Deep Tissue Hyperalgesia
Robert M. Bennett in The Clinical Neurobiology of Fibromyalgia and Myofascial Pain, 2020
Central sensitization of dorsal horn or brainstem neurons initiated by nociceptive activity from muscles may explain the expansion of pain with referral to other areas and probably also hyperalgesia in these areas. However, facilitated neurons cannot account for the decreased sensation to certain sensory stimuli in the referred area. Descending inhibitory control of the dorsal horn neurons may explain the decreased response to additional noxious stimuli in the referred pain area. Recently, we found that saline-induced muscle pain resulted in deep tissue hypoalgesia in extrasegmental areas [including the area of referred pain] distant from the pain focus (68,71). In addition, segmental inhibition at the spinal cord or brainstem level may contribute to the decreased sensitivity. In animals intramuscular capsaicin injections have shown to produce inhibition of C-fiber activity from the contralateral leg. This inhibition was blocked by cooling the spinal cord (89) and by spinal cord application of naloxone and phentolamine (90). Descending inhibitory mechanisms might, therefore, mask any eventual increase in somatosensory sensitivity caused by experimental pain.
Applied physiology: persistent visceral pain
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Cutaneous and visceral sensation appears to differ in relation to the effect of stress on the magnitude of responses to stimulation. Although stress-induced analgesia (or hypoalgesia) has been a long-recognized phenomenon associated with cutaneous sensation, it would appear that stress-induced hyperalgesia is the correlate phenomenon associated with visceral sensation. Clinically, stressful life events have been viewed as classic triggers for the evocation of diffuse abdominal complaints of presumed visceral origin.9 It is the rule, rather than the exception, that stressful life events, unless coupled with other major physiological events such as pregnancy, lead to an exacerbation of underlying pain disorders. A prominent role for stress in the pathophysiology and presentation of multiple clinical pain states, including irritable bowel syndrome, Crohn’s disease, interstitial cystitis, rheumatoid arthritis, and psoriasis, has been well documented.67,68,69,70,71 Using IC as a specific example, more than 60 percent of IC patients report symptom exacerbation by both acute and chronic stress, and clinical studies have shown that acute stress increases bladder pain and urgency in these individuals.72,73,74,75,76 Not only is there a significant positive relationship between stress and the IC symptoms of pain and urgency, but as severity of the disease increases, the relationship between stress and symptom manifestation becomes even more evident.76
Marine Algae in Diabetes and Its Complications
Se-Kwon Kim in Marine Biochemistry, 2023
Peripheral neuropathy leads to predominant sensory impairment, and its symptoms are hyperesthesia, pain, and a gradual loss of sensation due to the loss of nerve fibers. When hypoalgesia occurs, trauma and mechanical irritation cannot be noticed; as a result, foot ulcers and gangrene may occur, leading to amputation of the lower limbs (Pop-Busui et al., 2017). Diabetic neuropathy is a multifactorial disease. The probable etiology comprises hyperglycemia, non-enzymatic glycation of proteins, activation of a polyol pathway, free radicals and oxidative stress, a decrease in nitric oxide (NO) levels, and activation of protein kinase C-β (PKC-β) (Feldman et al., 2019; Pop-Busui et al., 2017; Martin et al., 2006; Galer et al., 2000). Studies show that these factors perform synergistically (Feldman et al., 1997).
Physical activity, self-efficacy and quality of life in patients with chronic pain, assessed during and 1 year after physiotherapy rehabilitation – a prospective follow-up study
Published in Disability and Rehabilitation, 2022
Emma Varkey, Angelica Dahlbäck, Monica Thulin, Mats Börjesson, Daniel Arvidsson, Jonatan Fridolfsson, Paulin Andréll
Since the current recommendations for PA are based on studies using self-reported data, our use of objective measurements should be interpreted with caution. Self-reported PA and objectively assessed PA generally show low to moderate agreement [41]. Nonetheless fewer than half of our patients reported adherence to the recommendations. This highlights the importance of improving the level of PA in patients with chronic pain to reduce the risk of both morbidity and mortality from many chronic diseases [10], and also to reduce secondary effects of pain such as depression, anxiety and sleeping disturbance [4]. In addition, exercise therapy over 8–12 weeks may induce clinically relevant reductions in pain in patients with osteoarthritis [42]. Further, a single session of exercise might induce hypoalgesia in persons without pain (exercise-induced hypoalgesia). In patients with chronic pain, the response can vary between hypoalgesia, reduced hypoalgesia, and, the opposite effect, hyperalgesia (i.e., increased sensitivity to pain), depending on the pain condition [11]. This may also explain why the evidence is inconsistent regarding the effects of improved pain severity after a period of exercise in chronic pain conditions [4].
Spinal and supraspinal modulation of pain responses by hypnosis, suggestions, and distraction
Published in American Journal of Clinical Hypnosis, 2021
Bérengère Houzé, Anouk Streff, Mathieu Piché, Pierre Rainville
Pain-evoked responses were also reduced to a comparable extent following suggestions of hypoalgesia without hypnosis. This contrasts with a previous report of larger analgesic effects of suggestions under hypnosis (De Pascalis et al., 2008) but is in line with previous works reporting little advantage of hypnotic induction in responding to suggestions (Braffman & Kirsch, 1999; Meyer & Lynn, 2011; Milling, Kirsch, Allen, & Reutenauer, 2005). Our results are therefore in line and contribute to Kirsch et al.’s thesis that the effect of hypnosis is largely derived from effects of suggestions (Kirsch et al., 2007). By delivering the very same suggestions with and without hypnosis induction, the relative contribution of hypnosis and suggestions was adequately evaluated in the present study (Kirsch et al., 2007; Rainville, 2008). The effectiveness of suggestions may be explained by imaginative suggestibility, response expectancies and motivation (Braffman & Kirsch, 1999; Meyer & Lynn, 2011; Milling et al., 2005). However, it is possible that the context of the study itself had an effect. Although the hypnotic and non-hypnotic sessions were randomized, participants knew that they were participating in a hypnosis study. This context effect could have resulted in similar modulation of pain responses when suggesting hypoalgesia with and without hypnosis (Milling et al., 2005). Further studies are needed to elucidate the conditions under which psychophysiological responses to suggestions are enhanced by hypnosis.
Perineural injection of botulinum toxin-A in painful peripheral nerve injury – a case series: pain relief, safety, sensory profile and sample size recommendation
Published in Current Medical Research and Opinion, 2019
Christine H. Meyer-Frießem, Lynn B. Eitner, Miriam Kaisler, Christoph Maier, Jan Vollert, Andrea Westermann, Peter K. Zahn, Carla A. Avila González
Contrasting the previous results after sBONT injection, possibly due to the injection location, pBONT-A did not show analgesic effects predominantly in patients with eminent hyperalgesia, whereas sBONT-A was more effective in patients with preserved small fiber function and hyperalgesia11,35. It is comprehensible that the efficacy of drugs corresponds with a specific site of action (e.g. with either capsaicin or sodium channel blockers, such as oxcarbazepine, efficacy varies in patients both with and without preserved small fiber function, e.g. thermal perception)44. However, this must be confirmed in a placebo-controlled study. There are two common sensory phenotypes in patients suffering from PNI: (i) painful hypoesthesia/hypoalgesia and (ii) preserved thermal sensory function with signs of a mechanical hyperalgesia24. Patients of the first group are considered to have a poor prognostic outcome, as most phenotype-specific treatment lately showed efficacy rather for hyperalgesic phenotypes47. Our data suggest that pBONT-A seems to be equally effective in patients showing sensory deficits without hyperalgesia, which would significantly improve outcome perspective for these patients. Still, this was a case series and the extrapolation potential is therefore highly limited, and we hope that these findings will inform future prospective trials. For these, we provide a first primer on how to plan sample size in a pBONT-A trial.
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