Neuropeptides, neurogenic inflammation and complex regional pain syndrome (CRPS)

This review explains symptoms and nature of neuropeptide signaling and its importance for clinical symptoms of CRPS. Neurogenic inflammation regularly accompanies excitation of primary afferent nociceptors. It has two major components-plasma extravasation and vasodilatation. The most important mediators are the calcitonin gene-related peptide (CGRP) and substance P (SP). After peripheral trauma immune reaction (e.g. cytokines) and the attempts of the tissue to regenerate (e.g. growth factors) sensitize nociceptors and amplify neurogenic inflammation. This cascade of events has been demonstrated in rat models of CRPS. Clinical findings in these animals strongly resemble clinical findings in CRPS, and can be prevented by anti-cytokine and anti-neuropeptide treatment. In CRPS patients, there is meanwhile also plenty of evidence that neurogenic inflammation contributes to clinical presentation. Increased cytokine production was demonstrated, as well as facilitated neurogenic inflammation. Very recently even "non-inflammatory" signs of CRPS (hyperhidrosis, cold skin) have been linked to neuropeptide signaling. Surprisingly, there was even moderately increased neurogenic inflammation in unaffected body regions. This favors the possibility that CRPS patients share genetic similarities. The future search for genetic commonalities will help us to further unravel the "mystery" CRPS.     

Parenting adolescent girls with type 1 diabetes: parents' perspectives

OBJECTIVE: To explore parents' perceptions of the impact of type 1 diabetes mellitus (DM) on the family and to better understand parent-child conflict, parental worries, and coping strategies related to the management of DM in adolescence. METHODS: Semistructured interviews were conducted with the parents of 30 adolescent girls who had DM for at least 1 year. Using standard procedures for content analysis, themes were identified from the parents' discussions. RESULTS: Although parents reported worries, conflicts, and negative impacts of the DM on their family, they also recognized positive aspects of the DM (e.g., it promotes adolescent responsibility) and had strategies to cope with its challenges (e.g., letting go of perfectionism in disease management, keeping a positive attitude). CONCLUSIONS: Findings from this study can be used by clinicians to assess parents' concerns about DM and to help them discover ways to cope with their worries and stay involved with the disease's management. Considering the parents' perspective will likely lead to parents feeling understood by the health care team and will help to reduce their worries.     

Mean sustained pain levels are linked to hemispherical side-to-side differences of primary somatosensory cortex in the complex regional pain syndrome I

Chronic back pain as well as phantom-limb pain is characterized by a close relationship between the amount of cortical reorganization and the magnitude of pain. In patients with positively assessed complex regional pain syndrome type I (CRPS I), we found a positive correlation between representational changes of primary somatosensory cortex (SI) and mean sustained pain levels. We investigated seven right-handed patients with CRPS I of one upper limb by means of somatosensory evoked potential (SSEP) mapping. Cortical representation of the CRPS-affected hand was significantly smaller than that of the contralateral healthy hand, giving rise to a substantial side difference. Subjective pain levels experienced over the last 4 weeks were estimated according to the visual analogue scale (VAS). Individual expansion of hand representation contralateral to the CRPS-affected limb was significantly correlated with mean pain intensity. Accordingly, low pain levels were linked to small representational side-to-side differences, while subjects with a distinctive hemispherical asymmetry reported the highest pain levels. Follow-up studies using functional imaging methods might be instrumental in providing a better understanding of this issue.     

Resilience among African American adolescent mothers: predictors of positive parenting in early infancy

OBJECTIVE: To use Nath et al.'s (1991) conceptual model of adolescent parenting to examine the relationship between resiliency factors measured shortly after delivery and maternal parenting behavior at 6 months. METHOD: We recruited 181 first-time, adolescent African American mothers at delivery. Data on resiliency factors (maturity, self-esteem, and mother-grandmother relationships) were collected when infants were 1-4 weeks of age. Data on parental nurturance and parenting satisfaction were examined through observations and self-report at 6 months. RESULTS: Multiple regression analyses were used to examine the longitudinal impact of resiliency factors on parental nurturance and parenting satisfaction. Maternal maturity, positive self-esteem, and positive adolescent mother-grandmother relationships (characterized by autonomy and mutuality) were associated with better parenting outcomes. Maternal parenting satisfaction was lowest when infants were temperamentally difficult and mothers and grandmothers had a confrontational relationship. CONCLUSIONS: Longitudinal associations between mother-grandmother relationships at delivery and parental behavior and satisfaction 6 months later may suggest an intergenerational transmission of parenting style. Recommendations are provided for intervention programs to enhance mother-grandmother relationships in contexts where adolescents are required to live with a guardian to receive government assistance.     

Systematic review of chronic pain in persons with Marfan syndrome

The purpose of this study was to explore the literature on chronic pain in adults with Marfan syndrome (MFS), critically appraising and synthesizing relevant literature. A systematic review was conducted by searching the published literature databases using available medical, physical, psychological, social databases and other sources. All studies that addressed pain in MFS, published in peer‐reviewed journals were assessed. Of 351 search results, 18 articles satisfied the eligibility criteria. All studies were cross‐sectional and quantitative; no randomized controlled trials or intervention studies were found. Most studies had small sample sizes, low response rates and mainly dealt with other aspects of the diagnosis than pain. Only one article dealt mainly with pain. The research on chronic pain in MFS is limited in size and quality. Despite these limitations, studies describe that the prevalence of pain in patients with MFS is high, varying from 47 to 92% and affecting several anatomic sites. In addition, chronic pain limits daily function and few studies describe treatment options for pain in patients with MFS. Research is needed to obtain more evidence‐based knowledge for developing more appropriate rehabilitation programs for people with MFS.     

Experiences of chronic low back pain: a meta-ethnography of qualitative research

Chronic low back pain (CLBP) is associated with a number of costly disability-related outcomes. It has received increasing attention from qualitative researchers studying its consequences for personal, social, and health care experiences. As research questions and methods diversify, there is a growing need to integrate findings emerging from these studies. A meta-ethnography was carried out to synthesise the findings of 38 separate qualitative articles published on the subjective experience of CLBP between 1994 and 2011. Studies were identified following a literature search and quality appraisal. Four themes were proposed after a process of translating the meaning of text extracts from the findings sections across all the articles. The themes referred to the undermining influence of pain, its disempowering impact on all levels, unsatisfying relationships with health care professionals, and learning to live with the pain. The findings are dominated by wide-ranging distress and loss but also acknowledge self-determination and resilience. Implications of the meta-ethnography for clinicians and future qualitative research are outlined, including the need to study relatively unexamined facets of subjective experience such as illness trajectory and social identity.     

Parent factors and adolescent sickle cell disease: associations with patterns of health service use

OBJECTIVE: To examine relationships among parent characteristics (parent-adolescent relationship, parents' illness knowledge, and parents' perceptions of illness-related burden) and use of routine and urgent health services among adolescents with sickle cell disease (SCD). METHOD: Seventy adolescents, ages 12-18, and their parents completed questionnaires assessing illness knowledge, perceptions of illness burden, parent-adolescent relationships, and adolescents' psychological functioning. Information about pain, routine services (i.e., care at home, clinic visits) and urgent service use (i.e., emergency department visits, hospitalizations) was obtained from parents and medical records. RESULTS: After we controlled for disease severity and life events, parents' perception of more illness-related stress was the strongest predictor of both types of service use. Greater parental knowledge about SCD also related to higher frequency of routine service use. Disease severity was strongly associated with frequency of urgent service use. CONCLUSIONS: Both parent characteristics and disease severity were associated with patterns of service use. Enhancing aspects of parental functioning may help families make adaptive decisions regarding health care services for SCD pain management.     

Disclosures of self-injurious thoughts and behaviors to parents in the context of adolescent therapy: A qualitative investigation

Self-injurious thoughts and behaviors (SITBs), including suicidal thoughts, suicide attempts, and nonsuicidal self-injury, are highly prevalent among adolescents. Identifying adolescents at risk for SITBs relies on their disclosure, and these disclosures commonly occur in therapy context. Moreover, therapists often breach confidentiality to inform adolescents' parent or guardian when they disclose SITBs. Research has explored rates of and barriers to disclosure among adolescents, yet no studies have examined adolescents' experiences of disclosure in the therapy context. Further, no studies have examined adolescents' experiences when their parents are then informed. In this study, we examined qualitative responses from 1495 adolescents who had experienced a SITB disclosure in the therapy context. Qualitative questions included asking adolescents to describe how the SITB disclosure occurred, how their parents were informed, and their parents' reactions. Using open and axial coding, several themes emerged. Adolescents described therapist breaches of confidentiality as collaborative, noncollaborative, or unclear. Adolescents described their parents' affective responses, communication about SITBs, validating and invalidating responses, treatment-oriented responses, and ways that parents restricted their access to people, places, and activities. Findings have implications for the development of clinical guidelines when adolescents disclose SITBs in therapy and highlight areas for future research in adolescent SITB disclosure.     

Parenting a child with Marfan syndrome: Distress and everyday problems

Marfan syndrome (MFS) is a multisystemic, autosomal dominant connective tissue disorder that occurs de novo in 25%. In many families, parent and child(ren) are affected, which may increase distress in parents. To assess distress, 42 mothers (29% MFS) and 25 fathers (60% MFS) of 43 affected children, completed the validated screening‐questionnaire Distress thermometer for parents of a chronically ill child, including questions on overall distress (score 0–10; ≥4 denoting “clinical distress”) and everyday problems (score 0–36). Data were compared to 1,134 control‐group‐parents of healthy children. Mothers reported significantly less overall distress (2, 1–4 vs. 3, 1–6; p = .049; r = ?.07) and total everyday problems (3, 0–6 vs. 4, 1–8; p = .03; r = ?.08) compared to control‐group‐mothers. Mothers without MFS reported significantly less overall distress compared to mothers with MFS, both of a child with MFS (1, 0–4 vs. 3.5, 2–5; p = .039; r = ?.17). No significant differences were found between the father‐groups, nor between the group of healthy parents of an affected child living together with an affected partner compared to control‐group‐parents. No differences in percentages of clinical distress were reported between mothers and control‐group‐mothers (33 vs. 42%); fathers and control‐group‐fathers (28 vs. 32%); nor between the other groups. Distress was not associated with the children's MFS characteristics. Concluding, parents of a child with MFS did not show more clinical distress compared to parents of healthy children. However, clinical distress was reported in approximately one‐third and may increase in case of acute medical complications. We advise monitoring distress in parents of a child with MFS to provide targeted support.     

免疫复合物致痛与甲醛致痛大鼠疼痛行为的比较

目的: 建立免疫复合物致痛模型并与甲醛致炎性痛模型比较,观察大鼠疼痛行为、局部炎症反应及p38 MAPK在脊髓表达的改变,探讨免疫复合物所致疼痛与普通炎性介质致痛的不同特点及发病机制。方法: 成年SD健康大鼠30只,随机分为正常对照组、甲醛组及免疫复合物组,每组10只。每组中各取5只大鼠分别鞘内注 射DMSO(对照组)或p38 MAPK抑制剂SB203580。各组分别在大鼠右后足底皮下注入20 μL PBS、甲醛及免疫复合物,于30 min、1 h、2 h、4 h、8 h、12 h测定疼痛行为,并于12 h后取大鼠脊髓采用Western blotting测定p38及活化p-p38蛋白表达。结果: (1) 致痛模型比较:甲醛致痛后大鼠后足立即出现红肿及自发痛,疼痛阈值30 min内迅速下降之后随时间推移缓解,脊髓活化的p-p38表达增加。免疫复合物组大鼠注射部位无红肿表现,疼痛阈值缓慢下降,至注射后8 h达到低谷,脊髓p38无明显活化。(2) p38 MAPK抑制剂SB203580可使甲醛组大鼠局部炎症反应及疼痛阈值下降,但对免疫复合物组及对照组大鼠无效。结论: p38 MAPK活化参与了甲醛所致炎症性疼痛的机制,但不参与免疫复合物致痛机制。本实验建立的抗体复合物致痛模型表现出与甲醛炎性痛不同的疼痛特点。     

Optimism and the Experience of Pain: A Systematic Review

Abstract

A growing body of literature provides evidence of the health-promoting effects of optimism, including its protective role in acute and chronic pain. Optimists are characterized by positive expectations concerning the future. These positive outcome expectancies lead to more and longer goal-directed efforts and the use of approach coping strategies. No systematic review on the effects of optimism on the experience of pain has so far been conducted. A search in the databases PubMed, Web of Science and PsycInfo, and the scanning of reference lists identified 69 eligible studies. These were categorized according to sample size, participants’ age and sex, design, optimism-pain relation as primary vs. secondary study objective, and level of study/publication quality. Overall percentages of positive, zero, and negative associations between optimism and pain as well as relative frequencies of these associations in the different categories were analyzed. About 70% of the studies showed a positive, i.e., beneficial association between optimism and at least one pain outcome. A larger percentage of beneficial associations was found in studies with experimental designs, in studies with the optimism-pain relation as primary objective, in high-quality studies/publications, and in studies including participants with a higher average age. The review suggests that optimism is associated with less acute and chronic pain, especially since a higher percentage of beneficial associations was found with high study/publication quality and with the primary focus on this relationship. For the moderating role of age, different explanations are proposed. Further research on causal relationships and on optimism-fostering clinical interventions is needed.     

Parenting in infancy and self-regulation in preschool: an investigation of the role of attachment history

Parenting and attachment are critical in the emergence of self-regulation (SR) in preschool. However, most studies use general indexes of parenting quality, failing to explore the unique contributions of sensitivity and home quality to SR. Further, the nature of the interplay between parenting and attachment history is not well understood. Using a sample of 938 children from The National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a series of structural equation models were fit to determine whether sensitivity and home quality concurrently predicted SR at 54 months, and whether attachment mediated or moderated these pathways. Results suggest that both sensitivity and home quality uniquely predict SR. Further, these early parenting variables were each indirectly associated with SR through children’s attachment history. That is, higher levels of sensitivity and home quality predicted secure attachment history, which, along with parenting, predicted more advanced SR skills at 54 months. No moderated pathways emerged, suggesting that attachment history may be best conceptualized as a mediating mechanism.     

Masseter muscle hyperactivity and myofascial pain dysfunction syndrome: A relationship under stress

Myofascial pain dysfunction syndrome (MPD) of the temporomandibular joint (TMJ) is a psychophysiological disorder that develops because of hyperactive muscles of mastication. Ten women meeting criteria for MPD and 12 symptom-free women participated in the study. The rationale for this study was to observe cardiovascular and masseter muscle changes during four contiguous experimental periods: baseline/adaptation, reaction time, recovery, and relaxation. MPD patients showed less masseter muscle activity and higher heart rates at baseline than controls. Controls had significantly higher masseter EMG activity during reaction time. Both groups showed significant elevation in masseter muscle activity and heart rate over the 14-min reaction period. MPD patients' recovery from stress was equivalent to controls' for both heart rate and masseter muscle activity. MPD patients exhibited significantly slower reaction times than controls. The results suggest that masseter muscle hyperactivity may not account for the development and maintenance of MPD.     

Parenting stress in families of children with Prader–Willi syndrome

Prader–Willi syndrome (PWS) is a neurodevelopmental disorder characterized by multiple endocrine, metabolic, respiratory, cognitive, and behavioral/psychiatric symptoms that may lead to severe emotional strain in their caregivers. In this study, we evaluated parenting stress by the Parenting Stress Index‐short form (PSI/SF) and parent‐reported behavioral symptoms by the Child Behavior Checklist (CBCL/6–18) in families of children with PWS. Sixty‐seven home‐resident PWS patients and their families were recruited in this study. The patients' mean age was 14.9 ± 8.3 years, and 33 (50.8%) were male. High parenting stress was reported by 41.5% families, as determined by high total stress scores of PSI/SF. The patients in high stress families were significantly older than those in low stress families (18.2 ± 8.0 vs. 12.6 ± 7.8 years, p = .007). CBCL/6–18 was used to evaluate the somatic and neuropsychiatric symptoms of PWS patients aged between 6 and 18 in the subgroup of the 35 families. In this subgroup, 37.1% of families reported high parenting stress. High stress families reported a higher T‐score in anxiety/depression, withdrawn behavior, somatic complaints, thought problems, attention problems, and delinquent and aggressive behavior of their children with PWS. After multivariate stepwise logistic regression analysis, the T‐score of somatic complaints was the only factor related to high parenting stress, with an odds ratio of 1.279. Our data demonstrated the high care burden of families with PWS and highlighted the importance of having dedicated medical care for both somatic and neuropsychiatric symptoms.