The Role and Treatment Implications of Peripheral and Central Processing of Pain, Pruritus, and Nausea in Heightened Somatic Awareness: A Review.

Pain, pruritus, and nausea are complex sensory and emotional physiological symptoms that can vary widely between people and even within an individual, depending on the context and meaning of the symptom and the psychological state of the person. This article reviews the acute neural transmission of pain, pruritus, and nausea symptoms, which can begin in the periphery and/or viscera. The subsequent multiple pathways in the central nervous system that become involved in the processing of these symptoms are also discussed. The authors describe human brain imaging studies that have revealed consistent cortical and subcortical networks activated by these symptoms, including sensory, limbic, and associative regions. In particular, the authors discuss information revealed by the studies regarding the primary somatosensory cortex, secondary somatosensory cortex, anterior cingulate cortex, insula, prefrontal cortex and thalamus, are the brain areas most commonly activated by noxious stimuli. Finally, the authors describe treatment options for chronic presentations of these symptoms, which are, in part, based on central nervous processing of these sensations.

A Case of Transient Global Amnesia: A Review and How It May Shed Further Insight into the Neurobiology of Delusions.

Transient global amnesia is a clinical syndrome characterized by the sudden onset of anterograde amnesia, accompanied by repetitive questioning, sometimes with a retrograde component, lasting up to 24 hours, without compromise of other neurologic function. Neuroimaging after an acutetransient global amnesia event often shows transient perturbation of specific hippocampal circuits that are involved in memory processing. Critical clinical distinctions, such as between transient global amnesia and other forms of transient amnesic episodes, as well as important clues to the underlying pathophysiologies are herein reviewed. Finally, we discuss the role of hippocampal insufficiency in the neurobiology of delusions.

Conceptualizing a subtype of patients with chronic pain: The necessity of obtaining a history of sexual abuse.

Lifetime history of sexual abuse is estimated to range between 15% and 25% in the general female population. Cross-sectional studies have shown that sexual assault survivors frequently report chronic musculoskeletal pain and functional somatic syndromes. Treating chronic pain with opioids went from being largely discouraged to being included in standards of care and titrating doses until patients self-report adequate control has become common practice, with 8% to 30% of patients with chronic noncancer pain receiving opioids. In this clinical review, we will discuss the association between survivors of sexual assault and chronic pain/functional somatic syndromes. We will further review evidence-based treatment strategies for this "pain-prone phenotype."

A Review of Select Centralized Pain Syndromes: Relationship With Childhood Sexual Abuse, Opiate Prescribing, and Treatment Implications for the Primary Care Physician.

Pain can be broadly divided into 3 classes, including nociceptive or inflammatory pain (protective), neuropathic (pathological, occurring after damage to the nervous system), or centralized (pathological, due to abnormal function but with no damage or inflammation to the nervous system). The latter has been posited to occur when descending analgesic pathways are attenuated and/or glutamatergic transmission is facilitated. Additionally, this "pain prone phenotype" can be associated with early life trauma and a suboptimal response to opiates. This article will review the relationships between centralized pain syndromes (ie, fibromyalgia, chronic low back pain), childhood sexual abuse, and opiate misuse. Finally, treatment implications, potentially effecting primary care physicians, will be discussed.