The Experts below are selected from a list of 63 Experts worldwide ranked by ideXlab platform

Henrik Bjarke Vaegter - One of the best experts on this subject based on the ideXlab platform.

  • attentional avoidance is associated with increased Pain sensitivity in patients with chronic Posttraumatic Pain and comorbid Posttraumatic stress
    The Clinical Journal of Pain, 2017
    Co-Authors: Mathea Harvold, Colin Macleod, Henrik Bjarke Vaegter
    Abstract:

    OBJECTIVES Posttraumatic stress disorder (PTSD) is common in chronic Posttraumatic Pain. Theoretical models suggest that attentional biases (AB) contribute to the development and maintenance of chronic Pain and PTSD; however, the influence of AB on clinical and heat Pain sensitivity in chronic Posttraumatic Pain patients is unknown. This study investigated AB for linguistic Pain-related stimuli and trauma-related stimuli, and clinical and thermal sensitivity in patients with chronic Posttraumatic Pain with and without PTSD. MATERIALS AND METHODS In total, 34 patients with chronic Posttraumatic cervical Pain performed the visual attentional probe task assessing patterns of selective attentional responding to trauma cues and to Pain cues. The task used short (500 ms) and long (1250 ms) stimulus exposure durations to ensure sensitivity to both the orienting and maintenance of attention. Heat Pain threshold was assessed at the nonPainful hand. Clinical Pain intensity, psychological distress (anxiety, depression, and disability), and PTSD symptomatology were assessed with questionnaires. RESULTS The Pain/PTSD group (N=14) demonstrated increased clinical and heat Pain sensitivity as well as psychological distress compared with the Pain/No-PTSD group (N=20; P<0.05). AB scores were significantly different between groups (P=0.04). Irrespective of stimulus exposure duration, the Pain/PTSD group demonstrated attentional bias away from trauma and Pain cues (avoidance), whereas the Pain/No-PTSD group demonstrated attentional bias toward Pain cues (vigilance). Attentional avoidance of Pain cues was associated with increased Pain intensity and heat Pain sensitivity (P<0.02). DISCUSSION These results suggest that attentional avoidance is associated with increased chronic Posttraumatic Pain. The causal contribution of attentional avoidance to Pain outcomes remains unclear.

Walter F Stewart - One of the best experts on this subject based on the ideXlab platform.

  • clinical trials of acute treatments for migraine including multiple attack studies of Pain disability and health related quality of life
    Neurology, 2005
    Co-Authors: Richard B Lipton, Marcelo E Bigal, Walter F Stewart
    Abstract:

    Because migraine has features in common with episodic monophasic Pain disorders (such as postoperative or Posttraumatic Pain) and with chronic Pain disorders (such as osteoarthritis or Painful neuropathy), it is often considered an episodic-chronic disorder. In clinical practice, the chronic aspects of migraine are addressed using preventive treatment strategies, while the episodic attacks are addressed by acute treatment strategies. Acute treatment strategies have generally been supported by clinical trial designs that focus on single attacks, whereas preventive treatment strategies evaluate multiple attacks over a period of time. Recently, long-term acute treatment clinical designs have emerged that may inform the design of clinical trials for other episodic-chronic disorders. After reviewing traditional acute treatment clinical trials, we focus here on study methods designed to evaluate treatment and management strategies for migraine over multiple attacks, including outcomes that assess the chronic-episodic nature of migraine (such as headache recurrence and consistency of relief), rather than relief from single attacks. We also discuss end points that reflect the treatment needs of patients, such as disability and health-related quality of life. The traditional randomized controlled trial designed to assess treatment efficacy for a single attack is insufficient to address the broader set of issues that arise in clinical practice. We consider clinical trials strategies designed to address the more complex clinical and policy requirements for meeting the needs of those with migraine.

Rolfdetlef Treede - One of the best experts on this subject based on the ideXlab platform.

Jeffrey S Jones - One of the best experts on this subject based on the ideXlab platform.

  • genetic polymorphisms in the dopamine receptor 2 predict acute Pain severity after motor vehicle collision
    The Clinical Journal of Pain, 2014
    Co-Authors: Yawar J Qadri, Andrey V Bortsov, Robert A Swor, David A Peak, Jeffrey S Jones, D Orrey, Niels K Rathlev, David C Lee, Robert M Domeier, Phyllis L Hendry
    Abstract:

    OBJECTIVES Dopaminergic signaling is implicated in nociceptive pathways. These effects are mediated largely through dopamine receptors and modulated in part by dopamine transporters. This study tested the hypothesis that genetic variants in the genes encoding dopamine receptor 2 (DRD2) and the dopamine active transporter (SLC6A3) influence acute Pain severity after motor vehicle collision. MATERIALS AND METHODS European Americans presenting to the emergency department after motor vehicle collision were recruited. Overall Pain intensity in emergency department was assessed using a 0 to 10 numeric rating scale. DNA was extracted from blood samples and genotyping of single-nucleotide polymorphisms (SNPs) in the DRD2 and SLC6A3 gene was performed. RESULTS A total of 948 patients completed evaluation. After correction for multiple comparisons, SNP rs6276 at DRD2 showed significant association with Pain scores, with individuals with the A/A genotype reporting lower mean Pain scores (5.3; 95% confidence interval [CI], 5.1-5.5) than those with A/G (5.9; 95% CI, 5.6-6.1) or G/G (5.7; 95% CI, 5.2-6.2) genotypes (P=0.0027). Secondary analyses revealed an interaction between sex and DRD2 SNPs rs4586205 and rs4648318 on Pain scores: females with 2 minor alleles had increased Pain intensity, whereas males with 2 minor alleles had less Pain than individuals with a major allele (interaction P=0.0019). DISCUSSION Genetic variants in DRD2 are associated with acute Pain after a traumatic stressful event. These results suggest that dopaminergic agents may be useful for the treatment of individuals with acute Posttraumatic Pain as part of a multimodal opioid-sparing analgesic regimen.

  • polymorphisms in the glucocorticoid receptor co chaperone fkbp5 predict persistent musculoskeletal Pain after traumatic stress exposure
    Pain, 2013
    Co-Authors: Andrey V Bortsov, Jennifer E Smith, Luda Diatchenko, A Soward, Jacob C Ulirsch, Catherine Rossi, Robert A Swor, William E Hauda, David A Peak, Jeffrey S Jones
    Abstract:

    Individual vulnerability factors influencing the function of the hypothalamic-pituitary-adrenal axis may contribute to the risk of the development of persistent musculoskeletal Pain after traumatic stress exposure. The objective of the study was to evaluate the association between polymorphisms in the gene encoding FK506 binding protein 51, FKBP5, a glucocorticoid receptor co-chaperone, and musculoskeletal Pain severity 6 weeks after 2 common trauma exposures. The study included data from 2 prospective emergency department-based cohorts: a discovery cohort (n = 949) of European Americans experiencing motor vehicle collision and a replication cohort of adult European American women experiencing sexual assault (n = 53). DNA was collected from trauma survivors at the time of initial assessment. Overall Pain and neck Pain 6 weeks after trauma exposure were assessed using a 0–10 numeric rating scale. After adjustment for multiple comparisons, 6 FKBP5 polymorphisms showed significant association (minimum P < 0.0001) with both overall and neck Pain in the discovery cohort. The association of rs3800373, rs9380526, rs9394314, rs2817032, and rs2817040 with neck Pain and/or overall Pain 6 weeks after trauma was replicated in the sexual assault cohort, showing the same direction of the effect in each case. The results of this study indicate that genetic variants in FKBP5 influence the severity of musculoskeletal Pain symptoms experienced during the weeks after motor vehicle collision and sexual assault. These results suggest that glucocorticoid pathways influence the development of persistent Posttraumatic Pain, and that such pathways may be a target of pharmacologic interventions aimed at improving recovery after trauma.

Shengting Li - One of the best experts on this subject based on the ideXlab platform.

  • sympathetic innervation and function in reflex sympathetic dystrophy
    Annals of Neurology, 2000
    Co-Authors: David S. Goldstein, Cees J Tack, Shengting Li
    Abstract:

    Patients with reflex sympathetic dystrophy have Posttraumatic Pain disproportionate to the injury and spreading beyond the distribution of any single peripheral nerve. We examined sympathetic neurocirculatory function and the role of sympathetic postganglionic nerve traffic in maintaining the Pain in 30 patients with reflex sympathetic dystrophy. Most had had the condition for more than 1 year, and 14 had undergone sympathectomy for the Pain. Positron emission tomographic scanning after administration of 13 N-ammonia was used to assess local perfusion, and 6-[ 18 F]fluorodopamine was used to assess sympathetic innervation. Rates of entry of norepinephrine in the regional venous drainage (spillovers) and regional plasma levels of L-dihydroxyphenylalanine (the immediate product of the rate-limiting enzymatic step in norepinephrine biosynthesis) and dihydroxyphenylglycol (the main neuronal metabolite of norepinephrine) were measured with and without intravenous trimethaphan for ganglion blockade. 13 N-Ammonia-derived radioactivity was less on the affected side than on the unaffected side, whereas 6-[ 18 F]fluorodopamine-derived radioactivity was symmetrical. Thus, perfusion-adjusted 6-[ 18 F]fluorodopamine-derived radioactivity was higher on the affected side. Norepinephrine spillover and arteriovenous increments in plasma levels of L-dihydroxyphenylalanine and dihydroxyphenylglycol did not differ significantly between affected and unaffected limbs, although 4 patients had noticeably less norepinephrine spillover and smaller arteriovenous increments in plasma dihydroxyphenylglycol on the affected side. Trimethaphan decreased the Pain in only 2 of 12 nonsympathectomized patients. The results indicate that patients with chronic unilateral reflex sympathetic dystrophy have decreased perfusion of the affected limb, symmetrical sympathetic innervation and norepinephrine synthesis, variably decreased release and turnover of norepinephrine in the affected limb, and failure of ganglion blockade to improve the Pain in most cases. These findings suggest augmented vasoconstriction, intact sympathetic terminal innervation, possibly impaired sympathetic neurotransmission, and Pain usually independent of sympathetic neurocirculatory outflows.