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Yarnitsky D.,Rambam Medical Center | Yarnitsky D.,Laboratory of Clinical Neurophysiology
Current Opinion in Anaesthesiology | Year: 2010

Purpose of review: There is a growing body of knowledge on pain modulation in various disease states. This article reviews the state of the art regarding the clinical relevance of pain inhibition as revealed by 'pain inhibits pain' test paradigms, trying to organize the clinically relevant data, and emphasizing the pathophysiology of pain. In line with recent experts' recommendations, the term conditioned pain modulation (CPM) will be used, replacing the previous terms 'diffuse noxious inhibitory control (DNIC)' or 'DNIC-like' effects. Recent findings: Most of the work in this context was done on the idiopathic pain syndromes, such as irritable bowel syndrome, temporomandibular disorders, fibromyalgia, and tension type headache. The pattern of reduced CPM efficiency seems common to these syndromes and an assertion is made that low CPM efficiency, reflecting low pain inhibitory capacity, is a pathogenetic factor in the development of the idiopathic pain syndromes. Low CPM efficiency was shown to be predictive of acute and chronic postoperative pain, and, in some reports, to be associated with neuropathic pain levels. SUMMARY: Low CPM efficiency is associated with higher pain morbidity and vice versa. Further work is awaited on clarifying plasticity of CPM and its relevance to selection and efficacy of pain therapy. © 2010 Wolters Kluwer Health | Lippincott Williams and Wilkins. Source


Panagiotis K.,Laboratory of Clinical Neurophysiology | Alexandra A.,Metropolitan Hospital | Nikos K.,Laboratory of Clinical Neurophysiology
Muscle and Nerve | Year: 2016

Introduction: In this study we aimed to determine the normal lower limits of sensory nerve action potential (SNAP) amplitude of the radial nerve by taking into account age, height, weight, and body mass index (BMI). Methods: Three hundred thirty-four volunteers, 168 men and 166 women, were recruited. Sensory nerve conduction studies of the radial nerve were performed, and reproducible waveforms were obtained. Results: The mean radial SNAP amplitude was 44.87±14.58 (range 24-92) μV. SNAP amplitude had a statistically strong negative correlation with age, height, weight, and BMI of the subjects. A multiple linear correlation equation was computed, based on age and BMI of the subjects, to calculate the lower normal limits of radial SNAP and to construct the corresponding nomogram. Conclusion The lower limit of normal SNAP amplitude of the radial nerve, determined in individual subjects using the nomogram, is a useful tool for detection of polyneuropathy. © 2016 Wiley Periodicals, Inc. Source


Nir R.-R.,Laboratory of Clinical Neurophysiology | Yarnitsky D.,Laboratory of Clinical Neurophysiology
Current Opinion in Supportive and Palliative Care | Year: 2015

Purpose of review Conditioned pain modulation (CPM) paradigms have been increasingly used over the past few years to assess endogenous analgesia capacity in healthy individuals and pain patients. The current review concentrates on selected recent literature advancing our understanding and practice of CPM. Recent findings The main themes covered by the present CPM review include underlying mechanisms, approaches to experimental investigation, practicality in clinical practice, neurophysiological and psychophysiological correlates, and pharmacological solutions to pain modulation dysfunction. Summary The reviewed literature refines the methodology used for eliciting CPM responses and characterizing their physiological attributes in healthy individuals and pain patients, and exemplifies the materializing concept of individualized pain medicine through targeting impaired mechanisms of pain modulation by designated drugs for optimal pain alleviation. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source


Cavalera C.,Catholic University of the Sacred Heart | Pagnini F.,Catholic University of the Sacred Heart | Rovaris M.,Multiple Sclerosis Rehabilitation Unit | Mendozzi L.,Multiple Sclerosis Rehabilitation Unit | And 3 more authors.
Trials | Year: 2016

Background: Mindfulness-based interventions, modified and shortened versions of meditation teachings, have proved to be effective in the improvement of quality of life in many clinical conditions, including chronic diseases. Preliminary results available in the literature and in clinical experience indicate a high potential for this treatment for the reduction of psychological suffering in people with chronic diseases. Methods/Design: This randomized controlled trial will investigate the impact of a multiple sclerosis (MS) specific telemedicine meditation intervention on the quality of life of people with multiple sclerosis and their caregivers. This trial will recruit 120 patients, men and women, with a diagnosis of relapsing-remitting or secondary progressive MS and their caregivers to participate in a 2-month intervention. Patients will undergo assessments of quality of life, anxiety, depression, quality of sleep, mindfulness and fatigue levels conducted at baseline, at week 8 (conclusion of the intervention) and at week 27 (6 months follow-up). Caregivers will complete assessments conducted at the same time for the same areas, plus caregiver burden. The intervention condition will consist of 2 hours/week of online meditation in a group setting led by a trainer, plus 1 hour/week of individual exercises. The control condition will incorporate a psycho-education online program and will require the same contact time commitment as the intervention condition. Discussion: Primary outcome measures will consist of assessments of quality of life, anxiety, and depression level. Assessments of mindfulness level, quality of sleep and fatigue level will be considered secondary outcome measures. This investigation will increase understanding of the role of meditation as part of a treatment plan for people with MS and their caregivers. Overall, this study design has the potential to lead to effective meditation intervention strategies for this population and improve their quality of life. Trial registration: Clinical Trials Register NCT02364505. https://clinicaltrials.gov/ct2/show/NCT02364505 © 2016 Cavalera et al. Source


Yarnitsky D.,Rambam Health Care Campus | Yarnitsky D.,Laboratory of Clinical Neurophysiology | Granot M.,Haifa University | Nahman-Averbuch H.,Laboratory of Clinical Neurophysiology | And 3 more authors.
Pain | Year: 2012

This study aims to individualize the selection of drugs for neuropathic pain by examining the potential coupling of a given drug's mechanism of action with the patient's pain modulation pattern. The latter is assessed by the conditioned pain modulation (CPM) and temporal summation (TS) protocols. We hypothesized that patients with a malfunctioning pain modulation pattern, such as less efficient CPM, would benefit more from drugs augmenting descending inhibitory pain control than would patients with a normal modulation pattern of efficient CPM. Thirty patients with painful diabetic neuropathy received 1 week of placebo, 1 week of 30 mg/d duloxetine, and 4 weeks of 60 mg/d duloxetine. Pain modulation was assessed psychophysically, both before and at the end of treatment. Patient assessment of drug efficacy, assessed weekly, was the study's primary outcome. Baseline CPM was found to be correlated with duloxetine efficacy (r = 0.628, P <.001, efficient CPM is marked negative), such that less efficient CPM predicted efficacious use of duloxetine. Regression analysis (R2 = 0.673; P =.012) showed that drug efficacy was predicted only by CPM (P =.001) and not by pretreatment pain levels, neuropathy severity, depression level, or patient assessment of improvement by placebo. Furthermore, beyond its predictive value, the treatment-induced improvement in CPM was correlated with drug efficacy (r = -0.411, P =.033). However, this improvement occurred only in patients with less efficient CPM (16.8 ± 16.0 to -1.1 ± 15.5, P <.050). No predictive role was found for TS. In conclusion, the coupling of CPM and duloxetine efficacy highlights the importance of pain pathophysiology in the clinical decision-making process. This evaluative approach promotes personalized pain therapy. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. Source

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