Dissociable Neural Mechanisms Underlying the Modulation of Pain and Anxiety? An fMRI Pilot Study

The down-regulation of pain through beliefs is commonly discussed as a form of emotion regulation. In line with this interpretation, the analgesic effect has been shown to co-occur with reduced anxiety and increased activity in the ventrolateral prefrontal cortex (VLPFC), which is a key region of emotion regulation. This link between pain and anxiety modulation raises the question whether the two effects are rooted in the same neural mechanism. In this pilot fMRI study, we compared the neural basis of the analgesic and anxiolytic effect of two types of threat modulation: a “behavioral control” paradigm, which involves the ability to terminate a noxious stimulus, and a “safety signaling” paradigm, which involves visual cues that signal the threat (or absence of threat) that a subsequent noxious stimulus might be of unusually high intensity. Analgesia was paralleled by VLPFC activity during behavioral control. Safety signaling engaged elements of the descending pain control system, including the rostral anterior cingulate cortex that showed increased functional connectivity with the periaqueductal gray and VLPFC. Anxiety reduction, in contrast, scaled with dorsolateral prefrontal cortex activation during behavioral control but had no distinct neural signature during safety signaling. Our pilot data therefore suggest that analgesic and anxiolytic effects are instantiated in distinguishable neural mechanisms and differ between distinct stress- and pain-modulatory approaches, supporting the recent notion of multiple pathways subserving top-down modulation of the pain experience. Additional studies in larger cohorts are needed to follow up on these preliminary findings

The effect of opioid therapy on sleep quality in patients with chronic non-malignant pain : a systematic review and exploratory meta-analysis

Current guidelines recommend opioid therapy to chronic non-malignant pain (CNP) patients when the benefits for pain and function outweigh risks. This systematic review examined the effects of opioid therapy on sleep – a valued functional outcome– in CNP. Electronic and hand searches of relevant studies up through July 2017 identified 18 eligible studies providing data from 3,746 CNP patients for analysis. Twelve of these studies were randomised controlled trials (RCTs) of up to 12-month in duration. Low-medium dosed oxycodone and transdermal fentanyl were the most tested therapies (n=4 each). Only two studies used objective sleep measure in addition to self-report ratings, questionnaires or sleep diary. Whilst calmer sleep with less body/leg movements and fewer awakenings could be achieved following opioid therapy, these might occur with increased sleep-disordered breathing and a much-shortened rapid eye movement (REM) sleep latency. Both the narrative synthesis and exploratory meta-analysis suggest that opioid therapy in CNP is associated with improved self-reported sleep quality. However, the effect is inconsistent, small (Standardised Mean Difference = 0.36), and may be accompanied by excessive daytime sleepiness. As a Cochrane-recommended assessment revealed “unclear” or “high” overall risk of bias for all studies, future opioid trials of stronger methodology and better reporting are needed to confirm and elucidate the effect

L'étude PROVE IT-TIMI-22 ou l'arroseur arrosé

L'importance des statines en prévention secondaire pour la maladie coronarienne est reconnue depuis les études 4S, CARE et LIPID, leurs indications s'étendant même maintenant aux patients avec un cholestérol normal. Le choix du type de statine, ainsi que sa dose, restent des questions ouvertes. L'étude PROVE IT-TIMI-22 a tenté de répondre à ces inconnues, en comparant l'atorvastatine à 80 mg/j à la pravastatine à 40 mg/j en prévention secondaire précoce. Il ressort que le traitement intensif avec l'atorvastatine a eu une action hypolipémiante plus marquée sur le LDL-cholestérol et un effet plus favorable sur l'évolution clinique basée sur un score composite. Nous proposons une analyse critique de cette étude et recommandons une certaine prudence avant d'appliquer ce traitement intensif de prévention secondaire à l'ensemble des patients avec une coronaropathie. [Auteurs] [abstract] The importance of statins in secondary prevention is wll established since the 4S, CARE and LIPID studies, their indications being now applied to even mornocholesterolemic patients. To date, it is still unclear which statin to choose, and at what dose. A recent study entitled "PROVE IT-TIMI-22" has compared 80 mg of atorvastatin/day to 40 mg of pravastatin/day in early secondary prevention. It appears that the intensive treatment with atorvastatin has been more effective on the LDL-cholesterol levels and has had a more favourable effect on the clinical evolution based on a composite score. We herein propose a critical review of this study and recommend a somewhat cautious attitude before giving high doses of atorvastatin in the secondary prevention of all the patients with coronary heart disease. [Authors]]]> Coronary Disease ; Anticholesteremic Agents oai:serval.unil.ch:BIB_39B68C2DF3A4 2022-05-07T01:15:42Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_39B68C2DF3A4 Social evolution: sick ants face death alone. info:doi:10.1016/j.cub.2009.12.037 info:eu-repo/semantics/altIdentifier/doi/10.1016/j.cub.2009.12.037 info:eu-repo/semantics/altIdentifier/pmid/20144768 Chapuisat, M. info:eu-repo/semantics/article article 2010 Current Biology, vol. 20, no. 3, pp. R104-R105 info:eu-repo/semantics/altIdentifier/eissn/1879-0445 urn:issn:0960-9822 <![CDATA[Social insects not only live altruistically, they die so: a new study reveals that moribund ants abandon their nests to die in seclusion, which reduces the risk of transmitting diseases to relatives

A test of positive suggestions about side effects as a way of enhancing the analgesic response to NSAIDs

Side effects are frequent in pharmacological pain management, potentially preceding analgesia and limiting drug tolerability. Discussing side effects is part of informed consent, yet can favor nocebo effects. This study aimed to test whether a positive suggestion regarding side effects, which could act as reminders of the medication having been absorbed, might favor analgesia in a clinical interaction model. Sixty-six healthy males participated in a study “to validate pupillometry as an objective measure of analgesia”. Participants were unknowingly randomized double-blind to positive vs control information about side effects embedded in a video regarding the study drugs. Sequences of moderately painful heat stimuli applied before and after treatment with diclofenac and atropine served to evaluate analgesia. Atropine was deceptively presented as a co-analgesic, but used to induce side effects. Adverse events (AE) were collected with the General Assessment of Side Effects (GASE) questionnaire prior to the second induced pain sequence. Debriefing fully informed participants regarding the purpose of the study and showed them the two videos.The combination of medication led to significant analgesia, without a between-group difference. Positive information about side effects increased the attribution of AE to the treatment compared to the control information. The total GASE score was correlated with analgesia, i.e., the more AEs reported, the stronger the analgesia. Interestingly, there was a significant between-groups difference on this correlation: the GASE score and analgesia correlated only in the positive information group. This provides evidence for a selective link between AEs and pain relief in the group who received the suggestion that AEs could be taken as a sign “that help was on the way”. During debriefing, 65% of participants said they would prefer to receive the positive message in a clinical context. Although the present results cannot be translated immediately to clinical pain conditions, they do indicate the importance of testing this type of modulation in a clinical context

Planification de la sortie : une intervention ciblée sur l'équipe médico-soignante

Les durées des séjours hospitaliers sont souvent prolongées à cause d'une mauvaise planification de la sortie des patients après une prise en charge aigue. Dans notre institution, un score (score J3) a été créé afin de favoriser l'identification précoce des patients à risque de durées de séjour prolongées, qui pourraient bénéficier d'une planification de la sortie structurée. Notre étude a évalué l'introduction d'un programme de planification de la sortie reposant sur le score J3 dans la routine clinique d'un service de médecine interne. Nous avons étudié la capacité des équipes médico-soignantes à utiliser l'outil de planification de la sortie et les effets du programme sur les durées de séjour des patients. Nous avons constaté qu'un programme éducatif-incitatif spécifique avait rendu les équipes médico-soignantes compétentes dans l'utilisation de cet outil. De plus, ce programme de planification de la sortie a permis de raccourcir les durées des séjours hospitaliers

Neural mechanisms and cognitive factors involved in the interaction between negative mood and pain

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Neural mechanisms and cognitive factors involved in the interaction between negative mood and pain

EThOS - Electronic Theses Online ServiceGBUnited Kingdo