Cerebral vasomotor reactivity in fibromyalgia patients and its relationship to central neuropathic pain
GULER Sibel1, KURTOGLU S. Hakan2, KEHAYA Sezgin1, PAMUK Nuri3, CELIK Yahya1
SEPTEMBER 30, 2016
Clinical Neuroscience - 2016;69(09-10)
GULER Sibel1, KURTOGLU S. Hakan2, KEHAYA Sezgin1, PAMUK Nuri3, CELIK Yahya1
SEPTEMBER 30, 2016
Clinical Neuroscience - 2016;69(09-10)
Background - Cerebral vasomotor reactivity, defined as the cerebral vasculature response to hypoxia, is not wellunderstood in fibromyalgia (FM) patients. This study investigated the difference in the cerebrovascular reactivity (i.e., responsiveness to hypercapnia was evaluated by use of breath- holding index) to the breath-holding index (BHI) between patients with fibromyalgia and a group of normal controls. Methods - The study included 40 FM patients and 40 healthy subjects. Cerebrovascular reactivity was evaluated using the BHI, which is a nonaggressive, well-tolerated, real-time, reproducible screening method to study cerebral haemodynamics. Insonation depth and basal velocity were symmetrical and not significantly different between the two groups (p>0.05). All patients completed the Revised Fibromyalgia Impact Questionnaire (FIQR), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS), and the somatization subscale of the SCL-90-R symptom checklist. Results - The BHI ranged from 0.30 to 2.20 (mean 1.11±0.45) in the FM patients and 1.10 to 2.80 (mean 1.90±0.35) in the control group (p<0.001). Disease duration and right BHIaverage and left BHIaverage values exhibited a significant negative correlation (r=-0.877; p<0.001, r=-0.842; p<0.001, respectively). As pain and fatigue scores increased, the right BHIaverage and left BHIaverage values decreased (r=-0.431; p=0.005, r=-0.544; p<0.001, r=-0.341; p=0.031, r=-0.644; p<0.001, respectively). Conclusions - BHI values showed that cerebrovascular reactivity in FM patients decreased in comparison to healthy individuals. BHI decreased as disease duration and severity increased. Cerebrovascular reactivity decreased in FM patients, and this phenomenon should be accepted as an abnormality. Additionally, this outcome may have been the result of a mechanism responsible for central neuropathic pain.
[Eating disorders are psychosomatic disorders affecting primarily women, and influence reproductive functions as well. They have an impact on ovarial cyclem fertility, course of pregnancy, process of delivery, post partum period. Moreover, some data show that they can influence the adult health status. Extensive research from the last three decades call the attention to the fact that besides the classical eating disorders (anorexia nervosa and bulimia nervosa) the newer types (e.g., orthorexia nervosa), and subclinical disorders also occur in a subgroup of pregnant women. For this reason it is of key importance that the personnel working in the territory of obstetrics and gynecology have a solid knowledge about the symptoms, screening and therapeutical opportunities, and outcome of these disorders. The review summarizes the recent research data about the relationship of eating disorders and pregnancy.]
[Functional imaging studies opened a new way to understand the neural activity underlying pain perception and the pathomechanism of chronic pain syndromes. In the last twenty years several results of functional magnetic resonance imaging (fMRI) studies have been published about examining the different aspects of complex pain experience. The aim of these studies is to understand the functioning of the pain control system, the so-called pain matrix, activated by acute nociceptive stimulus. Another important field of pain research is the investigation of neuronal processes underlying chronic pain, since the pathomechanism of this is still unclear. Our review aims to provide insight into the methods of pain research using fMRI and the achievements of the last few years.]
Background and purpose - Attachment theory provides an integrative perspective about the interplay between cognitive, affective, behavioral and interpersonal processes and is relevant for understanding irritable bowel syndrome (IBS) and panic disorder (PD). The aim of the present study was to examine the adult attachment style and parental bonding of IBS and PD patients. Methods - In a cross-sectional questionnaire-based study, 65 PD and 65 IBS patients with clinical diagnosis participated. Measures were Attachment Style Questionnaire, Experiences in Close Relationships Scale - Revised, and Parental Bonding Instrument. Results - The frequencies of insecure attachment (80.0% vs. 63.1%) and paternal neglect (35.4% vs. 16.9%) were higher in IBS than in PD (χ2 (1)=4.571, p=0.033, and χ2 (3)=7.831, p=0.050, respectively). The frequency of secure attachment was significantly higher for optimal paternal bonding than with suboptimal paternal bonding (75.0% vs. 21.9%, χ2 (1)=19.408, p<0.001). According to the results of multiple binary logistic analysis, optimal paternal bonding predicted secure attachment after adjusting for the background variables (OR=9.26, p=0.001). Conclusion - A high frequency of insecure attachment was present in both groups, especially in IBS. With regard to maternal bonding, IBS and PD groups showed similar patterns, while an apparent difference was observed for paternal bonding. These highlighted the developmental similarities of these two, symptomatically different disorders. While optimal maternal bonding did not predict adult attachment security, paternal bonding did thus replete with therapeutic implications. Attachment functions, like responsiveness, attunement and affection modulation were apparent in the psychotherapist-patient relationship as well.
[Dissection of the cervical and intracranial vasculature is a rare but important cause of ischaemic stroke especially in young adults. In the majority of cases it affects the extracranial vessels, mostly the internal carotid artery. It might be categorized as spontaneous or traumatic, causing diverse clinical symptoms. Dissection might lead to ipsilateral stroke mainly by artery-to-artery embolisation. Due to its relative rarity compared to the classic ischaemic stroke of the elderly, there are much less clinically relevant information for the clinician to rely on. Several large, randomised, multicentered, prospective studies and some smaller, retrospective analyses have been published recently concerning the genetic background, epidemiology, acute care and secondary prevention of supraaortic arterial dissection which helps the neurologist to provide evidence-based care for his patient. Our aim is to give a short, up-to-date overview of arterial dissections with two case reports.]
Background - To investigate contribution of glucocorticoids to the maintenance of gastric mucosal integrity during stress we predominantly used ulcerogenic stress models. Using these models we demonstrated that glucocorticoids released in response to the ulcerogenic stimuli attenuated their harmful action on the gastric mucosa. Purpose - In the present study we hypothesized that mild stressors does not damage the gastric mucosa due to gastroprotective action of glucocorticoids released in response to these stressors. Methods - To verify the hypothesis the effects of normally non-ulcerogenic mild stimuli (15-30 min cold-restraint) on the gastric mucosal integrity have been studied under the circumstances of inhibition of the hypothalamic-pituitaryadrenocortical axis in rats. The hypothalamic-pituitary-adrenocortical axis was inhibited by: 1) fast inhibitory action of metyrapone, inhibitor glucocorticoid synthesis; 2) fast inhibitory action of NBI 27914, the selective antagonist of cortricotropin- releasing factor receptor type 1; 3) delayed inhibitory action of a single pharmacological dose of cortisol injected one week before the onset of stress stimulus. Results - Each of these pretreatments significantly decreased 15-30 min cold-restraint-produced corticosterone levels: 37.2±1 vs 22.5±1.2 (p<0.05) after metyrapone; 52.1±0.9 vs 41.4±1 (p<0.05) after NBI, and 64.2±4.2 vs 16.7±1.5 (p<0.05) after cortisol pretreatment. The inhibition of stress-induced corticosterone rise resulted in an ap - pearance of gastric lesions after the onset of these mild stressors in rats. Conclusions - The results suggest that in rats with inhibited stress-induced corticosterone rise normally non-ulcerogenic stimuli are transformed into ulcerogenic ones and confirm the hypothesis. The findings further support for the point of view that glucocorticoids released during acute stress are gastroprotective factors.
Zoster-associated extremity paresis is a rare complication of herpes zoster (HZ) and is usually due to zoster-associated mononeuropathy. Complaints of a 77-year-old man started with pain in his right arm and 4 days later he developed itchy red HZ lesions in the same area. One week later, the patient developed weakness in his right arm. The patient was diagnosed with isolated axillary mononeuropathy by physical examination and electromyography. Here, we present a case of axillary mononeuropathy which is a rare complication of HZ infection and needs particular attention.
Lege Artis Medicinae
[Fibromyalgia is a chronic, non-inflammatory pain syndrome characterised by diffuse muscle pain and increased tenderness of specific tender points. The exact cause or pathomechanism of the disease is unknown. In the background, nociception and the pain processing pathways of the central nervous system are suspected as dysfunctional. The disease occurs primarily in middle-aged women. Occurence of fibromyalgia is between 1-4%, increasing up to 20% in a rheumatology clinic. In Canada, the cost of treatment of fibromyalgia was 350 million $ in 1993. Unfortunately, in Hungary no similar data is available. It is frequently joined by different vegetative and functional symptoms. One characteristic feature is insomnia, causing typical morning fatigue in patients. Effective therapy has yet to be found, although successful treatment may be achieved with drug therapy (amitryptilin), psychotherapy and aerobics with supplemental electro- and hydrotherapy. Patient education and involvement is also important for good therapeutic results and for the ability to return to work as soon as possible.]
[Pain, on the basis of its anatomical origin, can be nociceptive (somatic, visceral) or neuropathic, that is, occuring as a direct consequence of a lesion or disease affecting the somatosensory system. The past few years’ epidemiological studies showed that chronic neuropathic pain affects 7-8% of the general population. Diagnosis of neuropathic pain can be established without instrumental examinations, with the help of validated tests that can be used by any physician. Neuropathic pain greatly deteriorates the patients’ quality of life, and the effect of traditional analgesics is insufficient for its treatment. Thus, it is important to know those treatment procedures and drugs that have been proved to be efficient for relieving neuropathic pain.]
Hypertension and nephrology
[Angiotensin II (Ang II) by activating angiotensin type 1 receptors (AT1R) is one of the most potent vasoconstrictors in the regulation of vasomotor tone and thus systemic blood pressure. In this study, we hypothesized that aging alters Ang II - induced vasomotor responses and expression of vascular mRNA and protein angiotensin type 1 receptor (AT1R). Thus, carotid arteries were isolated from newborn, young, middle age, old and senescent rats and their vasomotor responses were measured in a myograph (DMT-600) to repeated administrations of Ang II. Vascular relative AT1R mRNA level was determined by qRT-PCR and the AT1R protein density was measured by Western blot. Contractions of vessels to the first administration of Ang II increased from newborn to young and middle age rats then they decreased to senescent rats. In general, second administration of Ang II elicited reduced contractions, but they also first increased and then they decreased to old age. Similarly, the AT1R mRNA level and the AT1R protein density increased from newborn to young and middle age rats then they decreased to senescent rats. The pattern of these changes correlated with functional vasomotor data. We conclude that aging (newborn to senescence) has substantial effects on Ang II-induced vasomotor responses and AT1R signaling suggesting that it is - and thus regulation of systemic blood pressure is - determined primarily by genetic programs.]
LAM Extra for General Practicioners
[Neuropathic pain is a chronic pain disorder due to a primary lesion and/or dysfunction of the peripheral or central nervous system. This tormenting condition causes a lot of distress to the patients, impairs their quality of life, and demands significant expenses. Chronic neuropathic pain is frequently under-diagnosed and mistreated. Explanations for these problems are the complex underlying pathomechanism, variability of symptoms, difficulties in diagnosis, and the differences between the treatment of this and other painful disorders. In addition, comorbid conditions such as anxiety, depression, and sleep disorders are often overlooked. Apart from the diagnostic difficulties, also treatment is usually unsatisfactory. Frequently NSAIDs are used, but they are usually not effective. Undoubtedly, even with the use of evidence-based treatment - such as duloxetine and pregabalin - complete pain relief is not always possible. Lack of proper medical education also contributes to problems in diagnosis and treatment. In western countries, diabetes is the most common cause of polyneuropathy. Painful diabetic neuropathy is the most intensely studied neuropathic pain condition; a lot of evidence comes from randomized controlled trials of this type of neuropathy. The same drugs as in the case of other neuropathic pain conditions are used for the symptomatic treatment of painful diabetic neuropathy. Etiological therapy is based on the best achievable glycemic control. A combination of etiological and symptomatic therapy can be a future treatment, but proving this will require further studies.]
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