40 results found
Bordeleau M, Cottin SC, Cantin L, et al., 2020, Effects of Tonic Spinal Cord Stimulation on External Mechanical and Thermal Stimuli Perception Using Quantitative Sensory Testing A Multicenter Stimulation ON-OFF Study on Chronic Pain Patients, CLINICAL JOURNAL OF PAIN, Vol: 36, Pages: 189-196, ISSN: 0749-8047
Meyer-Frießem CH, Attal N, Baron R, et al., 2020, Pain thresholds and intensities of CRPS type I and neuropathic pain in respect to sex., Eur J Pain
BACKGROUND AND AIMS: Healthy women have generally been found to have increased experimental pain perception and chronic pain has a higher prevalence in female as compared to male patients. However, no study has investigated whether pain intensity and pain perception thresholds are distinct or similar between sexes within various chronic pain entities. We investigated whether average pain intensities and pain thresholds assessed using quantitative sensory testing (QST) differed between women and men suffering from three distinct chronic pain conditions: Complex Regional Pain Syndrome (CRPS type I), peripheral nerve injury (PNI) or polyneuropathy (PNP), as compared to paired healthy volunteers. METHODS: QST data of 1,252 patients (669 female, 583 male) with PNI (n = 342), PNP (n = 571) or CRPS (n = 339), and average pain intensity reports from previously published studies were included. Absolute and z-values (adjusted for age and body region) of cold, heat, pressure (PPT) and pinprick pain thresholds were compared in generalized linear models with aetiology, duration of underlying pain disease and average pain intensity as fixed effects. RESULTS: Average pain intensity during the past four weeks did not differ between women and men, in both mean and range. In women absolute pain thresholds for cold, heat and pinprick were lower than in males across all diagnoses (p < .05). However, after z-transformation these differences disappeared except for PPT in CRPS (p = .001). DISCUSSION: Pain thresholds in patients show only minor sex differences. However, these differences mimic those observed in healthy subjects and do not seem to be linked to specific pathophysiological processes. SIGNIFICANCE: Female healthy participants and female patients with neuropathic pain conditions or CRPS I report lower pain thresholds compared to males, but pain intensity is similar and there is no sex difference in the extent to which the thr
Preclinical studies using animals to study the potential of a therapeutic drug or strategy are important steps before translation to clinical trials. However, evidence has shown that poor quality in the design and conduct of these studies has not only impeded clinical translation but also led to significant waste of valuable research resources. It is clear that experimental biases are related to the poor quality seen with preclinical studies. In this chapter, we will focus on hypothesis testing type of preclinical studies and explain general concepts and principles in relation to the design of in vivo experiments, provide definitions of experimental biases and how to avoid them, and discuss major sources contributing to experimental biases and how to mitigate these sources. We will also explore the differences between confirmatory and exploratory studies, and discuss available guidelines on preclinical studies and how to use them. This chapter, together with relevant information in other chapters in the handbook, provides a powerful tool to enhance scientific rigour for preclinical studies without restricting creativity.
Haroun OMO, Vollert J, Lockwood DN, et al., 2019, Clinical characteristics of neuropathic pain in leprosy and associated somatosensory profiles: a deep phenotyping study in India., Pain Rep, Vol: 4
This study investigated the clinical characteristics and somatosensory profiles of patients suffering from leprosy in Mumbai, India. A cross-sectional deep profiling study was conducted in 86 patients with leprosy (with and without pain) using an extensive battery of phenotyping measures including structured clinical examination, psychological state (General Health Questionnaire [GHQ-12]), and a quality-of-life condition-specific instrument (Brief Pain Inventory-short form). Quantitative sensory testing was performed according to the protocol of the German Research Network on Neuropathic Pain (DFNS) to assess the somatosensory profiles in the ulnar nerve innervation territory of all participants (dorsum of the hand). Reference data from 50 healthy Indian subjects were within the range of published DFNS values. Somatosensory profiles in leprosy patients with clinically or electroneurographically diagnosed neuropathy (with and without pain) revealed a profile of sensory loss to thermal and tactile stimuli combined with preservation of vibration and deep pressure detection. Sensory gain phenomena were not generally observed in patients with leprosy. In the group of subclinical neuropathy, a high degree of impaired thermal sensation was found, which could be clinically deployed to enhance identification of leprosy neuropathy at an early stage. Quantitative sensory testing can effectively document leprosy-associated neuropathy but does not distinguish between patients with or without pain. Patients with leprosy and neuropathic pain reported a poor quality of life and less psychological well-being compared with the pain-free patients with leprosy neuropathy.
Sturm D, Vollert J, Greiner T, 2019, Implementation of a Quality Index for Improvement of Quantification of Corneal Nerves in Corneal Confocal Microscopy Images: A Multicenter Study (vol 38, pg 921, 2019), CORNEA, Vol: 38, Pages: E49-E49, ISSN: 0277-3740
Meyer-Friessem CH, Eitner LB, Kaisler M, et al., 2019, Perineural injection of botulinum toxin-A in painful peripheral nerve injury - a case series: pain relief, safety, sensory profile and sample size recommendation, CURRENT MEDICAL RESEARCH AND OPINION, ISSN: 0300-7995
Frisaldi E, Shaibani A, Vollert J, et al., 2019, The placebo response in myasthenia gravis assessed by quantitative myasthenia gravis score: A meta-analysis, MUSCLE & NERVE, Vol: 59, Pages: 671-678, ISSN: 0148-639X
Bazika-Gerasch B, Maier C, Kumowski N, et al., 2019, Compared to limb pain of other origin, ultrasonographic osteodensitometry reveals loss of bone density in complex regional pain syndrome., Pain, Vol: 160, Pages: 1261-1269
Local osteopenia and altered bone metabolism are major complications of complex regional pain syndrome (CRPS), but quantitative assessment is difficult unless using X-ray or dual-energy X-ray absorptiometry. Ultrasound-based measurement of bone density (UBD) is a possible alternative but has never been used to detect unilateral disease such as CRPS. Therefore, the main outcome measure of this prospective study was the diagnostic utility of UBD in patients with lower-limb CRPS. Second, we compared the extent of unilateral and contralateral calcaneal bone density to that of other conditions with unilateral pain, general osteoporosis, and healthy subjects. Calcaneal osteodensitometry was bilaterally examined using ultrasound-based methodology. Bone mineral density values were converted to Z-scores based on age- and sex-dependent reference values. All patients completed a functional and an osteoporosis risk questionnaire. In patients with CRPS (n = 18), the bone mineral density values and Z-scores were significantly lower in both the affected (mean ± SD: 0.40 ± 0.08 and -1.1 ± 0.8, respectively) and nonaffected (0.46 ± 0.09 and -0.6 ± 0.9, respectively) limbs than in patients (n = 40) with other unilateral pain syndromes (affected: 0.51 ± 0.1 and -0.2 ± 1.1, respectively; nonaffected: 0.54 ± 0.11 and 0 ± 0.9, respectively) and healthy subjects (right side: 0.6 ± 0.1 and 0.1 ± 0.9, respectively). Conversely, in patients with known systemic osteoporosis, the Z-scores were lower bilaterally with smaller side-to-side differences than in those with CRPS (P < 0.05). Compared with subjects suffering from long-term CRPS (≥2.4 years), patients with shorter disease duration exhibited significantly lower Z-scores (P < 0.05). In conclusion, UBD revealed that CRPS is associated with both local and systemic alterations of bone metabolism.
Sturm D, Vollert J, Greiner T, et al., 2019, Implementation of a Quality Index for Improvement of Quantification of Corneal Nerves in Corneal Confocal Microcopy Images: A Multicenter Study., Cornea
PURPOSE: Corneal confocal microscopy (CCM) is an imaging method to detect loss of nerve fibers in the cornea. The impact of image quality on the CCM parameters has not been investigated. We developed a quality index (QI) with 3 stages for CCM images and compared the influence of the image quality on the quantification of corneal nerve parameters using 2 modes of analysis in healthy volunteers and patients with known peripheral neuropathy. METHODS: Images of 75 participants were a posteriori analyzed, including 25 each in 3 image quality groups (QI 1-QI 3). Corneal nerve fiber length (CNFL) was analyzed using automated and semiautomated software, and corneal nerve fiber density and corneal nerve branch density were quantified using automated image analysis. Three masked raters assessed CCM image quality (QI) independently and categorized images into groups QI 1-QI 3. In addition, statistical analysis was used to compare interrater reliability. Analysis of variance was used for analysis between the groups. Interrater reliability analysis between the image ratings was performed by calculating Fleiss' kappa and its 95% confidence interval. RESULTS: CNFL, corneal nerve fiber density, and corneal nerve branch density increased significantly with QI (P < 0.001, all post hoc tests P < 0.05). CNFL was higher using semiautomated compared with automated nerve analysis, independent of QI. Fleiss kappa coefficient for interrater reliability of QI was 0.72. CONCLUSIONS: The quantification of corneal nerve parameters depends on image quality, and poorer quality images are associated with lower values for corneal nerve parameters. We propose the QI as a tool to reduce variability in quantification of corneal nerve parameters.
Meyer-Friessem CH, Wiegand T, Eitner L, et al., 2019, Effects of Spinal Cord and Peripheral Nerve Stimulation Reflected in Sensory Profiles and Endogenous Pain Modulation, CLINICAL JOURNAL OF PAIN, Vol: 35, Pages: 111-120, ISSN: 0749-8047
Rausch V, Schwarzer A, Dietrich JW, et al., 2018, We miss the opportunity: Pretreament of osteoporosis in a German trauma center, PLoS ONE, Vol: 13, ISSN: 1932-6203
Osteoporosis remains a major health concern due to high incidence of fragility fractures followed by higher mortality and morbidity. Implementation of guidelines for diagnosis and treatment of osteoporosis is critically discussed internationally. Aim of this study was to evaluate implementation of these guidelines regarding diagnosis and therapy of osteoporosis in a developed western country. We hypothesized that (a) prior diagnosis of osteoporosis in patients with low-energy fractures is higher than the estimated incidence and (b) diagnosis and therapy of osteoporosis in patients with prior low-energy fractures is higher than in patients without prior low-energy fractures. 399 patients >60 years suffering low-energy-fractures of their spine, femur, humerus or forearm between 03/2014 and 04/2015 were recruited in a German trauma center. All received a standardized interview. In 21% (84/399) of all patients, osteoporosis was diagnosed prior to current admission. 34% (136/399) suffered a prior risk-fracture after age of 50. Of these, only 54% (73/136) reported about following dual-energy X-ray absorptiometry (DXA) to test for decreased bone-marrow-density with positive results in 68% (50/73). 38% (19/50) of these patients with fragility fractures and prior osteoporosis diagnosis received anti-osteoporotic medication. 66% (263/399) of all patients had no prior risk-fracture and were tested for osteoporosis by DXA in 36% (95/263), leading to positive results in 34% (32/95). 44% (14/32) of these patients received anti-osteoporotic medication. Applying FRAX, 33% of all patients showed a calculated 10-year-risk >20% for suffering a major osteoporotic fracture. 61% (83/136) of patients with a prior fracture had a 10-year-risk >20% of which 47% (39/83) patients received no prior DXA. Although guidelines recommend diagnosis and treatment of patients with low-energy fractures, opportunity for early treatment following risk fractures seems rarely used. Expedient risk a
Tampin B, Vollert J, Schmid AB, 2018, Sensory profiles are comparable in patients with distal and proximal entrapment neuropathies, while the pain experience differs, CURRENT MEDICAL RESEARCH AND OPINION, Vol: 34, Pages: 1899-1906, ISSN: 0300-7995
Rocha TM, Pimenta S, Bernardo A, et al., 2018, Determinants of non-nociceptive pain in Rheumatoid Arthritis, Acta Reumatologica Portuguesa, Vol: 2018, Pages: 291-303, ISSN: 0303-464X
© 2001-2019 Sociedade Portuguesa de Reumatologia. Introduction: Features suggestive of neuropathic pain (NP) have been described in rheumatoid arthritis (RA) in addition to nociceptive pain. We aimed to determine the clinical predictors of NP in RA patients and study its association with radiographic structural damage. Methods: Cross-sectional study was performed with RA patients followed at our Rheumatology department. Patients with diagnosed neuropathy of other origin, non-RA related risk factors for NP (e.g. diabetes mellitus) or fibromyalgia, according to expert opinion, were excluded. Demographic and clinical data were collec ted and disease activity/functional measures were evalua - ted. Two questionnaires were applied to assess NP: the Leeds Assessment of Neuropathic Symptoms (LANSS) and the painDETECT questionnaire (PDQ). Radiographs performed in up to 12 months before/after the evaluation were classified according to the modified van der Heijde Sharp's method. Univariate and multivariate logistic regression were performed to identify the predictors of NP. Results: 112 patients were included. 86 (77%) were women, with a mean (SD) age of 55.1 (10.8) years and median disease duration of 13 [2-41] years. 45 (40%) patients had NP by the LANSS (≥12) and 28% had a possible/likely NP in the PDQ (≥13). Female sex was predictive of NP by both tests and disease duration was inversely associated with LANSS NP. After adjusting for those two variables, pain Visual Analog Scale (VAS) and TJC were positive predictors of NP by both tests. The same was not true for SJC, ESR or CRP levels. DAS28-CRP was significantly associated with PDQ NP, losing its statistical significance after adjustment for TJC and pain VAS. The HAQ score increased the odds of NP for both tests, independently of DAS 28-CRP. Posi - tivity for ACPA and previous/current hydroxychloroquine treatment had lower odds of NP. 90 patients performed radiographic evaluation. Joint narrowing score was a s
Schwarzer A, Kaisler M, Kipping K, et al., 2018, Opioid intake prior to admission is not increased in elderly patients with low-energy fractures: A case-control study in a German hospital population, EUROPEAN JOURNAL OF PAIN, Vol: 22, Pages: 1651-1661, ISSN: 1090-3801
Martins Rocha T, Pimenta S, Bernardo A, et al., 2018, Determinants of non-nociceptive pain in Rheumatoid Arthritis, ACTA REUMATOLOGICA PORTUGUESA, Vol: 48, Pages: 291-303, ISSN: 0303-464X
Uceyler N, Vollert J, Broll B, et al., 2018, Sensory profiles and skin innervation of patients with painful and painless neuropathies, PAIN, Vol: 159, Pages: 1867-1876, ISSN: 0304-3959
Eitner L, Oezguel OS, Enax-Krumova EK, et al., 2018, Conditioned pain modulation using painful cutaneous electrical stimulation or simply habituation?, EUROPEAN JOURNAL OF PAIN, Vol: 22, Pages: 1281-1290, ISSN: 1090-3801
Rocha TM, Barbosa M, Pimenta S, et al., 2018, SOMATOSENSORY DYSFUNCTION IN RHEUMATOID ARTHRITIS - A QUANTITATIVE SENSORY TESTING ASSESSMENT, Congress of the European-League-Against-Rheumatism (EULAR), Publisher: BMJ PUBLISHING GROUP, Pages: 590-590, ISSN: 0003-4967
Vollert J, Magerl W, Baron R, et al., 2018, Pathophysiological mechanisms of neuropathic pain: comparison of sensory phenotypes in patients and human surrogate pain models, PAIN, Vol: 159, Pages: 1090-1102, ISSN: 0304-3959
Brechmann T, Maier C, Kaisler M, et al., 2018, Propofol sedation during gastrointestinal endoscopy arouses euphoria in a large subset of patients, UNITED EUROPEAN GASTROENTEROLOGY JOURNAL, Vol: 6, Pages: 536-546, ISSN: 2050-6406
Vollert J, Pasqualicchio C, Papenhoff M, et al., 2018, Grip strength feigning is hard to detect: an exploratory study, JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, Vol: 43, Pages: 193-198, ISSN: 1753-1934
Hegelmaier T, Kumowski N, Mainka T, et al., 2017, Remote ischaemic conditioning decreases blood flow and improves oxygen extraction in patients with early complex regional pain syndrome, EUROPEAN JOURNAL OF PAIN, Vol: 21, Pages: 1346-1354, ISSN: 1090-3801
Huber JL, Maier C, Mainka T, et al., 2017, Recovery of mechanical detection thresholds after direct digital nerve repair versus conduit implantation, JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, Vol: 42, Pages: 720-730, ISSN: 1753-1934
Eitner L, Vollert J, Maier C, et al., 2017, Botulinum toxin A injections in neuropathic pain. A posthoc subgroup analysis of patients with peripheral nerve injury, Schmerz, Vol: 31, Pages: 524-526, ISSN: 0932-433X
Kemp HI, Petropoulos IN, Rice ASC, et al., 2017, Use of Corneal Confocal Microscopy to Evaluate Small Nerve Fibers in Patients With Human Immunodeficiency Virus, JAMA OPHTHALMOLOGY, Vol: 135, Pages: 795-800, ISSN: 2168-6165
Importance Objective quantification of small fiber neuropathy in patients with human immunodeficiency virus (HIV)–associated sensory neuropathy (HIV-SN) is difficult but needed for diagnosis and monitoring. In vivo corneal confocal microscopy (IVCCM) can quantify small fiber damage.Objective To establish whether IVCCM can identify an abnormality in corneal nerve fibers and Langerhans cells in patients with and without HIV-SN.Design, Setting, and Participants This prospective, cross-sectional cohort study was conducted between July 24, 2015, and September 17, 2015. Twenty patients who were HIV positive were recruited from adult outpatient clinics at Chelsea and Westminster Hospital NHS Foundation Trust in England. These patients underwent IVCCM at Moorfields Eye Hospital NHS Foundation Trust in London, England, and the IVCCM images were analyzed at Weill Cornell Medicine–Qatar in Ar-Rayyan, Qatar. Patients were given a structured clinical examination and completed validated symptom questionnaires and the Clinical HIV-Associated Neuropathy Tool. Results from patients with HIV were compared with the results of the age- and sex-matched healthy control participants (n = 20). All participants were classified into 3 groups: controls, patients with HIV but without SN, and patients with HIV-SN.Main Outcomes and Measures Comparison of corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, corneal nerve fiber tortuosity, and corneal Langerhans cell density between healthy controls and patients with HIV with and without SN.Results All 40 participants were male, and most (≥70%) self-identified as white. Of the 20 patients with HIV, 14 (70%) had HIV-SN. This group was older (mean [SD] age, 57.7 [7.75] years) than the group without HIV-SN (mean [SD] age, 42.3 [7.26] years) and the controls (mean [SD] age, 53.8 [10.5] years). Corneal nerve fiber density was reduced in patients with HIV compared with the controls (26.
Vollert J, Maier C, Attal N, et al., 2017, Stratifying patients with peripheral neuropathic pain based on sensory profiles: algorithm and sample size recommendations, PAIN, Vol: 158, Pages: 1446-1455, ISSN: 0304-3959
In a recent cluster analysis, it has been shown that patients with peripheral neuropathic pain can be grouped into 3 sensory phenotypes based on quantitative sensory testing profiles, which are mainly characterized by either sensory loss, intact sensory function and mild thermal hyperalgesia and/or allodynia, or loss of thermal detection and mild mechanical hyperalgesia and/or allodynia. Here, we present an algorithm for allocation of individual patients to these subgroups. The algorithm is nondeterministic—ie, a patient can be sorted to more than one phenotype—and can separate patients with neuropathic pain from healthy subjects (sensitivity: 78%, specificity: 94%). We evaluated the frequency of each phenotype in a population of patients with painful diabetic polyneuropathy (n = 151), painful peripheral nerve injury (n = 335), and postherpetic neuralgia (n = 97) and propose sample sizes of study populations that need to be screened to reach a subpopulation large enough to conduct a phenotype-stratified study. The most common phenotype in diabetic polyneuropathy was sensory loss (83%), followed by mechanical hyperalgesia (75%) and thermal hyperalgesia (34%, note that percentages are overlapping and not additive). In peripheral nerve injury, frequencies were 37%, 59%, and 50%, and in postherpetic neuralgia, frequencies were 31%, 63%, and 46%. For parallel study design, either the estimated effect size of the treatment needs to be high (>0.7) or only phenotypes that are frequent in the clinical entity under study can realistically be performed. For crossover design, populations under 200 patients screened are sufficient for all phenotypes and clinical entities with a minimum estimated treatment effect size of 0.5.
Kumowski N, Hegelmaier T, Kolbenschlag J, et al., 2017, Unimpaired endogenous pain inhibition in the early phase of complex regional pain syndrome, EUROPEAN JOURNAL OF PAIN, Vol: 21, Pages: 855-865, ISSN: 1090-3801
Oezguel OS, Maier C, Enax-Krumova EK, et al., 2017, High test-retest-reliability of pain-related evoked potentials (PREP) in healthy subjects, NEUROSCIENCE LETTERS, Vol: 647, Pages: 110-116, ISSN: 0304-3940
Baron R, Maier C, Attal N, et al., 2016, Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles, PAIN, Vol: 158, Pages: 261-272, ISSN: 0304-3959
Patients with neuropathic pain are heterogeneous in etiology, pathophysiology, and clinical appearance. They exhibit a variety of pain-related sensory symptoms and signs (sensory profile). Different sensory profiles might indicate different classes of neurobiological mechanisms, and hence subgroups with different sensory profiles might respond differently to treatment. The aim of the investigation was to identify subgroups in a large sample of patients with neuropathic pain using hypothesis-free statistical methods on the database of 3 large multinational research networks (German Research Network on Neuropathic Pain (DFNS), IMI-Europain, and Neuropain). Standardized quantitative sensory testing was used in 902 (test cohort) and 233 (validation cohort) patients with peripheral neuropathic pain of different etiologies. For subgrouping, we performed a cluster analysis using 13 quantitative sensory testing parameters. Three distinct subgroups with characteristic sensory profiles were identified and replicated. Cluster 1 (sensory loss, 42%) showed a loss of small and large fiber function in combination with paradoxical heat sensations. Cluster 2 (thermal hyperalgesia, 33%) was characterized by preserved sensory functions in combination with heat and cold hyperalgesia and mild dynamic mechanical allodynia. Cluster 3 (mechanical hyperalgesia, 24%) was characterized by a loss of small fiber function in combination with pinprick hyperalgesia and dynamic mechanical allodynia. All clusters occurred across etiologies but frequencies differed. We present a new approach of subgrouping patients with peripheral neuropathic pain of different etiologies according to intrinsic sensory profiles. These 3 profiles may be related to pathophysiological mechanisms and may be useful in clinical trial design to enrich the study population for treatment responders.
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