Choosing non-pharmacological treatments for neuropathic pain in spinal cord injury: a qualitative study.

PURPOSE: The aims of this study were to explore (1) the considerations of people with spinal cord injury (SCI) in choosing to use non-pharmacological treatments (N-PTs) for neuropathic pain (NP), (2) which factors influence their decision and who is involved in this choice. MATERIALS AND METHODS: Eleven individuals with SCI and NP were interviewed. Interviews were transcribed verbatim, transcripts were analysed through thematic coding, following an inductive content analysis approach. RESULTS: A journey towards finding and choosing N-PTs emerged. Key phases in this journey were: motives, strategy and practical considerations. Pain and its impact on their life led participants to consider N-PTs. Motives were participants' negative attitudes towards regular medication, willingness to try everything and disappointment and frustration with the guidance from their health care provider (HCP). The search strategies often involved third parties and the internet. This led them to choose a specific N-PT. The journey was influenced by one's attitude, previous personal experience, experience of HCPs, financial considerations, availability and convenience of the treatment. CONCLUSIONS: The journey individuals with SCI and NP go through to find N-PTs to manage pain is difficult and often lonely. Findings highlight the importance of HCPs accompanying people with SCI in finding N-PTs.

People with spinal cord injury (SCI) often search for non-pharmacological treatments to treat their neuropathic pain.As people with SCI feel alone in their search, health care providers need to accompany them in seeking non-pharmacological treatments to try and alleviate their neuropathic pain.Influencing factors on this search are one's attitude, previous personal experience, experience of the health care provider, financial considerations, availability and convenience of the treatment.Awareness on these influencing factors is important to accompany people with SCI in their search.

Neuropathic pain in spinal cord injury: topical analgesics as a possible treatment.

STUDY DESIGN: Review of the literature and semi-structured interviews. OBJECTIVE: To explore the possible use of topical analgesics for the treatment of neuropathic pain (NP) in spinal cord injury (SCI). SETTING: Institute for Neuropathic Pain, Soest, The Netherlands. METHODS: A review was performed of studies on topical analgesics for SCI-related NP published up to May 2019. In addition, eight persons with SCI-related NP who were treated with topical analgesics were interviewed in a semi-structured interview on their experience with topical analgesics. RESULTS: Seven studies (five case reports and two case series) were found that evaluated the use of topical analgesics for SCI-related NP. None of the studies used a control treatment. Topical analgesics included baclofen, ketamine, lidocaine, capsaicin, and isosorbide dinitrate. All studies reported a decrease in NP over time. Persons interviewed were 49-72 years of age and all but one had an incomplete SCI. They used topical agents containing phenytoin, amitriptyline, baclofen, ketamine or loperamide. All showed a decrease in pain of at least 3 points on the 11-point numeric rating scale during this treatment. DISCUSSION/CONCLUSIONS: Evidence on the use of topical analgesics in SCI is scarce. Case reports, case series and interviews suggest that the use of topical analgesics can be beneficial in treating SCI-related NP. Placebo-controlled studies are required to investigate the effect of topical analgesics on SCI-related NP.

Atrophy and hypertrophy signalling in the diaphragm of patients with COPD.

We investigated whether atrophy and hypertrophy signalling were altered in the diaphragm of chronic obstructive pulmonary disease (COPD) patients. We studied diaphragm fibre dimensions and proportion, expression of markers of the ubiquitin-proteasome pathway, nuclear factor (NF)-kappaB pathways, muscle regulatory factors and myostatin in diaphragm biopsies from 19 patients with severe COPD and 13 patients without COPD. Type I proportion was significantly increased in the diaphragm of COPD patients while type II proportion was decreased. The cross-sectional area of all fibre types was reduced in the COPD patients. In addition, MAFbx mRNA was higher in the diaphragm of COPD patients while Nedd4 mRNA decreased. Cytoplasmatic levels of inhibitor protein IkappaBalpha and IkappaBbeta were decreased in the COPD patients as was NF-kappaB p50 DNA-binding activity. MyoD mRNA and its nuclear protein content were decreased in the diaphragm of COPD patients and myogenin mRNA and protein levels remained unchanged. Myostatin mRNA was decreased but its protein levels in the nuclear and cytoplasmic fraction were significantly increased in the COPD patients. These data show that the ubiquitin-proteasome pathway, the NF-kappaB pathway and myostatin protein were up-regulated in the diaphragm of COPD patients while MyoD expression was reduced. These alterations may contribute to diaphragm remodeling in COPD.

Markers of inflammation and disuse in vastus lateralis of chronic obstructive pulmonary disease patients.

BACKGROUND: Disuse and/or local inflammation in the muscle cannot be excluded as potential influences for the decreased muscle force in patients hospitalised due to an acute chronic obstructive pulmonary disease (COPD) exacerbation. This study aims to compare expression levels of markers of disuse (insulin-like growth factor-1 (IGF-I), MyoD and myogenin) and inflammation [interleukin-6 (IL-6), IL-8 and tumour necrosis factor-alpha (TNF-alpha)] in the muscle of hospitalised and stable COPD patients and healthy elderly. MATERIAL AND METHODS: Muscle biopsies (m. vastus lateralis) were taken in 14 hospitalised COPD patients (aged 68 +/- 8), 11 clinically stable COPD patients (aged 68 +/- 9) and seven healthy subjects (aged 70 +/- 7) to analyse local mRNA expression levels of IL-6, IL-8, TNF-alpha, IGF-I and protein expression levels of IGF-I, MyoD and myogenin. Relationships of these expression levels with lung and skeletal muscle function were investigated. RESULTS: IGF-I mRNA and MyoD protein levels were significantly lower in hospitalised patients compared to healthy subjects. MyoD protein levels were positively related to quadriceps force. Muscle IL-6 and IL-8 expression in hospitalised patients was similar compared to stable patients and healthy subjects and was not related to expression levels of muscle markers of disuse or quadriceps force. Muscle TNF-alpha and myogenin were not detected. CONCLUSION: Decreased expression levels of muscle IGF-I and MyoD in hospitalised patients suggest a potential influence of disuse in the increased muscle weakness during an acute COPD exacerbation. This study did not find any evidence supporting local inflammation via IL-6, IL-8 and/or TNF-alpha in the vastus lateralis muscle of COPD patients.

Formant transition duration and place perception in misarticulating children and adolescents.

The explanation of articulatory problems as an output speech disorder does not preclude the possibility that auditory processing problems are associated. Identification of brief auditory spectral cues in a place-of-articulation continuum was studied in children with articulation problems. First, it was shown that formant transition durations smaller than 20·0 ms dramatically decreased phonemic identification rates for alveolar stop consonants in control subjects. Identification tasks based on two place-of-articulation continua /pαk/-/tαk/ with F2/F3 transition durations of 52 and 20 ms were administered to groups of misarticulating children and adolescents and two control groups (children and adults). For all subject groups there was poorer phonetic processing with shorter transition durations of F2 and F3. The misarticulating subjects demonstrated poorer phonetic processing of formant transitions than did the control subjects. Shortening F2/F3 transition duration did not differentially influence perceptual behaviour between the experimental and the control groups. In determining the causal link between perception and production, an explanation of perception preceding production was favoured. It was argued that, in addition to assessing the specificity between perception and production mechanisms, assessment of perception of formant transitions may have potential as a clinical tool for evaluating phonetic processing.

The specific relation between perception and production errors for place of articulation in developmental apraxia of speech.

Developmental apraxia of speech is a disorder of phonological and articulatory output processes. However, it has been suggested that perceptual deficits may contribute to the disorder. Identification and discrimination tasks offer a fine-grained assessment of central auditory and phonetic functions. Seventeen children with developmental apraxia (mean age 8:9, years:months) and 16 control children (mean age 8:0) were administered tests of identification and discrimination of resynthesized and synthesized monosyllabic words differing in place-of-articulation of the initial voiced stop consonants. The resynthetic and synthetic words differed in the intensity of the third formant, a variable potentially enlarging their clinical value. The results of the identification task showed equal slopes for both subject groups, which indicates no phonetic processing deficit in developmental apraxia of speech. The hypothesized effect of the manipulation of the intensity of the third formant of the stimuli was not substantiated. However, the children with apraxia demonstrated poorer discrimination than the control children, which suggests affected auditory processing. Furthermore, analyses of discrimination performance and articulation data per apraxic subject demonstrated a specific relation between the degree to which auditory processing is affected and the frequency of place-of-articulation substitutions in production. This indicates the interdependence of perception and production. The results also suggest that the use of perceptual tasks has significant clinical value.

Perception of voicing cues by children with early otitis media with and without language impairment.

Research on the relationship between early otitis media with effusion (OME), language impairment, and central auditory processing has been equivocal. Identification and discrimination tasks provide us with a sensitive method of assessing speech perception on both an auditory and a phonetic level. The present study examined identification and discrimination of initial bilabial stop consonants differing in voicing by 9-year-old children with a history of severe OME. The groups studied were controlled for language impairment. The ability of these children to perceive major and minor voicing cues was examined using multiple voicing cues. Long-term effects of OME were found for both identification and discrimination performance. Children with OME produced an overall inconsistency in categorization, which suggests poorer phonetic processing. Discrimination was measured by means of "just noticeable differences" (JND). Children with early OME experience demonstrated a greater mean JND than children without early OME experience. Finally, in cases of language impairment with early OME, there was no additional deterioration of auditory or phonetic processing. It appears that either early OME or language impairment can lead to poorer perception.

Word deafness and auditory cortical function. A case history and hypothesis.

A patient who already had Wernicke's aphasia due to a left temporal lobe lesion suffered a severe deterioration specifically of auditory language comprehension, subsequent to right temporal lobe infarction. A detailed comparison of his new condition with his language status before the second stroke revealed that the newly acquired deficit was limited to tasks related to auditory input. Further investigations demonstrated a speech perceptual disorder, which we analysed as due to deficits both at the level of general auditory processes and at the level of phonetic analysis. We discuss some arguments related to hemisphere specialization of phonetic processing and to the disconnection explanation of word deafness that support the hypothesis of word deafness being generally caused by mixed deficits.

Perception and production of the final /s-ts/ contrast in Dutch by misarticulating children.

This study investigates the specific relationship between speech perception and speech production by comparing 6- and 7-year-old children who misarticulated the final consonant cluster /-ts/ with three control groups. One control group of children misarticulated other phonemes than the specific /-ts/ cluster, another group of children had no articulation problems at all, and a third control group consisted of normally articulating adults. Perception was studied by assessing identification functions on a /moes/-to-/moets/ speech continuum in which the silence period had been manipulated. Production was analyzed by measuring the silence periods in productions of the Dutch word muts. The results show a clear hierarchical trend: The poorer the articulation proficiency of a group, the more variability there is in both production and perception. In perception, this variability is not restricted to the problematic /-ts/ cluster but includes the whole /-s/-to-/-ts/ contrast. Furthermore, it appears that a general as well as a specific relationship exists between perception and production and that the character of this relationship does not support the motor theory of speech perception.