Facilitated Pronociceptive Pain Mechanisms in Radiating Back Pain Compared With Localized Back Pain

Vægter, Henrik Bjarke; Palsson, Thorvaldur Skuli; Graven‐Nielsen, Thomas

doi:10.1016/j.jpain.2017.03.002

Cited by 31 publications

(45 citation statements)

References 51 publications

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“…22,74,[77][78][79] In 8 studies, single-point pressure algometry was performed in addition to CPA. 49,72,73,75,76,[78][79][80] Other tests were performed in some studies, such as assessment of maximal isokinetic muscle strength, 15,80 manual tender point examination and tender point count, 15,19 myalgic score, 15 questionnaires to assess depression, anxiety, and pain catastrophizing, 15,19 self-reporting of somatosensory symptoms of neuropathic pain, 19 thermal pain sensitivity, 81,82 exercise-induced hypoalgesia, 75,80 cold-pressor test, 75,80 and provocation tests with hypertonic saline solution, 59 but these are beyond the scope of this systematic review.…”

Section: Assessment Methodsmentioning

confidence: 99%

“…The search identified 18 relevant studies, 7 of which also included healthy controls. 15,21,49,50,59,72,73 Four studies were of patients with chronic widespread pain or fibromyalgia, 15,19,59,74 8 studies were of patients with osteoarthritis, 22,49,73,[75][76][77][78][79] and then individual studies were of patients with rheumatoid arthritis, 50 chronic musculoskeletal pain, 80 chronic back pain, 81 chronic pain of different etiologies, 82 lateral epicondylalgia, 21 and patellofemoral pain. 72 Six studies included only females, 15,21,50,59,72,74 and the remaining 12 studies involved both male and female participants.…”

Section: Participantsmentioning

confidence: 99%

“…The mean age of participants was 60+ years in 8 studies, 22,49,73,[75][76][77][78][79] and under 40 years of age in 4 studies. 21,50,59,72 Fourteen studies reported the mean BMI 19,21,22,[73][74][75][76][77][78][79][80][81] or the weight and height 59,72 of the participants, and two studies reported the mean circumference of the limb studied. 15,59…”

Section: Participantsmentioning

confidence: 99%

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Cuff Pressure Algometry in Patients with Chronic Pain as Guidance for Circumferential Tissue Compression for Wearable Soft Exoskeletons: A Systematic Review

et al. 2018

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In this article, we report on a systematic review of the literature on pressure-pain thresholds induced and assessed by computerized cuff pressure algometry (CPA). The motivation for this review is to provide design guidance on pressure levels for wearable soft exoskeletons and similar wearable robotics devices. In our review, we focus on CPA studies of patients who are candidates for wearable soft exoskeletons, as pain-related physiological mechanisms reportedly differ significantly between healthy subjects and patients with chronic pain. The results indicate that circumferential limb compression in patients most likely becomes painful at ∼10-18 kPa and can become unbearable even below 25 kPa. The corresponding ranges for healthy control subjects are 20-42 kPa (painful limits) and 34-84 kPa (unbearable levels). In addition, the increase of pain with time tends to be significantly higher, and the adaptation to pain significantly lower, than in healthy subjects. The results of this review provide guidance to designers of wearable robotics for populations with chronic pain regarding rates and magnitudes of tissue compression that may be unacceptable to users.

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Section: Assessment Methodsmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

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Cuff Pressure Algometry in Patients with Chronic Pain as Guidance for Circumferential Tissue Compression for Wearable Soft Exoskeletons: A Systematic Review

et al. 2018

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“…69 Taken together with the present results, this indicates that alterations in thermal detection and pain sensation are likely not a prominent feature in AD as is the case, e.g., for certain neuropathic 16,56 and musculoskeletal pain etiologies. 28,89 Notably, a previous study found that noxious suprathreshold heat stimuli evoke itch in AD, conceptually corresponding to heat-induced alloknesis. 40 This type of sensory assessment is conceivably a more valuable assessment in AD patients than standardized thermal QST.…”

Section: Thermal Quantitative Sensory Testing Is Normal In Admentioning

confidence: 99%

Nonhistaminergic and mechanical itch sensitization in atopic dermatitis

Andersen

Elberling

Sølvsten

et al. 2017

Pain

112

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Chronic or episodic severe itch is recurrent in atopic dermatitis (AD). Nonhistaminergic itch pathways are suggested to dominate in AD itch, contributing to an "itch-scratch-itch cycle" that prolongs and worsens itch, pain, and skin lesions. We hypothesized that nonhistaminergic neuronal sensitization contributes to itch in AD. Hence, we compared sensitivity with thermal, mechanical, and chemical pruritic stimuli in patients with AD and controls. The study comprised 25 patients with AD with chronic itch and 25 healthy controls. Questionnaires on itch characteristics were administered, and sensory tests were conducted intralesionally, extralesionally, and in homologous areas of controls. Thermal and mechanical quantitative sensory testing (QST) as well as histamine and cowhage provocations were performed. Subsequently, hyperknesis and vasomotor reactivity were assessed. Average itch and associated pain among patients with AD were 60.7 ± 4.3 and 39.7 ± 5.2 (VAS0-100), respectively. Patients experienced significantly higher itch from cowhage both intralesionally and extralesionally compared with controls, whereas histamine-evoked itch intensity was not significantly different between groups. No group differences were found for thermal quantitative sensory testings or pain evoked by itch provocations. Patients had decreased mechanical detection thresholds intralesionally and increased mechanical pain sensitivity intralesionally and extralesionally. Lastly, patients exhibited intralesional and extralesional hyperknesis before chemical itch provocations and augmented hyperknesis after itch provocations. Increased itch in response to cowhage (but not histamine) suggests nonhistaminergic pathway-specific itch sensitization in AD, whereas increased susceptibility to mechanically evoked itch and pain, particularly intralesionally suggests sensitization of mechanosensitive circuitry not normally associated with itch. Drugs targeting the nonhistaminergic (PAR2/TRPA1) itch pathway and itch sensitization are promising for treating AD itch.

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“…However, itch-specific QST protocols are much less advanced and studied compared to pain. It remains to be explored whether assessment of itch sensitization correlates is useful for the purpose of subgrouping, for instance in patients with AD, akin to the sensory phenotyping being utilized within pain research 24,46,139,157 . The purpose of this review is to provide an overview of the definitions, present evidence regarding assessment techniques, and mechanisms of mechanical allo-and hyperknesis, while linking this evidence to the more familiar concepts of allodynia and hyperalgesia.…”

Section: Manuscriptmentioning

confidence: 99%

Alloknesis and hyperknesis—mechanisms, assessment methodology, and clinical implications of itch sensitization

Andersen

Akiyama

Nattkemper

et al. 2018

Pain

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Itch and pain share numerous mechanistic similarities. Patients with chronic itch conditions (for instance atopic dermatitis or neuropathic itch) often experience symptoms such as mechanical alloknesis and hyperknesis. These dysesthesias are analogous to the pain-associated phenomena allodynia and hyperalgesia, which are often observed, for example, in neuropathic pain conditions. Mechanical itch dysesthesias represent abnormal sensory states (caused by neuroplastic changes), wherein considerable itch is evoked, for instance by light cutaneous stimuli such as from clothing (alloknesis), or where increased itch is perceived in response to normally itch-evoking stimuli (hyperknesis). These itch sensitization phenomena have been explored in experimental human studies, observed in chronic itch patients, and in animal models of itch. Limited attention has been paid to these sensory phenomena in clinical studies, and it is unknown how they respond to antipruritics. Psychophysical quantitative sensory testing can quantify the presence, severity, and spatial extent of itch dysesthesias in chronic itch patients, providing a proxy measurement of itch sensitization. This review outlines current assessment techniques, knowledge on the mechanisms of mechanical alloknesis and hyperknesis, and presents the diverse results derived from clinical studies exploring the presence of itch dysesthesias in chronic itch patients. A key role of quantitative sensory testing and neuronal sensitization in patients with chronic pain is accepted and used in clinical assessments. However, the precise mechanisms and potential clinical implications of itch sensitization in chronic itch patients remain to be evaluated.

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Facilitated Pronociceptive Pain Mechanisms in Radiating Back Pain Compared With Localized Back Pain

Abstract: These findings have clinical implications because the underlying mechanisms in different back pain conditions may require different treatment strategies.

Cited by 31 publications

References 51 publications

Cuff Pressure Algometry in Patients with Chronic Pain as Guidance for Circumferential Tissue Compression for Wearable Soft Exoskeletons: A Systematic Review

Cuff Pressure Algometry in Patients with Chronic Pain as Guidance for Circumferential Tissue Compression for Wearable Soft Exoskeletons: A Systematic Review

Nonhistaminergic and mechanical itch sensitization in atopic dermatitis

Alloknesis and hyperknesis—mechanisms, assessment methodology, and clinical implications of itch sensitization

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