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Disenchantment with current pain management
Published in Stephen Buetow, Rethinking Pain in Person-Centred Health Care, 2020
Nociplastic pain is pain that persons “learn.” Up-regulation of their nervous system through prolonged stimulation produces a persistent state of high reactivity to sensations that would not otherwise cause nociceptors to fire. In this state, peripheral and central sensitization of nociceptive neurons to tactile and other stimuli lowers the threshold for pain perception even after initial pain-provoking tissue damage has healed.39,44,45 This state may confuse pain as a symptom, cause and pathology46 but it describes pain whose weakened relationship to the state of the tissues has become less predictable, for example in response to psychosocial factors that stimulate brain regions associated with emotion. In these conditions, sensitivity to pain can be abnormally heightened (hyperalgesia), while formerly non-painful stimuli may also become painful (allodynia).
Is Fibromyalgia a Central Pain State?
Published in Robert M. Bennett, The Clinical Neurobiology of Fibromyalgia and Myofascial Pain, 2020
symptom-chronic multifocal pain-and one sign-generalized allodynia/ hyperalgesia (1). The patient who is diagnosed with FMS, however, is polysymptomatic. Besides pain there is fatigue, sleep disturbance, psychological distress, impaired muscle function, and symptoms that are usually regarded as stress-related. Fibromyalgia is an illness, a syndrome, that effects three systems that regulate our well being: the nociceptive system, the stress-regulating system, and the immune system. These systems interact with each other, making it difficult to determine which of them is primarily affected in an individual patient. Psychological factors, personality traits, and social circumstances play a role for the total clinical picture. Fibromyalgia is indeed a biopsychosocial syndrome. The biological part concerns mainly pain and allodynia/hyper-algesia as well as biological changes related to continuous physical and emotional stress. This article will deal only with pain and allodynia. Allodynia is pain elicited by normally nonpainful stimuli. Hyperalgesia is increased pain intensity and prolonged pain duration evoked by stimuli that normally are painful.
Posttraumatic Headache
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Although PTHA may include migraine, some of Moskowitz’s work (61) may be pertinent here. He has shown that when stimulated antidromically, the trigeminal nerve can release vasoactive/algetic peptides such as substance P, neurokinin A, bradykinin, neuropeptides Y, vasoactive intestinal peptide (VIP) and calcitonin-gene-related peptide (CGRP) from its afferent nerves which innervate vascular structures. This can initiate a sterile inflammation that will lower the pain threshold, causing exacerbations in pain from typically benign behavior such as movement of the head. (This is NOT allodynia—that may be most commonly associated with migraine.) It is conceivable that such a disruption of the trigeminal system may possibly help determine neurogenic pain in some patients, who may be susceptible to migraine, who develop PTHA.
Development and evaluation of Hedyotis corymbosa (L.) extract containing phytosomes: a preclinical approach for treatment of neuropathic pain in rodent model
Published in Journal of Microencapsulation, 2023
Nitin Kumar, Radha Goel, Monika Singh, Neeraj Kant Sharma, Praveen Kumar Gaur, Pradeep Kumar Sharma
On day 7 of therapy, mechanical allodynia for both treated groups II and III were substantial when compared to negative control rats. The treated groups had increased mechanical allodynia, demonstrating its efficacy in treating neuropathic conditions. When compared to groups I and II on days 7 and 14, F2 treated rats (Group III) demonstrated a substantial increase in PWL (paw withdrawal latency) score, refer to Table 2. When compared to NCG rats (Group I) alone, rats in the HCE treated group (Group II) showed a substantial increase in PWL score on 7th and 14th day. Therefore, after SN ligation, rats receiving a dosage of F2, which is equal to 40 mg/kg/day HCA, had the most notable impact on lowering the nociceptive threshold. According to the neuroprotective effect observed in F2 treated rats, HCE administration through F2 formulation may be the most effective method for raising the threshold against transmission of pain.
Neuropsychiatric manifestations in primary Sjogren syndrome
Published in Expert Review of Clinical Immunology, 2022
Simone Appenzeller, Samuel de Oliveira Andrade, Mariana Freschi Bombini, Samara Rosa Sepresse, Fabiano Reis, Marcondes C. França
Painful (small fiber) sensory neuropathy and sensorimotor polyneuropathy are the most frequent PNS syndromes observed in pSS [30]. The first one is characterized by symmetric hypoesthesia and paresthesia that begin in the hands/feet and then extend proximally [33]. Neuropathic pain is a frequent counterpart and manifests as burning or shooting sensations. Allodynia is also frequently noticed. In some patients, the distribution of sensory deficits is not strictly symmetric, as one can see patchy areas of tactile or temperature loss involving the face or trunk. The presence of motor deficits indicates that there is no longer a pure sensory neuropathy (i.e. there is a sensorimotor polyneuropathy with involvement of large fibers). Weakness typically affects lower limb distal muscles and may cause feet to drop. Autonomic manifestations – such as hypo or anhidrosis and bowel dysfunction – may be found in either type of neuropathy [30].
Factors determining the response to treatment in patients with vestibular migraine
Published in Neurological Research, 2022
Ayşın Kısabay Ak, Neşe Çelebisoy, Hüseyin Nezih Özdemir, Figen Gökçay, Gülsüm Saruhan Durmaz, Dilek Top Kartı, Hülya Ertaşoğlu Toydemir, Vildan Yayla, Ayşe İlksen Çolpak Işıkay, İrem Erkent, Pınar Özçelik, Gülden Akdal, Ceyla Ataç, Şebnem Bıçakcı, Eylem Ozaydın-Göksu, Feray Güleç Uyaroğlu
Cutaneous allodynia is a common feature accompanying migraine attacks characterized by pain perception in response to non-noxious stimuli to the normal skin. Its prevalence in migraine patients has been reported to change from 50–80% [34]. It reflects sensitization of second- and third-order trigeminovascular neurons, in the trigeminal nucleus caudalis, and predicts a poor response to attack treatment [35]. Female gender, high body mass index, long history of migraine, high frequency of attacks and comorbidity with depression and anxiety have been found to be associated with the presence of allodynia [36–39]. It is also accepted as a predictor of migraine chronification [40]. The mean age of our patients was 42.2 years, and the mean age at the onset of migraine attacks was 24.5 years. In addition to being female, long history of migraine in our patients seems to be associated with the development of cutaneous allodynia and cutaneous allodynia was related to reduced response to prophylactic treatment. Response to treatment was poor in our patients on amitriptyline and defining allodynia. However, again, comorbid anxiety/depression was an additional risk factor in these patients.