P003. NSAIDs for symptomatic treatment of headache

Background and aims Clinical observations suggest that the use of non-steroidal anti-inflammatory drugs (NSAIDs) for symptomatic treatment of headache is not in line with recommendations by international guidelines [1]. The aim of the study was to evaluate NSAIDs use for episodic headache at the Headache Centre of the Chieti University in the period: January 2000-February 2013

Sleep affects cortical source modularity in temporal lobe epilepsy: A high-density EEG study

Objective: Interictal epileptiform discharges (IEDs) constitute a perturbation of ongoing cerebral rhythms, usually more frequent during sleep. The aim of the study was to determine whether sleep influences the spread of IEDs over the scalp and whether their distribution depends on vigilance-related modifications in cortical interactions. Methods: Wake and sleep 256-channel electroencephalography (EEG) data were recorded in 12 subjects with right temporal lobe epilepsy (TLE) differentiated by whether they had mesial or neocortical TLE. Spikes were selected during wake and sleep. The averaged waking signal was subtracted from the sleep signal and projected on a bidimensional scalp map; sleep and wake spike distributions were compared by using a t-test. The superimposed signal of sleep and wake traces was obtained; the rising phase of the spike, the peak, and the deflections following the spike were identified, and their cortical generator was calculated using low-resolution brain electromagnetic tomography (LORETA) for each group. Results: A mean of 21 IEDs in wake and 39 in sleep per subject were selected. As compared to wake, a larger IED scalp projection was detected during sleep in both mesial and neocortical TLE (p<0.05). A series of EEG deflections followed the spike, the cortical sources of which displayed alternating activations of different cortical areas in wake, substituted by isolated, stationary activations in sleep in mesial TLE and a silencing in neocortical TLE. Conclusion: During sleep, the IED scalp region increases, while cortical interaction decreases. Significance: The interaction of cortical modules in sleep and wake in TLE may influence the appearance of IEDs on scalp EEG; in addition, IEDs could be proxies for cerebral oscillation perturbation

Laparoscopic Cholecystectomy for Gallbladder Calculosis in Fibromyalgia Patients: Impact on Musculoskeletal Pain, Somatic Hyperalgesia and Central Sensitization

<div><p>Fibromyalgia, a chronic syndrome of diffuse musculoskeletal pain and somatic hyperalgesia from central sensitization, is very often comorbid with visceral pain conditions. In fibromyalgia patients with gallbladder calculosis, this study assessed the short and long-term impact of laparoscopic cholecystectomy on fibromyalgia pain symptoms. Fibromyalgia pain (VAS scale) and pain thresholds in tender points and control areas (skin, subcutis and muscle) were evaluated 1week before (basis) and 1week, 1,3,6 and 12months after laparoscopic cholecystectomy in fibromyalgia patients with symptomatic calculosis (n = 31) vs calculosis patients without fibromyalgia (n. 26) and at comparable time points in fibromyalgia patients not undergoing cholecystectomy, with symptomatic (n = 27) and asymptomatic (n = 28) calculosis, and no calculosis (n = 30). At basis, fibromyalgia+symptomatic calculosis patients presented a significant linear correlation between the number of previously experienced biliary colics and fibromyalgia pain (direct) and muscle thresholds (inverse)(p<0.0001). After cholecystectomy, fibromyalgia pain significantly increased and all thresholds significantly decreased at 1week and 1month (1-way ANOVA, p<0.01-p<0.001), the decrease in muscle thresholds correlating linearly with the peak postoperative pain at surgery site (p<0.003-p<0.0001). Fibromyalgia pain and thresholds returned to preoperative values at 3months, then pain significantly decreased and thresholds significantly increased at 6 and 12months (p<0.05-p<0.0001). Over the same 12-month period: in non-fibromyalgia patients undergoing cholecystectomy thresholds did not change; in all other fibromyalgia groups not undergoing cholecystectomy fibromyalgia pain and thresholds remained stable, except in fibromyalgia+symptomatic calculosis at 12months when pain significantly increased and muscle thresholds significantly decreased (p<0.05-p<0.0001). The results of the study show that biliary colics from gallbladder calculosis represent an exacerbating factor for fibromyalgia symptoms and that laparoscopic cholecystectomy produces only a transitory worsening of these symptoms, largely compensated by the long-term improvement/desensitization due to gallbladder removal. This study provides new insights into the role of visceral pain comorbidities and the effects of their treatment on fibromyalgia pain/hypersensitivity.</p></div

FMS symptoms and pain sensitivity in [sGb+Cholec].

<p>Patients with symptomatic gallbladder calculosis (sGb) subjected to cholecystectomy (Cholec) during the 1^st year (n = 26, Means ± SD). Evaluations performed at comparable time points as for patients in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0153408#pone.0153408.g005" target="_blank">Fig 5</a>. (A),(B),(C) Pain thresholds to electrical stimulation in skin, subcutis and muscle and to (D) pressure stimulation in muscle in control areas (mean of values recorded in trapezius, deltoid and quadriceps). No trend for variation in any of the recorded parameters. ANOVA for repeated measures: for EPTs in skin [P = 0.1050; F = 1.866], for EPTs in subcutis [P = 0.2035; F = 1.472]; for EPTs in muscle [P = 0.3216; F = 1.182]; for PPTs in muscle [P = 0.3018; F = 1.224].</p

FMS symptoms and pain sensitivity in [FMS].

<p>Patients with fibromyalgia (FMS) without gallbladder calculosis (n = 30, Means ± SD), followed for a period of 1 year at comparable time points as patients in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0153408#pone.0153408.g005" target="_blank">Fig 5</a>. (A) Spontaneous fibromyalgia pain (VAS); (B) Pain thresholds to pressure stimulation at the 18 Tender Points (TePs); (C),(D),(E) Pain thresholds to electrical stimulation in skin, subcutis and muscle and to (F) pressure stimulation in muscle in control areas (mean of values recorded in trapezius, deltoid and quadriceps). No significant trend for all parameters. ANOVA for repeated measures: for VAS [P = 0.1200; F = 1.782], for PPTs in TePs [P = 0.8699; F = 0.3679]; for EPTs in skin [P = 0.1460; F = 1.668], for EPTs in subcutis [P = 0.2237; F = 1.411], for EPTs in muscle [P = 0.1109; F = 1.828], for PPTs in muscle [P = 0.1113; F = 1.826].</p

Pain thresholds in control areas in basal conditions (1^st year study).

<p>Means ± SD for all patients’ groups. Significant trend at 1-way ANOVA: P<0.0001 for all parameters (F = 52.251 for EPTs in skin, 45.450 for EPTs in subcutis, 149.21 for EPTs in muscle, 254.60 for PPTs in muscle). The symbols over SD bars denote a significant difference with respect to the other groups.</p

Fibromyalgia symptoms.

<p>Comparison among groups at times 1w-12m – 1^st year study.</p

Biliary and fibromyalgia symptoms in basal conditions (1^st year-study).

<p>Biliary and fibromyalgia symptoms in basal conditions (1^st year-study).</p