-
The Journal of Pain Nov 2019Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In... (Review)
Review
Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In healthy, pain-free populations, a single bout of aerobic or resistance exercise typically leads to exercise-induced hypoalgesia (EIH), a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. In contrast, EIH is more variable in chronic pain populations and is more frequently impaired; with pain and pain sensitivity decreasing, remaining unchanged or, in some cases, even increasing in response to exercise. Pain exacerbation with exercise may be a major barrier to adherence, precipitating a cycle of physical inactivity that can lead to long-term worsening of both pain and disability. To optimize the therapeutic benefits of exercise, it is important to understand how EIH works, why it may be impaired in some people with chronic pain, and how this should be addressed in clinical practice. In this article, we provide an overview of EIH across different chronic pain conditions. We discuss possible biological mechanisms of EIH and the potential influence of sex and psychosocial factors, both in pain-free adults and, where possible, in individuals with chronic pain. The clinical implications of impaired EIH are discussed and recommendations are made for future research, including further exploration of individual differences in EIH, the relationship between exercise dose and EIH, the efficacy of combined treatments and the use of alternative measures to quantify EIH. PERSPECTIVE: This article provides a contemporary review of the acute effects of exercise on pain and pain sensitivity, including in people with chronic pain conditions. Existing findings are critically reviewed, clinical implications are discussed, and recommendations are offered for future research.
Topics: Chronic Pain; Exercise; Humans; Hyperalgesia; Hypesthesia; Pain Perception; Pain Threshold
PubMed: 30904519
DOI: 10.1016/j.jpain.2019.03.005 -
Cancer Oct 2022To explore the impact of acupuncture with other complementary and integrative medicine (CIM) modalities on chemotherapy-induced peripheral neuropathy (CIPN) and quality... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To explore the impact of acupuncture with other complementary and integrative medicine (CIM) modalities on chemotherapy-induced peripheral neuropathy (CIPN) and quality of life (QoL) in oncology patients.
METHODS
In this prospective, pragmatic, and patient-preference study, patients with CIPN were treated with acupuncture and CIM therapies (intervention group) or standard care alone (controls) for 6 weeks. Patients in the intervention arm were randomized to twice-weekly acupuncture-only (group A) or acupuncture with additional manual-movement or mind-body CIM therapies (group B). Severity of CIPN was assessed at baseline and at 6 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool. Other QoL-related outcomes were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC); and the Measure Yourself Concerns and Well-being questionnaire. Von Frey measurements examined perception thresholds.
RESULTS
Of 168 participants, 136 underwent the study intervention (group A, 69; group B, 67), with 32 controls. Baseline-to-6-week assessment scores improved significantly in the intervention arm (vs controls) on FACT-Tax (p = .038) and emotional well-being (p = .04) scores; FACT-TAX scores for hand numbness/tingling (p = .007) and discomfort (p < .0001); and EORTC physical functioning (p = .045). Intervention groups A and B showed improved FACT-Tax physical well-being (p < .001), FACT-TAX total score (p < .001), FACT-TAX feet discomfort (p = .003), and EORTC pain (p = .017) scores.
CONCLUSIONS
Acupuncture, with or without CIM modalities, can relieve CIPN-related symptoms during oncology treatment. This is most pronounced for hand numbness, tingling, pain, discomfort, and for physical functioning.
Topics: Acupuncture Therapy; Antineoplastic Agents; Humans; Hypesthesia; Neoplasms; Pain; Peripheral Nervous System Diseases; Prospective Studies; Quality of Life; Taxoids
PubMed: 35960141
DOI: 10.1002/cncr.34422 -
Ophthalmologica. Journal International... 2014Neurotrophic keratitis (NK) is a rare degenerative corneal disease that occurs as a result of partial or total impairment of trigeminal innervations, leading to a... (Review)
Review
Neurotrophic keratitis (NK) is a rare degenerative corneal disease that occurs as a result of partial or total impairment of trigeminal innervations, leading to a reduction (hypoesthesia) in or loss (anaesthesia) of corneal sensitivity. The impairment of sensory innervation causes a reduction in the lacrimation reflex and the vitality, metabolism and mitosis of epithelial cells, with subsequent deficiency in epithelial repair, stromal and intracellular oedema, loss of microvilli, and abnormal development of the basal lamina. Several recent studies have proposed different therapies based on different aetiopathogenetic theories. The aim of the therapy is to treat aetiopathogenesis and, at the same time, promote corneal healing. In this paper, we report the aetiology, diagnosis, management, and medical and surgical treatment of NK, also indicating future treatments based on the most recent studies.
Topics: Anesthesia; Animals; Cornea; Humans; Hypesthesia; Keratitis; Trigeminal Nerve Diseases
PubMed: 24107451
DOI: 10.1159/000354380 -
Tidsskrift For Den Norske Laegeforening... Feb 2022Numb chin syndrome describes sensory neuropathy characterised by numbness in the distribution of the terminal branch of the mandibular division of the trigeminal nerve....
BACKGROUND
Numb chin syndrome describes sensory neuropathy characterised by numbness in the distribution of the terminal branch of the mandibular division of the trigeminal nerve. This symptom may be overlooked by patients and clinicians due to its mild nature; however, it could represent a serious underlying pathology such as inflammatory conditions or malignancy.
CASE PRESENTATION
A man in his seventies presented with isolated numbness on the right side of the chin, and no other neurological or constitutional symptoms. Radiology showed a lytic mass in the right side of the mandible protruding through the mental foramen. A multidisciplinary approach revealed the cause of the patient's numb chin syndrome.
INTERPRETATION
This case report illustrates clinical considerations in a patient with numb chin syndrome.
Topics: Chin; Humans; Hypesthesia; Male; Neoplasms
PubMed: 35170922
DOI: 10.4045/tidsskr.21.0160 -
Journal of Plastic, Reconstructive &... Jan 2022The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity... (Review)
Review
BACKGROUND
The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity remains a major drawback. Despite an abundance of literature on donor-site morbidities, no consensus has been reached on exact incidences of sensory morbidities that vary largely between 0% and 46%. Incidences of neuropathic pain in the donor site following RFFF still lack, even though clinical experience shows it often occurs. Therefore, the purpose of this systematic review was to identify the incidence of neuropathic pain and altered sensation in the hand following harvesting of a RFFF.
METHODS
A systematic search was performed in multiple databases (Embase, Medline, Cochrane, Web of Science, and Google Scholar). Studies from 1990 onwards that reported donor-site morbidities following harvest of the RFFF were included. Analyzed parameters included hand pain, hypoesthesia, cold intolerance, hyperesthesia, neuroma formation, paresthesia, sharp sensation loss, light sensation loss, and defect closure.
RESULTS
Of the 987 selected studies, 51 eligible articles were selected. The mean level of evidence was 3 (SD 0.6). Twenty articles reported pain as a donor-site morbidity, and the mean incidence of pain reported was 23% (SD 7.8). Hypoesthesia was reported by 37 articles and had a mean incidence of 34% (SD 25). Locations of pain and hypoesthesia included, amongst others, the area of the radial sensory nerve and the skin graft area. The mean incidences of cold intolerance and hyperesthesia were 13% (SD 13) and 16% (SD 15), respectively.
CONCLUSION
The results of this systematic review suggest that 23% of all patients are dealing with neuropathic pain in the donor-site following harvest of an RFFF. Future studies should therefore focus on the prognostic factors and preventive measures of neuropathic pain to further improve clinical outcomes of this widely used flap.
Topics: Forearm; Free Tissue Flaps; Humans; Hyperesthesia; Hypesthesia; Incidence; Neuralgia; Plastic Surgery Procedures; Sensation; Skin Transplantation
PubMed: 34736849
DOI: 10.1016/j.bjps.2021.09.028 -
Journal of Hospital Medicine Apr 2020
Topics: Abdominal Pain; Adult; Female; Humans; Hypesthesia; Immunologic Factors; Methylprednisolone; Multiple Sclerosis; Natalizumab; Neuroprotective Agents
PubMed: 32118562
DOI: 10.12788/jhm.3358 -
BMC Neurology Mar 2017In unilateral neuropathic pain. e.g. after peripheral nerve injury, both positive and negative sensory signs occur often, accompanied by minor but equally directed... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In unilateral neuropathic pain. e.g. after peripheral nerve injury, both positive and negative sensory signs occur often, accompanied by minor but equally directed contralateral sensory changes. To mimic this feature, we experimentally aimed to induce concomitant c-fibre sensitization and block in healthy subjects and analyzed the bilateral sensory changes by quantitative sensory testing (QST) using the protocol of the German Research Network on Neuropathic Pain.
METHODS
Twenty eight healthy subjects were firstly randomized in 2 groups to receive either topical capsaicin (0.6%, 12 cm, application duration: 15 min.) or a lidocaine/prilocaine patch (25/25 mg, 10 cm, application duration: 60 min.) on the right volar forearm. Secondly, 7-14 days later in the same area either at first capsaicin (for 15 min.) and immediately afterwards local anesthetics (for 60 min.) was applied (Cap/LA), or in inversed order with the same application duration (LA/Cap). Before, after each application and 7-14 days later a QST was performed bilaterally.
STATISTICS
Wilcoxon-test, ANOVA, p < 0.05.
RESULTS
Single application of 0,6% capsaicin induced thermal hypoesthesia, cold hypoalgesia, heat hyperalgesia and tactile allodynia. Lidocaine/prilocaine alone induced thermal and tactile hypoesthesia as well as mechanical and cold hypoalgesia, and a heat hyperalgesia (to a smaller extent). Ipsilaterally both co-applications induced a combination of the above mentioned changes. Significant contralateral sensory changes occurred only after the co-application with concomitant sensitization and hypoesthesia and comprised increased cold (Cap/LA, LA/Cap) and mechanical detection as well as cold pain threshold (LA/Cap).
CONCLUSION
The present experimental model using combined application of capsaicin and LA imitates partly the complex sensory changes observed in patients with unilateral neuropathic pain and might be used as an additional surrogate model. Only the concomitant use both agents in the same area induces both positive and negative sensory signs ipsilaterally as well as parallel contralateral sensory changes (to a lesser extent).
TRIAL REGISTRATION
ClinicalTrials.gov Identifier NCT01540877 , registered on 23 February 2012.
Topics: Adult; Anesthetics, Local; Capsaicin; Female; Healthy Volunteers; Humans; Hypesthesia; Lidocaine; Male; Middle Aged; Models, Neurological; Neuralgia; Prilocaine; Sensory System Agents; Somatosensory Disorders; Young Adult
PubMed: 28335745
DOI: 10.1186/s12883-017-0839-9 -
BMJ Case Reports Oct 2020We report the first case of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection in Japan. A 54-year-old woman developed neurological symptoms after... (Review)
Review
We report the first case of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection in Japan. A 54-year-old woman developed neurological symptoms after SARS-CoV-2 infection. We tested for various antiganglioside antibodies, that had not been investigated in previous cases. The patient was diagnosed with GBS based on neurological and electrophysiological findings; no antiganglioside antibodies were detected. In previous reports, most patients with SARS-CoV-2-infection-related GBS had lower limb predominant symptoms, and antiganglioside antibody tests were negative. Our findings support the notion that non-immune abnormalities such as hyperinflammation following cytokine storms and microvascular disorders due to vascular endothelial damage may lead to neurological symptoms in patients with SARS-CoV-2 infection. Our case further highlights the need for careful diagnosis in suspected cases of GBS associated with SARS-CoV-2 infection.
Topics: COVID-19; Coronavirus Infections; Electromyography; Female; Guillain-Barre Syndrome; Humans; Hypesthesia; Japan; Middle Aged; Muscle Weakness; Pandemics; Pneumonia, Viral; Rare Diseases; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 33122241
DOI: 10.1136/bcr-2020-239218 -
Surgical Endoscopy Apr 2012Irritation of inguinal nerves with laparoscopic hernia repair may cause chronic neuralgia and hypoesthesia. Hypoesthesia in particular is generally not assessed... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Irritation of inguinal nerves with laparoscopic hernia repair may cause chronic neuralgia and hypoesthesia. Hypoesthesia in particular is generally not assessed objectively. We objectively investigated hypoesthesia and chronic pain after transabdominal preperitoneal inguinal hernia repair (TAPP) with titanium spiral tacks (STs) compared with tissue adhesive (TA) for mesh fixation.
METHODS
Mesh fixation in 80 TAPP procedures was randomized to fixation with ST (n = 40) or TA (n = 40). The outcome parameters included hypoesthesia assessed with von Frey monofilaments, early postoperative and chronic pain with the visual analog scale (VAS), morbidity (surgical-site infection, hematoma/seroma, relapse of hernia, trocar hernia), and recovery time to normal activity.
RESULTS
Median (range) follow-up was 38 (13-56) months. Demographic and baseline parameters were similar in the two groups. Prevalence of hypoesthesia was significantly higher at all postoperative times in the ST group (6 weeks: 32 vs. 6%; 6 months: 38 vs. 14%; 12 months: 34 vs. 13%; 13-56 months: 32 vs. 4%). Mean hypoesthesia scores over all time points were significantly higher in the ST group. The percentages of regions with hypoesthesia (abdominal, inguinal, or genitofemoral) following all procedures were higher in the ST group after 6 weeks (14 vs. 2%), 6 months (15 vs. 5%), and 13-56 months (22 vs. 4%). The intensity of pain decreased significantly in both groups over time.
CONCLUSIONS
Postoperative hypoesthesia depends on the method of mesh fixation during TAPP and is significantly reduced with TA compared with stapling.
Topics: Adult; Aged; Aged, 80 and over; Chronic Pain; Cyanoacrylates; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Hypesthesia; Length of Stay; Male; Middle Aged; Pain, Postoperative; Prospective Studies; Recurrence; Surgical Mesh; Surgical Stapling; Tissue Adhesives
PubMed: 22044970
DOI: 10.1007/s00464-011-2003-8 -
Annals of Clinical and Translational... Jun 2023Nodal/paranodal autoantibodies identified a group of peripheral neuropathies independent from chronic inflammatory demyelinating polyneuropathy (CIDP). However,...
OBJECTIVE
Nodal/paranodal autoantibodies identified a group of peripheral neuropathies independent from chronic inflammatory demyelinating polyneuropathy (CIDP). However, nodopathy with antibody against neurofascin 186 (NF186) was rarely reported. We presented a cohort of patients with anti-NF186 antibody and described the clinical profile of them.
METHODS
In this retrospective study, 195 patients diagnosed with CIDP and immune mediated idiopathic neuropathies were enrolled. Cell-based assay was used to screen anti-NF186 and anti-NF155 antibodies in serum samples. Teased-fiber immunofluorescence were used as a confirmatory assay. Clinical data of seropositive patients were collected and analyzed.
RESULTS
Among the patients with anti-NF186 antibody, seven patients (58.3%) presented acute or subacute disorder onset. Four patients (33.3%) were found to have asymmetric weakness or numbness. Distal weakness and/or numbness was the core feature. Sensory ataxia, tremor and central nervous system demyelination were rarely observed. Nerve conduction studies revealed predominant demyelinating with/without axonal loss. Brachial plexus MRI was normal in the majority of patients (6/7, 85.7%). Five patients (5/9, 55.6%) showed response to intravenous immunoglobulin. Eight patients (8/10, 80.0%) improved after corticosteroids. All patients (3/3,100%) responded to rituximab.
INTERPRETATION
In the study, we depicted the clinical profile of nodopathy with anti-NF186 antibody. The diversity of clinical features, electrophysiology results and pathological findings was specific in nodopathy with anti-NF186 antibody. Screening of autoantibody against NF186 in acute-onset neuropathy is recommended.
Topics: Humans; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Retrospective Studies; Hypesthesia; Cell Adhesion Molecules; Nerve Growth Factors; Autoantibodies
PubMed: 37060203
DOI: 10.1002/acn3.51775