Management of patients presenting with generalized musculoskeletal pain and a suspicion of Lyme disease.

Lyme disease is caused by bacteria of the B. burgdorferi sensu lato complex, and can give polymorphic clinical manifestations that can affect several organs such as the skin, the central nervous system, or the joints. In recent years, patients' associations and physicians have been supporting the hypothesis that this infection would manifest as chronic generalized musculoskeletal pain symptoms, named "chronic Lyme disease".

DOLORisk: study protocol for a multi-centre observational study to understand the risk factors and determinants of neuropathic pain.

Neuropathic pain is an increasingly prevalent condition and has a major impact on health and quality of life. However, the risk factors for the development and maintenance of neuropathic pain are poorly understood. Clinical, genetic and psychosocial factors all contribute to chronic pain, but their interactions have not been studied in large cohorts.

How can the stimulation of plantar cutaneous receptors improve postural control? Review and clinical commentary.

Postural control requires constant and subconscious postural sway to manage balance and achieve postural stability. These movements of regulation are based in particular on cutaneous plantar information. The foot constitutes a functional whole that participates in the mechanisms of postural control and regulation.

Pain Trajectory After Ankle Surgeries for Osteoarthritis.

Background:: The pain trajectory after ankle surgeries for osteoarthritis is relevant to describe. The purpose of this prospective study was to describe pain after ankle surgery and explore the link between perioperative factors and the development of postoperative pain.

Methods:: Duration, severity, type of preoperative pain, psychological distress, opioid consumption, and type of surgery were evaluated in 49 patients who were followed for 18 months.

QAPSA: post-marketing surveillance of capsaicin 8% patch for long-term use in patients with peripheral neuropathic pain in France.

Objective: To describe the characteristics of patients treated with the capsaicin 8% patch, prescribing conditions, long-term effects of repeat treatment on pain intensity and perception, quality of life, and impact on concomitant medication.

Methods: A national, longitudinal, prospective, non-interventional, post-marketing open study was conducted in 50 French pain centers. Adult volunteer non-diabetic patients with peripheral neuropathic pain receiving capsaicin 8% patch treatment were consecutively enrolled.

Electrophysiology in diagnosis and management of neuropathic pain.

Electrophysiological techniques demonstrate abnormalities in somatosensory transmission, hence providing objective evidence of 'somatosensory lesion or disease' which is crucial to the diagnosis of neuropathic pain (NP). Since most instances of NP result from damage to thermo-nociceptive pathways (thin fibres and spino-thalamo-cortical systems), specific activation of these is critical to ensure diagnostic accuracy. This is currently achieved using laser pulses or contact heat stimuli, and in a near future probably also with contact cold and intra-epidermal low-intensity currents.

Neuropathic pain: Definition, assessment and epidemiology.

Neuropathic pain has been a very active and productive clinical research field over the last 15 years. Studies have concerned multiple aspects of these complex chronic pain syndromes including their very definition, the elaboration of new diagnostic algorithms, the development of specific tools for their screening and measurement and their epidemiology. In this review, we summarize these recent evolutions that have impacted the way these pain syndromes are conceptualized and managed both in daily practice and in the clinical research setting.

Pharmacological treatments of neuropathic pain: The latest recommendations.

We provide an up-to-date review of the pharmacological treatment of neuropathic pain with emphasis on the latest evidence-based recommendations for its pharmacological treatment. Drugs proposed as first line include tricyclic antidepressants (particularly amitriptyline), serotonin-norepinephrine reuptake inhibitors (particularly duloxetine), pregabalin and gabapentin. Second line treatments include lidocaine plasters and capsaicin high concentration patches for peripheral neuropathic pain only, and tramadol.

Insular-limbic dissociation to intra-epidermal electrical Aδ activation: A comparative study with thermo-nociceptive laser stimulation.

Intra-epidermal electrical stimulation (IEES) has been shown to activate selectively Aδ fibers subserving spinothalamic-mediated sensations. Owing to electrically induced highly synchronous afferent volleys, IEES induces Aδ-mediated evoked potentials at nonpainful intensities, contrasting with thermo-nociceptive laser pulses which entail painful pricking sensations. Here, we recorded intracortical responses from sensory and limbic-cognitive regions of human subjects in response to IEE and laser stimuli, in order to test the hypothesis that IEES could dissociate the sensory from nonsensory networks of nociceptive processing.

Low additional thickness under the toes could change upright balance of healthy subjects.

The purpose of the study was to evaluate the effect of an additional thickness placed under the toes (TUT) on the CoP measures and to determine the optimum thickness required to maximize the postural control performance. Four conditions were compared: TUT 0 (control), 0.8, 3, and 6mm and four variables were computed from the CoP displacements.

Convergence of sensory and limbic noxious input into the anterior insula and the emergence of pain from nociception.

Two parallel di-synaptic routes convey nociceptive input to the telencephalon: the spino-thalamic system projecting principally to the posterior insula, and the spino-parabrachial pathway reaching the amygdalar nucleus. Interplay between the two systems underlies the sensory and emotional aspects of pain, and was explored here in humans with simultaneous recordings from the amygdala, posterior and anterior insulae. Onsets of thermo-nociceptive responses were virtually identical in the posterior insula and the amygdalar complex, but no significant functional connectivity was detected between them using coherence analysis.

Peripheral delta opioid receptors mediate duloxetine antiallodynic effect in a mouse model of neuropathic pain.

Peripheral delta opioid (DOP) receptors are essential for the antiallodynic effect of the tricyclic antidepressant nortriptyline. However, the population of DOP-expressing cells affected in neuropathic conditions or underlying the antiallodynic activity of antidepressants remains unknown. Using a mouse line in which DOP receptors were selectively ablated in cells expressing Nav1.

Neuropathic pain clinical trials: factors associated with decreases in estimated drug efficacy.

Multiple recent pharmacological clinical trials in neuropathic pain have failed to show beneficial effect of drugs with previously demonstrated efficacy, and estimates of drug efficacy seems to have decreased with accumulation of newer trials. However, this has not been systematically assessed. Here, we analyze time-dependent changes in estimated treatment effect size in pharmacological trials together with factors that may contribute to decreases in estimated effect size.

Phenylpyridine-2-ylguanidines and rigid mimetics as novel inhibitors of TNFα overproduction: Beneficial action in models of neuropathic pain and of acute lung inflammation.

4-phenylpyridin-2-yl-guanidine (5b): a new inhibitor of the overproduction of pro-inflammatory cytokines (TNFα and Il1β) was identified from a high-throughput screening of a chemical library on human peripheral blood mononuclear cells (PBMCs) after LPS stimulation. Derivatives, homologues and rigid mimetics of 5b were designed and synthesized, and their cytotoxicity and ability to inhibit TNFα overproduction were evaluated. Among them, compound 5b and its mimetic 12 (2-aminodihydroquinazoline) showed similar inhibitory activities, and were evaluated in vivo in models of lung inflammation and neuropathic pain in mice.

Headache Characteristics and Clinical Features of Elderly Migraine Patients.

Objective: To investigate the headache characteristics and clinical features of elderly migraine patients at a tertiary headache center.

Methods: We retrospectively reviewed 239 records of migraine patients, over the age of 64 at the first visit, who had migraine as defined by the International Classification of Headache Disorders 3rd edition (beta version) from 2006 to 2015 based on the Marseille registry at Timone Hospital.

Results: 13.

Pain in the elderly and cognition: state of play.

Cognitive impairment is commonly associated with the pain experience. This deterioration regarding several cognitive domains such as attention, speed of information processing, memory, learning and executive functions, represents a major obstacle to daily activities and mobility especially in the elderly for whom a decrease in mobility is a significant risk factor for death and disability. Regarding the demographic rising in the elderly population expected by 2050 (the proportion of persons aged 60 and above is expected to double according to ONU estimate) and the high prevalence of pain in this age reaching 80% in nursing homes, clinicians should be better aware of the links between pain and cognition in this population's segment so that they offer each patient an appropriate treatment.

Neuropathic pain in cancer: systematic review, performance of screening tools and analysis of symptom profiles.

Background: The objectives of this study were to evaluate the methodological quality of rigorous neuropathic pain assessment tools in applicable clinical studies, and determine the performance of screening tools for identifying neuropathic pain in patients with cancer.

Methods: Systematic literature search identified studies reporting use of Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Douleur Neuropathique en 4 (DN4) or painDETECT (PDQ) in cancer patients with a clinical diagnosis of neuropathic or not neuropathic pain. Individual patient data were requested to examine descriptor item profiles.

Assessment and manifestation of central sensitisation across different chronic pain conditions.

Unlabelled: Different neuroplastic processes can occur along the nociceptive pathways and may be important in the transition from acute to chronic pain and for diagnosis and development of optimal management strategies. The neuroplastic processes may result in gain (sensitisation) or loss (desensitisation) of function in relation to the incoming nociceptive signals. Such processes play important roles in chronic pain, and although the clinical manifestations differ across condition processes, they share some common mechanistic features.

Effect of ketamine combined with magnesium sulfate in neuropathic pain patients (KETAPAIN): study protocol for a randomized controlled trial.

Background: Neuropathic pain is difficult to treat, and the efficacy of recommended drugs remains limited. N-methyl-D-aspartate receptors are implicated, and antagonists are a pharmacological option. Ketamine is widely used in French pain clinics, but without consensus or recommendations.