Neurological Pain Syndromes Research Articles

Bladder capacity as a benchmark for patient stratification in interstitial cystitis/bladder pain syndrome

Objectives:In a previous study we reported that molecular profiling of bladder mucosal tissue from a modest number of IC/BPS patients resulted in a clear separation based on anesthetic bladder capacity (BC), with 400 cc representing the apparent breakpoint between low and non-low BC. The purpose of the current study was to revisit this earlier stratification finding, using a combination of molecular and clinical data, from a large and heterogeneous patient cohort. Materials and Methods:To provide an updated assessment of IC/BPS patient stratification based on anesthetic BC, whole genome gene expression data from 48 mucosal biopsy samples (41 IC/BPS patients; 7 controls) were analyzed with unsupervised clustering and principal component analysis (PCA) to identify primary clusters of patients. This identified three primary individual clusters: (1) IC/BPS patients with a BC between 200–500 cc (n=19), (2) IC/BPS patients with a BC of 501–1500 cc (n=22), and (3) controls. Next, complete demographic, clinical, and questionnaire data prospectively collected from an additional 450 patients from our patient registry were used to conduct a combined analysis to verify this relationship. Characteristics of all 491 IC/BPS patients were compared between those having the current low BC cutoff (≤400 cc) and the proposed new cutoff (≤500 cc) by utilizing independent samples t-test (continuous variables) and chi square tests (categorical variables; p ≤ 0.05 was considered significant). Results:A statistical comparison of the demographic and clinical characteristics of the entire 491 IC/BPS patient cohort showed that those with a bladder capacity ≤500 cc were older, were more likely to have Hunner lesions, and had higher symptom scores. This group also had a lower average number of non-urologic associated symptoms, pelvic pain syndromes, and neurologic, immune, or systemic pain syndromes. Conclusion:By combining newly acquired molecular data with clinical and demographic characteristics in a large cohort of IC/BPS patients, we conclude that anesthetic BC ≤ 500 cc provides a clinically meaningful biomarker for the bladder centric IC/BPS phenotypic subgroup.

Age-Related and Side-Dependent Differences in Hip Range of Motion among Female Indian Athletes: Establishing Reference Values

Restricted hip mobility and flexibility are always associated with increased risk for lower extremity injury and poor athletic performance in female athletes. Reference values for hip motions in female athletes by age and sports are lacking. The primary aim of the study is to document the active and passive range of motion of hip joint among adolescent and adult Indian female athletes. Next, to compare between the sides and age group in the same population. This is a cross-sectional study involving 498 healthy female athletes of age group 15-21 years involved in the high impact sports were conveniently selected for the measurements of hip active and passive range of motion with a Universal goniometer. Participants with recent history of musculoskeletal injury and neurological pain syndromes were excluded from the study. Comparing the baseline values of active and passive range of motion of hip joint, between adolescent and adult female athletes, revealed a significant difference (p<0.05) in both dominant and non-dominant leg except for passive hip abduction (p>0.05). However, adolescents demonstrated higher hip flexion, internal rotation, and external rotation, and adults showed greater hip extension. Active and passive reference values for hip range of motion is documented for South Indian female athletes in relation to age and high impact sports. Future research involving injury prediction, prevention and rehabilitation protocol among female sports can utilize these values.

A Systematic Review of Non-Opioid Pain Management in Chiari Malformation (Type 1) Patients: Current Evidence and Novel Therapeutic Opportunities.

Chiari Malformation Type I (CM) includes a range of cranial abnormalities at the junction of the skull with the spine, with common symptoms including pain and headaches. Currently, CM pain is managed medically through anti-inflammatory drugs, muscle relaxants, and opioids, while surgical management includes posterior fossa decompression. Given the adverse effects of opioid use, and an ongoing opioid epidemic, there is a need for safe, non-opioid alternatives for clinical pain management. This systematic review was performed to provide an update on the current literature pertaining to the treatment of CM pain with non-opioid alternatives. A literature search was performed in June 2022 utilizing the PubMed and Google Scholar databases, and articles were identified that included information regarding non-opioid pain management in CM patients. A total of 90 articles were obtained from this search, including 10 relevant, drug-specific studies. Two independent reviewers selected and included all relevant articles based on the chosen search criteria to minimize bias risk. Currently available treatments for neurosurgical pain management include anticonvulsants, corticosteroids, NSAIDs, anti-inflammatory drugs, NMDA receptor antagonists, local anesthetics, nerve blocks, scalp blocks, and neuromuscular blocks. While more information is needed on the use of non-opioid pain management, the present literature provides potential evidence of its efficacy amongst the CM patient population, on account of the success that non-opioid pain management has demonstrated within other neurological pain syndromes. Further research into non-pharmacological pain management would also benefit the CM population and could be generalized to related conditions.

Local stimulation with Alflutop in dorsopathy

The article summarizes the results of their own research in the field of one of the original areas of reflexology – pharmacopuncture or, in other words, local stimulation. This term in our case refers to a method of irritating reflexology points with small doses of drugs considered as low-energy factors. Synonyms of the method, reflecting little significant differences, are aquapuncture, biopuncture, mesotherapy and some others. In the mechanisms of method, the significance of the prolongation of the reflex response due to changes in the volume of tissues in the region of points and the formation of multiple depots of the drug used are highlighted. However, the issues of more subtle links remain unclear, which determined the purpose of the study – to identify as such the targeted effect of drugs used through local stimulation. Dorsopathy at the lumbosacral level was chosen as a research model, which is to a certain extent associated with the formation of reflexology in the country, the methods of which were largely developed and refined using the model of neurological pain syndromes. Naturally, we took into account the medical, social and economic significance of the problem. In a series of completed dissertation studies of our employees, the therapeutic possibilities of local use of the drug Alflutop, indicated for the studied pathology, were analyzed. Evaluation of the effectiveness of this approach was based on taking into account the dynamics of clinical and additional characteristics and, in particular, the results of psychological and electrophysiological examination, including zonal thermography, vascular tests, etc. At the same time, the addition and even potentiation of the reflex and drug links of the method was noted, which determines a reliable superiority over the standard therapeutic effect or placebo control. Fundamentally significant in this regard was the positive structural and modifying effect in relation to the state of the intervertebral discs, confirmed by the data of ultrasonic video densitometry of these structures. Attention should also be paid to the fact of strengthening the effectiveness of pharmacopuncture through the parallel use of modern hardware technology – low-frequency electromagnetic stimulation. The presented materials are also reflected in monographs, a number of methodological manuals and protected patents for the invention.

MP02-05 SYMPTOMS OF CENTRAL SENSITIZATION ARE ASSOCIATED WITH WORSE LOWER URINARY TRACT SYMPTOMS IN MEN

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-05 SYMPTOMS OF CENTRAL SENSITIZATION ARE ASSOCIATED WITH WORSE LOWER URINARY TRACT SYMPTOMS IN MEN Angela Senders, Kamran Sajadi, Scott Bauer, Thu Le, Ryan Wexler, Yiyi Chen, Barry Oken, and Lynn Marshall Angela SendersAngela Senders More articles by this author , Kamran SajadiKamran Sajadi More articles by this author , Scott BauerScott Bauer More articles by this author , Thu LeThu Le More articles by this author , Ryan WexlerRyan Wexler More articles by this author , Yiyi ChenYiyi Chen More articles by this author , Barry OkenBarry Oken More articles by this author , and Lynn MarshallLynn Marshall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Central sensitization (CS) is an impairment in the processing of sensory information that results in ongoing hypersensitivity to nociceptive and other somatic signals. CS has been examined as a possible mechanism of overactive bladder among women, but studies of CS and urinary symptoms among men are lacking. Our objective was to determine the association between CS symptoms and lower urinary tract symptoms (LUTS) among men. METHODS: We conducted a cross-sectional study using an electronic survey. From June-August 2020, we contacted 209 men, age 18 years or older, who had received urodynamic testing for LUTS in the past 3 years at our institution’s adult urology clinic. Of these, 75 did not respond, 43 declined, and 91 (44%) consented. We obtained demographics, history of diagnosed neurological conditions, chronic pain syndromes, current bladder or genital pain, the American Urological Association Symptom Index (AUASI) and the Central Sensitization Inventory (CSI). The CSI is a 25-item questionnaire quantifying symptoms commonly reported by people with CS, with the sum of items resulting in a total score of 0-100 points. A CSI score of ≥40 indicates moderate-to-severe CS-related symptoms. We used multivariable linear regression to model the association between moderate-to-severe CS and AUASI score. We estimated regression coefficients (β) and 95% confidence intervals (CI) adjusted first for age. The final model was adjusted for age, existing neurologic conditions (multiple sclerosis, Parkinson’s disease), chronic prostatitis (CP), chronic bladder or pelvic pain, and pain with urination or ejaculation in the past week. RESULTS: Among 90 men with complete data, the mean (standard deviation, sd) age was 66 (14) years, 76 (84%) were non-Hispanic white, 27 (30%) had CSI scores ≥ 40, and the mean (sd) AUASI score was 15 (9) points. Controlled for age, the AUASI score averaged 8 points greater among men with CS compared to men without CS (β=8.1, 95% CI: 4.3, 11.9). The positive association remained in the final model (β=7.6, 95% CI: 3.4, 11.7). When restricted to 53 men without neurologic conditions, CP, pain syndromes, or urination or ejaculation pain, the association remained (age-adjusted β=8.7, 95% CI: 2.5, 14.9). CONCLUSIONS: Symptoms suggestive of moderate-to-severe CS were common among men with a recent history of urodynamic testing for LUTS and associated with significantly greater AUASI scores. The association was independent of existing neurologic and chronic pain conditions including CP. Objective assessment for the presence of CS among men with LUTS is warranted. Source of Funding: Unfunded © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e13-e13 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angela Senders More articles by this author Kamran Sajadi More articles by this author Scott Bauer More articles by this author Thu Le More articles by this author Ryan Wexler More articles by this author Yiyi Chen More articles by this author Barry Oken More articles by this author Lynn Marshall More articles by this author Expand All Advertisement Loading ...

Pain in multiple sclerosis and neuromyelitis optica spectrum disorders

Multiple sclerosis and neuromyelitis optica spectrum disorders are autoimmune inflammatory diseases of the central nervous system, which can lead to a multitude of neurological complaints and pain syndromes. Pain may be an acute symptom during disease exacerbation as well as achronic symptom, whereby the latter sometimes substantially reduces the quality of life. The etiology of pain is very heterogeneous but the rapid differential diagnostic classification is decisive in order to be able to initiate a differentiated treatment strategy. Chronic pain must be differentiated from pain as a possible (early) symptom of an acute disease exacerbation, classified in more detail and individually treated. These include central neuropathic pain, pain associated with spasticity, musculoskeletal pain due to excess loading and pain as a side effect of immunotherapy and in the context of comorbidities. The treatment strategies are often insufficiently evidence-based due to the lack of data.

Intercostal nerves pulsed radiofrequency for intractable neuralgia treatment in athletes with sport trauma of the chest: A case-series study

Background: Athletes with trauma to the chest could be injured and suffer from an acute disturbing chest wall pain due to intercostal neuralgia. Pulsed radiofrequency (PRF) is an emerging safe therapy in many neurologic pain syndromes. Objectives: This study aimed to determine the effect of PRF on intercostal neuralgic pain in athletes complaining of severe chest pain and limited range of motion. Materials and Methods: This case-series study was conducted on athlete patients who suffered from severe chest pain that has limited their function. Eighteen athletes who were absent from physical training and sports activity due to intercostal neuralgia in their current season were admitted to our pain clinic. Intercostal nerve PRF was used to treat patients. Pain scale and return to sports activity were measured after PRF. Results: The mean time of absence from sports activity was 1.3 ± 0.6 weeks. The mean score of pain severity (numeric rating scale [NRS]) was 8.46 ± 1.85. In this study, 16 of 18 (88%) patients had effective pain relief (NRS <3) after PRF therapy. Besides, the NRS scores reduced by at least 90% in 16 of 18 (88%) patients as compared to the baseline. The mean NRS score was followed-up for 4 weeks. The scores significantly decreased at 1 (P = 0.001), 2 (P = 0.0015), and 4 (P = 0.0002) weeks following PRF compared to pre-PRF time. Conclusions: Pulsed radiofrequency is a suitable therapy for athletes with intercostal nerve entrapment pain, which provides adequate and quick pain relief, thus enabling them to resume their sport activities.

The enlarging spectrum of Nav1.7 mutations associated with neurological pain syndromes. (P2.022)

The enlarging spectrum of Nav1.7 mutations associated with neurological pain syndromes. (P2.022)

Main complications at treatment of nontraumatic intracerebral hematomas of brain hemispheres

Objective: to identify clinically significant complications. Materials and methods. Surgical treatment using different methods was performed in 116 patients with nontraumatic intracerebral hematomas; conservative treatment was performed in 100 patients. Results. The overall mortality at surgical treatment was 19.8% (at transcortical approach — 29%, trans- and parasilvial — 25%, after stereotactic removal — 7.1%), at conservative treatment — 19%. Causes of death: a) hemorrhage with brain stem inclination (after surgery — 65.2%, conservative treatment — 73.4%); b) thromboembolism (after surgery — 26%, conservative treatment — 15.8%); c) pneumonia (after surgery — 8.7%, conservative treatment — 10.5%); d) re-bleeding in the bed of the removed hematoma — 4.3%. Main clinically significant complications were identified: a) intra- and postoperative (marked brain edema, new bleeding in the cavity of removed hematoma, bacterial meningitis after ventricular drainage), somatic (thromboembolism, thrombophlebitis, pneumonia, septic condition), neurological (pain and spastic syndromes). Conclusions. The most significant cause of death is dislocation and impaction of the brain stem that necessitates further improve of operative techniques, including implementation of fasting-reclinating interventions. The second direction for complications incidence reducing and functional outcome improving is to optimize drug therapy, including widespread use of antioxidants, especially in comatose patients.

Do childhood cancer survivors with physical performance limitations reach healthy activity levels?

The extent to which physical performance limitations affect the ability of childhood cancer survivors to reach healthy activity levels is unknown. Therefore this study aims to describe the effect of different types of limitations on activity levels in survivors. Within the Swiss Childhood Cancer Survivor Study we sent a questionnaire to all survivors (≥16 years) registered in the Swiss Childhood Cancer Registry, who survived >5 years and were diagnosed 1976-2005 aged <16 years. We measured healthy activity levels using international guidelines and assessed different kinds of performance limitations (visual impairment, weight and endurance problems, cardiorespiratory, musculoskeletal, and neurological problems, pain and fatigue syndromes). The sample included 1,560 survivors (75% response rate), of whom 209 (13.5%) reported they have performance limitations. Forty-two percent of survivors with limitations reached healthy activity levels, compared to 57% of survivors without limitations. Least active were survivors with vision impairments (25% active), weight and endurance problems (27.3%), cardiorespiratory problems (36.4%), and musculoskeletal problems (43.1%). After adjusting for socio-demographic variables and type of cancer, we found that survivors with limitations were 1.4 (95%CI 1.0-2.0; P = 0.047) times more likely to be inactive. Although many survivors with physical performance limitations maintain healthy activity levels, there is room for improvement. Adapted and targeted physical activity counseling for survivors with performance limitations might help them to raise level of activity and pursue a healthy lifestyle.

Matrix Metalloproteinases in Neuropathic Pain and Migraine: Friends, Enemies, and Therapeutic Targets

Matrix metalloproteinases (MMPs) constitute a family of zinc-dependent endopeptidases that mediate extracellular matrix turnover and associated processes, such as cell survival, growth, and differentiation. This paper discusses important functions of MMP in the normal and injured nervous system, focusing on the role played by these proteases in neurological pain syndromes, most prominently in neuropathic pain and migraine headaches. In the past decade, metalloproteinases emerged as key modulators of neuropathic pain, with MMP-9 acting as an initiator of the neuropathic cascade. Increased MMP activity was detected in migraine patients, independent of aura, in tight association with metabolic derangements. The therapeutic implications of MMP inhibition are considered in the context of neurogenic pain regulation.

Changes of hemodynamics during the treatment of patients with neurologic pain syndromes by the method of dynamic electrical neurostimulation

The Doppler ultrasound technique was used to study blood flow characteristics for the evaluation of the efficacy of the treatment of painful neurological syndromes with the help of a DiaDENS apparatus allowing for dynamic changes of electrostimulation parameters. A significant improvement of the extracranial cerebral blood flow was achieved as early as the mid-course of 10 treatment sessions when the most pronounced stabilization of the clinical characteristics was apparent. Marked heterogeneity of responses of extracranial vessels to the therapeutic effect of dynamic electrostimulation (DENS) was documented, possibly due to the redistribution of the blood flow in certain vascular areas during the treatment. DENS applied to the lumbar region was shown to induce positive dynamics of the initially impaired blood flow in the tibial artery. It is concluded that positive hemodynamic changes in the cerebral blood flow constitute an important component of the anesthetic and general sanogenetic actions of DENS.

Cancer Rehabilitation Approaches to Neurologic Pain Syndromes in Malignancy

Pain is a common symptom in cancer patients. Thirty to fifty percent of patients will experience pain while undergoing cancer treatment, and 70 to 90% of patients with advanced disease report pain.1-7 In addition, greater than 50% of patients state their pain is incompletely controlled. In part, this is due to the difficulty physicians have in accurately assessing the patient's level of pain and response to treatment, as well as utilizing a treatment approach that is agreeable to the patient. It is common that patients underreport the severity of the pain that they are experiencing, as well as their inability to achieve pain control. There are many possible reasons for this, including their wish to appease the physician; the fear of confirming progression of their disease by admitting to having increased pain; and the concern of possible narcotic addiction. To address these problems, the World Health Organization, the American Pain Society, and the American Society of Clinical Oncology's Ad Hoc Committee on Cancer Pain have published guidelines for assessing and treating pain.8-10Pain is one of the most disabling conditions experienced by cancer patients.7,11-14 This disabling effect is exacerbated by the patient's fear of the loss of control of both the ability to regulate his/her pain and loss of control of his physical mobility due to the pain. Therefore, it affects the patient both physically and emotionally and further compromises the ability of the patient and family to deal with the disease.The perceived intensity of the pain as well as the level of disability experienced by the patient can be influenced by many variables such as family support and cultural background of the patient. These influences in the patient's life can magnify or diminish his/her perception of pain and disability. Therefore, in the same way that patients tolerate pain differently, the treatment approach must to some extent be appropriately individualized, periodically reviewed, and frequently altered to change with the needs of the patient. This is one reason why those involved with cancer rehabilitation use an individualized interdisciplinary approach to the patients' needs, including pain control. In addition to the traditional use of analgesics, chemotherapy, radiation therapy, surgery, and nerve blocks to palliate pain, cancer rehabilitation employs a wide range of other modalities, both physical and cognitive behavioral, in its treatment approach. Physical and occupational therapy utilize positioning, strengthening, transcutaneous electrical nerve stimulation (TENS), and other electrical stimulation modalities, orthotics, and other assistive devices to alleviate pain and maximize function. In addition, psychological support in its various forms, with both patient and family counseling, affords better handling of the disease. In some cases biofeedback and/or hypnosis can be utilized as an adjunct to pain control. Since the pathophysiology of cancer pain and its pharmacologic, surgical, and radiation treatments were dealt with in a previous issue, they will not be addressed further. This article will focus primarily on the more unique aspects of cancer rehabilitation, and the physical, nonpharmacologic, and behavioral approaches to pain management that practitioners commonly use in relation to neurological pain syndromes in cancer.

Charged particle irradiation of sacral chordomas

Purpose : The purpose of this report is determine the impact of charged particle irradiation at Lawrence Berkeley Laboratory (LBL) in treating patients with sacral chordomas. Overall survival, local control, complications, and predictive parameters are analyzed. Methods and Materials : Fourteen patients with sacral chordomas were treated with the charged particles helium and neon between 1977 and 1989. The median dose was 7565 cGyE and the median follow up is 5 years. All patients were treated post-operatively; ten had gross residual disease. Results : Kaplan-Meier survival at 5 years is 85%. Overall 5-year local control is 55%. A trend to improved local control at 5 years was seen in patients treated with neon when compared to patients treated with helium (62% vs 34%), in patients following complete resection versus patients with gross residual tumor (75% vs 40%), and in patients who had treatment courses under 73 days (61% vs 21%). Distant metastases were seen in two patients (14%). No patient developed neurologic sequelae or pain syndromes. One previously irradiated patient required colostomy, one patient had delayed wound healing following a negative post-radiation biopsy, and one patient developed a second malignancy. There were no genitourinary complications. Conclusion : Our experience indicates that post-operative charged particle irradiation of sacral chordomas appears to result in reasonable local control and survival with acceptable risk, and that additional evaluation on the use of heavy charged particles is warranted.

Neurologic Pain Syndromes in Patients with Cancer

One third of cancer patients in active therapy and two thirds of patients with far-advanced disease have significant pain. A series of specific neurologic pain syndromes occur in this population and are unique to this pain population. Early diagnosis and treatment are critical to prevent irreversible neurologic damage and chronic neuropathic pain.

Neurologic Pain Syndromes in Patients with Cancer

Recognizing and treating the cause of pain in the patient with cancer should be the initial approach to the management of this common symptom. Careful analysis of patients with cancer and pain has led to the elucidation of common neurologic pain syndromes unique to this disease process. Pain in patients with cancer is commonly the presenting symptom of neurologic involvement. Changes in the pattern of pain or neurologic deficits should be carefully evaluated to rule out the possibility that metastatic disease may be exacerbating existing neuropathic pain. This chronic intractable pain syndrome can markedly debilitate the patient and needs an aggressive approach with drug therapy as the first-line approach.