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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 August 2020) | Viewed by 68589

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Dr. Robert D. Gerwin

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Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
Interests: acute and chronic neuromuscular pain; myofascial pain; fibromyalgia; pain co-morbidities; the role of the sympathetic nervous system in pain; the role of ion channelopathies in pain; nociceptive and nociplastic pain syndromes
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Special Issue Information

Dear Colleagues,

This IJERPH Special Issue on “Chronic Pain and Headache” will focus on these two problems by bringing together experts who present evidence-based discussions of the mechanisms underlying chronic migraine headache, chronic tension, and daily headache, and new treatment modalities for these conditions, including the new medications that target calcitonin-gene-related-peptide (CGRP) and neuromodulatory devices. Chronic pain as an illness with its own consequences of physical and psychological features and chronic widespread pain will round out the articles in this Special Issue. This timely discussion is highly relevant, as chronic pain and headache have become predominant problems in general medical and specialty clinics, and as new treatments are being developed to address and avoid the problems of adverse drug effects, of medication overuse headache, and of opioid-related addiction and mortality.

Assoc. Prof. Dr. Robert D. Gerwin
Guest Editor

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Keywords

Chronic Widespread Pain
Chronic Migraine Headache
Chronic Daily Headache
Neuromodulation
Calcitonin-gene-related-peptide (CGRP)
Central Sensitization

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Published Papers (10 papers)

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Research

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20 pages, 690 KiB

Open AccessArticle

Non-Cancer Chronic Pain Conditions and Risk for Incident Alzheimer’s Disease and Related Dementias in Community-Dwelling Older Adults: A Population-Based Retrospective Cohort Study of United States Medicare Beneficiaries, 2001–2013

by Sumaira Khalid, Usha Sambamoorthi and Kim E. Innes

Int. J. Environ. Res. Public Health 2020, 17(15), 5454; https://doi.org/10.3390/ijerph17155454 - 29 Jul 2020

Cited by 20 | Viewed by 3097

Abstract

Accumulating evidence suggests that certain chronic pain conditions may increase risk for incident Alzheimer’s disease and related dementias (ADRD). Rigorous longitudinal research remains relatively sparse, and the relation of overall chronic pain condition burden to ADRD risk remains little studied, as has the potential mediating role of sleep and mood disorders. In this retrospective cohort study, we investigated the association of common non-cancer chronic pain conditions (NCPC) at baseline to subsequent risk for incident ADRD, and assessed the potential mediating effects of mood and sleep disorders, using baseline and 2-year follow-up data using 11 pooled cohorts (2001–2013) drawn from the U.S. Medicare Current Beneficiaries Survey (MCBS). The study sample comprised 16,934 community-dwelling adults aged ≥65 and ADRD-free at baseline. NCPC included: headache, osteoarthritis, joint pain, back or neck pain, and neuropathic pain, ascertained using claims data; incident ADRD (N = 1149) was identified using claims and survey data. NCPC at baseline remained associated with incident ADRD after adjustment for sociodemographics, lifestyle characteristics, medical history, medications, and other factors (adjusted odds ratio (AOR) for any vs. no NCPC = 1.21, 95% confidence interval (CI) = 1.04–1.40; p = 0.003); the strength and magnitude of this association rose significantly with increasing number of diagnosed NCPCs (AOR for 4+ vs. 0 conditions = 1.91, CI = 1.31–2.80, p-trend < 0.00001). Inclusion of sleep disorders and/or depression/anxiety modestly reduced these risk estimates. Sensitivity analyses yielded similar findings. NCPC was significantly and positively associated with incident ADRD; this association may be partially mediated by mood and sleep disorders. Additional prospective studies with longer-term follow-up are warranted to confirm and extend our findings. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

12 pages, 471 KiB

Open AccessArticle

One-Year Follow-Up after Multimodal Rehabilitation for Patients with Whiplash-Associated Disorders

by Viktor Björsenius, Monika Löfgren and Britt-Marie Stålnacke

Int. J. Environ. Res. Public Health 2020, 17(13), 4784; https://doi.org/10.3390/ijerph17134784 - 3 Jul 2020

Cited by 5 | Viewed by 3224

Abstract

Long-term symptoms after whiplash injury often comprise neck pain, headache, anxiety, depression, functional impairment and low quality of life. In an observational cohort study, we examined physical and mental health effects in patients with subacute to chronic whiplash-associated disorders (WAD) after participation in a multimodal rehabilitation (MMR) program. MMR is a team-based multi-professional method based on a bio-psycho-social model with a cognitive focus to reach an individualized and common goal for the team and patient together. Standardized self-report questionnaires were filled in three times: before MMR, after MMR, and one year after MMR. A total of 322 participants completed the program, 161 of whom responded in full and were further analyzed. At one-year follow-up after MMR, a significant improvement was seen in the evaluation of the primary outcomes (physical and mental health) and secondary outcomes (anxiety, depression, pain intensity and interference with life). Women improved on all outcomes while men did not improve on the psychological measures (mental health, depression and anxiety). This study indicates that a MMR program could be beneficial for patients with subacute to chronic WAD, at least for women, since the outcomes at one-year follow-up were positive. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

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9 pages, 330 KiB

Open AccessArticle

Exploring Changes in Activity Patterns in Individuals with Chronic Pain

by Elena Rocío Serrano-Ibáñez, Rebecca Bendayan, Carmen Ramírez-Maestre, Alicia Eva López-Martínez, Gema Teresa Ruíz-Párraga, Madelon Peters and Rosa Esteve

Int. J. Environ. Res. Public Health 2020, 17(10), 3560; https://doi.org/10.3390/ijerph17103560 - 19 May 2020

Cited by 3 | Viewed by 1956

Abstract

This longitudinal study explored whether activity patterns change over time in a sample of 56 individuals with chronic musculoskeletal pain over a 15-day period. Once a day, the participants recorded their level of pain intensity and the degree to which they had engaged in several specific activity patterns. Linear mixed models with random coefficients were used to investigate the rate of change in the activity patterns. Age, sex, pain intensity, and pain duration were controlled. The results show that excessive persistence was the only self-reported activity pattern to show a linear change over the 15-day period. There was a decrease in excessive persistence, and this decrease was slower with higher levels of activity avoidance. However, no significant association was found between sex, age, pain intensity, and pain duration and excessive persistence at baseline or change over time. At baseline, a positive association was found between excessive persistence and pain avoidance, pain-related persistence, and pacing to reduce pain, and a negative association was found between excessive persistence and pacing to save energy for valued activities. This result suggests a profile characterized by alternate periods of high and low activity that, in this study, were unrelated to longitudinal changes in pain intensity. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

15 pages, 1358 KiB

Open AccessArticle

Stress-Recovery State in Fibromyalgia Patients and Healthy People. Relationship with the Cardiovascular Response to Stress in Laboratory Conditions

by Borja Matías Pompa, Almudena López López, Miriam Alonso Fernández, Estefanía Vargas Moreno and José Luis González Gutiérrez

Int. J. Environ. Res. Public Health 2020, 17(9), 3138; https://doi.org/10.3390/ijerph17093138 - 30 Apr 2020

Cited by 1 | Viewed by 2699

Abstract

The current study´s objective was to determine the relationship between stress-recovery state and cardiovascular response to an acute stressor in a sample of female fibromyalgia patients in comparison with a control group of healthy participants. The laboratory procedure was completed by 36 participants with fibromyalgia and by 38 healthy women who were exposed to an arithmetic task with harassment while blood pressure and heart rate were measured during task exposure. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

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11 pages, 732 KiB

Open AccessArticle

Changes of Somatosensory Phenotype in the Course of Disease in Osteoarthritis Patients

by Johanna Höper, Lara Schraml, Janne Gierthmühlen, Stephanie M. Helfert, Stefanie Rehm, Susanne Härtig, Ove Schröder, Michael Lankes, Frieder C. Traulsen, Andreas Seekamp and Ralf Baron

Int. J. Environ. Res. Public Health 2020, 17(9), 3085; https://doi.org/10.3390/ijerph17093085 - 29 Apr 2020

Cited by 2 | Viewed by 2946

Abstract

To investigate sensory changes, physical function (pF), quality of life (QoL) and pain intensity of patients with osteoarthritis (OA) in the natural course of disease, and patients undergoing total joint replacement therapy (TJR) 31 (20 females, mean age 64.6 ± 10.4 years), patients with OA were investigated with questionnaires and quantitative sensory testing (QST) in the area of referred pain at the thigh at baseline and follow-up 22–49 weeks later; changes were analyzed separately for patients with (n = 13) and without TJR (n = 18). In patients without TJR pain intensity, pF, QoL did not improve, and increased pain sensitivity to cold and a stronger loss of detection were observed. In patients after TJR, however, a reduction in mechanical pain sensitivity and allodynia occurred in accordance with a reduction of pain intensity and improvement of functionality while QoL did not improve. Additionally, an increased sensitivity to heat pain and a more pronounced loss of mechanical detection could be observed in this group. TJR seems to stop peripheral pain input leading to a reduction of pain intensity and central sensitization, but surgery-induced sensory changes such as peripheral sensitization and loss of detection occur. Furthermore, TJR has favorable effects on pain intensity and functionality but not QoL. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

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10 pages, 2141 KiB

Open AccessArticle

T_1ρ-Mapping for Musculoskeletal Pain Diagnosis: Case Series of Variation of Water Bound Glycosaminoglycans Quantification before and after Fascial Manipulation^® in Subjects with Elbow Pain

by Rajiv G. Menon, Stephen F. Oswald, Preeti Raghavan, Ravinder R. Regatte and Antonio Stecco

Int. J. Environ. Res. Public Health 2020, 17(3), 708; https://doi.org/10.3390/ijerph17030708 - 22 Jan 2020

Cited by 20 | Viewed by 9043

Abstract

Diagnosis and management of musculoskeletal pain is a major clinical challenge. Following this need, the first aim of our study was to provide an innovative magnetic resonance technique called T_1ρ to quantify possible alterations in elbow pain, a common musculoskeletal pain syndrome that has not a clear etiology. Five patients were recruited presenting chronic elbow pain (>3 months), with an age between 30 and 70 years old. Patients underwent two T_1ρ-mapping evaluations, one before and one after the series of Fascial Manipulation^® (FM) treatments. After the first MRI evaluation, a Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to quantify the symptoms and pain intensity. Patients then received three sessions of FM, once a week for 40 min each. A statistically significant difference was found between bound and unbound water concentration before and after FM treatment. Our preliminary data suggest that the application of the manual method seems to decrease the concentration of unbound water inside the deep fascia in the most chronic patients. This could explain the change in viscosity perceived by many practitioners as well as the decrease of symptoms due to the restoration of the normal property of the loose connective tissue. Being able to identify an altered deep fascial area may better guide therapies, contributing to a more nuanced view of the mechanisms of pain. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

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17 pages, 348 KiB

Open AccessArticle

Pain Intensity among Community-Dwelling African American Older Adults in an Economically Disadvantaged Area of Los Angeles: Social, Behavioral, and Health Determinants

by Meghan C. Evans, Mohsen Bazargan, Sharon Cobb and Shervin Assari

Int. J. Environ. Res. Public Health 2019, 16(20), 3894; https://doi.org/10.3390/ijerph16203894 - 14 Oct 2019

Cited by 14 | Viewed by 3910

Abstract

Background. Although social, behavioral, and health factors influence prevalence and intensity of pain, very few studies have investigated correlates of pain among economically disadvantaged older African American (AA) adults. Objective. This study explored social, behavioral, and health correlates of pain intensity among community-dwelling AA older adults in an economically disadvantaged area of Los Angeles. Methods. A cross-sectional study on 740 AA older adults (age ≥ 55 years) was conducted in South Los Angeles between 2015 and 2018. Exploratory variables were age, gender, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, pain-related chronic medical conditions (CMCs), and depressive symptoms. Dependent variable was pain intensity. Linear regression was used for data analysis. Results. Age, financial difficulties, living alone, smoking, pain-related chronic medical conditions, and depressive symptoms were associated with pain intensity. Individuals with lower age, higher financial difficulties, those who lived alone, those with a higher number of pain-related chronic medical conditions, more depressive symptoms, and nonsmokers reported more pain intensity. Gender, educational attainment, marital status, and drinking were not associated with pain intensity. Conclusion. The results may help with the health promotion of economically disadvantaged AA older adults in urban areas. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

Review

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20 pages, 590 KiB

Open AccessReview

Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome—An Evidence-Based Narrative Review and Etiological Hypothesis

by Robert Gerwin

Int. J. Environ. Res. Public Health 2020, 17(19), 7012; https://doi.org/10.3390/ijerph17197012 - 25 Sep 2020

Cited by 25 | Viewed by 28961

Abstract

Trigeminal neuralgia (TN), the most common form of severe facial pain, may be confused with an ill-defined persistent idiopathic facial pain (PIFP). Facial pain is reviewed and a detailed discussion of TN and PIFP is presented. A possible cause for PIFP is proposed. (1) Methods: Databases were searched for articles related to facial pain, TN, and PIFP. Relevant articles were selected, and all systematic reviews and meta-analyses were included. (2) Discussion: The lifetime prevalence for TN is approximately 0.3% and for PIFP approximately 0.03%. TN is 15–20 times more common in persons with multiple sclerosis. Most cases of TN are caused by neurovascular compression, but a significant number are secondary to inflammation, tumor or trauma. The cause of PIFP remains unknown. Well-established TN treatment protocols include pharmacotherapy, neurotoxin denervation, peripheral nerve ablation, focused radiation, and microvascular decompression, with high rates of relief and varying degrees of adverse outcomes. No such protocols exist for PIFP. (3) Conclusion: PIFP may be confused with TN, but treatment possibilities differ greatly. Head and neck muscle myofascial pain syndrome is suggested as a possible cause of PIFP, a consideration that could open new approaches to treatment. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

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15 pages, 394 KiB

Open AccessReview

The Case for Comorbid Myofascial Pain—A Qualitative Review

by Simon Vulfsons and Amir Minerbi

Int. J. Environ. Res. Public Health 2020, 17(14), 5188; https://doi.org/10.3390/ijerph17145188 - 17 Jul 2020

Cited by 10 | Viewed by 3607

Abstract

Myofascial pain syndrome is widely considered to be among the most prevalent pain conditions, both in the community and in specialized pain clinics. While myofascial pain often arises in otherwise healthy individuals, evidence is mounting that its prevalence may be even higher in individuals with various comorbidities. Comorbid myofascial pain has been observed in a wide variety of medical conditions, including malignant tumors, osteoarthritis, neurological conditions, and mental health conditions. Here, we review the evidence of comorbid myofascial pain and discuss the diagnostic and therapeutic implications of its recognition. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

17 pages, 720 KiB

Open AccessReview

Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review

by César Fernández-de-las-Peñas, Lidiane L. Florencio, Gustavo Plaza-Manzano and José L. Arias-Buría

Int. J. Environ. Res. Public Health 2020, 17(11), 4126; https://doi.org/10.3390/ijerph17114126 - 9 Jun 2020

Cited by 27 | Viewed by 8369

Abstract

Headache is the clinical syndrome most commonly observed by neurologists in daily practice. Pharmacological and non-pharmacological treatments are commonly used for the management of headaches; however, the clinical reasoning behind these interventions is not properly applied. We conducted a narrative literature review using as data sources for academic PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, PEDro, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, and SCOPUS. This narrative literature review mainly considered systematic reviews, meta-analyses, randomised clinical trials, and expert opinions published after the year 2000 discussing clinical reasoning for application of non-pharmacological interventions in individuals with tension-type, migraine, and cervicogenic headaches. After the data extraction, we organized the literature thematically as follows: (1) mapping of theoretical aspects of non-pharmacological interventions; (2) summarizing most updated literature about effectiveness of non-pharmacological interventions grouped by targeted tissue and headache; (3) identifying research gaps in the existing literature and proposing hypotheses for better understanding of current clinical reasoning. We found that there are many non-pharmacological treatment strategies used for headaches, including beyond the tissue-based impairment treatments (bottom-up) and strategies targeting the central nervous system (top down). Bottom-up strategies include joint-biased, soft-tissue biased, or needling interventions, whereas top-down strategies include exercise and cognitive interventions. Evidence shows that the effectiveness of these interventions depends on the application of proper clinical reasoning, since not all strategies are effective for all headaches. For instance, evidence of non-pharmacological interventions is more controversial for migraines than for tension-type or cervicogenic headaches, since migraine pathogenesis involves activation of sub-cortical structures and the trigemino- vascular system, whereas pathogenesis of tension-type or cervicogenic headaches is most associated to musculoskeletal impairments of the cervical spine. We conclude that current literature suggests that not all non-pharmacological interventions are effective for all headaches, and that multimodal, not isolated, approaches seem to be more effective for patients with headaches. Most published studies have reported small clinical effects in the short term. This narrative literature review provides some hypotheses for discrepancies in the available literature and future research. Clinical reasoning should be applied to better understand the effects of non-pharmacological interventions. Full article

(This article belongs to the Special Issue Chronic Pain and Headache)

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