PDQ and either NRS or PCS and drew best-fit lines for patients with leg pain only. We divided patients with both leg and back pain into two clusters: located above or below the baselines, and then we drew the best-fit lines for each cluster. We performed factor analysis on PDQ items and developed and validated a discriminant to identify patients located above the baseline in another cohort of musculoskeletal disorders. Results We analyzed 163 patients with lumbar disorders and 205 patients with joint disorders. PDQ correlated exponentially with NRS and PCS of the patients located above the baseline in both disorder groups and correlated linearly or logarithmically in patients located below the baseline. Factor analysis revealed three sets of pain characteristics for each disorder. We developed the discriminant from PDQ items to identify patients showing exponential correlations and then validated it in another cohort of 137 patients. The coefficient for “pressure-evoked pain” was the highest in the discriminant. Conclusions Mathematical models indicate neuropathic components demonstrate linear correlations with NRS and PCS generally, but exponential correlations in a cluster of the patients with musculoskeletal pain. We developed and validated the discriminant based on pain characteristics to identify such patients; “pressure-evoked pain” was the most significant contributor.

Microstructural plasticity in nociceptive pathways after spinal cord injury

ObjectiveTo track the interplay between (micro-) structural changes along the trajectories of nociceptive pathways and its relation to the presence and intensity of neuropathic pain (NP) after spinal cord injury...

Practical experience of using disease-modifying drugs for lumbosacral dorsalgia

Pain in the lumbosacral localization occurs in more than 70% of people and the main contingent of those who seek medical help are patients of working age [1]. The causes of its occurrence are degenerative and dystrophic processes of intervertebral discs and facet joints and muscle tonic reactions. Combined disease-modifying drugs (chondroprotectors) are highly effective in the complex treatment of such diseases. In a group of 39 patients, a study was conducted of the efficiency of the use of modern chondroprotector Flexinovo for nonspecific pain in the lower back, 1 tablet per day for 3 months, with an assessment of the patient's condition during 6 months. A statistically significant decrease in pain intensity according to a visual analogue scale is achieved by the end of the course of treatment, with an increase in the effect by the end of the observation from 6.00 (5.00; 6.00), pc-6m &lt;0.001Z, 4.50 (4.00; 6.00), p3m-6m &lt;0.001 and 1.00 (1.00; 2.25), respectively. Also, the intensity of neuropathic pain decreases according to the DN4 scale, with dynamics from the moment of screening (3 (2; 3), pc-3m &lt;0.001) to the end of the drug use (1 (1; 2) and follow-up 1 (1; 2), (p3m-6m = 0.46). During the observation period, there was a positive effect on the quality of life according to the SF-36 scale with an improvement in general health parameters over time from 52 (50; 62) to 72 (72; 77), respectively (p &lt;0.001). Less pronounced improvements were noted in this sample on the scale of emotional functioning - 33.3 (33.3; 66.7) and 66.7 (66.7; 100), accordingly (p &lt;0.001). All the studied patients showed clinically significant satisfaction with the treatment.

Correlation between the Neuropathic PainDETECT Screening Questionnaire and Pain Intensity in Chronic Pain Patients.

Background and Objectives: Pain is a multidimensional phenomenon with a wide range regarding the location, intensity and quality. Patients with chronic pain, in particular those suffering from mixed pain, often present a special challenge. The PainDETECT questionnaire (PD-Q) is a screening instrument designed to classify whether a patient has neuropathic pain (NP), often rated as more distressing compared to nociceptive pain. The objective of this study was to investigate whether the PD-Q score correlates with pain intensity, measured with the numeric rating scale (NRS), in chronic pain patients in an outpatient setting. Materials and Methods: A questionnaire-based study was conducted to identify the associations between the unidimensional NRS scale for pain intensity and the PD-Q score for screening of an NP component in an outpatient setting. Participants were asked to fill in the questionnaire themselves. Results: One hundred seventy-six participants completed the PD-Q questionnaire and rated pain on the NRS scale at the baseline visit. The PD-Q and NRS scores significantly correlated at the baseline visit and the 1-month follow-up visit in chronic pain patients. The identification of a neuropathic component in chronic pain may permit more targeted and effective pain management. Conclusions: The findings of our questionnaire suggest that a significant proportion of chronic pain patients had manifested features of NP at the first visit to the outpatient clinic. The PD-Q is a useful screening tool to alert clinicians of NP that may need further diagnostic evaluation or therapeutic intervention and may also help to predict treatment response. Further research is needed to investigate if a correlation is predictive of treatment response when pain therapy targets NP.

69742 miR-338-5p as a Biomarker of Neuropathic Pain After Spinal Cord Injury

ABSTRACT IMPACT: Identification of microRNA (miRNA) associated with neuropathic pain after spinal cord injury (SCI) will elucidate underlying epigenetic mechanisms contributing to its development and identify targets for intervention to optimize treatment strategies and outcomes. OBJECTIVES/GOALS: Approximately 70% of individuals with SCI experience neuropathic pain, which is refractory to pharmacologic intervention, and can reduce overall health and wellbeing. This study aims to identify predictive miRNA biomarkers of neuropathic pain after SCI to identify targets for the development of efficacious interventions. METHODS/STUDY POPULATION: Blood samples and clinical outcome measures were collected from adult participants with SCI with neuropathic pain (n = 28) and without neuropathic pain (n = 15). The sample population consisted of a mean age of 39 (SD = 12.12), 8 female (20%), with 13 classified as acute SCI (within 3 months post injury) and 30 as chronic SCI (&gt; 3 years post injury). Pain presence, type, and intensity were assessed with the International Spinal Cord Injury Basic Pain Dataset (ISCIBPDS). Serum miRNA sequencing counts were produced from blood samples. Fold change and independent t-tests assessed differential expression between those with and without neuropathic pain, and those with chronic or acute SCI. Linear regression was performed to explore the relationship between miRNA expression and ISCIBPDS pain intensity ratings. RESULTS/ANTICIPATED RESULTS: In individuals with SCI, significant downregulation of expression of miR-338-5p was present in those with neuropathic pain compared to those without neuropathic pain (fold change = 0.81, p = 0.04). A significant relationship between expression of miR-338-5p and highest reported neuropathic pain intensity on the ISCIBPDS was identified (R2 = 0.15, F = 7.32, p &lt; 0.01). Covariates of sex, age, and years post injury were not found to significantly influence the relationship between miRNA expression and ISCIBPDS intensity ratings. No significant differences in miR-338-5p expression were identified between participants with acute and chronic SCI, or with nociceptive pain ratings, demonstrating specificity of the relationship between miR-338-5p differential expression with pain of a neuropathic nature. DISCUSSION/SIGNIFICANCE OF FINDINGS: These findings, along with validated targets of miR-338-5p in the NF-KB neuroinflammatory signaling pathway, suggest that miR-338-5p may serve a neuroprotective role in modulating neuroinflammation, and that its downregulation may result in maladaptive neuroplastic mechanisms contributing to the development of neuropathic pain after SCI.