Characterization of small nerve fibers in painful distal symmetric polyneuropathy and healthy controls

Characterization of small nerve fibers in painful distal symmetric polyneuropathy and healthy... Abstracts / Scandinavian Journal of Pain 8 (2015) 47–54participants reporting chronic pain (≥3 months) were tested byusing bivariate and multivariate statistical analysis.Results: The prevalence of chronic pain among respondentswas 47.5%. Among participants reporting chronic pain, 53.2% hadconsulted a health care provider for pain during the previous sixmonths. Predictors for pain related health care utilization were paininterference with daily life and pain pattern (daily pain) as well asphysical components of HRQoL. Even though health care utilization was not related to gender, there were gender differences inpain-related predictors for health care utilization. Interference withdaily life and pain pattern were the strongest predictors amongwomen, but interference with life and the physical components ofHRQoL were the strongest predictors for men. Pain related healthcare utilization was not related to socio-demographic variables.Conclusions: Pain related variables are better predictorsof chronic pain related health care utilization than sociodemographics. Even though gender does not predict chronicpain-related health care utilization, there are gender differences inthe relationships between pain-related variables and health careutilization. These gender differences warrant further exploration.http://dx.doi.org/10.1016/j.sjpain.2015.04.013Cerebrospinal fluid levels of substance P (SP)N-terminal fragment SP1–7 in patients withneuropathic painA. Jonsson a,∗ , A.-L. Lind b , M. Hallberg a , F.Nyberg a , T. Gordh baUppsala University, Department of PharmaceuticalBiosciences, Uppsala, Swedenb Uppsala University Hospital, Department ofSurgical Sciences, Anaesthesiology and IntensiveCare, Uppsala, SwedenE-mail address: Anna.Jonsson@farmbio.uu.se (A.Jonsson).Aims: Neuropathic pain is a complex and painful condition,which is difficult to treat and causes a lot of suffering. The substanceP (SP) system is well known to be involved in nociceptive signalingand it has previously been shown that the cerebrospinal fluid (CSF)level of SP is decreased in neuropathic pain. In this study we analyzed CSF from chronic neuropathic pain patients for the levels ofSP1–7 , an N-terminal fragment of SP with the ability to alleviatethermal as well as mechanical hypersensitivity in different animalmodels of chronic neuropathic pain, e.g. [1,2].Methods: CSF was collected from 11 neuropathic pain patients,treated with SCS, who had refrained from using their spinal cordstimulator for 48 h. Control CSF was collected from 11 patientswithout any known neurological disorder, who underwent minorsurgery under spinal anesthesia. The CSF samples were analyzedfor the levels of SP1–7 using radioimmunoassay.Results: The results revealed a decrease in the level of SP1–7compared to controls. We believe that the lower level of SP1–7 mostlikely is a consequence of reduced amount of its precursor SP in theneuropathic pain patients.Conclusions: Our results indicate that the SP system is changedin patients with neuropathic pain and that SP-related peptides,including SP1–7 , might serve as biological markers for the pathophysiology of chronic neuropathic pain.References[1] Carlsson A, Ohsawa M, Hallberg M, Nyberg F, Kamei J. Substance P1–7 inducesantihyperalgesia in diabetic mice through a mechanism involving the naloxonesensitive sigma receptors. Eur J Pharmacol 2010;626:250–5.51[2] Carlsson-Jonsson A, Gao T, Hao J, Fransson R, Sandström A, Nyberg F, WiesenfeldHallin Z, Xu X-J. N-terminal truncations of substance P1–7 amide affect its actionon spinal cord injury-induced mechanical allodynia in rats. Eur J Pharmacol2014;738:319–25.http://dx.doi.org/10.1016/j.sjpain.2015.04.014Characterization of small nerve fibers in painfuldistal symmetric polyneuropathy and healthycontrolsP. Karlsson a,d,∗ , S. Haroutounian a,b , M.Polydefkis c , J.R. Nyengaard d , T.S. Jensen a,eaDanish Pain Research Center, Aarhus UniversityHospital, Aarhus, Denmarkb Department of Anesthesiology, WashingtonUniversity School of Medicine, St. Louis, MO, USAc Department of Neurology, The Johns HopkinsHospital, Baltimore, MD, USAd Stereology and Electron Microscopy Laboratoryand Centre for Stochastic Geometry and AdvancedBioimaging, Aarhus University Hospital, Aarhus,Denmarke Department of Neurology, Aarhus UniversityHospital, Aarhus, DenmarkE-mail address: pall@clin.au.dk (P. Karlsson).Aims: The introduction of skin biopsies to examine smallnerve fiber morphology together with functional measures suchas quantitative sensory testing (QST) has led to an improvement indiagnosing patients with small fiber neuropathy (SFN). Quantification of intraepidermal nerve fiber density (IENFD) is an importantmeasure in SFN. However, the relationship between structureand function is not straightforward and the morphological andfunctional fiber characteristics are still unclear. This study aimedto combine structural and functional measurements to improvethe diagnosis of distal symmetric polyneuropathy and small fiberinvolvement. Additionally, we investigated whether patients andhealthy controls have differential patterns of correlations betweenstructural and functional nerve measurements.Methods: 17 patients with painful distal symmetric polyneuropathy (DSP) and 19 controls underwent comprehensive smallfiber assessments that included quantitative sensory testing,response to topical capsaicin and analysis of skin biopsy samples(IENFD, epidermal and dermal nerve fiber length densities (eNFLD,dNFLD) and swellings).Results: DSP patients had reduced sensitivity to cold andheat, diminished capsaicin response, and lower IENFD, eNFLD anddNFLD (all p < 0.0003). The correlation between structural and functional parameters was better in controls than in DSP. A diagnosticapproach of combined IENFD and eNFLD utilization, increased DSPdiagnostic sensitivity from 82.0% to 100% and specificity from 84.0%to 89.5%.Conclusions: A correlation is found between functional andstructural small fiber parameters for DSP and controls, and anapproach to improve diagnostic accuracy in DSP is suggested.http://dx.doi.org/10.1016/j.sjpain.2015.04.015 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Characterization of small nerve fibers in painful distal symmetric polyneuropathy and healthy controls

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de Gruyter
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© 2015 Scandinavian Association for the Study of Pain
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1877-8860
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10.1016/j.sjpain.2015.04.015
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Abstract

Abstracts / Scandinavian Journal of Pain 8 (2015) 47–54participants reporting chronic pain (≥3 months) were tested byusing bivariate and multivariate statistical analysis.Results: The prevalence of chronic pain among respondentswas 47.5%. Among participants reporting chronic pain, 53.2% hadconsulted a health care provider for pain during the previous sixmonths. Predictors for pain related health care utilization were paininterference with daily life and pain pattern (daily pain) as well asphysical components of HRQoL. Even though health care utilization was not related to gender, there were gender differences inpain-related predictors for health care utilization. Interference withdaily life and pain pattern were the strongest predictors amongwomen, but interference with life and the physical components ofHRQoL were the strongest predictors for men. Pain related healthcare utilization was not related to socio-demographic variables.Conclusions: Pain related variables are better predictorsof chronic pain related health care utilization than sociodemographics. Even though gender does not predict chronicpain-related health care utilization, there are gender differences inthe relationships between pain-related variables and health careutilization. These gender differences warrant further exploration.http://dx.doi.org/10.1016/j.sjpain.2015.04.013Cerebrospinal fluid levels of substance P (SP)N-terminal fragment SP1–7 in patients withneuropathic painA. Jonsson a,∗ , A.-L. Lind b , M. Hallberg a , F.Nyberg a , T. Gordh baUppsala University, Department of PharmaceuticalBiosciences, Uppsala, Swedenb Uppsala University Hospital, Department ofSurgical Sciences, Anaesthesiology and IntensiveCare, Uppsala, SwedenE-mail address: Anna.Jonsson@farmbio.uu.se (A.Jonsson).Aims: Neuropathic pain is a complex and painful condition,which is difficult to treat and causes a lot of suffering. The substanceP (SP) system is well known to be involved in nociceptive signalingand it has previously been shown that the cerebrospinal fluid (CSF)level of SP is decreased in neuropathic pain. In this study we analyzed CSF from chronic neuropathic pain patients for the levels ofSP1–7 , an N-terminal fragment of SP with the ability to alleviatethermal as well as mechanical hypersensitivity in different animalmodels of chronic neuropathic pain, e.g. [1,2].Methods: CSF was collected from 11 neuropathic pain patients,treated with SCS, who had refrained from using their spinal cordstimulator for 48 h. Control CSF was collected from 11 patientswithout any known neurological disorder, who underwent minorsurgery under spinal anesthesia. The CSF samples were analyzedfor the levels of SP1–7 using radioimmunoassay.Results: The results revealed a decrease in the level of SP1–7compared to controls. We believe that the lower level of SP1–7 mostlikely is a consequence of reduced amount of its precursor SP in theneuropathic pain patients.Conclusions: Our results indicate that the SP system is changedin patients with neuropathic pain and that SP-related peptides,including SP1–7 , might serve as biological markers for the pathophysiology of chronic neuropathic pain.References[1] Carlsson A, Ohsawa M, Hallberg M, Nyberg F, Kamei J. Substance P1–7 inducesantihyperalgesia in diabetic mice through a mechanism involving the naloxonesensitive sigma receptors. Eur J Pharmacol 2010;626:250–5.51[2] Carlsson-Jonsson A, Gao T, Hao J, Fransson R, Sandström A, Nyberg F, WiesenfeldHallin Z, Xu X-J. N-terminal truncations of substance P1–7 amide affect its actionon spinal cord injury-induced mechanical allodynia in rats. Eur J Pharmacol2014;738:319–25.http://dx.doi.org/10.1016/j.sjpain.2015.04.014Characterization of small nerve fibers in painfuldistal symmetric polyneuropathy and healthycontrolsP. Karlsson a,d,∗ , S. Haroutounian a,b , M.Polydefkis c , J.R. Nyengaard d , T.S. Jensen a,eaDanish Pain Research Center, Aarhus UniversityHospital, Aarhus, Denmarkb Department of Anesthesiology, WashingtonUniversity School of Medicine, St. Louis, MO, USAc Department of Neurology, The Johns HopkinsHospital, Baltimore, MD, USAd Stereology and Electron Microscopy Laboratoryand Centre for Stochastic Geometry and AdvancedBioimaging, Aarhus University Hospital, Aarhus,Denmarke Department of Neurology, Aarhus UniversityHospital, Aarhus, DenmarkE-mail address: pall@clin.au.dk (P. Karlsson).Aims: The introduction of skin biopsies to examine smallnerve fiber morphology together with functional measures suchas quantitative sensory testing (QST) has led to an improvement indiagnosing patients with small fiber neuropathy (SFN). Quantification of intraepidermal nerve fiber density (IENFD) is an importantmeasure in SFN. However, the relationship between structureand function is not straightforward and the morphological andfunctional fiber characteristics are still unclear. This study aimedto combine structural and functional measurements to improvethe diagnosis of distal symmetric polyneuropathy and small fiberinvolvement. Additionally, we investigated whether patients andhealthy controls have differential patterns of correlations betweenstructural and functional nerve measurements.Methods: 17 patients with painful distal symmetric polyneuropathy (DSP) and 19 controls underwent comprehensive smallfiber assessments that included quantitative sensory testing,response to topical capsaicin and analysis of skin biopsy samples(IENFD, epidermal and dermal nerve fiber length densities (eNFLD,dNFLD) and swellings).Results: DSP patients had reduced sensitivity to cold andheat, diminished capsaicin response, and lower IENFD, eNFLD anddNFLD (all p < 0.0003). The correlation between structural and functional parameters was better in controls than in DSP. A diagnosticapproach of combined IENFD and eNFLD utilization, increased DSPdiagnostic sensitivity from 82.0% to 100% and specificity from 84.0%to 89.5%.Conclusions: A correlation is found between functional andstructural small fiber parameters for DSP and controls, and anapproach to improve diagnostic accuracy in DSP is suggested.http://dx.doi.org/10.1016/j.sjpain.2015.04.015

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Scandinavian Journal of Painde Gruyter

Published: Jul 1, 2015

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