Pain Syndrome Patients Research Articles

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The role of generalized muscule hyperfacilitation in pathogenesis and clinical picture of myofascial pain syndrome. Possible option of its correction

Introduction. Psychoemotional stress contributes to the increase of the muscle tone and the development of general muscle hyperfacilitation. This in turn makes the diagnostics by manual muscle testing impossible and complicates the course of myofascial pain syndrome, which explains the interest of practitioners in methods of its correction. However, possible methods of correction described in literature do not always lead to the desired result, which is the cause of the further search for solutions to this problem. The goal of research — was to determine the clinical effi cacy of Bach remedies selected with the help of vegetative resonance testing and manual muscle testing in treatment of patients with myofascial pain syndrome against the background of generalized hyperfacilitation.Materials and methods. A prospective, controlled, randomized trial was conducted in the period from January to December 2018 at the Department of Restorative Medicine, Rehabilitation and Balneology at the Sechenov First Moscow State Medical University. The work is based on the results of observation and treatment of 60 patients aged 21 to 65 years. Before and after the treatment practitioners performed osteopathic diagnostics, manual muscle testing according to the methodology, used in applied kinesiology. Assessment of psychological status was carried out using the Spielberger–Khanin test and Well-being-activity-mood questionnaire (WAM questionnaire). The level of pain manifestation was assessed with the use of the visual analogue scale (VAS). All patients were divided into two statistically comparable groups of 30 people using the method of simple randomization. Patients of both groups underwent osteopathic correction of dysfunctions with a frequency of one time per week, only 3–5 sessions. Patients of the 1st group, in addition to osteopathic treatment, underwent therapy with individually selected Bach remedies.Results. In all patients of the 1st group, generalized muscle hyperfacilitation regressed already by the 2nd–3rd procedure, while in the 2nd group it was eliminated only by the 4th procedure in 12 (40%) patients, and in the remaining patients it stopped only by the end of the course. The study of the regression of myofascial pain syndrome showed a difference in the rate of occurrence of the analgesic effect in the groups. So, patients of the 1st group experienced a persistent antinociceptive effect after the 2nd procedure, and in the 2nd group a similar effect was noted only by the 4th–5th session. In patients of the 1st group, the severity of pain after treatment averaged 10,4±4,5 points according to VAS, in patients of the 2nd group it averaged 20,3±4,3 points (p<0,01). The results of psychological testing according to the Spielberger–Khanin questionnaire also revealed a positive dynamics in the psychoemotional state of patients of both groups. After treatment, in 27 (90 %) patients of the 1st group, the results of the test showed the norm (<30 points), while in the 2nd group the test showed the norm only in 19 (63,3 %) patients. A comparative analysis of the results of psychological testing by the WAM method, performed at the end of the treatment, showed a positive dynamics in the psychoemotional state (categories of well-being, activity, mood) in patients of both groups, but in the 1st group the changes were more pronounced (p=0,05). It should be noted that only in patients of the 1st group this indicator was in the range of 5–5,5 points after the treatment, which corresponds to the norm criteria for this questionnaire.Conclusion. The use of Bach remedies individually selected with the help of manual muscle testing and the vegetative resonance testing helps to increase the effectiveness of the treatment of myofascial pain syndrome in patients with generalized muscle hyperfacilitation formed against the background of the chronic stress.

Interactions between Musculoskeletal Dysfunction, Emotional Distress and Cytokines in Patients with Chronic Low Back Pain Syndrome

Despite different treatment methods, for approximately 30% of patients acute back pain turns into chronic pain syndrome which accompanied by disability creates remarkable material damage to patients themselves, to health care and to the society. The aim of the study was to analyse the interaction between musculoskeletal dysfunction, emotional distress and related disability, and their underlying neuroimonological pathophysiological mechanisms, in patients with chronic low back pain syndrome. The subjects were 43 patients, mean age 45 ± 1.3 years, with clinical diagnosis of lumbar spine disk pathology with chronic low back pain syndrome and present manifestation of emotional distress. All patients had complex assessment that included lumbar spine and pelvic motor control tests, muscle and ligaments palpation tests, Hospital Anxiety and Depression Scale, PF subscale of SF-36 survey, Visual Analogue Scale, immunological analysis of blood to detect the level of cytokines. The results approved interaction (p < 0.05) between motor control and palpation tests results, emotional distress features and pain intensity. Therefore musculoskeletal dysfunction in patients with chronic low back pain is connected both with physical and psycho-emotional factors, which has to be taken into account both when evaluating functional tests and during the treatment process. Clinically important finding is that limitation in physical activities in chronic low back pain patients are affected both by motor control impairment and depression symptoms, as well as pain intensity, which has to be remembered during rehabilitation planning process. Some of cytokines (TNF-a, IL-6, IL-8, IL-10, IL-2) correlated with emotional disturbances physical disturbances, pain syndrome characteristics and physical disability in patients with chronic low back pain. IL-10 and IL-8 appeared to be two of the most characteristic cytokines. It is interesting to note, that in literature studies have approved the role of IL-10 in the pathogenesis of chronic, widespread pain syndrome, but IL-8 has been shown in the role of the pathogenesis of radicular pain syndrome in patients with lumbar spine disk pathology [1, 2]. Studies of cytokines extend the understanding of bio-psycho-social aspects of chronic pain syndrome pathogenesis therefore improving process of assessment, clinical reasoning and therapy.Keywords: musculoskeletal dysfunction, emotional distress, chronic pain, cytokines.

IL-19 as a Biomarker for the Severity of Acute Myocardial Infarction

Interleukin-19 (IL-19) has been shown to be involved in coronary artery diseases and atherosclerosis, while its expression in myocardial infarction is poorly understood. In this study, the dynamic increase in circulating IL-19 in acute ST-segment elevation myocardial infarction (STEMI) patients was detected. Both plasma IL-19 levels and IL-19 mRNA expression in peripheral blood mononuclear cells (PBMCs) from STEMI patients and chest pain syndrome (CPS) patients were detected at different time points, including 1d, 3d, 7d and 14d after treatment and on admission. Compared with the CPS patients, IL-19 levels and IL-19 gene expression were significantly increased in STEMI patients and peaked at 1d. From 1-14d, refocusing treatment, including emergency percutaneous coronary intervention (PCI) and thrombolysis, markedly reduced IL-19 expression and promoted its recovery; of the treatments, the effect of emergency PCI was most significant. In addition, similar trends were also observed with cTnI, NT-proBNP and C-reactive protein (CRP) levels. Furthermore, correlation analysis showed that IL-19 levels were positively correlated with cTnI, NT-proBNP, CRP levels and left ventricular ejection fraction (LVEF) in STEMI patients. IL-19 is correlated with the severity of acute myocardial infarction, which may be a new idea for the clinical treatment of myocardial infarction.

Comparison of the Efficacy Between Transurethral Coagulation and Transurethral Resection of Hunner Lesion in Interstitial Cystitis/Bladder Pain Syndrome Patients: A Prospective Randomized Controlled Trial

BackgroundInterstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by chronic pelvic pain related to the bladder with no effective treatment options. ObjectiveTo evaluate the efficacy and safety of transurethral resection (TUR) and transurethral coagulation (TUC) as treatments for Hunner lesion (HL) in IC/BPS. Design, setting, and participantsA single-center, prospective, randomized controlled trial involving 126 patients with HL in IC/BPS. InterventionTUR or TUC. Outcome measurements and statistical analysisPrimary outcome was recurrence-free time after surgery. Secondary outcomes included change of the number of frequency, nocturia, urgency episodes in voiding diaries, O’Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), pelvic pain and urgency/frequency (PUF) symptom scale, and visual analog scale (VAS) for pain and risk factors for recurrence. Results and limitationsThere were no differences in the recurrence-free time between treatment groups, a difference of 12.2 mo (95% confidence interval [CI], 11.1–17.6) for TUR, and a difference of 11.5 mo (95% CI, 9.03–16.1; p=0.735) for TUC. No difference was found in decreased mean daytime frequency, nocturia, urgency episodes, ICSI, ICPI, PUF symptom scale, and VAS for pain between both groups over 12 mo. Regardless of treatment types, there were significant improvements in all symptom questionnaires and pain compared with baseline (all, p < 0.05). Treatment type (TUR or TUC), age, sex, previous history of hydrodistension, and number of HLs did not affect recurrence. Incidence of bladder injury was higher in the TUR group (7.9%) than in the TUC group (3.4%). ConclusionsThere was no difference in the recurrence-free time and effect on urinary symptoms, including pain between TUC and TUR, for HL. Taking into account procedure-related complications, the surgeon can choose the method with which he/she is most familiar and comfortable. Patient summaryIn patients with bladder pain syndrome with Hunner lesions, both endoscopic resection and coagulation of the lesions are effective treatments.

The influence of anesthesia and analgesia on the formation of chronic pain syndrome in patients undergoing total knee or hip arthroplasty. Article

Introduction. Total knee and hip replacement surgery for stages 3–4 of osteoarthritis often complicated by chronic postoperative pain syndrome (CPOP). Objectives. The aim of the study was to choosing anesthesia that lid to decries the incidence of CPOP. Materials and methods. The study included 104 patients over 65 years old who underwent total knee or hip arthroplasty. Patients were divided into two groups: combined spinal-epidural anesthesia and extended epidural analgesia (CSEA) — 53 patients; general anesthesia and multicomponent postoperative analgesia (GA) — 51 patients. The Western Ontario MacMaster (WOMAC) scale and The Douleur Neuropathique 4 Questions (DN4) scale was used. Indicators were evaluated in 3, 6 and 12 months after surgery. We also assess the area of the hyperalgesia zone in the early postoperative period. Results. The WOMAC score was 85.7 ± 9.99 points in the CSEA group and 99.0 ± 11.68 in the GA group 3 months after surgery (p &lt; 0.01), 81.3 ± 10.19 versus 93, 8 ± 11.31 after 6 months (p &lt; 0.01) and 78.7 ± 10.48 versus 89.9 ± 10.77 after a year (p &lt; 0.01). The formation of CPOP was observed in 16 (15.4 %) patients, 4 (7.5 %) patients in the CSEA group and 12 (23.53 %) patients in the GA group (p &lt; 0.05). The neuropathic component of chronic pain was observed in 10 (62.5 %) patients, somewhat less often in the CSEA group (p &gt; 0.05). In patients with advanced CPOP, it was noted that the area of the secondary hyperalgesia zone in the first two days after surgery was significantly larger. The hyperalgesia zone was significantly smaller in patients with CSEA. Conclusions. Performing knee or hip joint replacement using CSEA compared with GA without a regional component is associated with a lower risk of developing CPOP syndrome and better functional rehabilitation.

MODERN METHODS OF COMPLEX CORRECTION OF PSYCHOSOMATIC DISORDERS IN PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS

The aim: About 10% of socially active women of reproductive age suffer from endometriosis, is determined by the frequent occurrence of menstrual and reproductive functions disorders, and pelvic pain syndrome in patients. The difficulties of therapeutic treatment of chronic pain syndrome in external genital endometriosis (EGE) are associated with polymorphism of pain mechanisms, and delayed diagnosis and treatment. The aim of the study is to improve the effectiveness of the treatment of external genital endometriosis. Material and methods: We examined 60 female patients of reproductive age, 40 - with histologically verified diagnosis of external genital endometriosis and 20 healthy women. We used the following methods of examination: general clinical, instrumental, endoscopic, morphological, the Visual Analogue Scale (VAS) to quantify pain, the Beck Depression Scale and the SF-36 questionnaire. Results: Before the treatment of patients with EGE, VAS scale scores indicated pain in 100% of patients, the indicators of depression and level of anxiety go beyond the normative. The results of the pre-treatment questionnaire indicated lower quality of life scores on the scales of physical and mental health components. As a result of treatment there was significant decrease in the manifestations of pain, depression and anxiety, with women receiving complex therapy (hormone therapy got antidepressants and non-drug correction methods). Сonclusions: Chronic pelvic pain syndrome associated with EGE and accompanied by an unfavorable psychological state, depressive states, anxiety symptoms, and psychosomatic disorders. New approaches to the treatment of clinical manifestations of EGE are needed, taking into account patients' psycho-emotional status and the life quality analysis. We pathogenetically justified the use of drugs that affect the psychosomatic status of patients with EGE and showed that they could significantly improve the quality of life.

Place of hypovitaminosis D in the formation of chronic pain syndrome in patients with persistent idiopathic facial pain

Place of hypovitaminosis D in the formation of chronic pain syndrome in patients with persistent idiopathic facial pain

The Impact of Tobacco Smoking on Spinal Cord Stimulation Effectiveness in Complex Regional Pain Syndrome Patients

We aim to investigate the correlation of smoking and spinal cord stimulation (SCS) effectiveness for pain relief in complex regional pain syndrome (CRPS) patients while controlling for possible confounding factors including opioid intake. Following Institutional Review Board approval, a retrospective cohort study was performed by collecting data for all CRPS patients treated with SCS at Cleveland Clinic between 1998 and 2013. We divided patients into three groups based on their smoking status at the time of SCS device implant: Current smokers, former smokers, or nonsmokers. We used a linear mixed modeling to assess the association between smoking status and pain score at baseline and at 3, 6, and 12 months. We then used pairwise t-tests for post hoc comparisons of pain scores. Of the 420 CRPS patients treated with SCS implants, the reduction in pain score was highest among nonsmokers. Nonsmokers demonstrated a consistent and steady decrease in pain scores over time, whereas the current and former smoker cohorts showed an initial reduction in pain at three months compared to baseline which was not sustained to the 12-months benchmark. Nonetheless, former smokers continued to report slightly lower pain scores than current smokers, although not statistically significant. The baseline opioid consumption was least among nonsmokers (30 [0, 62] oral mg morphine sulfate equivalent). We also found a statistically significant association between time postimplant and reported pain score (χ2 = 508.88, p < 0.001). The overall mean pain score for all three cohorts was highest at baseline (7.6 ± 1.7) and showed a decrease at the 3, 6, and 12 months postimplant time points with mean score of 5.7 ± 2.0, 5.6 ± 2.3, and 5.4 ± 2.5, respectively. Tobacco cigarette smoking was associated with reduced SCS effectiveness for pain relief.

Treatment of complex regional pain syndrome of patients seen in the chronic pain outpatient clinic of UFMA University Hospital

Treatment of complex regional pain syndrome of patients seen in the chronic pain outpatient clinic of UFMA University Hospital

Complex regional pain syndrome patient immunoglobulin M has pronociceptive effects in the skin and spinal cord of tibia fracture mice.

It has been proposed that complex regional pain syndrome (CRPS) is a post-traumatic autoimmune disease. Previously, we observed that B cells are required for the full expression of CRPS-like changes in a mouse tibia fracture model and that serum immunoglobulin M (IgM) antibodies from fracture mice have pronociceptive effects in muMT fracture mice lacking B cells. The current study evaluated the pronociceptive effects of injecting CRPS patient serum or antibodies into muMT fracture mice by measuring hind paw allodynia and unweighting changes. Complex regional pain syndrome serum binding was measured against autoantigens previously identified in the fracture mouse model. Both CRPS patient serum or IgM antibodies had pronociceptive effects in the fracture limb when injected systemically in muMT fracture mice, but normal subject serum and CRPS patient IgG antibodies had no effect. Furthermore, CRPS serum IgM antibodies had pronociceptive effects when injected into the fracture limb hind paw skin or intrathecally in the muMT fracture mice. Early (1-12 months after injury) CRPS patient (n = 20) sera were always pronociceptive after systemic injection, and chronic (>12 months after injury) CRPS sera were rarely pronociceptive (2/20 patients), while sera from normal subjects (n = 20) and from patients with uncomplicated recoveries from orthopedic surgery and/or fracture (n = 15) were never pronociceptive. Increased CRPS serum IgM binding was observed for keratin 16, histone 3.2, gamma actin, and alpha enolase autoantigens. We postulate that CRPS patient IgM antibodies bind to neoantigens in the fracture mouse skin and spinal cord to initiate a regionally restricted pronociceptive complement response potentially contributing to the CRPS disease process.

Is Migraine an MPV-Related Disease? An Observational Study of Polish Neurological Patients.

Many studies have found correlations between abnormal MPV and clinical reactivity in a variety of diseases. In the present paper, we sought MPV-related neurological diseases that are less frequently reported in the literature. The electronic medical records of 852 neurological patients with mean platelet volume (MPV) measurements (F = 45%, age = 55.7 ± 18.7, 8–104) were searched after the patients had received a diagnosis of a neurological disease (new and old episodes) according to the nine classes of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). A set of consecutive statistical methods (i.e., cluster analysis, segmented regression, linear correlation, propensity score matching, and mixed effects Poisson regression) were used to establish a link between MPV and neurological disease. A statistically significant (p < 0.05) relationship with MPV was found only in pain syndrome patients, with seven out of eight clinically diagnosed migraine episodes. With all other ICD-10 classes of neurological diseases, the effect of MPV was found to be nonsignificant (p > 0.05). MPV may implicate a clinical relationship with pain syndrome and migraine episodes. More complex statistics could help analyse data and find new correlations.

Nerve growth factor and Tropomyosin receptor kinase A are increased in the gastric mucosa of patients with functional dyspepsia

BackgroundNerve growth factor (NGF) and enteric glial cells (EGCs) are associated with visceral hypersensitivity and gastrointestinal motility disorder, which may represent the pathogenesis of functional dyspepsia (FD). This study aimed to investigate the expression of NGF, its high affinity receptor tropomyosin receptor kinase A (TrkA) and the EGC activation marker glial fibrillary acidic protein (GFAP) in the gastric mucosa of patients with FD and the association of these proteins with dyspeptic symptoms.MethodsGastric mucosal biopsies taken from 27 FD patients (9 epigastric pain syndrome (EPS) patients, 7 postprandial distress syndrome (PDS) patients and 11 EPS overlap PDS patients) and 26 control subjects were used for analysis. The expression of NGF, TrkA and GFAP was examined, and the association of these proteins with dyspeptic symptoms, including epigastric pain, postprandial fullness, early satiation and epigastric burning, was analysed.ResultsThe expression levels of NGF, TrkA, and GFAP in the gastric mucosa were significantly higher in the EPS group, the PDS group, and the EPS overlap PDS group than in the healthy control group. There was no significant difference between the FD subgroups. TrkA colocalized with GFAP, which indicated that TrkA was localized to EGCs, and the expression of TrkA in EGCs was significantly higher in the FD group than in the control group. Changes in the expression of NGF, TrkA, and GFAP were positively correlated with epigastric pain, postprandial fullness and early satiation but had no significant relationship with epigastric burning.ConclusionsThe increased expression of gastric NGF, TrkA and GFAP might be involved in FD pathophysiology and symptom perception.

Implications of the putamen in pain and motor deficits in complex regional pain syndrome.

Complex regional pain syndrome (CRPS) develops after-limb injury, with persistent pain and deficits in movement frequently co-occurring. The striatum is critical for mediating multiple mechanisms that are often aberrant in CRPS, which includes sensory and pain processing, motor function, and goal-directed behaviors associated with movement. Yet, much remains unknown with regards to the morphological and functional properties of the striatum and its subregions in this disease. Thus, we investigated 20 patients (15 female, age 58 ± 9 years, right-handed) diagnosed with chronic (6+ months of pain duration) CRPS in the right hand and 20 matched, healthy controls with anatomical and resting-state, functional magnetic resonance imaging. In addition, a comprehensive clinical and behavioral evaluation was performed, where each participant's pain, motor function, and medical history were assessed. Complex regional pain syndrome patients harbored significant abnormalities in hand coordination, dexterity, and strength. These clinical pain- and movement-related findings in CRPS patients were concomitant with bilateral decreases in gray matter density in the putamen as well as functional connectivity increases and decreases among the putamen and pre-/postcentral gyri and cerebellum, respectively. Importantly, higher levels of clinical pain and motor impairment were associated with increased putamen-pre-/postcentral gyri functional connectivity strengths. Collectively, these findings suggest that putaminal alterations, specifically the functional interactions with sensorimotor structures, may underpin clinical pain and motor impairment in chronic CRPS patients.

Back pain and osteoporosis

The aging process is accompanied by a structural change and a decrease in the functional activity of organs and tissues, including the bone, with the development of osteoporosis (OP).Objective: to assess the characteristics of pain syndrome in OP patients with nonspecific chronic vertebrogenic lumbar ischialgia (CLI).Patients and methods. Sixty elderly patients with CLI in the presence and absence of OP were examined. All the patients underwent dual-energy X-ray absorptiometry and ultrasound to diagnose the degree of OP and spinal deformity; a flexible rod was used according to the method described by M.A. Kathleen to estimate the angle of kyphosis, lordosis, and scoliosis. The investigators determined pain intensity by a numerical rating scale, the presence of a neuropathic pain component by the DN4 pain scale, the level of anxiety and depression by the Hospital Anxiety and Depression Scale, cognitive status by the Montreal Cognitive Function Rating Scale, the degree of disability by the Oswestry questionnaire, and quality of life by the SF-12 Health Survey.Results and discussion. Our study showed that OP alone is not a cause of CLI in elderly patients. There were no statistically significant differences in the sources and intensity of pain, the degree of anxiety and depressive disorders, impaired quality of life, cognitive status, and degree of disability in patients with chronic lumbar pain syndrome in the presence and absence of OP. Vertebral deformity resulting from OP leads mainly to an obvious poor posture with an increase in thoracic kyphosis, straightening of lumbar lordosis, and S-curve lumbar and thoracic scoliosis, which can also cause secondary muscle spasm.Patients with back pain in the presence of OP are treated in accordance with the general principles of management of patients with non-specific back pain, but taking into account the underlying disease. The paper presents current recommendations for the treatment of nonspecific back pain, for the management of patients with OP, as well as the updated clinical recommendations for the prevention of fractures in OP and osteopenia.Conclusion. Patients with OP are noted to have predominantly chronic musculoskeletal pain in the presence of severe spinal deformity, but the level of this evidence is very low. The features of pain syndrome in patients with nonspecific vertebrogenic chronic lumbar ischialgia in the presence of OP call for further investigations.

Labeled substance P as a neuropeptide reporter substance for enzyme activity

Recently, we developed a bradykinin reporter assay and demonstrated the differing protease activity in Complex Regional Pain Syndrome patients vs. controls. In order to further characterize CRPS pathophysiology, the neuropeptide substance P was evaluated as possible reporter substance, here. It was labeled with a chromophore at the lysine residue and generated two major fragments following incubation with serum (amino acid residues 3–8 and 3–11) which were reproducibly separated by thin-layer chromatography. Dabsylated substance P was shown to be a substrate of angiotensin-converting enzyme. The combination of both bradykinin and substance P reporter substances with specific enzyme inhibitors will shed more light on biochemical pathways in inflammatory processes and pain. Comparative clinical studies are now needed to define the application range of both assays in more detail.

Editorial Comment from Dr Tanaka to Tadalafil is sufficiently effective for severe chronic prostatitis/chronic pelvic pain syndrome in patients with benign prostatic hyperplasia.

Editorial Comment from Dr Tanaka to Tadalafil is sufficiently effective for severe chronic prostatitis/chronic pelvic pain syndrome in patients with benign prostatic hyperplasia.

Editorial Comment from Dr Amanoto Tadalafil is sufficiently effective for severe chronic prostatitis/chronic pelvic pain syndrome in patients with benign prostatic hyperplasia.

Editorial Comment from Dr Amanoto Tadalafil is sufficiently effective for severe chronic prostatitis/chronic pelvic pain syndrome in patients with benign prostatic hyperplasia.

Tadalafil is sufficiently effective for severe chronic prostatitis/chronic pelvic pain syndrome in patients with benign prostatic hyperplasia.

To investigate the efficacy of tadalafil for patients with benign prostatic hyperplasia and chronic prostatitis/chronic pelvic pain syndrome. Tadalafil 5mg was given each morning for 12weeks to patients diagnosed as having either moderate or severe lower urinary tract symptoms. Voiding symptoms were compared between patients with a high (≥4; high group) and low (<4; low group) pain subscore of the National Institutes of Health Chronic Prostatitis Symptom Index before and after tadalafil administration. The correlation between changes in the Chronic Prostatitis Symptom Index and the International Prostate Symptom Score during treatment was also investigated. At baseline, the pain subscore of the Chronic Prostatitis Symptom Index was high (≥4) in 24 of 74 (32.4%) patients. The International Prostate Symptom Score in the group with a high pain subscore was significantly higher than that in the group with a low pain subscore. International Prostate Symptom Score, National Institutes of Health Chronic Prostatitis Symptom Index total score and pain subscore were all significantly improved after treatment. The change in the Chronic Prostatitis Symptom Index total score correlated positively with the change in the International Prostate Symptom Score. The decrease in the International Prostate Symptom Score was significantly greater in the group with high versus low pain subscore. Tadalafil is sufficiently effective in the treatment of patients with benign prostatic hyperplasia and severe chronic prostatitis/chronic pelvic pain syndrome.

Fine-Grained Mapping of Cortical Somatotopies in Chronic Complex Regional Pain Syndrome.

It has long been thought that severe chronic pain conditions, such as complex regional pain syndrome (CRPS), are not only associated with, but even maintained by a reorganization of the somatotopic representation of the affected limb in primary somatosensory cortex (S1). This notion has driven treatments that aim to restore S1 representations in CRPS patients, such as sensory discrimination training and mirror therapy. However, this notion is based on both indirect and incomplete evidence obtained with imaging methods with low spatial resolution. Here, we used fMRI to characterize the S1 representation of the affected and unaffected hand in humans (of either sex) with unilateral CRPS. The cortical area, location, and geometry of the S1 representation of the CRPS hand were largely comparable with those of both the unaffected hand and healthy controls. We found no differential relation between affected versus unaffected hand map measures and clinical measures (pain severity, upper limb disability, disease duration). Thus, if any map reorganization occurs, it does not appear to be directly related to pain and disease severity. These findings compel us to reconsider the cortical mechanisms underlying CRPS and the rationale for interventions that aim to “restore” somatotopic representations to treat pain.SIGNIFICANCE STATEMENT This study shows that the spatial map of the fingers in somatosensory cortex is largely preserved in chronic complex regional pain syndrome (CRPS). These findings challenge the treatment rationale for restoring somatotopic representations in complex regional pain syndrome patients.